Most attention to the risks from fish consumption has focused on recreational anglers and on fish caught by individuals, but the majority of fish that people eat are purchased from commercial sources. We examined mercury levels in three types of fish  commonly available in New Jersey stores, sampling different regions of the state, in communities with high and low per capita incomes, and in both supermarkets and specialty fish markets. We were interested in species-specific levels of mercury in New Jersey fish and whether these levels were similar to data generated nationally by the Food and Drug Administration  on the same types of fish. Such information is critical for providing public health advice. We were also interested in whether mercury levels in three common species of fish differed by region of the state, economic neighborhood, or type of store. We found significant species differences, with tuna having the highest levels and flounder the lowest levels. There were no significant differences in mercury levels as a function of type of store or economic neighborhood. There was only one regional difference: flounder from fish markets along the Jersey shore had higher mercury levels than flounder bought in other markets. We also examined mercury levels in six other commonly available fish and two shellfish from central New Jersey markets. There were significant differences in availability and in mercury levels among fish and shellfish. Both shrimp and scallops had total mercury levels < 0.02 ppm (wet weight). Large shrimp had significantly lower levels of mercury than small shrimp. For tuna, sea bass, croaker, whiting, scallops, and shrimp, the levels of mercury were higher in New Jersey samples than those reported by the FDA. Consumers selecting fish for ease of availability (present in > 50% of markets) would select flounder, snapper, bluefish, and tuna , and those selecting only for price would select whiting, porgy, croaker, and bluefish . Flounder was the fish with the best relationship among availability, cost, and low mercury levels. We suggest that state agencies responsible for protecting the health of their citizens should obtain information on fish availability in markets and fish preferences of diverse groups of citizens and use this information to select fish for analysis of contaminant levels, providing data on the most commonly eaten fish that will help people make informed decisions about risks from fish consumption. Fish are an important source of protein for many people throughout the world, and their importance in the diet has increased among health-conscious Americans. Not only are fish an important source of nutrients, but fishing is a popular pastime , in urbaHowever, contaminant levels, particularly methyl mercury and polychlorinated biphenyls (PCBs), are sufficiently high in some fish to cause adverse human health effects in people consuming large quantities . Fish coState agencies respond to the risk of chemicals in fish by issuing consumption advisories to inform the public about possible risks . The number of fish advisories due to chemicals, such as mercury and PCBs, has increased in the United States over the last decade . With fea) examination of mercury levels in tuna, bluefish, and flounder purchased over a broad geographical range stratified by region, economics, and store type; and b) examination of mercury levels in a range of different fish and shellfish purchased in central New Jersey. We were interested in species-specific levels of mercury in New Jersey fish and whether these levels were similar to data generated nationally by the FDA on the same species (mainly from 1990 to 1992). A determination of whether national data on mercury concentrations by commercial fish species represents concentrations found in local fish can help public health providers and state health officials design their health and consumption advisories. New Jersey was specifically interested in whether the mercury levels in fish commonly sold in the state were in the range where issuing consumption advisories should be considered.In this study we examined total mercury levels in fish in New Jersey. We used a two-tiered approach: We examined different regions of New Jersey because the sources of the fish might differ. That is, fish sold in stores in southern New Jersey often comes from fish markets in Philadelphia, Pennsylvania, while fish in northern New Jersey often comes from the Fulton Fish Market in New York, New York. Thus, commercial fish enter New Jersey markets from several sources: the Fulton Fish Market, the Philadelphia fish market, commercial landings along the New Jersey coast, supermarket wholesalers, and party and charter boats. Further, fish caught locally (such as flounder and bluefish) often comes from the nearest fishing ports. Similarly, upscale and downscale markets may obtain their fish from different sources, particularly for locally available fish. Thus, it is important to understand whether mercury levels might differ in fish purchased in different regions of the state. We initially selected the three types of fish, tuna, bluefish, flounder, based on their widespread availability and the belief that they are commonly consumed and would represent high, medium, and low mercury concentrations . Other fFish consumers face a series of choices regarding whether to eat fish they catch or commercial fish, which species to eat, what trophic level or size of fish to eat, and how much fish to eat. To make these decisions, they must know the levels of contaminants in the fish that are commercially available. The advisories promulgated by state agencies and the FDA deal with fish that have high mercury levels and often do not provide information on fish that may be low in mercury. This study partly addresses this issue. We also combined information on availability and price with mercury levels to consider how people might reduce their risk within their local community.a) determine fish availability (and price) in the state generally (b) buy three types of fish from supermarkets and fish markets throughout the state, in towns with higher and lower socioeconomic status (SES); c) use the information on availability and hypothesized mercury levels to select six additional fish and two shellfish for mercury analysis to provide information on a broader range of species; d) determine the total mercury in these fish and shellfish; and e) compare the mercury data from this study with that available from the FDA that is otherwise used by state health departments and the public for guidance. The FDA generally obtains its fish by random, geographically stratified sampling  buy sampling , combineNew Jersey is commonly divided into regions for administrative purposes, including the relatively urbanized north and the very rural south, as well as a large, central suburban region. For the fish availability (and price) aspect of the study , we visiFor collection of fish for mercury analysis, we selected one town of higher and one of lower SES in each of the three regions and randomly selected individual stores from New Jersey’s Seafood and Fish Index Page . Both thThunnus albacaras), although verification to the species level is not certain. A variety of flatfish are sold under the rubric of flounder, and these may come from New Jersey waters or from remote parts of the globe. Bluefish  is a popular east coast sport fish and in the past decade has become widely available in stores. Tuna are large predatory fish; bluefish are medium sized predatory fish; and flounder are bottom-dwelling fish, usually reported to be low in mercury  at 80× power. Digested samples were subsequently diluted in 100 mL deionized water. All laboratory equipment and containers were washed in 10% HNO3 solution before each use  sample of fish tissue was digested in ultrex ultrapure nitric acid in a microwave using a digestion protocol of three stages of 10 min each under 50, 100, and 150 lb per square inch .Mercury was analyzed by the cold vapor technique using the Portable Zeeman Lumex (RA-915) mercury analyzer , with an instrument detection level of 0.2 ng/g, and a matrix level of quantification of 0.002 μg/g. All concentrations are expressed in parts per million  of total mercury on a wet-weight basis. In another study  we foundp < 0.05, but values up to p < 0.10 are presented to allow the reader to evaluate whether increased sample sizes would have resulted in significance.We used Kruskal-Wallis nonparametric one-way analysis of variance  to examine differences among fish species and locations. We also used ANOVA with Duncan multiple range tests to identify the significant differences . The lev2 = 26.3, p < 0.001). However, for all three species, there were few differences in mercury as a function of region, type of market, and economic neighborhood , perhaps because there is growth dilution in large shrimp.There were also significant differences in mercury levels among the other species of fish and shellfish examined . Large sOnce a personal choice has been made to eat fish, the consumer must decide what types to eat. This decision may be based on several social and economic factors besides mercury concentrations, including price and availability. The fish examined in this study were not equally available in all stores, nor were they equally priced . Only whOther than the mercury levels in commercial fish and shellfish reported by the Most of the risk assessments for fish consumption examine chronic exposure, and not a single meal. However, there is recent concern that one meal of fish with a very high mercury content (a pulsed exposure) might adversely impact a developing fetus at a critical developmental period. People are faced with making rational decisions about whether to eat fish or not and what fish to eat. Their choices are influenced by both the benefits and the risks of consuming fish  and by cMany of the fish and shellfish examined in this study had levels of mercury < 0.10 ppm and would pose little risk to a developing fetus. Our data suggest that consumers have choices of both shellfish and fish with low mercury levels, and such information should be provided to the public. Information on mercury levels in commercial fish will also be useful to the public in balancing the risks from self-caught and commercial fish. That is, with information on mercury (or other contaminants) in fish from their local lakes or streams, anglers or the family cook can determine whether to eat commercial or self-caught fish and how much of each species to eat. We are a long way from having sufficient information on mercury for people to make these decisions, but we suggest that agencies should go in this direction. From a public health standpoint, commercial fish is the main point of intervention to reduce methyl mercury exposure in the public.Risk communication is effective only if the intended message reaches the audience, and if people have acquired sufficient information to feel that they are making informed decisions. Public health officials also hope that risk communication