NEW DIRECTIONS IN MEDICAL OUTCOMES RESEARCH: THE VIEW FROM HARVARD

This study evaluates the emerging field of medical outcomes research based on interviews at Harvard Medical School. Medical outcomes research at Harvard is multifaceted, but may be summarized as involving certain key components. The emphasis at Harvard is on “quality of care,” viewed as a combination of outcomes evaluation and process evaluation, delivery of the service and its result. In a time of shrinking budgets, outcomes and process research can be justified economically because of the relatively low cost of patient self‐reports and because of their usefulness. Physicians may be motivated to measure quality of care by emphasizing the positive effects of research on the process of care and outcomes. Medical outcomes research is a field that is undergoing change and is becoming increasingly oriented toward the practical needs of patients and physicians.     

Reinvention As Reform: Assessing the National Performance Review

The conclusion of the Clinton Administration presents an opportune time to investigate the outcomes of the National Performance Review (NPR). Any such evaluation, however, is complicated by the nature of the objectives sought, many of which relate to subtle and elusive elements of organizational life: empowering employees, inducing a less risk-adverse culture, and enhancing the quality of service delivery. The strategy employed here as a means of gaining insight into such phenomena was to couple a broad review of government-wide survey results with an in-depth investigation into the impact of NPR on a single agency, the Social Security Administration. A conclusion is that many of the NPR's "higher-order" objectives have not been met on a systemic basis. While a variety of proximate explanations for this finding can be identified, a more fundamental explanation relates to a failure by the sponsors to adjust their strategy to account for basic differences between NPR and past reforms.     

Non-State Actors and Terrorism: Applying the Law of State Responsibility and the Due Diligence Principle

Netherlands International Law Review -     

A cross‐Canada analysis of the efficiency of residential recycling services

Abstract: The primary purpose of this article is to investigate the factors that predict the efficiency of residential recycling collection services in Canadian local governments. The findings are based on a survey of 128 residential recycling producers from all regions of Canada. One of the most significant findings is the lack of a relationship between private‐sector companies collecting recyclables and the overall efficiency of collection operations. The dominance of the private‐sector collection of recyclables (over seventy‐seven per cent of all producers were contracted companies) does not translate into greater efficiencies. The most important variables in the model are amenable to local control. They include tonnes collected per vehicle per year, requiring full bins, inclusion of composting operations in the overall recycling program, the number of different kinds of materials recycled, participation rate, and reliance on side‐loading collection vehicles. Among the direct predictors of unit costs, the key underlying factor is the productivity of residential recycling operations. Because recyclables are marketed, handling them takes time, reduces the weights that collection vehicles can carry, and generally reduces productivity. Even diligent efforts to improve productivity will not bring recycling costs down to the levels for residential solid‐waste collection. Sommaire: L'objectif principal du présent article est d'examiner les facteurs qui prévoient l'efficacité des services de collecte de produits recyclables résidentiels dans les municipalités canadiennes. Les résultats reposent sur un sondage réalisé auprès de 128 producteurs de collecte de produits recyclables résidentiels opérant dans toutes les régions du Canada. L'un des résultats les plus notoires est le manque de relations entre les sociétés du secteur privé qui récupèrent les produits recyclables et l'efficacité d'ensemble des opérations de collecte. La prédominance de la collecte de produits recyclables par le secteur privé (plus de soixante‐dix‐sept pour cent de tous les producteurs étaient des sociétés contractuelles) ne se traduit pas par une plus grande efficacité. Les variables les plus importantes du modèle peuvent faire l'objet d'un contrôle local. Elles comprennent les tonnes récupérées par véhicule par an, l'exigence de poubelles pleines, l'inclusion d'opérations de compostage au programme général de recyclage, le nombre de différentes sortes de matériaux recyclés, le taux de participation, et le recours à des camions de collecte à chargement latéral. Parmi les variables explicatives directes des coûts unitaires, le principal facteur sous‐jacent est la productivité des opérations de recyclage résidentiel. Comme les produits recyclables sont commercialisés, leur manutention prend du temps, réduit le poids que les camions de collecte peuvent transporter, et réduit d'une manière générale la productivité. Même des efforts diligents pour améliorer la productivité ne feront pas baisser les coûts du recyclage aux niveaux de ceux de la collecte des déchets solides résidentiels.     

A comparison of insanity defense standards on juror decision making

Following the Hinckley acquittal, 17 states and the federal government made changes to the insanity defense, including revising the standard, reassigning the burden of proof, and altering the standard of proof. Two studies were conducted to determine whether the specific insanity standard (including the assignment of burden of proof and standard of proof) employed had a significant effect on mock jurors' verdicts. Participants' comprehension of insanity defense instructions was measured and the factors jurors used to decide whether to find the defendant not guilty by reason of insanity (NGRI) were also assessed. Participants' comprehension of insanity defense standards was very low. When asked to identify the factors they considered important in determining whether to find a defendant NGRI, only three elements of insanity defense standards were identified as significant. The results may have important implications for policy decisions regarding the insanity defense.     

Problems of definition: What is organized crime?

What do most people, or at least most Americans, think of when they hear, see, or read the term “organized crime”? What do they know about it? And from whence do they get their information? What about law enforcement practitioners, prosecutors, judges, and politicians? And, what about academics and journalists, the folks who study and write about organized crime? Agreeing upon a commonly accepted definition of just what is organized crime has been a continuing problem for both research and policy. The discussion that follows addresses various dimensions of this problem, looks at the implications, and makes certain recommendations.