Effects of Adverse Perinatal Outcomes (APO)

Effects of Adverse Perinatal Outcomes (APO) Specific Aims Adverse perinatal outcomes (APO) include infants birth defects, maternal pregnant and obstetric complications. Birth defects, including major congenital malformation (MCM) and minor anomaly (MA), become the leading causes of infant morbidity, mortality, and years of potential life lost in the United States.1 Low birth weight (LBW), abnormal condition of new born (ACNB), preterm birth, and Developmental Delay or Disability (DDD) are also birth anomalies that impacts the infants health.2-5 The association of in utero exposure to teratogenic medications with infant birth defects and other anomalies has been widely investigated.6,7 The literature has shown that taking antiepileptic drugs (AEDs) poses an increased risk of having child with congenital malformations in women with epilepsy.79 The most common MCMs caused by in utero exposure to AEDs are orofacial clefts, cardiac abnormalities, neural tube defects, urologic defects, and skeletal abnormalities.80 In utero exposure to valproate, the most teratogenic AED, was associated with elevated risk of impaired cognitive function for children at 3 years of age, and reduced cognitive abilities for children at 6 years old.98,101 However, study results for many medications, such as antidepressants, opioids, antipsychotics, and antibiotics, are inconsistent for fetal safety.[1*-8*] The limited data source and rare incidence of birth defects, ACNBs, and other anomalies restrain the study power, and makes some studies inconclusiv e.8-10 Our long term goal is to determine the association between teratogenic effects of medications that mothers exposed during pregnancy and infants birth defects. The major objective of this study is to build a linked database in Rhode Island (RI) to facilitate the subsequent research on teratogenic effects of medication in RI population. The birth defects and birth certificates data from the Department of Health (DoH) and pharmacy claims from the Medicaid program offer an essential resource to investigate these aims. The availability of hospital diagnoses and birth records offers a significant advantage for investigating birth defects with corresponding clinical conditions in large population with a longitudinal approach. Our team is well suited to conduct this research given extensive expertise in contemporary pharmacoepidemiology, many years of experience on drug safety research, prior drug utilization and birth defects study with the linked data from another state, and clinical expertise from obstetric and gynecologic physicians. Our specific aims are to generate a linked data and investigate the medication utilization and assess the corresponding birth defects with the following efforts: Aim 1: To build a linked database that includes mothers medications prescribed during pregnancy and subsequent adverse perinatal outcomes. We hypothesize that the data from two state departments can be internally linked using identifiers. Mothers medication prescriptions will be extracted from Medicaid claims provided by the RI Executive Office of Health Human Services (EOHHS). The adverse perinatal outcomes include: MCMs, MAs, abnormal conditions of new born, fetal death, and low birth weight, and maternal adverse pregnancy and obstetrical complications. All of these outcomes will be obtained from birth certificates, institutional and professional claims that are collected and managed by RI Department of Health (DoH). These two parts of data will be linked by the deterministic or probabilistic linking strategy using mothers medical record number, name, and date of born. We will apply for IRB approval with a waiver of informed consent by RI DoH, EOHHS, Brown, and URI. Aim 2: To characterize the patterns of medication use in women during pregnancy. We hypothesize that medication use in women during pregnancy changes in recent years. Many medications, such as AEDs, statin, or angiotensin converting enzyme (ACE), have been classified as teratogens and categorized as D or X by the Food and Drug Administration (FDA). However, studies have found that these teratogenic drugs still have been prescribed to pregnant women.5-7 Some medications with contradictive results reported from the literature may have increased use in pregnant women. We will examine the prescribing patterns of these medications in pregnant women with varied age, race, comorbidities, co-medications, as well as medication types and doses. The utilization pattern will be delineated in secular trends and mapped geographically, as will facility, provider, and state-level variations. Aim 3: To assess infants birth defects and birth anomalies using advanced statistical model. We will identify all corresponding birth defects, including MCM, MA, LBW, ACNB, DDD, preterm birth, and fetal death and compare the birth defect rates in mothers with varied demographic characteristics and medication exposure. Previous studies have suggested that the LVM can be used to combine four specific birth defects together to create a severity index.16-18 We hypothesize that this LVM can be improved and optimized to combine any number of components with a proper weight on severity and frequency to evaluate the overall health status of infants. B. Significance and Innovation Birth defects occur in 3 5% of children born in the United States and account for 20% of all infant deaths.1,2 During 2010-2012, RI DoH identified 1,390 newborns with at least one birth defect.3 The rate of birth defects in RI increased by 14.2% from 2008 to 2012.3 It was reported that 2-3% of birth defects are due to teratogen-induced malformations, which refer to malformations resulting from environmental or in utero exposure to teratogens.4 In the United States, about 3 million people currently live with teratogen-induced malformations.4 The FDA defined the pregnancy category to enforce the labeling of drugs with respect to their effects on pregnant women. Some medications, such as AEDs, statin, or ACEs, have been classified in FDA pregnant category D or X due to their teratogenic effects. Previous studies reported a two- to three-fold increase in the malformation rate among infants with in utero exposure to AEDs.21,22,81,82 The incidence rates in infants with in utero exposure to AEDs were 3.1% to 9.0% for MCMs, 37% for one MA, and 11% for two MAs.21,80-83 The risk of malformations for infants with in utero exposure to valproate is 7.3-fold higher than that of non-exposed, and 4-fold higher than those exposed to all other AEDs.7 Some widely used medications, such as antidepressants, opioids, antipsychotics, and antibiotics, tend to have increased utilization in pregnant women while the results from teratogenic studies are controversial and inclusive.