Mental Disorder, Violence, and Gender

Recent studies have reported comparable rates of violence among men and women with mental disorder, raising important issues for clinical risk assessment. This study examines the relationship between gender and violence using data from the MacArthur Violence Risk Assessment Study. Patients in acute psychiatric wards were interviewed 5 times over the year following their discharge to the community. Results showed some differences between men and women in the violence committed immediately following discharge, with rates for men being higher. But the prevalence of violence over the 1 year was similar for female and male discharged patients. However, there were substantial gender differences in the situational context of the violence committed. Men were more likely to have been drinking or using street drugs, and less likely to have been adhering to prescribed psychotropic medication, prior to committing violence. The violence committed by men was more likely to result in serious injury than the violence committed by women, and men were more likely than women to be arrested after committing a violent act. Women were more likely to target family members and to be violent in the home.     

Violate, incur sanctions, and exhaust: the steep price of judicial review under Illinois Council

This Article analyzes the decision in Shalala v. Illinois Council on Long Term Care, Inc., in which the Supreme Court held that providers seeking to challenge Medicare regulations must first pursue those challenges through an administrative review process, except when application of this rule would result in "no review at all." In reaching this decision, the five-justice majority rejected the interpretation given to prior holdings by many commentators and circuits, and reasoned that it was appropriate to require providers to exhaust their administrative appeals even though the penalties for the challenged violations would not be stayed during the process. Given the nature of the administrative appeal process and the scope of penalties that may be assessed against Medicare providers, the author argues that the decision in Illinois Council evidences excessive deference towards the agency, or a disinclination on the part of the court towards entertaining Medicare lawsuits, either of which bodes ill for providers seeking judicial relief.     

Stochastic models of the Social Security trust funds

Each year in March, the Board of Trustees of the Social Security trust funds reports on the current and projected financial condition of the Social Security programs. Those programs, which pay monthly benefits to retired workers and their families, to the survivors of deceased workers, and to disabled workers and their families, are financed through the Old-Age, Survivors, and Disability Insurance (OASDI) Trust Funds. In their 2003 report, the Trustees present, for the first time, results from a stochastic model of the combined OASDI trust funds. Stochastic modeling is an important new tool for Social Security policy analysis and offers the promise of valuable new insights into the financial status of the OASDI trust funds and the effects of policy changes. The results presented in this article demonstrate that several stochastic models deliver broadly consistent results even though they use very different approaches and assumptions. However, they also show that the variation in trust fund outcomes differs as the approach and assumptions are varied. Which approach and assumptions are best suited for Social Security policy analysis remains an open question. Further research is needed before the promise of stochastic modeling is fully realized. For example, neither parameter uncertainty nor variability in ultimate assumption values is recognized explicitly in the analyses. Despite this caveat, stochastic modeling results are already shedding new light on the range and distribution of trust fund outcomes that might occur in the future.     

Interdisciplinary problem-solving: Next steps in the Greater Yellowstone Ecosystem

The Greater Yellowstone Ecosystem, a 7.6-million-hectare region in the Central Rocky Mountains of the United States, is used to illustrate both the challenges and means to improve problem solving in the natural resources arena. The challenges in this world-famous region are contextual (rapid change, growth, pluralism, complexity, state/federal conflicts, and lack of a common perspective), institutional (multiple organizations with overlapping authority and control and disparate mandates, uneven leadership, lack of creativity in problem solving, and resistance to change), and human (diverse perspectives and values and epistemological limitations). To overcome these challenges, an interdisciplinary method that integrates knowledge to improve policy making is briefly described. It provides a framework with a comprehensive set of categories to use in investigating and analyzing problems and inventing alternatives for substantive, process, and structural improvements. Five programs or interventions, all of which are based on this method, are suggested to address the challenges facing Greater Yellowstone: (1) workshops for capacity building, (2) leadership, staff development, and student internships, (3) case analyses and appraisals for policy learning, (4) problem-solving exercises and decision seminars, and (5) prototyping exercises to improve interdisciplinary and interagency coordination. These are described, examples given, and benefits outlined.     

Human Rights and Unfair Dismissal: Private Acts in Public Spaces

This article addresses the termination of employment because of the conduct of the employee in her leisure time, in the light of the right to private life. It explores the impact on the retention of employment of activities taking place outside the workplace and outside working hours, and argues that the approach of UK courts and tribunals, which is based on a primarily spatial conceptualisation of privacy, is flawed. A fresh approach to privacy, resting on the idea of domination, is proposed, which is sensitive to the particularities of the employment relationship. Considering the fairness enquiry in dismissal, it argues that off‐duty conduct may lead to lawful termination of employment only if there is a clear and present impact or a high likelihood of such impact on business interests; a speculative and marginal danger does not suffice. It further proposes that a particularly meticulous test is appropriate when certain suspect categories, such as the employees' sexual preferences, are at stake.     

Hair analysis for cocaine: Factors in laboratory contamination studies and their relevance to proficiency sample preparation and hair testing practices

Hair samples were contaminated by rubbing with cocaine (COC) followed by sweat application, multiple shampoo treatments and storage. The samples were then washed with isopropanol for 15 min, followed by sequential aqueous washes totaling 3.5 h. The amount of drug in the last wash was used to calculate a wash criterion to determine whether samples were positive due to use or contamination. Analyses of cocaine and metabolites were done by LC/MS/MS. These procedures were applied to samples produced by a U.S. government-sponsored cooperative study, in which this laboratory participated, and to samples in a parallel in-house study. All contaminated samples in both studies were correctly identified as contaminated by cutoff, benzoylecgonine (BE) presence, BE ratio, and/or the wash criterion. A method for determining hair porosity was applied to samples in both studies, and porosity characteristics of hair are discussed as they relate to experimental and real-world contamination of hair, preparation of proficiency survey samples, and analysis of unknown hair samples.