Medical Error and Patient Safety: Understanding Cultures in Conflict

Evidence documenting the high rate of medical errors to patients has taken a prominent place on the health care radar screen. The injuries and deaths associated with medical errors represent a major public health problem with significant economic costs and erosion of trust in the health care system. Between 44,000 and 98,000 deaths due to preventable medical errors are estimated to occur each year, making medical errors the eighth leading cause of death in the United States. However, the recent prominence of the issue of safety or error does not reflect a new phenomenon or sudden rift in the quality of health care (although it is a system fraying at the edges). Rather, the prominence of the issue reflects a radical change in the culture of health care, and in how relationships within the health care system are structured and perceived. In this paper, I discuss the multiple factors responsible for the change in the culture of health care. First, the culture has shifted from a clinician cantered system, in which decision making is one–sided, to a shared system of negotiated care between clinician and patient, and, often, between administrator or payer. Second, the nature of quality in health care has changed due to the geometric increase in the availability of technological and pharmaceutical enhancements to patient care. Third, the health care culture continues to rely on outdated models of conflict resolution. Finally, the regulatory structure of health system oversight was set in place when fee–for–service care governed physician–patient relationships and where few external technologies were available. In the current health care culture, that structure seems inadequate and diffuse, with multiple and overlapping federal and state regulatory structures that make implementation of patient safety systems difficult.     

Feminism,imperialism and orientalism: the challenge of the ‘Indian woman’

Abstract

This article examines the content and process of imperialist discourse on the ‘Indian woman’ in the writings of two North American women, one writing at the time of ‘first wave’ feminism, the other a key exponent of the ‘second wave’ of the movement. By analysing these writings, it demonstrates how the content of the discourse was reproduced over time ith different but parallel effects in the changed political circumstances, in the first case producing the Western imperial powers as superior on the scale of civilisation, and in the second case producing Western women as the leaders of global feminism. It also identifies how the process of creating written images occurred within the context of each author's social relations with the subject, the reader and the other authors, showing how an orientalist discourse can be produced through the author's representation of the human subjects of whom she writes; how this discourse can be reproduced through the author's uncritical use of earlier writers; and how the discourse can be activated in the audience through the author's failure to challenge established cognitive structures in the reader.     

Women in German Politics: Still Jobs for the Boys?

Today the proportion of German politicians who are female is at an all time high. This has largely been achieved via quotas and most of the main parties now operate some kind of quota system. But have quantitative improvements in female representation in been matched by qualitative improvements? This article seeks to answer this question by looking not only at the number of women in parliaments and other collective bodies, but also in the highest echelons of power. It outlines each party's policies regarding the promotion of women and the factors which enhance or hamper their impact. A brief comparison of female political representation in eastern and western Germany is also provided. The author argues that measures such as quotas have increased the number of female German politicians but still do not guarantee them equal access to positions of real power. Furthermore, the incorporation of pro-equality principles into party statutes has not automatically led to their assimilation into party cultures, especially in the case of well-established parties which only recently addressed the gender imbalance in their ranks.     

The Berlin Land Election 2006

This article examines the 2006 Berlin Land election, including the election campaigns of the main parties, the results, and the process of post-election coalition formation. While few doubted that the Social Democratic Party (SPD) would emerge as the largest party, and that the highly popular Klaus Wowereit would continue as Berlin's governing mayor; the big questions were what coalition he would lead and whether Berliners would vote for a continuation of the (initially controversial) red–red coalition comprising the SPD and the Left Party. Party of Democratic Socialism (PDS).     

Cannabis Profiling Based on Its Elemental Composition—Is It Possible?

Abstract: Elemental composition of 85 cannabis samples was established using GF AAS and ICP OES methods. The robustness of the method was determined by analyzing eight independently prepared replicates from a single cannabis plant. The accuracy of the method was established by analyzing four plant certified reference material samples. The ability of discriminant analysis using elemental compositions to distinguish between fiber cannabis samples collected from four different regions of Poland was evaluated. Then, a classification model was developed that correctly classified selected samples of known origin. Cannabis samples confiscated by law enforcement agencies have also been subjected to discriminant analysis. A classification model has been developed for four locations in Poland (Bia?ystok, Ko?cierzyna, the environs of Skar?ysko Kamienna, and Bydgoszcz), to help determine where samples of unknown origin could have been grown.     