changes behavior in the desired direction. Yet people cannot make rational decisions about whether to eat fish and what kinds of fish to eat unless they have information on the risks from different choices. In our view, this means knowing not only which fish have high levels of mercury—the communication the FDA and states provide—but information on fish species that usually have low contaminant levels. Although some mercury data have been available for many years, only recently have the concentrations of omega-3 fatty acids in different fish been publicized.It has so far proven easier for agencies to promulgate advisories that tell the public or at-risk audiences what fish not to eat than to advise them about what species of fish are low in contaminants and therefore good to eat. There are several reasons this may be true. First, contaminant analyses are expensive and time-consuming, and agencies concentrate their effort where there is a known or suspected risk. Second, advising people not to eat a fish when contaminant levels have actually declined does not have the same potential adverse effect as telling people to eat a fish that turns out to have high levels . Third, telling people that one or two species of fish are low in contaminants, while not addressing others, may pose a problem in terms of the marketplace or industry equity, and, finally, the availability of different species of fish differs among geographical regions of the state, and contaminant data on the commonly available fish will be most useful. A regional breakdown is not available in the FDA data .Public health officials and appropriate state agencies should consider making available to the public information on fish that are low in mercury. This would balance the information that is currently available on fish that are high in mercury and allow people to continue to eat fish (often in large quantities) without undue harm to themselves or their children. In addition, there are ethnic preferences in fish , 2004, aa) fish preferences of consumers as a function of economic, social, and ethnic background; b) fish availability in different regions and in different economic strata; and c) contaminant levels using a suite of fish that optimize for trophic level, consumer preferences, and market availability. This information could then be made available for the state overall, to specific geographical regions, and to different target audiences. With such information, people can make informed decisions about the species of fish to eat within their region and incomes. People’s perceptions, needs, and values with respect to fish consumption are only one part of the equation; the affected communities themselves should be involved in every step of the fish consumption advisory process . We found that consumers optimizing for easy availability would select flounder, snapper, bluefish and tuna, whereas those selecting only for price would select whiting, porgy, croaker, and bluefish. Flounder demonstrated the best relationship among availability, cost, and low mercury levels. We suggest that agencies responsible for protecting human health should obtain information on fish availability and cost in markets, as well as fish preferences, and use this information to select fish for analysis of contaminant levels. This would provide data on the most commonly eaten fish. Public health officials could then provide the public with information on mercury, cost, and availability for commercial fish, allowing them to make informed decisions about which fish to eat.In the original manuscript published online, the authors stated that they found “single fillets of tuna, Chilean sea bass, croaker, and red snapper that had > 2 ppm mercury.” This statement has been corrected here to indicate that “only tuna fillets had > 2 ppm mercury.”


A simple colorimetric test, the MTT assay, has been adapted for chemosensitivity testing of human small cell lung cancer cell lines, and fresh tumour samples. Optimal conditions for clinical chemosensitivity testing were determined using established SCLC lines. Nineteen different chemotherapeutic agents were tested, and sixteen of them were found to be cytotoxic in this assay system. The drug sensitivity of a panel of 16 SCLC cell lines was measured and compared. There was very little intraexperiment variation, but the interexperiment variation was significant. Cell lines which were derived from patients who had not received chemotherapy at the time the cell line was established were more sensitive  than lines derived from treated patients, and the differences were statistically significant for two of the drugs. One cell line, NCI-H209, which was derived from an untreated patient, stood out as being the most sensitive or among the most sensitive to all of the drugs tested. Another cell line, H69AR, which is a multidrug resistant subline of the cell line NCI-H69, was the most resistant to many of the natural product drugs tested. Multiple drug chemosensitivity testing was performed on eight fresh tumour samples from SCLC patients . It was possible to perform chemosensitivity testing on all of the clinical samples in which sufficient tumour cells were available. The drug sensitivity of the clinical samples was, in most cases, within the same range as for the cell lines. Since this assay is very rapid and simple to perform, it may have practical applications in clinical drug sensitivity testing of human tumours.


At the time of the Foot and Mouth disease (FMD) outbreak of 2001, there were limited reports in the literature as to the cattle population structure in Britain. In this paper we examine the temporal patterns of cattle births, deaths, imports and movements occurring within Britain, reported to the Department for the Environment, Food and Rural Affairs (DEFRA) through the British Cattle Movement service (BCMS) during the period 1st, 10th and 20th of each month.In Britain, the number of reported cattle births exhibit strong seasonality characterised by a large spring peak followed by a smaller autumn peak. Other event types also exhibit strong seasonal trends; both the reported number of cattle slaughtered and "on-farm" cattle deaths increase during the final part of the year. After allowing for seasonal components by smoothing the data, we illustrate that there is very little remaining non-seasonal trend in the number of cattle births, "on-farm" deaths, slaughterhouse deaths, on- and off-movements. However after allowing for seasonal fluctuations the number of cattle imports has been decreasing since 2002. Reporting of movements, births and deaths was more frequent on certain days of the week. For instance, greater numbers of cattle were slaughtered on Tuesdays, Wednesdays and Thursdays. Evidence for digit preference was found in the reporting of births and "on-farm" deaths with particular bias towards over reporting on the 1This study provides insight into the population and movement dynamics of the British cattle population. Although the population is in constant flux, seasonal and long term trends can be identified in the number of reported births, deaths and movements of cattle. Incorporating this temporal variation in epidemic disease modelling may result in more accurate model predictions and may usefully inform future surveillance strategies. Mathematical modelling approaches are increasingly being employed to inform disease control strategies. Interest in these techniques in this context has been greatly augmented by recent disease outbreaks within the British cattle population. The accuracy of such models relies upon accurate estimates of population structure as temporal trends in the births, deaths and movements of cattle may impact substantially on pathogen transmission dynamics. For instance, birth rate may affect rapidity of spread due to supply of susceptible individuals into the population. Understanding the dynamics of the cattle population may also inform timing of resources and therefore the efficacy of surveillance schemes.et al. [In addition to factors associated with pathogen transmissibility and host susceptibility, population characteristics can drive the temporal and spatial patterns of disease occurrence. For example, the widespread movement of livestock (often over considerable distances) that occurred prior to the detection of foot and mouth disease (FMD) in 2001 resulted in transmission of disease to several spatially distinct foci, one of the main differences between the outbreak of 2001 compared with that of 1967 [et al. , quantifThe individual identification and tracing of the cattle population is a requirement of all member states of the European Union (Regulation 820/97). Within Britain a centralised tracing system capable of identifying individual cattle for the purposes of public health was established in the form of the British Cattle Movement Service (BCMS). Mitchell et al. (2005) provided a short historical overview of the changes to the reporting of cattle movements in Britain. Since 2001 it has been mandatory for all keepers of cattle in Britain to register births, deaths and movements to BCMS via telephone, post or internet. This data is then collated by the Department for Environment, Food and Rural Affairs (DEFRA) as part of the Rapid Analysis and Detection of Animal Risk (RADAR) information management system .st Jan 2002 to 28th Feb 2005.This extensive database resource provides the reported event  histories of all cattle in Britain. The database of cattle births, deaths and movements reported to BCMS contains records from as early as 1996. However, initially, data reporting by animal keepers was not mandatory. Also, as a result of the Foot and Mouth Disease outbreak of 2001, many animals were slaughtered and movement restrictions were imposed on the industry, and data collected during this period are atypical. In this paper we consider only movements of cattle for the period 1Time series analysis, of which data smoothing forms a necessary first step, can be applied to temporal data to identify two basic components: trend and seasonality ,6. TrendFor each type of event  the raw data, 3-point moving average, residuals (after accounting for the 3-point moving average) and 53-point weighted moving average are illustrated.t, minus the 3-point moving average at time t) shows a greater degree of variation in the early summer of 2003 and also two further periods during the summer of 2004  were in agreement with the trends reported above and shall therefore not be presented for a second time. The model parameter values and standard errors are plotted for births, imports and "on-farm" deaths in Figures st, 10th, 20th, 28th and 30th. From the model the dates 1st, 10th and 20th were all associated with a significantly (P < 0.0001) increased number of reported births on these dates even after allowing for month and day of the week in the model. Calf births were less likely to be reported as having occurred on Sundays and were more likely to be reported as having occurred on Mondays  and Fridays compared to other days of the week.Figure st, 