[1*-8*] It is difficult to distinguish between the real non-inferior results and power deficiency owing to rare outcomes. It has led to an urgent need to determine the fetal safety of these medications and prevent teratogenic medications prescribing to pregnant women. However, the limited data source and rare incidence of birth defect outcomes impact the study power, and makes studies inconclusive.8-10 Traditional claims data (data from Medicaid or private health plans) is not suitable for birth defect research as it only contains medical information for either mother or infant, not both. Birth certificates or birth defects data doesnt include mothers medication information. As such, to investigate utilization patterns and teratogenic effects of medications, we need to link mothers pharmacy claims with infants birth defects assessments. The linkage should be conducted in a secure data server with patients identifiers. The main goal of this proposed one-year pilot study is to collaborate with the RI EOHHS and RI DOH and generate a linked statewide dataset that includes mothers pharmacy claims and infants birth defect outcomes. This linked dataset will facilitate the researchers in Brown and URI to conduct studies regarding drug-induced birth defects in RI and provide a potential for combining RI linked data with the linked data from other states to conducting drug teratogenic studies in large population. Innovation This proposed study will generate a linked data with combining Medicaid pharmacy claims from the RI EOHHS and birth certificates and birth defects from the RI DOH. This would make RI become the fourth state that possesses the linked mother-infant data in the United States, besides California, Texas, and Florida. Our approach will provide a large linked dataset to facilitate the researchers from URI and Brown to conduct drug-induced birth defects studies. This linked dataset will provide a potential for future drug teratogenic research in large population with combining the RI linked data with the linked data from other states. Our approach will employ state of the art, innovative pharmacoepidemiologic study designs and statistical models, to improve the study power and efficiency. A latent variable model will be employed in this study to combine all birth defects outcomes into a continuous severity score to assess the overall infants morbidity and mortality. C. Approach Data Sources This study is based on a statewide, retrospective 11-year data sources: RI birth certificates and birth defects from January 1, 2006 to December 31, 2016. In Rhode Island, birth certificates are collected in the hospital within 24 to 48 hours after the baby birth. The RI DoH collects and manages birth certificate data for all infants born in RI. Birth dates and places for infants, and demographic characteristics for infants, mothers, and fathers are all recorded in birth certificates. The RI Birth Defects dataset consists of birth defects registry data prepared and maintained by RI DoH. Infant birth defects, including MCMs and MAs, were identified 0-365 days after live birth from hospital inpatient and outpatient claims. This study includes infants who were born in RI between January 01, 2006 and December 31, 2016. Medication information will be provided by the RI EOHHS. The data is comprised of eligibility, medical, and pharmacy claims for services from inpatient hospitals, outpatient clinics, emergency rooms, and pharmacies from January 01 2005 to December 31 2016. Brief demographics for enrolled members are included in Medicaid claims data, such as age, gender, race, residency, etc. Medicaid claims data do not include claims for managed care or Medicare enrollees. We excluded patients with dual eligibility, and thus restricted the drug exposure cohort to pregnant women who were only in the fee-for-service or primary care case management program. Each data source will be cleaned first, and then linked with other corresponding datasets using a multi-step linkage approach in which three methods of linkage are applied in sequence Deterministic, Fuzzy Matching, and Probabilistic.156 Records will be first matched deterministically, based on exact matches of unique combinations of personal identifiers including Social Security Numbers, Date of Birth, and Mothers Names (used for the linkage of BVS to Medicaid only). Records that cannot be exactly matched due to missing or poor data quality will be linked using Fuzzy Matching.156,157 Fuzzy Matching allows at least one occurrence of Social Security Number digit transpositions, name misspelling, or day or month errors in birth date fields.157 Remaining unmatched records will be linked using probabilistic techniques, based on statistical weighting of combinations of personal identifiers. Probabilistic linkage involved a two-step process. 1) Deterministic matching from the first merging step empirically derived weights to the non-missing fields based on successful linkages. 2) After the unlinked data matched with several records by weights, the matches with the highest statistical probability (indicating by high weights) will be chosen. The record remained unmatched when no high weights could be obtained. Study Cohort This study includes female Rhode Island Medicaid enrollees who were older than 15 years of age, delivered a live singleton infant between January 01, 2006 and December 31, 2016, and are enrolled in the Medicaid program as identified by pregnancy status. The study cohort of mother-infant pairs will be generated by linking the Rhode Island Medicaid claims data and Rhode Island Birth defects data using strategies described above. Many women joined the Medicaid program after becoming pregnant. We excluded the women who were enrolled in Medicaid program after a positive pregnant test. More exclusion criteria for maternal-infant pair include: mothers with less than 6 months of Medicaid eligibility before pregnancy; mothers who lost Medicaid eligibility during pregnancy; mothers with dual enrollment with Medicare, HMO, or other private health plans; mothers giving multiple births; mothers with diabetes