Public Health involvement in alcohol licensing decisions: policy, partnerships and professional ideology

The Police Reform and Social Responsibility Act 2011 added ‘health bodies’ as Responsible Authorities within licensing decisions and, in practice, Directors of Public Health undertook this role. Despite the Act enabling Public Health departments to engage with alcohol licensing decisions to facilitate the inclusion of Public Health in licensing, wide variations in involvement levels by Public Health departments persist. If this variation continues, it will potentially create a missed opportunity relating to potential improvements in population health relating to alcohol. This research was funded by Alcohol Research UK (now merged with Alcohol Concern). The subject matter is an important area of research, and to date, has only received limited attention. This research adopted an approach which allowed the exploration of the experiences of Public Health professionals engagement in alcohol licensing decisions in London. The specific research questions were: • How is national policy around the role of Public Health in alcohol licensing, translated and implemented at a local authority level? • What are the factors that facilitate or impede Public Health engagement in alcohol licensing partnerships? Qualitative data was collected through twenty-one in-depth interviews in a purposeful sample of London boroughs, consisting of five areas (six London boroughs as one Public Health department covered two boroughs). This was combined with analysis of relevant documentation and field notes of observations of fourteen Licensing Sub-Committee meetings in one London borough over a seven-month period. Thematic analysis of data was completed to identify emerging themes and to fully answer the research questions. This study provided new knowledge, plus added to existing knowledge, with key themes relating to: • The role of Public Health within licensing decisions • Engagement and challenges to licensing partnership

The Long-Term Cognitive and Psychological Effects of Mild Traumatic Brain Injury (mTBI)

Mild Traumatic Brain Injury (mTBI), commonly referred to as a concussion, is a prevalent injury in the United States, with several million occurring every year. Many of these injuries take place while playing a sport, particularly in those activities that have higher rates of impact with another person, such as hockey, soccer, or football. While most recover quickly from an mTBI, some individuals may have longer term effects. Recent literature has provided some evidence for long-term dysfunction in head injured individuals, with these dysfunctions appearing as changes in cognition or psychological well-being. Some of the most frequently reported cognitive symptoms were difficulty with attention, insomnia, confusion, and memory loss. On the psychological side, depression, anxiety, insomnia, and agitation are often reported. In order to further examine such symptoms, a sample of 56 retired National Football League players participating in a medical monitoring program were assessed for their long-term cognitive and psychological functioning. In the first set of analyses, a neurocognitive battery was used to assess cognition on a set of three self-reported outcome measures: Number of Concussions, Number of Losses of Consciousness, and Number of Undiagnosed Concussions. The battery was composed of tests divided into one of five areas of cognition: Complex Attention and Processing Speed, Learning and Memory, Visual-Perceptual Processing, Language, or Executive Function. These results were assessed with descriptive statistics, linear regression, and an ANOVA for confirmation of significance (p≤0.01). The results in Complex Attention and Processing Speed, Learning and Memory were not associated with any of the three outcome measures. In Visual-Perceptual Processing, the Number of Concussions was found to be associated with the results on the Block Design test (p=0.003). The Number of Concussions was also found to be significantly associated with the Category Test, a measure of Executive Function (p=0.003). Three tests were found to be significantly associated with the Number of Losses of Consciousness (Boston Naming Test, p=0.006, Controlled Oral Word Associations: FAS Letter Fluency Test, p=0.001, and Similarities p=0.01). Of note, these reported results were all significant after the removal of any participant that failed 2 or more Performance Validity Tests, but showed a normal T-score mean and standard deviation. This may indicate that only a few participants are experiencing any long-term cognitive deficits; an increased sample size should be recruited for confirmation of these results. In the second set of analyses, two psychological tests were administered: the Minnesota Multiphasic Personality Inventory – version 2 RF (MMPI-2RF) and the Mini-International Neuropsychiatric Interview – Plus version (MINI+). The first test is made up of 9 areas of that measure a range of personality and psychological health issues. The second test conducts a brief psychological examination, looking for clinically relevant Axis I and II psychological disorders, falling into 22 diagnoses. As in the previous study, these data were analyzed with descriptive statistics and any individual with Symptom Validity Scale failures was removed from the final analysis. For the MMPI-2RF, a linear regression was conducted, as well as post hoc corrections with Tukey and ANOVA for confirmation of significance (p≤0.01). One significant outcome was found in the Somatic-Cognitive area, Head Pain Complaint (p=0.003). Two significant results were found on Internalizing scale, one in the outcome measure Number of Losses of Consciousness (BRF, p=0.01) and one in the outcome measure Number of Undiagnosed Concussions (SFD, p=0.01). A final significant result was seen on the PSY-5 scales (psychopathology), Introversion/Low Positive Emotion (p=0.01). Each of these results indicates a decreased interest in interpersonal relationships and gives an impression of lowered ability to self-regulate anxious emotions. A similar vein of significant results were found on the MINI+, with Anxiety (Dx2, p=0.001) and Panic Disorder (Dx16, p=0.007) appearing in the outcome measure Number of Concussions. Taken together, these results may indicate a relationship between anxiety and antisocial tendencies and those suffering from multiple head injuries. This work aimed to elucidate a relationship between concussions and cognitive and psychological health. The state of the science review in chapter two found several gaps in the literature and some of the issues in long-term study of concussion, such as the differences between symptoms in individuals with single versus multiple injuries. In chapters two and three, evidence was found for a small subpopulation with multiple recovery issues over time, though the overall population had normal recovery from their injuries. Of the three outcome measures studied, the Number of Concussions was most often associated with both cognitive and psychological symptoms over time. These chapters set a working model for future subjects to contribute to our growing body of knowledge. Future directions for this work include increasing the number of participants, more thoroughly studying the differences between single and multiple injury, and increasing the types of testing to include imaging work and anatomical differences in head injured individuals