10th and 20th of the month. There were deficits in the reports for odd numbers adjacent to multiples of 10, such as the 9th, 11th, 19th and 31st of each month ).After accounting for months with fewer than 31 days, further exploration of the data on reported calf birth dates indicated a notable tendency to report the 1th of any month and the number of cattle imported on that day when compared to the 1st. There was a trend for increased number of import movements occurring later in the week and Friday was significantly (P < 0.001) associated with more import movements compared to Mondays and Sundays.The generalised linear model output for live cattle imports Figure  revealedth–27th and 30th and 31st days of any given month were associated with significantly (P < 0.05) fewer cattle slaughtered on these days. Mid- periods of any given month were associated with an increased number of cattle reportedly slaughtered. Not surprisingly, Tuesdays, Wednesdays and Thursdays were associated with significantly more slaughterhouse deaths when compared to Mondays and Fridays (P < 0.001), which were also significantly associated with increased numbers of deaths compared to weekend days (P < 0.001).The first four days and the 24st, 10th and 20th of the month, as highlighted above. "On-farm" deaths reportedly occurring on a Monday were overrepresented compared to other days of the week and this effect was found to be significant (P < 0.001) compared to all others days of the week. Weekdays were also significantly more associated with reported "on-farm" deaths than were weekend days.Figure et al. [In this paper we have identified seasonal and other temporal trends in the reported births, deaths and movement of cattle within Britain. The findings reported in this paper are supported by Mitchell et al. . HoweverCattle are managed on animal holdings, with management often determined by season. Hence it was not surprising that we found considerable variation, with distinct seasonality in the number of reported births , deaths and movement of cattle. Trends in the dynamics of the cattle population, (i.e. births and deaths) indicate strong seasonal fluctuations accompanied by relatively small changes year on year. There is evidence that the cattle population is steadily increasing year on year, which concurs with the birth rate in recent years exceeding the overall death rate. However, the effect of gradual restocking of farms following the FMD outbreak in 2001 and improvements in data capture and data quality over recent years are likely to have contributed to the observed increase in the number of cattle in the population.An important feature of this analysis is the examination of residuals in the temporal data after allowing for seasonal fluctuations. The residuals for live imports of cattle reveal no obvious trend and can be regarded as noise (unexplained variation). However for most other events, examination of the residuals reveals further temporal features in the data. For births, slaughterhouse and "on-farm" deaths a spring spike in 2003 is evident that is not explained by seasonal extremes in trends. This observation can not be explained by changes in data management or quality by BCMS at that time . Although not necessarily related, the spring spike in residuals in 2003 does coincide with a change in the legislation governing cattle movements when the stand-still rule in England and Wales reduced from 20 to 6 days. Other biases may account for the observation, and further exploration may be warranted.By examining the appearance of spikes on the residual plots in this way, outbreaks of disease leading to higher mortality may be highlighted. However, outbreaks of disease are often localised and therefore analysing regional, as opposed to national data, may be more informative. Furthermore, highlighting periods in real-time when the number of "on-farm" deaths are above or below the normal seasonal fluctuations, may lead to a more reactive and flexible surveillance. This approach to identifying localised disease "hot spots" has been discussed on a small spatial scale for cases of gastrointestinal disease in humans . The repIn this paper we characterised the data regarding cattle deaths into "on-farm" deaths, reported by agricultural holdings, landless keepers, knackers yard, hunt kennels, markets and on common land (perceived to be culled or diseased cattle) and those occurring at slaughterhouse premises . Although this distinction has proved useful the assumption that cattle arriving at slaughterhouses enter the food or feed chain may not be the case for a small proportion of cattle that arrive at the slaughterhouse. Equally, our assumption that cattle deaths on agricultural holdings, at hunt kennels, or knackers yards etc., are due to disease is also likely to be an overestimation of the amount of disease as many cattle on farms will be culled due to age related factors and may not be diseased. Therefore the data for "on-farm" deaths may be more useful in disease surveillance if additional information collected.Importation of live cattle also affects the cattle population dynamics within Britain. In contrast to the trend for births and deaths, imports have been decreasing year on year since 2002, possibly reflecting the increased demand for cattle immediately following the 2001 FMD outbreak. This reduction in the numbers of cattle imported from other countries may have important implications for risk assessments associated with the importation of cattle disease into the national herd. In addition other temporal trends highlighted such as periods of the year, dates of the month and days of the week when increased numbers of cattle are imported could help to direct resources as part of an informed surveillance program.We have presented evidence that records of cattle births and "on-farm" deaths taken from the RADAR information management system are subject to a reporting bias, namely digit preference, with preferential reporting of dates ending in a multiple of 10's, even numbers or the first of the month. It is unlikely that there would be any biological explanation for this effect. Digit preference, the preferential reporting of dates or numbers by subjects, typically those ending in zero or five, is a well documented reporting bias that has been investigated in several health-related contexts, including blood-pressure measurements , self-reAs well as error occurring in reporting, others sources of error may be introduced during data editing. Within the raw data reported by animal keepers obvious and illogical discrepancies exist, e.g. the reporting of a birth date that is after death has been reported to occur. In such cases, data editing by data suppliers (either BCMS and/or DEFRA) is undertaken to ensure that events in cattle movement histories are logical and sequential. Hence, this editing process may also be a source for the preferential selection of particular dates.The apparent preferential reporting of Mondays as the day on which most births and "on-farm" deaths occur on animal holdings may result from biased observation. Due to the  lower intensity of observation of cattle during the weekend, some births and "on-farm" deaths that occur over a weekend may only be detected on Mondays when closer inspection of the cattle herd resumes. It may also be the case that if cattle fall ill during the weekend, euthanasia by a veterinary surgeon would not occur until after the weekend, when consultation charges may be lower.It is likely and, indeed, intended that data on cattle movements obtained via the RADAR information management system will become more widely available to scientific researchers in the future. It is important that biases inherent within the database be considered. In general terms, the digit preference reporting bias that we have identified may only cause small discrepancies between the reported and the actual dates of calf births and deaths. Although for many studies this may not be important, some studies may need to consider and adjust for the effect of this bias; for example studies assessing mortality in calf cohorts using data extracted from RADAR information management system, where small deviations in the age of calves are likely to be important. Methods exist for the correction of this bias within datasets . HoweverWhilst digit preference is a natural phenomenon associated with recall, measures to reduce or avoid this source of bias within the data may be worthwhile. Consultation with animal keepers may suggest important improvements for the methods of reporting of births and deaths that may lead to a reduction in the bias. Identification of animal holdings for whom records suggest substantial digit preference may be used to target incentives to improve the accuracy of reporting births and deaths. It is also of significance to highlight that in different applications, evidence of bias within data, can also aid in the detection of fraudulent claims .A limitation of this study is the assumption that all movements, births and deaths of cattle are subsequently reported to DEFRA. There has been some speculation within the industry as to the extent of unreported or misreported cattle movements and therefore the efficacy of surveillance policy based on incorrect field data. Further issues of data quality associated with the data handling may also be introducing sources of error.The recording of sequential observations in the form of daily cattle births, deaths and movements within Britain provides a large data set, archetypal for use in time series analysis. Identifying trends in movement of cattle and the underlying population dynamics may assist the planning of appropriate disease surveillance schemes that can be seasonally adjusted to cope with increasing surveillance at times of the year when movements are at a peak. Further time series analysis may also aid in the prediction of future trends in movements and population dynamics. Using complex time series analysis the ability to forecast and predict future number of movements that may occur on a particular day may of use again for surveillance purposes. However, restructuring within the cattle industry, in response to rapid changes in government legislation (lifting of the ban on cattle over 30 months entering the food and feed chain), are also likely to cause continued changes to the cattle population structure in Britain. These changes require continued monitoring.All data regarding cattle births, deaths and movements including imports were obtained from DEFRA's RADAR information management system based on data downloaded from the BCMS cattle tracing system (CTS) on 08/04/2005.A dataset containing records of cattle births and deaths since 1996 (coinciding with the introduction of cattle passports) was extracted. Initial graphical exploration of the data indicated that records (and in particular on and off movements) pre 2001 were incomplete. Changes in recording methods, scrutiny and capture, as well as the FMD outbreak of 2001 have all contributed to this period of uncertainty and variability in the