Policing Medicaid and Medicare managed care: the role of courts and administrative agencies

The much-publicized 2000 case of Frew v. Gilbert, in which a federal judge castigated the State of Texas for deficiencies in its Medicaid program, brought renewed attention to the issue of regulating the quality of care in Medicaid and Medicare HMOs. Frew and other recent cases highlight both the promise and the pitfalls of relying on courts to correct deficiencies in public managed care programs. This article argues that while litigation over inadequacies in Medicare and Medicaid managed care can serve an important signaling function in alerting agencies and legislatures about the need for reform, the role of the courts in policing public managed care is circumscribed by several constraints. Barriers to class action litigation and differences in the institutional capacities of courts and administrative agencies mean that litigation is best viewed as a supplement, not an alternative, to a renewed commitment to strong quality monitoring on the part of Centers for Medicare and Medicaid Services and state Medicaid agencies.     

Associating gunpowder and residues from commercial ammunition using compositional analysis

Qualitatively identifying and quantitatively determining the additives in smokeless gunpowder to calculate a numerical propellant to stabilizer (P/S) ratio is a new approach to associate handgun-fired organic gunshot residues (OGSR) with unfired powder. In past work, the P/S values of handgun OGSR and cartridges loaded with known gunpowders were evaluated. In this study, gunpowder and residue samples were obtained from seven boxes of commercial 38 caliber ammunition with the goals of associating cartridges within a box and matching residues to unfired powders, based on the P/S value and the qualitative identity of the additives. Gunpowder samples from four of the seven boxes of ammunition could be easily differentiated. When visual comparisons of the cartridge powders were considered in addition to composition, powder samples from all seven boxes of ammunition could be reliably differentiated. Handgun OGSR was also collected and evaluated in bulk as well as for individual particles. In some cases, residues could be reliably differentiated based on P/S and additive identity. It was instructive to evaluate the composition of individual unfired gunpowder and OGSR particles. We determined that both the numerical centroid and dispersity of the P/S measurements provide information for associations and exclusions. Associating measurements from residue particles with those of residue samples collected from a test firing of the same weapon and ammunition appears to be a useful approach to account for any changes in composition that occur during the firing process.     

Characterization and validation studies of powerPlex 2.1, a nine-locus short tandem repeat (STR) multiplex system and penta D monoplex

In order to increase the power of discrimination for human identification purposes, a nine-locus short tandem repeat (STR) multiplex, the GenePrint PowerPlex 2.1 system (PowerPlex 2.1) developed by Promega Corporation and a separate pentanucleotide-repeat locus, Penta D, were tested. This megaplex system includes the highly polymorphic loci FGA, TPOX, D8S1179, vWA, Penta E, D18S51, D21S11, TH01, and D3S1358 and may be used in combination with the eight-locus STR multiplex, the GenePrint PowerPlex 1.1 system (PowerPlex 1.1) that has been previously developed. Three of the loci, TPOX, TH01 and vWA, have been included in both systems for quality control purposes. As with PowerPlex 1.1, PowerPlex 2.1 is also based on a two-color detection of fluorescent-labeled DNA products amplified by polymerase chain reaction (PCR) and provides a valuable tool for accurate and rapid allele determination. The primer sequences used in the PowerPlex 2.1/Penta D system are also presented in this report. To meet the "Quality Assurance Standards for Forensic DNA Testing Laboratories" (FBI), we tested the efficiency and reproducibility of the PowerPlex 2.1/PentaD system by several validation studies that were conducted as a joint project among seven laboratories. Validation tests included concordance studies, sensitivity, and species specificity determination, as well as performance in forensic and environmentally impacted samples. The results produced from these tests demonstrated the consistency and reliability of the PowerPlex 2.1/Penta D system.     

Studying Perceptions of Juror Influence In Vivo: A Social Relations Analysis

Because of legal constraints and statistical limitations there has been little research on social influence in actual juries. We used Kenny's (1994) social relations model to examine jurors' perceptions of social influence in the jury. After rendering a verdict in criminal or civil court cases, jurors rated how influential each member of the jury had been and provided self-reports of their personality traits. Perceptions of influence in the jury were mostly in the eye of the beholder, with jurors high in Conscientiousness and low in Openness being most likely to report that they were personally influenced by other jurors. There were small but statistically significant levels of consensus in the ratings of how influential the jurors were. To the extent that they did agree, jurors rated extraverted, tall men as most influential.     

The Effects of Interviewer Gender and Child Gender on the Informativeness of Alleged Child Sexual Abuse Victims in Forensic Interviews

Most students of forensic interviews have focused on the interrogatory techniques used to elicit information from alleged child abuse victims. We asked how the gender of the interviewer and the gender of the child affected this process. Forensic investigators in three countries used either the NICHD structured interview protocol or local standard interview practices to interview 672 alleged victims who ranged in age from 4 to 14 years. Analyses of the interviews showed significant effects of gender on both the interviewers' behavior and the amount of information provided by children. Female interviewers asked boys more invitations, as well as absolutely and proportionally more suggestive questions, than they did girls, whereas male interviewers interviewed boys and girls similarly. Children's responses varied depending on their gender and age, the gender of the interviewer, and the type of question asked. Girls of all ages provided more information in response to directive questions posed by female rather than male interviewers whereas boys did not respond differently to male and female interviewers. The oldest girls provided more information in response to option-posing questions posed by male interviewers. More information was provided by the younger children in response to suggestive prompts from interviewers of the opposite gender. The gender-of-interviewer effects were attenuated in protocol-guided interviews.