mellitus (ICD-9-CM: 249.x, 250.x, 790.29, or used of any antidiabetics during baseline), hypertension (ICD-9-CM: 401.x, 416.x, 796.2, , 997.91, 459.3, or used of any antihypertensive drugs during baseline), or HIV pre-pregnancy (ICD-9-CM: 042, 079.53, V08, V01.79, 795.71, or used of any antiretroviral drugs); Infants who were twins, triplets, quadruplets or more; outliers involving infants with birth weight less than 350 g or above 6000 g; mothers or infants missing critical information, such as infants birth weigh t, mothers demographic information, or perinatal medical information. Only less than 1% of infants are missing birth weight records in the birth certificate, these will be excluded from the study.20 Overall Study Design This is a retrospective cohort study based on linked mothers Medicaid claims and state birth registry data. The infants birth date will be the study index date. The drug exposure window will be defined as the subsequent 9-month pregnancy period after the first day of mothers last menstrual date. We will use a 6-month baseline period prior to the first date of mothers last menstrual date to obtain the baseline demographic and clinical information. Birth defect outcomes will be detected 0-365 days after the live birth. The entire study period lasts from January 01 2005 to December 31 2016. Drug Exposure Pharmacy claims in Medicaid have been approved as an accurate source for the assessment of drug exposure in observational studies.158 Mothers medication exposure during pregnancy will be obtained from Medicaid pharmacy claims using NDC codes for filled prescription medications, and the number of days for which the medication is supplied.160 The birth anomalies are associated with exposure during entire pregnancy, MCM relates to the teratogen exposure during the first trimester, and MA and LBW associates with the maternal medication exposure at the third trimester.161 Maternal medication exposure during entire pregnancy period can affect the occurrence of varied birth defects. The exposure window, thus, will be established as a period of 14 days prior to the first day of the mothers last menstrual period (LMP) to the date when infant is born. The drug exposure will be defined as any one dose of study medications dispensed during the exposure window, including which the medication is d ispensed before the exposure window but its supply days cover at least 1 day of the exposure window. Adding 14 days prior to the pregnancy is to include the conception period and the residual effects of medications. Sensitivity study will be conducted to examine the different definitions of medication exposure windows. The mothers LMP will be obtained from birth certificates. If the dates are not available in birth certificates (about 13% of LMP in birth certificates are missing), then this information will be imputed from clinical estimates.163-165 The literature suggests that LMP from birth certificates and clinical estimates agrees within 2 weeks.166 Outcome Assessment In this study, we will identify all individual adverse infant outcomes: birth defects (involving MCM and MA), ACNB, LBW, DDD, and preterm birth from the DoH birth defects data. MCM is defined as an abnormality of an essential anatomic structure that is present at birth and interferes significantly with function and/or requires major intervention.38,39 MCM includes heart malformations, urological defects, oro-facial defects, neural tube defects, and skeletal abnormalities, etc..38,40,41 Drug-induced MCMs mostly occur between the third and eighth week of gestation.44 Any impairment before three weeks is more likely to result in fatality. The fetus becomes less sensitive to teratogenic effects after the eighth week, when the organs have developed. 2-1 delineates the time window of exposure to teratogens and associated MCMs and MAs.44 MA, also called minor congenital malformations, is the abnormal morphologic feature that does not cause serious medical or cosmetic consequences45. Identification of MA can be difficult due to the definition and the easy-variable occurrence area.46 Approximately 70% of MAs occur on the face or hands.46 The prevalence of MA is less than 4% in the general population, and varies by race, ethnicity, and gender.45,46 In healthy newborns, about 15% to 20% have one MA, 0.8% have two MAs, and 0.5% have three or more MAs.46 MA mostly occurs after the eighth week of gestation, which is so-called fetal period.44 The use of teratogens during this period may induce MAs by disturbing the growth of tissues or organs.44 ACNB includes seven medical conditions for new born infants. Infants birth weight less than 2500g, 1500g, and 1000g are categorized respectively as low birth weight (LBW), very low birth weight (VLBW), and extremely low birth weight (ELBW). Infants with low birth weight are likely to be born before 37 weeks of pregnancy. In 2009, 8.16% of live born infants showed low birth weight.50 The high risk of infant mortality and morbidity associated with low birth weight has been documented.51 Although this positive association has been ameliorated over time with improved perinatal technology and intensive care, low birth weight and prematurity still have been identified as risk factors predisposing to cardiovascular dysfunction, lung disorder, hypertension, type 2 diabetes, renal diseases, autism, and developmental delay.52-56 MCM, MA, DDD, and fetal death will be collected from birth to the first 365 days of life using the ICD-9 CM code (740-759.9, 315, 768.0, 768.1) from inpatient and outpatient claims. ACNB and preterm birth will be identified from Rhode Island birth certificatedata, and one year follow ups in infant hospital discharge data. Infant birth weight is accurately recorded in the birth certificate.19 It was noted in previous studies that these birth defects outcomes are highly related to each other.59,70-75 MCM, MA, VLBW, and ELBW relate to significant morbidity, mortality, and childhood disability or serious pregnancy or obstetric complications. 