A Model for Analysing and Grading the Quality of Scientific Authorities Presented to State Legislative Committees

Longitudinal studies have confirmed that human brains continue to mature and restructure throughout adolescence, with the prefrontal cortex – responsible for executive functions – maturing into an individual’s twenties. Studies examining adolescent decision-making demonstrate that young people prioritise rewards when assessing risk, take more risks in ‘hot’ contexts and are more likely to take risks when in the presence of their peers. These findings have motivated arguments that the immaturity of an adolescent brain could impact on culpability for criminal offences; a point recognised by the US Supreme Court in 2005: From a moral standpoint it would be misguided to equate the failings of a minor with those of an adult, for a greater possibility exists that a minor's character deficiencies will be reformed. Indeed, “[t]he relevance of youth as a mitigating factor derives from the fact that the signature qualities of youth are transient; as individuals mature, the impetuousness and recklessness that may dominate in younger years can subside.” Since 2007, states have begun to ‘Raise the Age’ and move towards a national consensus of 18 for the upper age limit of juvenile court jurisdiction. Vermont has even gone beyond this, raising the age limit to 20. Little is known, however, about the extent to which, one, the evidential body of adolescent brain science is informing this legislative movement, or, two, robust science is presented to legislative decision-makers and by whom. We have developed a model for analysing and grading the quality of scientific arguments and authorities presented to legislative committees examining ‘Raise the Age’ legislation and have applied it to four states: Connecticut, Vermont, Michigan and Wisconsin. The former two were selected as states which had already, or were repeatedly attempting, to raise the age of juvenile jurisdiction above 18 and the latter two were states which, as of 2018, had not reached the national consensus of 18. Almost 700 pieces of evidence were examined, assessing criteria including whether studies were peer-reviewed, performed in humans, randomised control trials or whether they were opinion-based. Testimony was also categorised by author and a thematic analysis conducted. Our research has shown that campaign organisations, academia, religious groups, police chiefs and parents regularly provide testimony in this public process and that the themes of funding, recidivism and serious offences are repeatedly referenced. The model tells us that overall, although detailed scientific arguments about brain science and culpability are made to the legislature, poor quality evidence is provided to support these and, most often, there is a lack of scientific evidence entirely. This paper provides a summary of the results from Connecticut, Michigan, Vermont and Wisconsin. Part I discusses the methodology and development of the analysis model and Part II offers conclusions about the quality of science referenced, who participates, and the themes discussed in public committee testimony

Understanding the distribution of A&E attendances and hospital admissions for the case managed population: A single case cross sectional study

Aim To describe the characteristics of case-managed patients presenting at accident and emergency (A & E) and to explore the distribution of their attendances and admissions. Background Recently, the UK Government announced extended-hours primary care provision in an effort to reduce the growing utilization of A & E. No evidence is available to understand the use of acute services by this high-risk patient group. Method A cross-sectional design utilising routinely collected anonymsed A & E attendance and hospital admission data from 2010 to 2015. Results The case-managed population is typically 70 years and older and most often arrive at A & E via emergency services and during the night (00:00–08:59). A large proportion are subsequently admitted having a statistically significant A & E conversion rate. No variables were predictive of admission. Conclusion The high level of A&E conversion could indicate case-managed patients are presenting appropriately with acute clinical need. However, inadequate provision in primary-care could drive decisions for admitting vulnerable patients

Risk factors associated with heel pressure ulcer development in adult population: A systematic literature review

Aims The main aim of this systematic literature review was to identify risk factors for development of heel pressure ulcers and quantify their effect. Background Pressure ulcers remain one of the key patient safety challenges across all health care settings and heels are the second most common site for developing pressure ulcers after the sacrum. Design Quantitative systematic review. Methods Data sources: Electronic databases were searched for studies published between 1809 to March 2020 using keywords, Medical Subject Headings, and other index terms, as well as combinations of these terms and appropriate synonyms. Study eligibility criteria: Previous systematic literature reviews, cohort, case control and cross-sectional studies investigating risk factors for developing heel pressure ulcers. Only articles published in English were reviewed with no restrictions on date of publication. Participants: patients aged 18 years and above in any care setting. Study selection, data extraction, risk of bias and quality assessment were completed by two independent reviewers. Disagreements were resolved by discussion. Results Eleven studies met the eligibility criteria and several potential risk factors were identified. However, eligible studies were mainly moderate to low quality except for three high quality studies. Conclusions There is a paucity of high quality evidence to identify risk factors associated with heel pressure ulcer development. Immobility, diabetes, vascular disease, impaired nutrition, perfusion issues, mechanical ventilation, surgery, and Braden subscales were identified as potential risk factors for developing heel pressure ulcers however, further well-designed studies are required to elucidate these factors. Other risk factors may also exist and require further investigation