Public health participation in alcohol licensing decisions in England: the importance of navigating "contested space"

The Police Reform and Social Responsibility Act of 2011, added ‘health bodies’ as responsible authorities in licensing and, in practice, Directors of Public Health undertook this role. Despite this legislation facilitating the inclusion of public health in partnerships around licensing in England, wide variations in involvement levels by Public Health professionals persist This article is based on the findings from interviews that explored the experiences of public health professionals engaging with local established partnerships around alcohol licensing. Qualitative data were collected through twenty-one interviews in a purposeful sample of London boroughs. These data were combined with analyses of relevant area documentation and observations of fourteen licensing sub-committee meetings in one London borough over a seven-month period. Thematic analysis of all data sources was conducted to identify emerging themes. This study highlighted the importance of successful navigation of the ‘contested space’ (Hunter and Perkins, 2014) surrounding both public health practice and licensing partnerships. In some instances, contested spaces were successfully negotiated and public health departments achieved an increased level of participation within the partnership. Ultimately, improvements in engagement levels of public health teams within licensing could be achieved. The paper explores a neglected aspect of research around partnership working and highlights the issues arising when a new partner attempts to enter an existing partnership

Silver Nanoparticle Aggregates as Highly Efficient Plasmonic Antennas for Fluorescence Enhancement

The enhanced local fields around plasmonic structures can lead to enhancement of the excitation and modification of the emission quantum yield of fluorophores. So far, high enhancement of fluorescence intensity from dye molecules was demonstrated using bow-tie gap antenna made by e-beam lithography. However, the high manufacturing cost and the fact that currently there are no effective ways to place fluorophores only at the gap prevent the use of these structures for enhancing fluorescence-based biochemical assays. We report on the simultaneous modification of fluorescence intensity and lifetime of dye-labeled DNA in the presence of aggregated silver nanoparticles. The nanoparticle aggregates act as efficient plasmonic antennas, leading to more than 2 orders of magnitude enhancement of the average fluorescence. This is comparable to the best-reported fluorescence enhancement for a single molecule but here applies to the average signal detected from all fluorophores in the system. This highlights the remarkable efficiency of this system for surface-enhanced fluorescence. Moreover, we show that the fluorescence intensity enhancement varies with the plasmon resonance position and measure a significant reduction (300×) of the fluorescence lifetime. Both observations are shown to be in agreement with the electromagnetic model of surface-enhanced fluorescence

Hierarchical Bayesian inference of the Initial Mass Function in Composite Stellar Populations

The initial mass function (IMF) is a key ingredient in many studies of galaxy formation and evolution. Although the IMF is often assumed to be universal, there is continuing evidence that it is not universal. Spectroscopic studies that derive the IMF of the unresolved stellar populations of a galaxy often assume that this spectrum can be described by a single stellar population (SSP). To alleviate these limitations, in this paper we have developed a unique hierarchical Bayesian framework for modelling composite stellar populations (CSPs). Within this framework we use a parameterized IMF prior to regulate a direct inference of the IMF. We use this new framework to determine the number of SSPs that is required to fit a set of realistic CSP mock spectra. The CSP mock spectra that we use are based on semi-analytic models and have an IMF that varies as a function of stellar velocity dispersion of the galaxy. Our results suggest that using a single SSP biases the determination of the IMF slope to a higher value than the true slope, although the trend with stellar velocity dispersion is overall recovered. If we include more SSPs in the fit, the Bayesian evidence increases significantly and the inferred IMF slopes of our mock spectra converge, within the errors, to their true values. Most of the bias is already removed by using two SSPs instead of one. We show that we can reconstruct the variable IMF of our mock spectra for signal-to-noise ratios exceeding $\sim$75.Comment: Accepted for publication in MNRAS, 16 pages, 8 figure

Hospital Community Benefits After the ACA: Partnerships for Community Health Improvement

Examines states' and localities' efforts to promote community health and systemic change through collaborations focused on community health needs assessments, priority setting, strategic planning, and the implementation of health improvement initiatives

Hospital Community Benefits After the ACA: The Emerging Federal Framework

Outlines the federal framework on requirements for hospitals to provide community benefit activities in exchange for tax-exempt status under the 2010 healthcare reform, including community health needs assessments; state policy options; and challenges

Hospital Community Benefits After the ACA: Building on State Experience

Analyzes hospitals' requirements to conduct community health needs assessments, financial assistance and billing and collection policies, and community benefit reporting and oversight strategies. Notes implications for federal and state law and practice