58,70-75 About 6-42% of evolving cognitive dysfunction, 9-26% of neurosensory disabilities, 1-15% of blindness, and 0-9% of deafness occurred in infants born with VLBW and ELBW.71 A significantly higher risk of DDD was found in infants born with MCM (prevalence rate: 8.3, 95%CI: 7.6-9.0).72 A 44% 86% of mortality rate occurs in infants with ELBW (500-750g).73 Moreover, infants with 1, 2, or 3 MAs had a risk rate of corresponding MCMs at 3%, 10%, or 20%, respectively.46 Some risk factors, such as infant gender, maternal age, race, social-economic status, BMI, smoking, alcohol use, nulliparity, comorbidity, and comedication during pregnancy are risk factors for all of these outcomes.75-78 Latent Variable Model Liu and Roth developed an LVM to incorporate four important BD outcomes into a single measurement, the infant morbidity index, to describe an infants overall tendency to BD.13 We will apply this model to combine all birth defects outcomes defined in this study into a continuous index of overall adverse perinatal outcome (APO) in this study. The combined outcome will be evaluated in terms of validity and reliability to ensure the appropriate use of this new methodology. MCM, MA, ACNB, Fetal Death, and DDD will be categorized as a binary variable, and assumed Bernoulli distributed.21 Four levels of LBW will be modeled as a multinomial variable since the four birth weight categories are mutually exclusive and each has its own probability. The summation of the individual probabilities of birth defects outcomes equals one. The unobserved index score will be assumed log-normally distributed. Based upon the assumption of local independence, responses of individual component outcomes are independent given the latent variable.22,23 Thus, the overall probabilities of component outcomes conditional on the latent variable are equal to the products of conditional probability for each individual component outcome.21 Based on the local independence and Bayes rule, the joint distribution for component outcomes can be expressed as an integral of product of multinomial variable for conditional distribution of each component outcome and marginal distribution of latent variable.22-24 Marginal distribution of the latent variable is described as log normal. Given the observed outcomes, we can obtain the posterior distribution of the latent severity score. Furthermore, we assume that the conditional distribution of each categorical observed outcome is nonlinear function of the latent variable.13 The conditional distribution of observed outcome and the latent variable will be linked by two parameters in the non-linear function.The probability of any specific observed outcome equals to 0 when the value of the latent variable equals to 0 because the latent variable accounts for all variation of the observed component outcomes and the relationship among these component outcomes.13 In the non-linear function, the probability of an infant having an individual birth defect outcome is assumed zero if the latent variable is zero, and every normal level (no birth defect or normal weight) will be treated as a reference. The latent variable positively associates with observed outcomes. The larger the latent variable, the higher the probability of the observed outcome.13 Latent Trait Model will be conducted using SAS Proc IML. The proportion of each outcome combination will be calculated. Then each parameter will be estimated using the iteration function for EGNLS starting from iteration 0 with initialized value until the stepping coefficient is less than 10-9. The final results are the estimates of all parameters. The estimate of latent variable will be obtained by entering the computed parameters into posterior function.13 Sensitivity Studies In order to examine the proper definition of exposure window, sensitive studies will be conducted with the exposure window defined as the period of 3, 7, 21, or 30 days prior to the first day of the mothers LMP to the infants birth date. D. Timeline Table. Study Timeline of the Study. Time Period Study Progress Before 07/01/2017 Obtain IRB approval from URI, Brown, RI DoH, and RI EOHHS. Complete DUA with RI DoH and RI EOHHS. 07/01/2017 08/01/2017 Complete data linkage for specific aim 1 08/01/2017 10/01/2017 Complete data cleaning, manipulating, variable editing, and analyses for demographic and clinical characteristics 10/01/2017 01/31/2018 Complete specific aim 2 02/01/2018 02/28/2018 Submit an abstract to the annual meeting of International Society of Pharmacoepidemiology (ISPE) 03/01/2018 06/30/2018 Complete specific aim 3 and submit a journal article

Fiction and Literary Works Essay

With that said, it is important to remember that all literary works cannot always be easily classified into a single genre. Moreover, literary works which might be classified as belonging to one genre might possess many qualities more typical of other genres. For example, Shakespeare’s Macbeth is classified as drama, but in many respects takes the form of poetry. In other words, sometimes the differences between categories like drama, poetry, and the short story are not so easily defined. Often a short story might contain poetic or dramatic qualities, or a poem might include narrative and dramatic features. In your post, summarize the major similarities and differences between the forms of drama, poetry, and the short story. Demonstrate your ideas with textual examples from the course readings. In your response, include at least one example of each literary form. If you wish, you may also point to examples which indicate the blurring of literary genres (e. g. , the poetic qualities of Macbeth or the dramatic elements of Gift of the Magi). There are so much to say when it comes to similarities with drama, poetry and a short story. Personally I see that all three have some subliminal message for the audience whether it is lessons learn or an experience personal to the writer. In literary perspectives, like mentioned above, sometimes a poem or short story can merge with another genre such as drama. An example of a short story that can be drama is perhaps â€Å"The Necklace† because the story is about a lady who borrows and loses something her friend lent her and went through so much trouble to replace it instead of coming clean with the friend. A drama is meant to have characters that perform and we see this is a short story known as â€Å"I’m Going† where we see the characters clearly speaking and also we get narrative information to help the audience understand the plot and setting. Poetry is written in different formats or rhythms but can also tell a story but does not always have a plot. All have some sort of tone to set the seriousness or relax humor of the literary work. â€Å"My Papa’s Waltz† is a poem which tells a story of a father and son yet there are also dramatic features as the story is told.