dataset. Therefore all further analyses were conducted on reported births, deaths and movements of cattle occurring between 1/1/2002 and 28/2/2005.The original database contains records of births, deaths, "on" and "off" movements and imports reported by each animal holding for any given day. From this we created a dataset including date of event , location type and number of animals involved in the event. In the original database an "off" or "on" movement may be classified into several further classifications depending on the source of the information regarding the movement. For our analyses we collapsed these subdivisions to define the movement only as an on- or off movement of cattle.Using information from the location type descriptor, where possible (approximately 80% of records), we differentiated between cattle deaths for the purposes of food or animal feed purposes (assumed to be deaths reported on slaughterhouse premises) and deaths due to culling or disease . For the purposes of this paper these shall be defined as "on-farm" deaths. Deaths at other location types were contained within the data, however this only accounted for a very small percentage (<1%) of the reported deaths and were therefore not included in this analysis.st of every month was also available in the data extract from DEFRA's RADAR information management system. Summing across animal holdings allowed the total cattle population in Britain to be calculated. Data storage, management and manipulation was achieved using a number of software packages including PostgreSQL [The count of cattle on each animal holding on the 1stgreSQL , MicrosostgreSQL .The choice of time interval for representing the data is important; concise data sets are more readily manipulated but important information in the data may be lost if long intervals are chosen. The data on births, deaths and movements exist as daily observations. Initially, we plotted the raw daily data but when smoothing the data we summed across weeks and also by months. After initial investigation, summing monthly data resulted in essential features of the original trace being lost. Treating the data as weekly observations appeared to be a suitable compromise and intuitive due to the 6-day movement restriction that applies to farms in England and Wales. This restriction prohibits any movement of livestock off an animal premise if livestock have been moved onto the premises in the last 6 days.n surrounding elements, where n is the width of the smoothing window [Temporal trends evident after plotting the raw data, were further explored using a range of smoothing techniques; a useful way of making seasonal components clearer. Here we used moving average smoothing which replaces each element of the series by the mean of g window ,6. Esseng window .To explore the relationship between the number of births, deaths and movements of cattle and time varying covariates we fitted generalised linear models (GLM) using the daily records as the independent variable with year, month, day of the month, and day of the week included as dependent variables . As manyWhere the GLM output suggested potential digit preference this was further evaluated by calculating the expected distribution of births per days of the month, taking into account the number of months with less than 31 days, and comparing the observed number to the expected number of days. Our assumption was that over a sufficiently long period of time, births occur randomly over time.SE carried out all descriptive and statistical analysis. RC conceived of the study provided guidance and advice on all aspects of analysis and writing.


The aim of this paper is to show how researchers balance between scientific rigour and localisation in conducting pragmatic trial research. Our case is the Quattro Study, a pragmatic trial on the effectiveness of multidisciplinary patient care teams used in primary health care centres in deprived neighbourhoods of two major cities in the Netherlands for intensified secondary prevention of cardiovascular diseases.For this study an ethnographic design was used. We observed and interviewed the researchers and the practice nurses. All gathered research documents, transcribed observations and interviews were analysed thematically.Conducting a pragmatic trial is a continuous balancing act between meeting methodological demands and implementing a complex intervention in routine primary health care. As an effect, the research design had to be adjusted pragmatically several times and the intervention that was meant to be tailor-made became a rather stringent procedure.A pragmatic trial research is a dynamic process that, in order to be able to assess the validity and reliability of any effects of interventions must also have a continuous process of methodological and practical reflection. Ethnographic analysis, as we show, is therefore of complementary value. The question has been raised to what extent evidence from controlled clinical trials on prevention interventions is of value in the routine clinical practice of primary care -6. ExplaThe way that researchers actually deal with conducting pragmatic trials remains largely unexplored. In fact, there have been few publications examining the work that goes into producing evaluative outcomes and managing pragmatic trials or, for that matter, on RCTs (e.g.). In thiWe used an ethnographic design. By means of participant observations -18, the After the observation period, all transcripts, minutes, and research documents were analysed more in-depth. We analysed all information manually and thematically, establishing overarching categories.Aim of the Quattro-study was to examine the effectiveness and cost-effectiveness of a multidisciplinary collaboration between a practice nurse, a peer health educator, the GP, and assistant in providing intensified preventive care in general practices located in deprived neighbourhoods. The Quattro Study was a randomised controlled trial (RCT) carried out in three primary health care centres located in the deprived neighbourhoods of Rotterdam and The Hague. Patients in the intervention group obtained Quattro-care and three-monthly assessments of the risk profile. Patients from control group A received usual GP care and three-monthly risk assessments and the GP as well as the patient were informed about the results of these measurements. It was thought to be ethically and practically unacceptable to assess a risk profile and not to inform the patient and GP about the results. However, this approach of assessing risk and informing patients and GP interferes with daily practice and may bias the results. Therefore, a blinded control group B was needed to quantify the effect of the risk assessments. This group received usual GP care and was measured once at the end of the study.The follow-up period for the intervention and control group A was 12 months and the intervention programme lasted 9 months. Participants in the study were patients at high risk of developing CVD; i.e. patients with a modifiable part of the absolute 10-year risk equal or greater than 5% contributed by smoking, hypertension or hypercholesterolemia.The intervention consisted of the formation of a primary care team in the general practice composed of the GP, assistant, practice nurse and peer health educator (Quattro-care). The intervention protocol was based on GP guidelines for hypertension, hypercholesterolemia, diabetes mellitus, smoking and obesity, and described the procedures for the intervention team (GP (treatment task), practice nurse , assistant (logistic task) and peer health educator ). Although the main lines of the protocol were fixed for participating general practices , the protocol allowed adapting to tailor the intervention to the individual practice needs and organisation.The effectiveness of the multidisciplinary collaboration was assessed by comparing patients from the intervention group with those from control group A after one year follow-up with regards to the reduction achieved in the absolute 10-year risk of developing CVD.Control group B, aimed to quantify the effect of structured risk assessments performed in control group A, was compared with control group A.The study ran from August 2000 until December 2005. Complementary qualitative research was considered necessary during the execution of the trial to evaluate feasibility, implementation and experiences with Quattro-care of health care professionals, patients and researchers. Ethical approval for the Quattro Study, which also incorporated the complementary qualitative research, was obtained from the Health Ethics Board of Erasmus University Medical Center in Rotterdam.Patient recruitment was a major concern in the Quattro Study. The researchers had to adapt the inclusion procedure to overcome a too homogeneous composition in, and a shortage of, eligible patients. The research team decided to change the age parameters from 18–70 years of age to 30–70 years of age in order to ensure a more representable proportion of the target population (document selection criteria addendum 2). Changing the age parameters in a study performed in deprived neighbourhoods would prevent a possible over-representation of indigenous male patients with a high absolute risk of CVD, with little or no elevated cardiovascular risk factors (document selection criteria addendum 2). Focusing on the absolute 10-year risk alone for both male and female patients would result in excluding a large number of eligible, relatively young, predominantly female patients . The incThe participating GPs were able to decide whether patients had to be protected from the stress of participation because of a too complex medical history (severe co-morbidity). The GPs vetoed 641 patients . The reasons for rejection were 'the patient being under care of a specialist', 'the patient being correctly monitored' or 'other reason:...' (document patient risk profile form). This elimination of patients proved to be a disproportionate part of the eligible group of patients and adopting the GP vetoes would result in a too small target population needed for the study. Besides, the amount of vetoed patients was unevenly distributed among the participating GPs, making future comparison and extrapolation of found effects difficult. To enable the intervention to represent routine medical decision-making the research team chose to review the vetoed patients and readmitted 43 patients. Eventually, from the selected 2,263 eligible patients between 30–70 years old and with at least one CVD risk factor, the researchers were able to include 1,665 eligible patients into the study .For the researchers, blinding patients and preventing contamination between intervention and control group A patients were major concerns for establishing the effectiveness of the study. Blinding patients for the health care professional, however, proved to be problematic. The problems started to develop as soon as the patients arrived at the centres for their appointments. For the assistants at the reception desks it was unclear to which