The Culprit in Target-Absent Lineups: Understanding Young Children’s False Positive Responding

Young children (4- to 7-years old; N = 59) and adults (N = 53) were shown a series of targets that were either familiar (i.e., popular cartoon characters) or unfamiliar (unknown human faces) to assess whether children’s false positive responding with target-absent lineups is driven by social factors to a greater degree than cognitive factors. Although children were able to produce correct identification rates with virtually 100% accuracy for the cartoon characters, they produced a significantly lower correct rejection rate compared to adults. Children also produced a significantly lower correct rejection rate for the human faces compared to adults. These data are discussed for understanding children’s identification evidence.     

A survey of paint flakes on the clothing of persons suspected of involvement in crime

A survey was undertaken to determine the background level of paint flakes on the clothing of persons suspected of involvement in crime. The debris from 100 garments submitted for casework examination was studied and paint flakes recovered where present. Seventy two percent of garments bore one or more flakes. A total of 703 flakes were recovered; size, topcoat colour, and number and colour of any under-layers were recorded for each. The distribution of paint flakes on clothing surfaces and in pockets was also noted. Results were compared with the previously published survey of Pearson, May and Dabbs (1971). This survey provides scientists with an updated data set for reference when considering the strength of paint evidence.     

Does Lineup Size Matter with Child Witnesses

Children’s (N = 89) identification accuracy was examined as a function of lineup size. Participants (8–13 years) viewed a videotaped staged event, described what was witnessed and then were presented with either a target-present or—absent lineup containing 6 versus 12 lineup members. The elimination lineup procedure (Pozzulo and Lindsay J Appl Psychol 38: 2195–2209 1999) was used to present lineups. No significant differences in correct identification rates were found across the target-present sized lineups. In addition, the target was likely to “survive” at a comparable rate regardless of lineup size. Moreover, there was no significant difference in correct rejection rate as a function of lineup size. The non significance of these data are critical given that most research with child witnesses uses 6-person lineups whereas in many real world contexts larger sized lineups are used (e.g., 12-person in Canada).     

Longevity of spermatozoa in the post-ejaculatory urine of fertile men

Many scientists of varying clinical backgrounds have described the phenomenon of spermaturia in animals, adolescents as well as fertile and infertile men. Nevertheless, research for an expert opinion on a law case in the field of forensic medicine revealed a lack of valid information about the longevity of spermatozoa in post-ejaculatory urine (PEU) of fertile men.Our goal was to measure the appearance of vivid sperm in PEU while considering the factor of time in order to predict a realistic interval, in which positive sperm findings might occur. Therefore ten healthy, young men donated their sperm for fertility analysis and a urine sample prior to and after ejaculation. The time intervals between ejaculation and the first micturition were preset ranging between 30 min and maximal 11 h. Each ejaculate underwent a semen analysis. The pre- and post-ejaculatory urine samples were screened for the presence of viable and motile spermatozoa. Semen parameters were determined and related to the sperm findings in the precipitate of the urine samples. The amount, the viability and motility status of the detected spermatozoa were recorded after each preset time interval.The results showed that none of the 10 participants had sperm in their urine samples prior to ejaculation. The average sperm concentration was 50.1 ± 25.8 million/ml. After a time span of 30 min 59.5% of the first fractions of PEU samples were sperm positive, after 2 and 4 h still 70%, and after 5 h sperm were no longer detected. The last motile spermatozoa could be found after 4.5 h. It seems that remaining sperm in the urethra are washed out with the first micturition in the majority of fertile men, however, the conclusion as to whether sperm findings >5 h after ejaculation are improbable needs to be confirmed by further investigations.