A critical evaluation of the use of “stop and search” by the police Essay

A critical evaluation of the use of â€Å"stop and search† by the police Introduction            Police officers have a fundamental function to maintain law and order in the society (Smith, G. 2001: 372). They deal with crimes and arrest offenders. They are supposed to be vigilant all the time and monitoring any potential criminal activity and prevent its occurrence where possible. According toHess, K. M., &Wrobleski, H. M. (2006: 57), they do this by taking part in community patrols and responding to emergency calls. As the complexity of civilization is increasing, so is the level of crimes (Nick, et al., 2000: 7). This makes the role of the police officers even more challenging. In order to realize their objectives, police officers should make sure that they create and maintain a good relationship with the general public. This is because the potential criminals are in the community and information regarding them is also within the community. Again, any successful policing operation must be done within the stipulated regulations by the state. Otherwise, any o peration done outside the guidelines is deemed unlawful (Hagan, F. E. 2008: 89). It is also of greatest importance for the police officers to uphold the principle of transparency, consensus, legitimacy and accountability when carrying out their operations (Nick, et al., 2000: 8). The use of the â€Å"stop and search† by the police is under section one of the Police and Criminal Evidence Act (1984) (Ozin, P. & Spivey, P. 2006: 28). This section gives police officers powers to stop any individual or vehicle in the public place and conduct a search on the basis of suspicion. This operation has its successes and its shortcomings. The aim of this paper is to critically put into perspective the place of this policing operation in the society.            The Police and Criminal Evidence Act (1984) has given police officers power to detain offenders, to stop and search people and vehicles in connection with offences whether actual or suspected, to arrest without warrant for minor offences and to control the behavior of persons in public places (Hagan, F. E. 2008.: 28). With regard to the power to stop and search a person or a vehicle, the aim is to search for evidence to support the suspicion leveled against the person. According to Hagan, F. E. (2008: 30), stop and search is done where there is suspicion of possessing stolen goods, firearms, illegal fireworks, articles suspected to be for use in committing a criminal act such as theft, fraud or burglary among others. In carrying out such an operation on an individual, clear and reasonable suspicion should exist to avoid subjecting innocent people to embarrassments and anxiety. This is categorically contained in the Police and Criminal Evidence Act (1984) section on e (Bevan, V., &Lidstone, K. W.1985: 29). Police officers are supposed to be guided by the provisions in the Act (Great Britain. Home Office, 2012: 17). However, this is far from the truth. Critical look at the stop and search operations reveal that though somehow helpful in controlling criminal activities, it has pitfalls that need proper considerations.            Discretion has been recognized as one of the key elements in a good policing operation (Norris,  C., et al., 1992: 113; Nick et al., 2000: 21). However, discretion as far as police stop and search practices are concerned has been questioned. First and foremost, let us look at the issue of the legitimacy in the stop and search policing. There are three fundamental questions that we need to ask ourselves with regard to legitimacy of this policing. First, we need to ask ourselves how do police officers decide who to stop and search? Secondly, which factors prompt the police officers to carry out stops and searches of the public? Finally, which factors form the basis for the reasonable suspicion that underpin the stop and search on a particular individual? Police officers have been accused of conducting stop and search operations discriminatorily (Browling, B. & Philips, C., 2007: 965). In Whales and England, it has been reported that whenever there is an alarm and n eed to carry out a public stop and search operation, a black person is seven times more likely to be searched than a white person. If this is the case then, the police officers make the operation illegitimate in terms of its effectiveness (Miller, J. 2000: 21). The blacks, regardless of whether they are law-abiding and innocent or otherwise, feel vulnerable and alienated. Miller, J. (2000: 21-23) argues that awhite person who is a potential criminal may survive detection simply because the level of reasonable suspicion on him or her is low compared to that attached to the black counterpart. It is imperative to mention that according to the labeling theory of criminology, constant application of stigmatizing label on the blacks may stimulate the deviant behavior in otherwise law-abiding people (Hagan, E., 2008: 116-118).            The power in the Act stipulates that before a stop and search is done, a police officer should have reasonable suspicion on the suspect (Nick et al., 2000: 4-6). Based on the ambiguity of the reasonable suspicion, it is expected that the interpretation of this requirements will vary from one police officer to another. It has been established through research that this is actually true. Suspicion is rooted in the culture of the police and resistant to change from external influences (Norris,  C., et al., 1992: 189). Therefore, following the requirements of the Act as to how to develop suspicion is not easy. Often, police officers develop suspicion against people based on the generalizations. They use a person’s age, appearance, behavior and location as the landmarks (Delsol, R. 2006: 48). This generalization forms the roots for alienating some members of the public. They assume that young men are the prime suspects for any criminal activity. As already ment ioned, it becomes even worse if you are a black and living in poor parts of the region in Whales and England (Nick, et al. 2000: 6). Here, we again ask; does being young increase your chances of committing a crime? No. Being young is not a motivating factor! Do black people become potential criminals simply because they are black? No. This notion has been perpetuated by the racist attitude that generally plagues the world. In the same manner, being poor or living in a poor estate does not make one qualify to be a potential criminal. It is not a motivating factor on its own. Therefore, police officers’ ways of developing the theme of reasonable suspicion require proper understanding. Clarification has to be made in the Act as to whether, and to what extent is stop and search policing is acceptable (Nick, et al., 2000 26). In view of this, reasonable suspicion for stop and search encounters can be obtained from the following: if the person fits the description given of the susp ect, if the person behaves suspiciously, if the person is out at unusual time like at night or if the person is found in a place associated with the crime(Stone, V., & Pettigrew, N. 2000: 142).            