group a particular patient belonged and 'mistakes' in the allocation of patients were made. Control group A patients were either seen as intervention group patients when they were not, or were referred back to the researchers without receiving Quattro care (field notes research progress meeting 10-09-2003 and 23-03-2004).The research team decided to provide the health care centres with a list of names of the patients included in intervention and control group A. This point received an additional remark in the minutes: "Methodologically not really correct, but a concession" (minutes research progress meeting 10-09-2003). As the researchers provided name lists to the health care centres, the researchers endangered the internal validity of the project as they informed the health care centres about which patients belonged to which research group. In the study design the possibility of contamination was already incorporated, as the centres were responsible for the internal organisation of the intervention and adjusting the intervention to the local circumstances . The trial was, therefore, not badly designed; the research team was merely forced to make it workable for the centres.For the researchers the assessment of the effectiveness of the multidisciplinary care teams was the core of the whole project. They planned the individual patient education sessions given by the practice nurse and/or migrant health educator. Multidisciplinary team meetings attended by all four professionals were to follow each other continuously within the centres . This part of the project differed between the care practices, as multidisciplinary team meetings were either organised , limited to only practice nurses and GPs, or informal deliberations. Because all health centres appropriated the intervention towards their own local circumstances, the set-up of the intervention differed for each centre.too many concessions the results will drift away from the original idea, meaning we cannot say anything about the whole project at the end" (conversation researcher 01-06-2004). The team eventually developed a Quattro guideline for the health care centres to work with and organised regular supportive intervention progress meetings for the practice nurses and peer health educators.The adjustments in the centres endangered the establishment of the ultimate effect of the project and were seen as "seriously inconvenient for the study. This way, the trial becomes impure." (field note research progress meeting 11-05-2004). As a result, the research team increased its interference in the intervention by having the multidisciplinary team meetings stringently implemented for establishing the effect of the structural collaborative care opposed to regular care on the reduction of CVD risk less ambiguously. " [...] if we make The project leader, however, constantly tried to prevent research interference within the health care centres from happening because, for him, these differences in practice were not a problem but important for gaining insight into what kind of organisational preconditions primary health care must meet if the implementation of prevention projects is to be successful (conversation project leader 10-09-2003). "To be able to say anything about the effects of such a prevention project in real life practice, the trial has to have as little contact with the actual intervention as possible" (conversation project leader 10-09-2003).For establishing the effectiveness of the project, the researchers needed to be informed by the professionals about the data from the follow-up. The needed data were the physical measurements of patients, like BMI, blood pressure, total cholesterol, and fasting capillary glucose levels (or HbA1c). Moreover, they also needed data to measure the (costs of the) intervention, such as time spent by all professionals on the specific parts of this project, i.e. intake, patient consultations, and multidisciplinary meetings .Getting the professionals to register and deliver the data, however, proved to be problematic (minutes research progress meeting 20-01-2004). As a result the researchers took measures concerning the data collection. First, the research team decided that the forms used by the health care professionals should contain fixed data, so that the researchers could use these forms too (minutes research progress meeting 20-01-2004). They also decided " [...] the research assistants would have to resolve the lacunas in the research data" (field note research progress meeting 03-02-2004). However, some lacunas in data could not be resolved. Data was either not recorded, and thus the research assistants had to retrieve these missing data from the health care centres, or patients had not gone for their lab measurements, resulting in data not being retrievable at all.The follow-up of patients in this way increasingly became important as measuring point to establish the effectiveness of the trial, underscoring the systematic nature of the data collection. As the promise of tailoring the intervention resulted in the professionals appropriating the follow-up procedures, informing the researchers about the meantime follow-up results was seen to be an interference with the daily routines. The researchers, however, had to increase their efforts to collect the meantime follow-up results in order to be able to establish the effectiveness of the intervention systematically, as missing data in trials entails a validity problem for analysing the ultimate estimate of effect. The question to what extent the opportunity of tailoring the intervention and its execution to the local circumstances of the health care centres would result in appropriations in data collection was, however, not addressed.Executing a pragmatic trial is a continuous balancing act for the researchers. Researchers constantly balance between meeting methodological demands to produce a scientifically rigorous effectiveness study and applying a pragmatic approach to making feasible and implementing a preventive intervention in primary health care. Both systematic and pragmatic approaches proved to be difficult to retain. By means of ethnographic analysis, we showed that the researchers conducting the Quattro Study had to adjust the research to enable the intervention's uptake in routine primary care. The researchers adapted the inclusion procedure to overcome the homogeneous composition of, and a shortage in, eligible patients and provided the health care professionals the name lists of included patients in order to restrict the provision of care to research groups. Moreover, the researchers had to increase their interference in the pragmatic execution of the intervention to have the trial performed more systematically. The researchers increased their interference in the organisation of the intervention by having the multidisciplinary team meetings implemented stringently and by having the data collected as systematically as possible. Our contention is that this balancing act is not a feature of this specific trial, nor that it points at methodological weaknesses, but a structural dilemma for pragmatic trials.Pragmatic trials, we showed in this paper, pose substantial challenges to investigators. Such trials hold the premise of being both 'pragmatic'  and 'systematic' . The constant interaction between research and primary care leads to continuous adjustments in research and intervention. Reconciling the tensions between the two different intellectual traditions, as indicated by Campbell et al  and illuAs pragmatic trial research is a dynamic process in which the parts of research and  practice will be redefined repeatedly, a continuous process of methodological and practical reflection is imperative. Otherwise, pragmatic trials may end up in being just a contradiction in terms. So, we do not suggest to solely focus on practical research strategies for improving study design, trial execution and generalisability of results as advocated by Campbell et al.  and WardWe therefore consider the information acquired by qualitative research important in both formative  and procOur ethnographic analysis itself of course also does have certain limitations. One is that our process evaluation on conducting a pragmatic trial may be biased due to the fact we only observed one pragmatic trial case. Because we did not observe other researchers conducting other pragmatic trials, we are aware that our accounts may not be generalisable in all respects. However, we do argue that balancing pragmatism and systematisation are structural to all pragmatic trials, although this may take different forms in other pragmatic trials. Secondly, our accounts may also be biased due to the fact that systematic ethnographic observations in the Quattro Study only started when the implementation was already taking place. All information about the project prior to those observations came out of the project's archive and on the basis of interviews and may thus be subjected to out-of-context interpretations. However, we have tried to triangulate all data as much as possible to overcome these biases.Pragmatic trials on complex interventions in primary health care pose substantial challenges to investigators. As we have shown, pragmatic trial research consists of constant interaction between research and health care practices; this leads to adjustments in research with respect to what part of the study should be systematically performed and executed to answer to scientific demands and what part of the project could have a pragmatic set-up in the health care centres. In the practice of pragmatic trial research, parts of research and health care practice will be redefined over and over again. Because pragmatic trial research is a dynamic process, in order to be able to assess the validity and reliability of any effects of interventions, it must also have a continuous process of methodological and practical reflection. Ethnographic analysis, as we showed, is therefore of complementary value.The author(s) declare that they have no competing interests.YJ had the original idea for this article. YJ and AB drew up the manuscript. Ethnographic data collection on the execution of the pragmatic trial and the performance of the intervention in the health care centres was done by YJ. RB, MB, MF and RF took part in reviewing the manuscript. All authors read and approved the final version of the article.The pre-publication history for this paper can be accessed here:


