The health care state in the information age

The computerization of the medical record has important implications for the governance of health care, and the importance of health care means that changes wrought there are indicative of changes in government as a whole. This paper draws on work in public policy, medical sociology and studies of science and technology, as well as on cross–national empirical research in Britain and France. It describes the recent development of information policy in health care as an exercise in state–building, realized specifically in the governance of the health professions. The paper concludes with a discussion of what is both new and not so new in the form and extent of state power which emerges.     

What's Gender Got to Do with It? Incivility in the Federal Courts

The current study examines experiences of interpersonal mistreatment in federal litigation among a random sample of 4,608 practicing attorneys. Using both quantitative and qualitative survey data, we documented the nature and interplay of general incivility, gender-related incivility, and unwanted sexual attention. Nearly 75% of female attorneys had experienced some form of this misconduct in the previous five years, compared to half of male attorneys. An in-depth examination of instigators revealed that not only fellow attorneys but also federal judges, court personnel, marshals, and court security officers instigated the inappropriate behavior. We further found that most attorneys responded to this mistreatment with avoidance and denial; few used or trusted existing reporting mechanisms. The current study surpassed simple prevalence estimates to document effects of interpersonal mistreatment on the professional well-being of targeted attorneys. We discuss implications of these results, drawing on theories of social dominance, sex-role spillover, cognitive stress, organizations, and intervention.     

Esophageal injury in fatal rear-impact collisions

Neck injuries resulting from motor vehicle collisions (MVC), often referred to as whiplash trauma and injury, often demonstrate little or no evidence of significant tissue damage. In rare instances, however, serious injury to the anterior neck organ injuries can result from such trauma. The present study describes esophageal injury associated with rear-impact collisions, based on a unique case report, review of the scientific literature and a query in the National Automotive Sampling System (NASS) database of the US National Highway Traffic Safety Administration. The Medline search and present case study totaled five cases of rear-impact collision-related serious esophageal injury (laceration or rupture). In the four published cases all patients survived, whereas in the presented case study, the patient died due to mediastinitis and sepsis. The NASS query revealed an additional three cases out of a total of 55,926 investigated crashes. All three cases were associated with fatalities. Although no anatomical or bioengineering studies have presented data on the behavior of the esophagus during rear-impact whiplash loading, sudden tensile and/or compressive forces is the likely explanation of injury, often in combination with a local fracture of a vertebral body. In these 8 cases significant esophageal injury carried a substantial (50%) risk of mortality. Clinicians should be aware of the potential for significant complications in the whiplash trauma-exposed patient who complains of chest pain, mid-thoracic pain, discomfort in the neck and throat, respiratory distress, or hoarseness. For those forensic specialists involved in whiplash cases these study results highlight the need to consider esophageal injuries as a rare but potential consequence of whiplash trauma.     

Democracy,Al Qaeda,and the Causes of Terrorism: A Strategic Analysis of U.S. Policy

How will the strategy of spreading democracy affect the threat of terrorism from Al Qaeda and likeminded Islamic extremist groups? This article analyzes how spreading democracy would impact four different sets of underlying motivations that lead to this kind of terrorism. It will show that the widespread belief in the power of democracy is likely misplaced because democracy will be unlikely to change perceptions of occupation, will itself threaten Islamic identity and culture, will be unlikely to mitigate economic grievances, and will be unlikely to provide a more legitimate government than one based on religious law.