Redefining Youth: The Case for Applying The Principles of Miller v. Alabama to Criminal Cases Involving Adults in Late Adolescence

In 2012, in Miller v. Alabama, the United States Supreme Court held it unconstitutional to impose a mandatory sentence of life without parole on children because such a sentence fails to adequately account for a child’s developmental stage or ability to weigh long-term consequences. Children are fundamentally different from adults, making them more susceptible to lack of self-regulation, poor decision making, and peer pressure. In Miller, the Court found that these aspects of children’s behavior made children less culpable than adults. Psychological studies have demonstrated that adolescence is more protracted than previously recognized. Profound malleability of the brain characterizes the period between ages ten and twenty-five. This malleability often results in changes in behavior, unanticipated reactions, and poor decision-making in these individuals. However, scientific findings support the contention that this same malleability allows adolescents to rehabilitate, making a case for rapid positive change. Individuals between eighteen and twenty-one years old can be considered to have entered a period known as “late adolescence,” a time more akin to adolescence than adulthood. Late adolescence may help explain why criminality in young adults dramatically decreases around the time they reach age twenty-two and continues to decline until their mid-twenties. This article argues that courts should apply Miller when sentencing late adolescents. Therefore, courts should extend the ban on mandatory life without parole to youth who committed a crime before turning twenty-one. I\u27ve been struck by the upside-down priorities of the juvenile justice system. We are willing to spend the least amount of money to keep the kid at home, more to put him in a foster home and the most to institutionalize him. -Marian Wright Edelma

The application of impregnating armature windings in iron resin within high-speed electron motors

This thesis summarizes the testing of an iron-filled resin to impregnate armature windings within a toothless air-core electric motor. The objective is to compare the magnetic permeabilities with thermal losses through an ecore test setup to extrapolate how the resin would behave within a high-speed electric motor. More specifically, the goal is to characterize the power losses within the iron resin using the Steinmetz equation to extrapolate the losses inside high-speed electric motors. These characterizations were conducted using a calorimetric experiment to compute losses within the system. The results are important because by increasing the power output and maintaining a low weight, power density can be increased. The results of this experiment will help predict if an iron resin will increase the permeability allowing for a higher power density within the electric motors while keeping power emitted low. These experiments are run for the NASA Fixed Wing project to improve the power density of the electric motor to 8 HP/kg while maintaining 96% efficiency.Ope

Dissecting American health care: Commentaries on health, policy, and politics

The intersection of health care, politics, and policy is a controversial one, and this book of lively essays takes on many of today’s hot health topics: alternative medicine, health care reform, screening mammograms, taxes to change behavior, gun control, and many more. Former Assistant Surgeon General Douglas Kamerow, a family doctor, journal editor, and NPR commentator, combines evidence, opinion, and humor in 47 essays from his health policy columns in the medical journal BMJ and his nationally broadcast radio commentaries

Advertising in Medical Journals: Should Current Practices Change?

Fugh-Berman and colleagues surveyed medical journals' policies and practices on advertising. Pharmaceutical products, they say, dominate journals' advertising pages, creating conflicts of interests

Cardiovascular benefits and risks across the physical activity continuum.

PURPOSE OF REVIEW: Habitual physical activity can reduce the risk of future cardiovascular morbidity and mortality. This review evaluates recent publications that have assessed the impact of the dose of physical (in)activity on cardiovascular outcomes. RECENT FINDINGS: Sedentary behavior, characterized by prolonged sitting, is increasingly prevalent across the globe and increases the risk for cardiovascular events in a dose-dependent fashion. Similarly, the number of individuals performing endurance exercise events has tripled over the last 2 decades, and some studies suggest that the high volumes of exercise training and competition may attenuate the health benefits of a physically active lifestyle. SUMMARY: Breaking up sitting time or replacing sitting by (light) physical activity are effective strategies to attenuate its detrimental health effects. Low doses of physical activity, preferably at a high intensity, significantly reduce the risk for cardiovascular and all-cause mortality. Larger doses of exercise yield larger health benefits. Extreme doses of exercise neither increase nor decrease the risk for adverse outcomes. Athletes demonstrate a transient cardiac dysfunction and biomarker release directly postexercise. Chronic exercise training may increase the risk for atrial fibrillation, but is also associated with a superior life expectancy compared with the general population

Case management for the treatment of patients with major depression in general practices – rationale, design and conduct of a cluster randomized controlled trial – PRoMPT (Primary care Monitoring for depressive Patient's Trial) [ISRCTN66386086] – Study protocol

BACKGROUND: Depression is a disorder with high prevalence in primary health care and a significant burden of illness. The delivery of health care for depression, as well as other chronic illnesses, has been criticized for several reasons and new strategies to address the needs of these illnesses have been advocated. Case management is a patient-centered approach which has shown efficacy in the treatment of depression in highly organized Health Maintenance Organization (HMO) settings and which might also be effective in other, less structured settings. METHODS/DESIGN: PRoMPT (PRimary care Monitoring for depressive Patients Trial) is a cluster randomised controlled trial with General Practice (GP) as the unit of randomisation. The aim of the study is to evaluate a GP applied case-management for patients with major depressive disorder. 70 GPs were randomised either to intervention group or to control group with the control group delivering usual care. Each GP will include 10 patients suffering from major depressive disorder according to the DSM-IV criteria. The intervention group will receive treatment based on standardized guidelines and monthly telephone monitoring from a trained practice nurse. The nurse investigates the patient's status concerning the MDD criteria, his adherence to GPs prescriptions, possible side effects of medication, and treatment goal attainment. The control group receives usual care – including recommended guidelines. Main outcome measure is the cumulative score of the section depressive disorders (PHQ-9) from the German version of the Prime MD Patient Health Questionnaire (PHQ-D). Secondary outcome measures are the Beck-Depression-Inventory, self-reported adherence (adapted from Moriskey) and the SF-36. In addition, data are collected about patients' satisfaction (EUROPEP-tool), medication, health care utilization, comorbidity, suicide attempts and days out of work. The study comprises three assessment times: baseline (T0) , follow-up after 6 months (T1) and follow-up after 12 months (T2). DISCUSSION: Depression is now recognized as a disorder with a high prevalence in primary care but with insufficient treatment response. Case management seems to be a promising intervention which has the potential to bridge the gap of the usually time-limited and fragmented provision of care. Case management has been proven to be effective in several studies but its application in the private general medical practice setting remains unclear

