Addressing the shortage of kidneys for transplantation: purchase and allocation through chain auctions

Transplantation is generally the treatment of choice for those suffering from kidney failure. Not only does transplantation offer improved quality of life and increased longevity relative to dialysis, it also reduces end-stage renal disease program expenditures, providing savings to Medicare. Unfortunately, the waiting list for kidney transplants is long, growing, and unlikely to be substantially reduced by increases in the recovery of cadaveric kidneys. Another approach is to obtain more kidneys through payment to living "donors," or vendors. Such direct commodification, in which a price is placed on kidneys, has generally been opposed by medical ethicists. Much of the ethical debate, however, has been in terms of commodification through market exchange. Recognizing that there are different ethical concerns associated with the purchase of kidneys and their allocation, it is possible to design a variety of institutional arrangements for the commodification of kidneys that pose different sets of ethical concerns. We specify three such alternatives in detail sufficient to allow an assessment of their likely consequences and we compare these alternatives to current policy in terms of the desirable goals of promoting human dignity, equity, efficiency, and fiscal advantage. This policy analysis leads us to recommend that kidneys be purchased at administered prices by a nonprofit organization and allocated to the transplant centers that can organize the longest chains of transplants involving willing-but-incompatible donor-patient dyads.     

The Direction of Deception: Neuro-Linguistic Programming as a Lie Detection Tool

There is a myth in popular psychology, often echoed in police literature, but as yet untested, that specific eye movements pertain to lying and truth telling. According to this line of thought, eye movements to the sender??s right indicate lying, as the sender??s eyes are drawn to the side of his/her brain where their fabrication is being created. We have put this hypothesis, derived from ??Neuro-Linguistic Programming?? to the test in two experiments. In Experiment 1, a total of 204 participants (all air passengers) were interviewed at an international airport about their forthcoming trip. All participants answered one question truthfully and one question deceptively. Some participants answered a third question truthfully, whereas others answered the same question deceptively. No conclusive evidence was found for a relationship between specific eye movements and deception. In Experiment 2, a total of 31 participants discussed their real occupation in one interview and a pretend occupation in another interview. Only three of the 31 participants revealed the eye movement pattern predicted by NLP. Reasons for the existence of the myth that liars display specific eye movements are discussed.     

Forensic Facial Reconstruction: Relationship Between the Alar Cartilage and Piriform Aperture

During forensic facial reconstruction, facial features may be predicted based on the parameters of the skull. This study evaluated the relationships between alar cartilage and piriform aperture and nose morphology and facial typology. Ninety‐six cone beam computed tomography images of Brazilian subjects (49 males and 47 females) were used in this study. OsiriX software was used to perform the following measurements: nasal width, distance between alar base insertion points, lower width of the piriform aperture, and upper width of the piriform aperture. Nasal width was associated with the lower width of the piriform aperture, sex, skeletal vertical pattern of the face, and age. The current study contributes to the improvement of forensic facial guides by identifying the relationships between the alar cartilages and characteristics of the biological profile of members of a population that has been little studied thus far.     

Interdisciplinary Teamwork in Family Law Practice

For attorneys who engage in matrimonial practice, work is often performed by a sole practitioner. While members of other professions have already demonstrated that interdisciplinary practice and teamwork are integral to efficiency, client satisfaction, and career success, matrimonial attorneys are just beginning to work in deliberately constructed interdisciplinary teams. In this article, we examine the definition of teamwork and highlight the characteristics of an effective team, drawing examples from the business, medical, and mental health fields. We then determine how successful teams are built and explore the application of such approaches within matrimonial practice, offering recommendations for research and effective use of teams to help families that are facing conflict and reorganization.     