Though stipulated in a legal frame, public stops and searches have been carried out in an unlawful manner. Persons have been subjected to embarrassing searches in public (Evans,  J.  M. 1990: 54). Sometimes, false information has been planted on the suspect in order to have him or her charged and prosecuted illegally (Nick et a., 2000: 29). Often, when police officers are on patrol at the scene of crime, efforts are made to incriminate someone. In such circumstances, an innocent person suffers unlawfully in the hands of the police officers who are supposed to safeguard the rights of such a person. As already mentioned, stops and searches operations are carried out disproportionately. This is evidenced by the statics obtained in Whales and England (Browling, B., & Philips, C. 2007: 154). Racism and ethnicity is rife in these operations. According to Browling, B & Philips, C (2007: 154), shocking statistics show that a black is seven times likely to be stopped an d searched than a white. An Asian is twice likely to be stopped and searched that a white counterpart. The bitter truth is that the same trend as persisted despite numerous debates to change it.It has been established through studies by FitzGerald (1999: 42) that calls from the public had contribution in the disproportionality observed in the stop and searches. Bias in the suspect description can also be responsible for disproportionate stops and searches according to Browling, B., & Philips, C. (2007: 157). He argues that most descriptions made in incidences of robbery suit members of the minority communities. However, this is a much disputed view because it borders on ethnicity. This view notwithstanding though, police officers do not use description information given but use race to suspect an offender. This is typical ethnicity in policing. It often damages the relations within and between communities. It is important to note that if the policing is perceived unfair, then its le gitimacy will be greatly undermined and co-operation of the public with the police and willingness to obey the law will be decreased (Terris, B. J. 1997: 93).            Public confidence is indispensable in determining the success and legitimacy of stops and searches. It is built upon the trust that stops and searches are used fairly and effectively. This is the center of the principle of policing by consent. It encourages the public to co-operate with and give assistance to the police. According to Janet, B & Chan, L (1999: 13), if police treated people including offenders with respect in order to reduce fear, then the level of co-operation between them and the community would improve. As already stated, one of the things that make the operation legitimate in the eyes of the public is the police decision on who to stop. Stone and Pettigrew (2000) suggest that police officers should only stop people for genuine and good reasons. In addition, they should not target those that they feel like but target the â€Å"real criminals†. Public stops and searches that are deemed inappropriate because they are based on negative stereot yping constitute harassment.            The manner in which public stops and searches are carried is also of great concern. It is required that a police officer should introduce himself or herself to the suspect and clearly state the reason for stopping the individual (Nick et al., 2000: 29). According to Nick et al (2000 29) when a search is necessary, the person should be frisked in a dignified manner. If necessary, the person can only be asked to remove the outer clothes only such as a coat. If an in-depth search is necessary where the person may be asked to remove all his or her clothes, then the person has to be taken to police custody and search be conducted in privacy. For such kind of a search, a police officer of the same gender as the suspect will be involved.This constitutes respect to the person upon whom the search is done. The results of the search should also be communicated to the person accurately and as soon as possible to alleviate excessive anxiety (Zander, M. 1985: 27). In all this p rocess, a police officer must remain polite even when the situation appears difficult to handle. If this simple requirement is not followed, the public lose confidence in the stop and search policing operation. Distrust usually follows and finally, co-operation is lost between the police officers and the members of the public (Nick et al 2000: 32).            It is important to look at some of the possible sources of suspicion. One of the factors that give indirect information about a suspect is age. As already mentioned above, police officers are greatly prompted to stop young people because they are associated with â€Å"causing trouble† generally (Nick, et al., 2000: 19). Furthermore, it is more likely that youths found on the road very early in the morning, whether walking or driving, will be stopped and searched. In addition, youths found driving out of the city at night got stopped on the suspicion that the driver might be drunk (Nick, et al., 2000: 20). It becomes even worse if the youths are found in groups. This focus on young people with regard to stop and searches has been recognized by Stone and Pettigrew (2000: 187). This generalization is not appropriate because there is nothing that links a young person directly to being a criminal. Unless police officers apply the provisions in the Act that stipul ate that age should not be used as a basis to develop suspicion, the problem is inclined to prevail.            Moreover, how a person is dressed has been a prompting factor to conduct a stop and search by the police officers. Nick, et al (2000: 20) mention that people found in dark clothes at night were deemed to be potential candidates to commit a criminal act. They were thus liable to stop and search operations by the police officers. Does this then mean that people should not wear dark clothes at night? According to the police officers, those who wear dark clothes at night do so in an attempt to conceal their identity. They also argue that such people do so to make it hard to notice them at night. Accordingly, they assume that such people could be out to commit a crime or have already committed one and therefore trying to escape. Others styles of adornment have also been labeled as suspicious. According to Stone and Pettigrew, (2000: 187), white people on skinhead hairstyle and blacks on dreadlocks got stopped and searched frequently. This is because such styles are asso ciated with criminals. However, this is again based on generalization and should not form basis for developing reasonable suspicion on a suspect according to the PACE Act.            