Illiteracy, low educational status, and cardiovascular mortality in India

Background: Influence of education, a marker of SES, on cardiovascular disease (CVD) mortality has not been evaluated in low-income countries. To determine influence of education on CVD mortality a cohort study was performed in India. Methods: 148,173 individuals aged ≥ 35 years were recruited in Mumbai during 1991-1997 and followed to ascertain vital status during 1997-2003. Subjects were divided according to educational status into one of the five groups: illiterate, primary school ( ≦ 5 years of formal education), middle school (6-8 years), secondary school (9-10 years) and college (> 10 years). Multivariate analyses using Cox proportional hazard model was performed an

Patients with Alcohol Problems in the Emergency Department, Part 1: Improving Detection *

Medical and social problems related to alcohol use are frequently seen in the ED. Often, the tempo of emergency medicine practice seems to preclude assessment beyond that required by the acute complaint. However, detection of ED patients with alcohol problems can occur using brief screening tools. This article was developed by members of the SAEM Substance Abuse Task Force, and describes screening tools that have been used successfully to identify atrisk and dependent drinkers. Their brevity, reproducibility, and accuracy vary somewhat, but screening can be realistically performed in the busy ED setting. The early detection of patients with alcohol problems would provide the opportunity for early intervention, and may reduce subsequent morbidity and mortality in this patient population.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72559/1/j.1553-2712.1998.tb02696.x.pd

Comparing generic drug markets in Europe and the United States: prices, volumes, and spending

Our study indicates that there are opportunities for cost savings in generic drug markets in Europe and the United States. Regulators should make it easier for generic drugs to reach the market. Regulators and payers should apply measures to stimulate price competition among generic drugmakers and to increase generic drug use. To meaningfully evaluate policy options, it is important to analyze historical context and understand why similar initiatives failed previously. Context: Rising drug prices are putting pressure on health care budgets. Policymakers are assessing how they can save money through generic drugs. Methods: We compared generic drug prices and market shares in 13 European countries, using data from 2013, to assess the amount of variation that exists between countries. To place these results in context, we reviewed evidence from recent studies on the prices and use of generics in Europe and the United States. We also surveyed peer‐reviewed studies, gray literature, and books published since 2000 to (1) outline existing generic drug policies in European countries and the United States; (2) identify ways to increase generic drug use and to promote price competition among generic drug companies; and (3) explore barriers to implementing reform of generic drug policies, using a historical example from the United States as a case study. Findings: The prices and market shares of generics vary widely across Europe. For example, prices charged by manufacturers in Switzerland are, on average, more than 2.5 times those in Germany and more than 6 times those in the United Kingdom, based on the results of a commonly used price index. The proportion of prescriptions filled with generics ranges from 17% in Switzerland to 83% in the United Kingdom. By comparison, the United States has historically had low generic drug prices and high rates of generic drug use (84% in 2013), but has in recent years experienced sharp price increases for some off‐patent products. There are policy solutions to address issues in Europe and the United States, such as streamlining the generic drug approval process and requiring generic prescribing and substitution where such policies are not yet in place. The history of substitution laws in the United States provides insights into the economic, political, and cultural issues influencing the adoption of generic drug policies. Conclusions: Governments should apply coherent supply‐ and demand‐side policies in generic drug markets. An immediate priority is to convince more physicians, pharmacists, and patients that generic drugs are bioequivalent to branded products. Special‐interest groups continue to obstruct reform in Europe and the United States

Reorganisation of GP surgeries during the COVID-19 outbreak: analysis of guidelines from 15 countries

BACKGROUND: General practitioners (GPs) play a key role in managing the COVID-19 outbreak. However, they may encounter difficulties adapting their practices to the pandemic. We provide here an analysis of guidelines for the reorganisation of GP surgeries during the beginning of the pandemic from 15 countries. METHODS: A network of GPs collaborated together in a three-step process: (i) identification of key recommendations of GP surgery reorganisation, according to WHO, CDC and health professional resources from health care facilities; (ii) collection of key recommendations included in the guidelines published in 15 countries; (iii) analysis, comparison and synthesis of the results. RESULTS: Recommendations for the reorganisation of GP surgeries of four types were identified: (i) reorganisation of GP consultations (cancelation of non-urgent consultations, follow-up via e-consultations), (ii) reorganisation of GP surgeries (area partitioning, visual alerts and signs, strict hygiene measures), (iii) reorganisation of medical examinations by GPs (equipment, hygiene, partial clinical examinations, patient education), (iv) reorganisation of GP staff (equipment, management, meetings, collaboration with the local community). CONCLUSIONS: We provide here an analysis of guidelines for the reorganisation of GP surgeries during the beginning of the COVID-19 outbreak from 15 countries. These guidelines focus principally on clinical care, with less attention paid to staff management, and the area of epidemiological surveillance and research is largely neglected. The differences of guidelines between countries and the difficulty to apply them in routine care, highlight the need of advanced research in primary care. Thereby, primary care would be able to provide recommendations adapted to the real-world settings and with stronger evidence, which is especially necessary during pandemics