Bodies found in the waterways of New York City

We reviewed the case records for all decedents recovered from the waterways of New York City over a three year period (1997-2000). The epidemiological profile, circumstances, toxicology findings, putrefactive changes, date of recovery, length of immersion, and injuries were examined. There were 123 deaths: 52 suicides, 50 undetermined, 16 accidents, and five homicides. The causes of death included: 97 drownings, 13 undetermined, and 13 other. Of all the floating decedents, 27% were without putrefactive change. All found after two or more weeks of immersion were recovered from November to May. The detection of ethanol and illicit drugs was 53% in the accident, 41% in the suicide, and 33% in the undetermined groups. Detection of ethanol and/or drugs of abuse is not a reliable criterion to distinguish suicide from accident. The identification of the deceased is pivotal for determining the manner of these deaths. Therefore, a great reliance is placed upon the medical investigator and the police (including the missing persons bureau) to determine the circumstances and identification of the decedent.     

Women's participation in democratic innovation apparatuses: the case of the autonomous region of the Basque country,Spain

Since 1990, many democratic regimes have seen an increasing number of democratic innovation apparatuses that have been the subject of many of the reflections of democratic theory. Furthermore, the notion of participation has been a priority since the early stages of the institutionalisation of gender studies. Many analyses of the presence and the voice of women in representative spaces and in social movements have been made. However, both areas of study seem to have developed in parallel, giving rise to a knowledge gap when it comes to the participation of women in public affairs by the democratic innovation apparatuses. This article is situated at the intersection of those areas. It analyses the relationship between women's participation and the extension of the public sphere in terms of obstacles. Based on the analysis of the participatory biographies of 42 women and six men who participate in 15 democratic innovation apparatuses implemented between 1978 and 2014 in the Autonomous Region of the Basque Country (Spain), five discussion groups and two direct observations, the obstacles met by the women when carrying out their participatory project in those governance apparatuses are identified. The article concludes by highlighting the currency of the public versus private and reason versus emotion categories to explain the objectivized and incorporated structure of the obstacles. Copyright © 2016 John Wiley & Sons, Ltd.     

Use of "therapeutic complication" as a manner of death

Analyses of deaths due to therapeutic complications (TCs) provide important quality of care information for medical providers. In New York City, 463 deaths were investigated by the Office of Chief Medical Examiner and certified with TC as the manner of death in 2003. The TC manner of death is used for fatalities due to predictable complications of appropriate medical therapy. All death certificates and select autopsy, hospital, and investigation reports were reviewed. Data concerning cause of death, contributing conditions, age, race, and sex were extracted. The types of complications and the causes of death were classified into various types of surgical and nonsurgical categories of complications. These included: postoperative infections, pulmonary emboli, and technical and medication complications. The use of TC as a manner of death has benefits and limitations. Without the TC option, one is forced to certify certain deaths (e.g., penicillin anaphylaxis) either as natural or accident. The TC option allows easy identification and tracking of medical complications for public health purposes and also allows more consistent reporting of natural and medical-accidental deaths. In general, complications that occur during emergency surgeries/procedures for natural disease, tend to be certified with a natural manner. The "but for" test may be used to distinguish natural from TC deaths. There are criteria for distinguishing TC from accidents and homicides. TCs that occur during treatment of a potentially life-threatening injury, are superseded by the manner dictated by the circumstances of the initiating injury. The certification of TC usually does not address errors of omission, clinical judgement/management, or missed diagnoses.     

Understanding Multilevel Governance Processes through Complexity Theory: An Empirical Case Study of the Quebec Health-Care System

This paper aims to contribute to a better understanding of multilevel governance processes. We do so by focusing on the in-depth examination of the institutional changes recently implemented in the Quebec health care delivery system that require a close collaboration between interdependent actors acting at various levels of governance. Our three research questions are: (1) How does multi-level governance emerge in a pluralist institutuional context? (2) How do multi-level governance processes shape the adaptive capacity of the organization to its environment? (3) How does institutional context influence these multi-governance processes?Our empirical investigation is inspired by the theory of complexity which invites us to pay attention to three processes: self-organization, eco-self organization and co-evolution. This study shows that the effectiveness of multi-level governance processes do not only go through the implementation of instruments aiming at aligning the action of lower government levels with the objectives of the upper levels as suggested by numerous existing works. More precisely, it suggests that more distributed and coordinated processes favor a more homogenous form of adaptation (Miller and Page, 2007) taking into account the interdependence between stakeholders.