Patient competence and professional incompetence: disagreements in capacity assessments in one Australian jurisdiction, and their educational implications

The determination of capacity to make medical, personal and financial decisions has significant individual and social implications. Medical and other health professionals are traditionally relied on by courts and tribunals to provide clinical and psychometric evidence of the presence or absence of capacity, or competence. Concern has long been expressed over the variability of these assessments. A survey of 285 decisions of the Queensland Guardianship and Assessment Tribunal (GAAT) between 2005 and 2008 was conducted to estimate the incidence of disagreement between health professionals in capacity assessments; to provide examples of conflicting assessments and models of assessment used; and to consider the educational implications of disagreements. While the final capacity determinations by the GAAT appear sound, this case series, and other studies in the capacity literature, strongly suggest the need to improve the education of health professionals, especially doctors, at undergraduate and postgraduate levels, in the practical assessment of capacity as a fundamental clinical skill.     

Characterization and differentiation of aluminum powders used in improvised explosive devices – Part 1: Proof of concept of the utility of particle micromorphometry

Aluminum (Al) powders are commonly used in improvised explosive devices as metallic fuels, a component of explosive mixtures. These powders can be obtained readily from industrial‐scale and consumer products, and produced using unsophisticated “kitchen chemistry” techniques. This research demonstrates the potential of automated particle micromorphometry for comparisons between known source and questioned Al powders recovered from IEDs, as well as for insight into the method of Al powder manufacture. Al powder samples were obtained from legitimate manufacturers, and 56 samples were produced “in‐house” from Al‐containing spray paints and ball‐milled Al foils. Transmitted light microscope images of Al powder particles were acquired using an automated stage with automated z‐focus; 17 size and shape parameters were measured for all particles. Approximately 37,000–2,500,000 particles/sample were analyzed using an open‐source statistical package with customized code. Dimensionality reduction was required for processing the large datasets: eight of the 17 measured variables were selected based on inspection of the correlation matrix. Data from four subsamples from each of the 56 samples produced using “in‐house” methods were analyzed using ANOVA to assess the within‐ and between‐sample variation. High within‐sample variation was noted; however, ANOVA and post‐hoc Tukey's honestly significant difference (HSD) tests demonstrated that the between‐sample variation was substantially larger than the within‐sample variation. Each sample could be differentiated from all other samples in the test set. Future experiments will focus on ways to reduce the within‐sample variation, and additional statistical and microanalytical methods to classify sources and confidently constrain the method of Al powder manufacture.     

Liberals and Australian Foreign Policy*

Since the Second World War, Liberal governments trying to adapt to a rapidly changing international environment have been mindful of Australian interests, and especially the ongoing search for security. Adapting to declining British power, to militant communism in East and Southeast Asia, and to a new, under‐defined alliance with the United States was no easy task. The Colombo Plan for aid to South and Southeast Asia and the dismantling of the White Australia Policy represented two forms of positive engagement with Asia. Since the 1970s, Liberal governments have played significant roles in the strengthening of the Commonwealth; strengthening ties with key countries in Asia; and maintaining a sometimes problematic security relationship with the United States. On this latter point, however, the most recent Liberal governments have not performed well, in becoming more subservient to the Americans.     

Cognitive-behavioral treatment of men who batter: The short-term effects of group therapy

A cognitive-behavioral approach for the treatment of wife abuse was evaluated using a pre-post design and multiple outcome measures. The treatment approach consisted of assertiveness training, relaxation training, and cognitive restructuring. Treatment also focused on increasing the client's acceptance of sex-role changes. Data were available on 92 men who completed 12 sessions of a skills group and eight sessions of a supplemental process group. There were significant changes in the desired direction in anger level, jealousy, depression, and attitudes about women's roles. These changes were maintained after adjusting scores for social desirability response bias. The importance of adjusting scores for response bias or obtaining spouse's reports of the man's behavior is discussed.     

A discriminant function analysis of deciduous teeth to determine sex

Studies of deciduous teeth have concluded that crown size differences in these teeth between males and females are not reliable sex discriminators, in contrast to such differences in permanent teeth. This study measured the mesiodistal and faciolingual crown diameters of all deciduous teeth, as well as those of the permanent first molars, of 162 children from the Burlington Orthodontic Growth Study, conducted earlier in Burlington, Ontario, Canada. All 40 deciduous tooth diameters (20 mesiolingual and 20 faciolingual) were significantly different between the sexes, as were the permanent tooth diameters. Using three to five measurements of deciduous teeth, discriminant analyses of several samplings of these children produced discriminant functions in which 76 to 90% of the holdout samples were correctly classified by sex. Combinations of deciduous and permanent measurements were used to classify 83 to 85% of the holdout samples correctly. When compared with published data on other sample populations, the Burlington group is the most dimorphic for deciduous teeth and is within the range of permanent tooth dimorphisms of other populations. The level of classification accuracy, when using discriminant analysis of the deciduous teeth, can approach the accuracy levels of analysis using the permanent teeth.     

Government Borrowing in Australia

This article examines the Australian experience with coordinatedgovernment borrowing from federation to the present day. Itreveals significant changes in the purposes for which the borrowingarrangements were originally designed and are now used. Largelyfor this reason, the outward form of the arrangements no longerresembles their actual operation, causing severe accountabilityproblems. Whatever the advantages of coordinated governmentborrowing for economic management in a federal system, the Australianexperience shows that it may have economic disadvantages aswell. The time has come, therefore, for the borrowing arrangementsto be rethought and revised.