The type of the car driven also sometimes gave grounds for suspicion. Police officers report being prompted to stop old cars because they suspected a possibility of it having defects or lacking insurance or road tax (Nick, et al., 2000: 21-22). In addition, high-powered cars were targeted because they were likely to be stolen. In their opinion, police officers classify cars that are less likely to be stolen and those that are most susceptible to theft. Furthermore, high-class cars are suspected to be ferrying illegal items. This is based on the assumption that criminal are tempted to use flashy cars to lower their probability of being nabbed by police. In addition, car thieves steal high-class cars more often than their low-class counterparts. But based on these assumptions, the police officers run a risk of stopping and searching the innocent. This becomes a big problem if one will be subjected to constant stops and searches because of the model of their car. Acco rding to Nick et al. (2000: 22), blacks or Asian people who possessed expensive cars would be stopped a lot more compared to the whites. By extension, some people had been forced to change the model of their cars in an attempt to avoid constant harassments from the police officers. The result of this generalized operationpropagated negative stereotyping on the minority ethnic groups. It meant that these people from minority groups did not hold good jobs and therefore could not afford expensive cars. This generates resentment and bad relationship between the public and the police officers.            Police officers often did congruency assessment on the individual in an attempt to establish and develop reasonable suspicion on the suspect (Webber, L. 2013: 47). They compared the driver of the vehicle and the class of that vehicle. If no congruency existed in their own opinion, the driver would be suspected to be a thief. If this driver is actually the owner of this vehicle, it goes without saying that he or she will feel offended to the extreme. This also could happen if a person was found in a place that does not suit him or her. For instance, police officers report developing suspicion on a person found in a school compound and not dressed like a student (Nick, et al., 2000: 24). This usually happens because police officers have learnt to associate certain places with certain people. They have assumed that there are places that are exclusively for the whites and others for the blacks. This means that if a person of the white ethnic group is found in some area s where blacks are predominant, the first instinct to the police officers is that such a person is doing illegal drug business. Similarly, if a black person is found around premises that are known to belong exclusively to whites, the instinct of the police officers would take such a person as a suspect intending to steal. This assumption is wrong because it promotes ethnicity and alienating to a large degree according to Nick et al (2000: 34).            Police officers also rely on suspicious activities to develop suspicion on an individual (Weitzer,  R., &Tuch,  S.  A. 2004: 59). The argument is that such behavior like checking locks or looking inside cars are suspicious activities. People hanging or loitering around got stopped and questioned frequently on their intentions (Nick, et al., 2000: 25). At a hotspot of crime, these observations can be relied upon as sources of reasonable suspicion. But one may ask; what constitutes a suspicious activity in driving? Perhaps a police officer may observe the manner in which the vehicle is driven aimlessly. Also, speeding the car at the sight of police officers may suggest a criminal intent. This can be a reliable source of suspicion too. Also, taking unusual routes may suggest something sinister such as avoiding a police stop and search operation. In addition, cars that are parked in secluded places generate suspicion. A police officer may be prompted to carry out a search on such a situation.            Moreover, police officers are often prompted to stop a person on the grounds of furtive behavior (Nick, et al., 2000: 39). Furtive behavior is described as avoiding being seen, attempting to hide an object, trying to run away or feeling nervous in the presence of police officers. These elusive forms of behavior can arguably be grounds to develop reasonable suspicion. To some degree, a police officer will be right in interpreting them to suit his or her opinions. For instance, a suspect would try as much as possible to avoid being seen. In the same way, if someone is in possession of an object that is illegal, stolen or intended for committing a crime, then he or she will try to hide it. In addition, a person will try to run away from police officers if he or she knows that they have done something that can lead to their arrest. Again, police officers tend to assume that one would be nervous in their presence if he or she is guilty. This is how police officers may w ant to justify using furtive behavior to develop suspicion on a person.            However, there is a limitation to using furtive behavior as a ground to develop suspicion (Williams, B. N., &Stah, M.2008: 73). This is because furtive behavior may be culturally or socially motivated sometimes. For instance, culture may dictate when and to what extent is making an eye contact appropriate. Feeling uneasy in the presence of police officers can happen even when the person feels that there is nothing to hide. This is associated with the fear of being stopped or searched (Stone and Pettigrew, 2000: 192). A person may opt to run away instead of being subjected to police search even when there is no reasonable ground to fear. By extension, some fear being incriminated falsely by police.            In the study done by Nick, et al., (2000: 24), it was established that police officers usually targeted the person that they already knew. On receiving the suspect description, most police officers attach it to a prolific offender who is the current target of the police surveillance. Furthermore, according to the Stone and Pettigrew (2000: 188), police officers targeted persons who had a criminal record in the past. This is actually against the provisions in the PACE Act that clearly states that a person cannot be suspected because of their past history. Some people have also reported having been stopped and questioned simply because they were found walking with a person known to the police. This is offending to say the least. If a person is suspected to be a criminal just because he or she has been involved in criminal activity in the past without reasonable suspicion is tantamount to police harassment. It also makes a reformed criminal to constantly feel guilty a nd develop tactics to survive in such an environment. Some may become hostile while others may revert to committing crimes (Smith, G., 2009: 253). They will take it that the society does not trust in them anymore and that they are unwanted. As a result, a bigger problem result thanks to the unreasonable police officers.            