The reasons why patients decide to consult a general practitioner vary enormously. While there may be individual reasons for this variation, the family context has a significant and unique influence upon the frequency of individuals' visits. The objective of this study was to explore which family factors can explain the differences between strikingly high, and correspondingly low, family consultation rates in families with children aged up to 21.Data were used from the second Dutch national survey of general practice. This survey extracted from the medical records of 96 practices in the Netherlands, information on all consultations with patients during 2001. We defined, through multilevel analysis, two groups of families. These had respectively, predominantly high, and low, contact frequencies due to a significant family influence upon the frequency of the individual's first contacts. Binomial logistic regression analyses were used to analyse which of the family factors, related to shared circumstances and socialisation conditions, can explain the differences in consultation rates between the two groups of families.In almost 3% of all families, individual consultation rates decrease significantly due to family influence. In 11% of the families, individual consultation rates significantly increase due to family influence. While taking into account the health status of family members, family factors can explain family consultation rates. These factors include circumstances such as their economic status and number of children, as well as socialisation conditions such as specific health knowledge and family beliefs. The chance of significant low frequencies of contact due to family influences increases significantly with factors such as, paid employment of parents in the health care sector, low expectations of general practitioners' care for minor ailments and a western cultural background.Family circumstances can easily be identified and will add to the understanding of the health complaints of the individual patient in the consulting room. Family circumstances related to health risks often cannot be changed but they can illuminate the reasons for a visit, and mould strategies for prevention, treatment or recovery. Health beliefs, on the other hand, may be influenced by providing specific knowledge. People's decisions to consult a general practitioner vary enormously -7. Next Differences between families can help to explain differences in individual consultation rates. If socialisation processes and family circumstances can explain consultation patterns, this would mean that family factors, other than an individual's illness, are part of the decision to consult the general practitioner. Family attitudes towards illness may prevent people from consulting a doctor in time, resulting in unnecessary difficulties for patients or more costs for the health care system. For general practitioners it is interesting to know which family factors influence individual frequencies of contact. This may help both to understand the reasons underlying individual consultations, and to choose adequate strategies for treatment or communication. The question posed in this study is: To what extent can the family context explain differences between both strikingly high, and low, consultation rates among families with children aged up to 21?Data were used from the second Dutch national survey of general practice . This suBackground information about family members' socio-demographic characteristics was collected by means of a one-page questionnaire with 14 items in four languages sent to all people listed with the 96 practices  . This quThe interview included questions about health complaints, use of health services, attitudes and beliefs. Only one member from each family was interviewed; responses were attributed to all members of that family. In children aged under 12, the interview was conducted with a parent. The internal validity of the one-page questionnaire and the health interview were good .Families were defined as having at least one parent living together with at least one child and being listed in the same practice. Almost all non-institutionalised Dutch citizens are listed in a general practice. Family members are usually listed in the same practice. General practice therefore provides adequate information for studying consultation behaviour in families. For this study we selected families with one or more children aged < = 21 years. The minimum age of children was set at two years because children below this age also attend baby or child health clinics. Families with children below the age of two or above the age of 21 were not excluded. Only the children in the specific age categories were excluded. This resulted in a study population of 42 397 families . Earlier research into this study population showed that the family accounted for 22% of the variance in the frequency of individuals' first contacts [In the present study we used a multilevel poisson regression model with three levels, individual, family and practice, to define three groups of families based on their family effects . This faHealth status is the most important predictor for consultation rates of individuals ,8. HealtShared circumstances were defined as: The type of insurance; the educational level of the parents; the employment of the mother; and the number of children Table . The typprocess of socialisation. Rather, we evaluated socialisation conditions including: the health knowledge of the parents; family health beliefs, such as expectations of general practice care in case of minor ailments; trust in health care; and performance of self-care activities . The analysis was done twice, once based on the entire population Table , and oncIn almost 3% of all families, the family effect on individual consultation rates was significantly negative (lowering-effect families), in 11% of the families the family effect was significantly positive: these are the raising-effect families. Based on the multilevel analyses, the average effect of lowering-effect families on the frequencies of individuals first contacts is -0.5 contacts per year, per individual . In these families, the contact frequency per year for each family member is 0.5 lower than can be expected on the basis of age and sex. For the raising-effect families this figure is +1.6 per year, per individual (95% CI: +0.5 to +5.3).As expected, in raising-effect families more members rate their health as bad Table . FurtherIn the logistic regression analysis we analysed to what extent health status, shared family circumstances and socialisation conditions can explain differences in consultation behaviour between lowering-effect and raising-effect families Table . In stepIn step three, socialisation conditions are added to the model. Paid employment of one of the parents in the health care sector, and both parents having a western cultural background, significantly increase the chance of low frequencies of contact due to a family effect. When adding the indicators for socialisation, the effect of the fathers' educational level is no longer significant. In Table This research focuses on the family influence upon an individual's consultation behaviour. The results indicate that striking variations in family consultation rates can be explained, especially by the family health status, but also by family circumstances such as economic status and number of children, as well as socialisation factors such as health knowledge and family beliefs. This study is unique in that the effect of the family has been translated into higher or lower individual contact frequencies than could be expected on the basis of an individual's characteristics. For example, per individual, per year, members of lowering-effect families have 0.5 fewer first contacts than could be expected, based upon their individual characteristics. This may not seem much, but it is substantial in view of the individual mean frequency of first contacts: 1 contact for each member per year.It must be noted that in this study we evaluated the family effect on frequencies of contact in general. Related to specific diagnoses the family effect on frequencies of contact may show other relationships.The family health status explains most variance in consultation behaviour between the families. This corresponds with the existing literature on individual consultation behaviour . HoweverIn addition to family health status, another consideration for general practitioners is whether a patient belongs to a larger family, since this decreases the odds for high consultation rates due to family influence. As stated in the introduction, a lack of time  or the pIndeed, knowledge and the family's health beliefs, influence people's use of health services alongside other considerations such as the family health status and shared circumstances . The famThe family context is a factor general practitioners can identify in the consultation room that will add to their understanding of the health complaints of the individual patient. To do so, easy and feasible questions have been developed for use in consultations to enable the general practitioner to be informed about the family context of individual patients ,3,27.The cross-sectional design of the study made it difficult to evaluate socialisation processes. Instead, we made use of indicators to evaluate socialisation conditions and socio-economic family circumstances. Our indicators were based, as much as possible, on existing knowledge, but they may still have caused bias. Also, the questions asked in the health interview were not directed at family functioning and family relationships, known to be of importance for outcomes related to health and consultation patterns .Furthermore, the relatively small sample that completed the health interviews restricted the possibilities and power of the second regression analysis. We had to eliminate the non-significant variables from the analyses to keep a stable model. To limit the risk of bias this may have caused, we analysed the omitted variables in separate logistic analyses, controlled for the family health status. By doing this, only the educational level of the father was significant (p = 0.01). However, accounting for the educational level of the father in the final analysis did not produce different results. But this may also be caused by the issue of missing data. Information about the type of insurance, the educational level of the parents and the cultural background of the parents was missing in about 20% of the families. Such incomplete information about the educational level of the parents and cultural background, occurred significantly more often in the families with strikingly low consultation rates.This study shows that general practitioners need to take the social context of patients into account. Information about their patients' social contexts helps general practitioners to add or delete probabilities that may point towards correct diagnoses and treatment.Next to the family health status, shared circumstances and socialisation play an important role. Such factors as a high income, larger family size, specific health knowledge, health beliefs, and expectations of care, explain part of the differences in contact frequencies between families with low and families with high consultation rates, due to a family effect. Specific knowledge and/or networks in the health care sector seem more influential than the educational level of the parents. Socio-economic circumstances often cannot be changed but may shed a different light on prevention, treatment or recovery. In conclusion, for general practitioners, it seems fruitful to stay alert to factors beyond individual illness and to make the extra benefits of such a contextual approach more visible. In the Netherlands, they are the only health practitioners that can take advantage of the fact that they often see members of the same family in their consulting room.The author(s) declare that they have no competing interests.MC, LvD, WvdB, DdeB and PG were involved in the study design. Primary data-analysis was conducted by PS and MC, with the other authors contributing. MC drafted the paper, which was revised by all co-authors. All authors read and approved the final manuscript.The pre-publication history for this paper can be accessed here:


As the "war on drugs" enters the latter half of its third decade since being forged into the American lexicon by President Ronald Reagan, the public has grown more skeptical of the current strategy and has proven to be receptive to a broader consideration of alternatives to incarceration. This has been the case most notably with marijuana offenses, where the policy discussion has shifted in some localities to one of decriminalization or de-prioritizing law enforcement resources dedicated to pursuing possession offenses. Despite the increased profile surrounding marijuana policy in recent years, there remains a significant degree of misunderstanding regarding the current strategy, both in terms of how resources are being allocated and to what eventual gain.Previous studies have analyzed drug offenses as a general category, but there has yet to be a single study that has focused specifically on marijuana offenders at all stages of the system. This report analyzes multiple sources of data for the period 1990–2002 from each of the critical points in the criminal justice system, from arrest through court processing and into the correctional system, to create an overall portrait of this country's strategy in dealing with marijuana use.The study found that since 1990, the primary focus of the war on drugs has shifted to low-level marijuana offenses. During the study period, 82% of the increase in drug arrests nationally  was for marijuana offenses, and virtually all of that increase was in possession offenses. Of the nearly 700,000 arrests in 2002, 88% were for possession. Only 1 in 18 of these arrests results in a felony conviction, with the rest either being dismissed or adjudicated as a misdemeanor, meaning that a substantial amount of resources, roughly $4 billion per year for marijuana alone, is being dedicated to minor offenses.The results of this study suggest that law enforcement resources are not being effectively allocated to offenses which are most costly to society. The financial and personnel investment in marijuana offenses, at all points in the criminal justice system, diverts funds away from other crime types, thereby representing a questionable policy choice. The War on Marijuana: The Transformation of the War on Drugs in the 1990sFederal law enforcement is targeted effectively at convicting major drug traffickers and punishing them with longer lockups in prison. . An examination of historical drug arrest patterns illustrates the role of policy decisions in shaping the trends of the 1990s. As seen in Figure hard, costly, or dangerous), but the current manifestation of the drug war, from the law enforcement perspective, is targeted disproportionately at marijuana use.However, over the course of the 1990s a tangible shift toward arrest patterns of the early 1980s began to reemerge. Law enforcement agencies arrested fewer people for cocaine and heroin offenses and began to arrest more people for marijuana possession and sale. By 1996, marijuana had once again surpassed heroin and cocaine as the primary drug of arrest, a gap which has widened since then. Early pursuit of the "war on drugs" targeted heroin and cocaine  are non-Hispanic whites and 14% are black, rates that are similar to lifetime use patterns as well (76% white and 11% black) ndividual police officers and police departments as a whole must decide which laws to attempt to enforce and how rigorously" . IncreasBenson, Rasmussen and Kim find support for this hypothesis. Looking at data from Florida, they conclude that every additional drug arrest leads to an increase of 0.7 Index (serious) crimes . The autThe shift in the 1990s towards more aggressive policing of marijuana may have siphoned law enforcement resources away from certain Index crimes. Rasmussen and Benson suggest that not only is this a possible scenario, but that there are institutional incentives in place that encourage the pursuit of drug crimes. Civil asset forfeiture, which permits law enforcement agencies to seize all or a portion of property obtained during a drug investigation, creates an incentive for administrators to dedicate more resources to drug enforcement. " [L]aw enforcement agencies focus resources on enforcement of drug laws because of the financial gains for the agencies arising from forfeitures" . Indeed,The geographical variation in marijuana arrest patterns at the local level illustrates the critical role of discretion in defining a law enforcement agency's policy. Table Several key findings can be identified from these figures:• Every major county except for Fairfax, Virginia experienced an increase in marijuana arrests between 1990 and 2002;• The growth rates in marijuana arrests in the top 10 counties ranged from 20%  to 418% ;• In 1990, 11 of the 20 counties in our sample had more than 1,000 marijuana arrests; in 2002, all but one had more than 1,000 marijuana arrests.A number of counties had very few arrests in 1990, so the growth these counties experienced produced astronomical increases. Eight counties more than doubled their marijuana arrests between 1990 and 2002, with some increasing five- and ten-fold. In addition to the near uniform patterns of growth, the other noteworthy trend was the consistent growth in arrests for possession. In nearly every county in the sample, the growth rate for possession arrests far exceeded that for sales or manufacturing. Despite the similarities, there are variations in the degree of growth, and there are also a number of counties that experienced a decline in some types of marijuana arrests. In the ten most populous counties, the growth in arrests ranged from 20% (San Diego) to 418% . This variation was affected by the size of the county and the degree to which each had been pursuing marijuana violations in 1990 versus 2002. It also underscores the importance of individual policymakers and practitioners making decisions that shift the emphasis in enforcement policy. Short of a localized, rapid increase in marijuana sales and use, for a county to experience the size of growth witnessed in Clark (Nevada), Shelby (Tennessee), or most of the counties in this sample, a tangible modification of marijuana arrest policies is the most likely cause. As a means of demonstrating this point, we examine the trends in marijuana arrest patterns in New York City and discuss the impact of contemporaneous political developments.Examining city level arrest patterns is an instructive approach to provide context to national level trends. In the case of New York City, the 1990s represented a profound shift in policing strategy that resulted in an exponential growth in marijuana arrests. Although the experience in New York City may not be representative of developments across the country, it is an example of the ways in which the decisions of local officials played a role in the national increase in marijuana arrests.Prior to the election of Mayor Rudolph Giuliani in 1994, the New York City Police Department applied a low-key approach towards marijuana use and distribution. Marijuana offenses were usually treated with a fine issued in the form of a citation, and in many cases individuals were not required to report to court, but were permitted to handle the ticket in the same fashion as a traffic summons. The election of Mayor Giuliani, with a promise of addressing "quality of life" issues  in New YShifting away from the "community policing" model of the previous Dinkins administration, Commissioner Bratton implemented a strategy of "zero tolerance" policing. Grounded in the philosophy of "broken windows," zero tolerance policing is characterized by aggressive policing of traditionally ignored, minor offenses. If left unchecked, according to supporters of this approach, this allows an element of criminality to take root in a community, leading to more serious criminal behavior. New York police officers increased their use of stop-and-frisk searches in an effort to crack down on public nuisance offenses. In 1997, a New York Police Department unit of 433 officers performed stop-and-frisk searches on about 45,000 people . In the The new policing strategy was crafted to target violations of public order, and to increase the overall risk of apprehension for all offenses. By casting as wide a net as possible, the police sought to increase the likelihood of apprehending more substantial criminal offenders. Supporters of this approach contend that increasing the probability of arrest provides a deterrent effect to persons carrying weapons or illegal drugs on the street.The way in which law enforcement implements this policy is through increased use of the "stop-and-frisk" technique. "A 'stop' intervention provides an occasion for the police to have contact with persons presumably involved in low-level criminality" without meeting the evidentiary burden necessary to make an arrest, while providing a pretense for further investigation . One NewSuch an approach is more intrusive than conventional policing and increases the likelihood that persons will face arrest for low-level violations, such as marijuana use, that may have been ignored in the past. Moreover, opponents contend that this aggressive approach results in racially discriminatory arrest patterns and is tantamount to police harassment. The growth in the use of the "stop-and-frisk" technique in New York City in the 1990s unquestionably was partly responsible for the increase in the number of low-level marijuana arrests during that period. The discretion that police officers have in initiating a stop is evidenced by the fact that less than one-third of all encounters are the result of a person meeting the description of a suspect for a crime . An analAs Figure Nationally, the proportion of marijuana arrests from New York City also grew exponentially. In 1990, 1.6% of all marijuana arrests nationally occurred in New York City; that figure more than quadrupled to 7.2% by 2002. The proportion of possession arrests from New York City grew ten-fold, from 0.7% to 7.4% of national arrests. This translates into more than 12% of the growth in national marijuana arrests between 1990 and 2002. While New York City represents approximately 3% of the nation's population and 2.1% of the nation's total arrests, more than 7% of all marijuana arrests in the entire country in 2002 occurred in New York City. These figures indicate a citywide policy that, in the process of executing a