Time and place also often formed the basis for the police officers to develop suspicion on an individual. Findinga person at a particular place and at a particular time of the day may give police officers a basis to suspect that person (Evans, J. M., 1990: 439). For instance, if a person is found at the site of crime at night, the first impression that the police officer on patrol gets is that the person might have been involved in the committing of the crime. Again, if a person is found in a car in an isolated place at night, then that becomes the basis of developing a reasonable suspicion to stop and search such a person. However, it is not obvious that if someone is found ina certain place and at a particular time he or she is up to some criminal activity. Stone and Pettigrew (2000: 162) give an accountof the sufferings of the blacks and Asians in England who worked in fast food outlets, minicab drivers, shift workers at factories or as postmen. Their work requi red them to walk or drive at night occasionally. On such occasions, they often got stopped and searched to the disappointments of the officers because they never found anything suspicious with them. This is to overrule the notion that being found on the road at unusual time does not necessarily mean you are a suspect.            Police officers also rely on the descriptive information given by a victim or witness about the suspect. This information should be as accurate as possible (Webber, L., 2013: 78). It helps the police officers have a general idea on who to stop and search and who not to. However, this does not always happen because the information given may not be reliable. The caller may not be able to give a correct description of the suspect. In addition, the person receiving the information may record incomplete information that does not help much. In such instances, police officers are left to use their method of generalizing (Nick et al., 2000: 32).            In addition, intelligence information is usually given to the police officers on the ground by the intelligence agency (Gelman, A., et al., 2007: 815). The information is meant to assist them to make rational decisions and know where and when to do intensive stop and search operations. The information given to the police officers should be accurate and clear to assist in the operations. The intelligence information may be on the types of crimes that are predominant in a particular place, the crime hotspots, both seasonal and long-term as well as the information regarding the well-known criminals (Miller, J., 2000: 49). Intelligence information can greatly influence how the police officers carry out their patrols because they tend to direct most of their effort towards hotspots (Nick et al., 2000: 34). But it is not surprising that most police officers tend to use generalization and stereotypes to make stops and searches instead of relying on the given intelligence information.            In conclusion, stop and search policing is an effective policing technique used by police if done in accordance with the provided regulations. Some of the issues that arise in the practice of stop and searching in the policing service need evaluation. The most important of all is the issue of discrimination and disproportionality in these stops and searches. As we have seen, this often leads to poor relationship within the community. People lack trust and confidence in the police services. Some people feel vulnerable when they are subjected to unlawful stops and searches. According to Weitzer, R. and Tuch, S. (2004: 321), police unit should find the most suitable way to conduct stops and searches in a manner that yield many positive results and minimize negative result. References Behan,  T.  R. (1988). Stop and Frisk: A Clarification. American Bar Association Journal, 54(10), 968-969. Bevan, V., &Lidstone, K. W. (1985).A Guide to the Police and Criminal Evidence Act 1984. London: Butterworths. Browling, B., & Philips, C. (2007). Disproportionate and discriminatory: reviewing the evidence on police stop and search. The Modern Law Review, 70(6), 936-961. Delsol, R. (2006). Institutional Racism, the Police Stop and Search: A Comparative Study of stop and Search in the UK and USA. New York: University of Warwick. Evans,  J.  M. (1990). Police Power to Stop without Arrest.The Modern Law Review, 33(4), 438-441. Gelman,  A., Fagan,  J., & Kiss,  A. (2007).An Analysis of the New York City Police Department’s â€Å"Stop-and-Frisk† Policy in the Context of Claims of Racial Bias.Journal of the American Statistical Association, 102(479), 813-823. Hagan, F. E. (2008). Introduction to criminology: theories, methods, and criminal behavior (6th Ed.). Thousand Oaks, Calif.: Sage Publications. Hess, K. M., &Wrobleski, H. M. (2006) Police Operations: Theory and Practice. (4th Ed.). Belmont, CA: Thomson/Wadsworth. Janet,  B., & Chan,  L. (1999).Governing Police Practice: Limits of the New Accountability.The British Journal of Sociology, 50(2), 251-270. Miller, J. (2000). Profiling populations available for stops and searches. London: Home office, Policing and Reducing Crime Unit, Research, Development and Statistics Directorate. Nick, B., Paul, Q. & Joel, M. (2000). Police Stops, Decision-making and Practice. Police ResearchSeries.Paper 130. Norris,  C., Fielding,  N., Kemp,  C., & Fielding,  J. (1992). Black and Blue: An Analysis of the Influence of Race on Being Stopped by the Police. The British Journal of Sociology, 43(2), 207-224. Ozin, P., Norton, H., & Spivey, P. (2006). PACE: A Practical Guide to the Police and Criminal Evidence Act 1984. Oxford: Oxford University Press. Smith, G (2001) ‘Why Don’t More People Complain Against the Police?’European Journal of Criminology.6 (3) 249-266 Stone, V., & Pettigrew, N. (2000).The views of the public on stops and searches. London: Home Office, Policing and Reducing Crime Unit, Research, Development and Statistics Directorate. Terris,  B.  J. (1997). The Role of the Police.Annals of the American Academy of Political and Social Science, 374(24), 58-69. Tomaskovic,  D., Wright,  C.  P., Czaja,  R., & Miller,  K. (2006).Self-reports of Police Speeding Stops by Race: Results from the North Carolina Reverse Record Check Survey.Journal of Quantitative Criminology, 22(4), 279-297. Webber, L. (2013). Stop and Search: Police Power in Global Context. Abingdon, U.K.: Routledge. Weitzer,  R., &Tuch,  S.  A. (2004).Race and Perceptions of Police Misconduct.Social Problems, 51(3), 305-325. Williams, B. N., &Stah, M. (2008). An Analysis Of police Traffic Stops And Searches in Kentucky: A Mixed Methods Approach Offering Heuristic And Practical Implications. Policy Sciences, 41(3), 221-243. Willis, C. F. (1997). The Use, Effectiveness, and the Impact of Police Search powers. London: Home Office. Zander, M. (1985). The Police And Criminal Evidence Act 1984. London: Sweet & Maxwell Police Review Publishing Corporation. Source document

Should the Federal Minimum Wage Be Raised - 900 Words

Our entire society in the United States is complicating whether or not our nation should raise the federal minimum wage. Ranging from researchers who have been studying this incompatible topic throughout their entire lives to amateurs who simply expose their opinions without any logical reasoning to the public are still not able to come to an agreement for a stable minimum wage. Many citizens may assume that increasing the minimum wage, $7.25, an hour, by a couple dollars may not make a significant impact to our economy. However, there still coexists a complex reason behind this whole topic that is currently disabling our society to contemplate on a solution. Generally, most traditionalists who believe that increasing the minimum wage may hurt the young and unskilled workers in an economical perspective. 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