zero-tolerance policing model, has demonstrably shifted towards the targeting of marijuana users for arrest.Although not all large American cities were experiencing as significant an upward turn in marijuana arrests as in New York City, the country was moving in that direction on a national scale. Domestically the rapid growth in marijuana arrests has led to a number of situations in which local officials have succumbed to the overwhelming increase in workload and have responded by demanding a change in practice. In 2000, local district attorneys in Texas declined to accept low-level drug prosecutions from federal agencies because they could not keep up with the number of arrests . One disIn Syracuse, the proportion of resources dedicated to drug enforcement raised concern with the city's auditor. The auditor's report to the mayor noted that drug-related arrests "exceeded arrests for assaults, disturbances, and larcenies combined," and that arrests for marijuana comprised nearly one-third of all drug arrests . City AuIn Chicago, similar concerns have been raised, this time in a report submitted by a city police sergeant . SergeanThese concerns of practitioners are translating into reform measures at the ballot box. In the late 1990s, Arizona passed Proposition 200, which among other reforms, explicitly noted that drug use was to be treated as a health problem, with monies dedicated to treatment and education rather than incarceration. More recently, Proposition 36 in California created a protocol to divert low-level drug offenders into treatment rather than prison. In Seattle, the passage of Initiative 75 reduced marijuana for adult personal use to the lowest law enforcement priority, estimated to be saving tens of thousands of dollars in state prison and local jail costs. In addition to the numerous state initiatives in the past few years permitting the use of marijuana for medical purposes, there have also been efforts to reform the response to recreational use.In the 2004 election, a number of state and local initiatives addressed the need for change in the manner in which law enforcement treats marijuana use . In OaklIn addition to these domestic changes, there have also been similar developments abroad. In May of 2004, Russia decriminalized the possession of small amounts of narcotics, including marijuana. Canada continues to debate decriminalization of marijuana, but in June of 2003, Toronto Police Chief Julian Fantino declared that he had instructed his officers to discontinue making arrests for simple possession of marijuana . In respEngland has also been experimenting with decriminalization. In August of 2001, the police commissioner in Brixton announced that the police would no longer be making arrests for personal possession of marijuana, as a result of the police and courts being overrun with marijuana related arrests. In Brixton, about 90% of all drug arrests are for possession and about 75% of those possession arrests are for marijuana . By the The common thread in these developments has been a response by officials to the significant amount of time and resources that law enforcement officials dedicate to the pursuit of marijuana offenses. Dissatisfaction with the pursuit of the war on drugs has led a number of the nation's leading policing administrators to call for reform. A 2004 survey of 300 chiefs of police indicated that two-thirds of respondents believed that the response by law enforcement to drug use and sale had been unsuccessful . Three-qDuring the period after the beginning of the modern "drug war," a measurable shift in drug enforcement strategy could be identified. As seen previously in Figure With the benefit of hindsight, fourteen years later it is clear that the drug war did not wind down. However, a closer examination of the growth in drug arrests indicates that there was a kernel of truth to the Rasmussen and Benson prediction about the abatement of drug enforcement. The 1990s ushered in a fundamental change in the way the drug war was pursued. As the crack cocaine market began to constrict in urban areas and the use of cocaine, heroin, and other substances remained flat, the category of primary drug abuse violation arrests skewed significantly towards marijuana, and particularly possession. Of the nearly one-half million increase in drug abuse violations between 1990 and 2002, 79% was for marijuana possession.The precipitous growth of marijuana possession arrests is striking in the context of declining overall crime rates and stability in other drug abuse violations, as well as general use patterns nationally. Moreover, the growth in marijuana possession arrests beginning in the early 1990s was incongruous with the initial justification of the war on drugs in the 1980s, which stressed cocaine and heroin as targeted substances.Marijuana arrests may have increased during the 1990s as a function of structural changes in criminal behavior and law enforcement strategies that increased the likelihood of marijuana arrests within the pre-existing routines of law enforcement officers. By the early 1990s, drug abuse arrests were leveling off and overall crime rates were decreasing as well. Beginning in 1992, violent and property crime would begin a sustained reduction for the longest duration in 30 years. During that same period, President Clinton was spearheading a movement to place 100,000 more police officers on the streets as a means of combating crime. The decade of the 1990s was characterized by these two trends: rapidly decreasing violent and property crime  and a rapid increase in law enforcement manpower.These two trends may have combined to increase the probability of arrest for marijuana offenses. Law enforcement agencies prioritize their labor allocation; if serious crime is an entrenched problem in a given area, minor violations are likely to receive less attention. However, as the degree of serious crime diminishes, law enforcement agents are likely to turn their attention to nuisance crimes such as prostitution and petty drug crimes. The growth in stop-and-frisk searches in New York City is an example of this shift in practice. Therefore, as violent and property crime dropped through the 1990s, the growing ranks of law enforcement officers were more likely to pay attention to minor crimes such as marijuana possession, which would drive up arrest rates .There has been little study of the method in which law enforcement agents respond to marijuana possession, but a Maryland study is instructive regarding the manner in which many marijuana arrests occur . The autThe results from Maryland suggest that the growth in marijuana arrests was not the result of an upper-level directive; rather, it may simply be the product of an aggregation of law enforcement officers making more arrests while in the process of their daily patrol routine.In the case of New York City, it is apparent that the growth in marijuana arrests was the result of the use of zero tolerance policing, and particularly, an increase in "stop-and-frisk" encounters. This approach primarily resulted in possession arrests and, as we will demonstrate in the next section, most of these were dismissed. Given the substantial law enforcement investment in such cases, the question is whether using stops for low-level offenses as a pretense for detecting more serious criminality is an effective approach to public safety. It clearly is not the most efficient, as evidenced in an Attorney General report concluding that only one out of every nine stops resulted in an arrest for any type of crime . While tNational Judicial Reporting Program, which issues a biennial survey of felony sentences in state courts ut the contributions are neither as sizable as anticipated, nor as consistent ... [What is empirically evident is that the growth in marijuana arrests over the 1990s has not led to a decrease in use or availability, nor an increase in cost. Meanwhile, billions are being spent nationally on the apprehension and processing of marijuana arrestees with no demonstrable impact on the use of marijuana itself, or any general reduction in other criminal behavior. Our analysis of criminal justice processing of marijuana use over the 1990s suggests that the contemporary approach is apportioning resources inefficiently at each stage of the system. In order to address issues of marijuana and the criminal justice system in a more effective manner, policymakers and practitioners should consider the following recommendations.As has become policy in jurisdictions such as Seattle and Oakland, law enforcement agencies should categorize enforcement of marijuana possession as a low priority so as to conserve police resources for more serious offenses.Marijuana arrests in some cities have been justified on the premise that arresting people for marijuana possession disrupts other, potentially more serious, behaviors. Such strategies result in substantially increased numbers of low-level marijuana arrests, with little evidence that they are actually effective in suppressing other criminal behaviors. Further, they contribute to the mistrust of law enforcement, particularly in communities of color that have been disproportionately targeted by such practices.Few marijuana possession arrests result in any significant jail or prison time, yet they are cumulatively quite costly to the court system through the engagement of prosecutors, defense counsel, judges, and probation officers. Prosecutors should use their discretion in appropriate cases to drop charges and/or utilize community resources at the earliest possible stage of court proceedings in order to effect outcomes that represent a reasonable allocation of resources.In most states felony drug convictions carry a set of collateral consequences in addition to whatever punishment is directly imposed. These may include a ban on receipt of welfare benefits, prohibition on living in public housing, loss of student loans, and loss of the right to vote. These punishments place additional burdens on ex-offenders attempting to reenter the community. Therefore, to the extent that the interests of justice can be served through a misdemeanor conviction rather than a felony, prosecutors should use their charging discretion to pursue such outcomes.National debate on drug issues has too often been characterized by "soundbites" that distort the policy issues under consideration. In the case of marijuana, proposals for decriminalization represent an alternative approach to current policy. Consideration of such options should be addressed in the context of the findings of this report, including the substantial criminal justice and social costs involved in the large-scale prosecution of marijuana offenders. National debate on marijuana policy, and drug policy generally, should be focused on the most effective ways of addressing substance abuse and the most efficient allocation of law enforcement resources.For the period of the war on drugs, federal funding – currently $19 billion a year – has been allocated in a 2:1 ratio of enforcement to treatment/prevention . These p