Is there a rationale for regionalizing organ transplantation services?

This paper explores issues in the designation of centers to provide organ transplantation procedures and aftercare, a decision faced increasingly by policymakers, planners, and payers. As background for consideration of the regionalization of organ transplantation services, an array of models of regionalization of health services, ranging from full-scale vertical integration to market-enhancing information provision, is described. In the United States, regionalization has mainly followed the designation model within the certificate-of-need system; vertical integration has been adopted only in limited ways. Next, the authors' review of current approaches to the regionalization of organ transplantation centers by public and private payers indicates that designation of centers is increasing, although the empirical evidence concerning the classes of hospitals upon which designation decisions rest is weak. The authors then review the literature on the relationship between volumes and outcomes on surgical services with particular reference to organ transplantation, which on the whole suggests that a relationship between volumes and outcomes exists. Original empirical analysis of data on kidney transplants that were secured from the Health Care Financing Administration is then presented. The study of the effects of hospital and surgeon volumes on graft and patient survival and of the effect of volume on charges found no systematic influence of hospital or surgeon volumes on graft or patient survival. Some evidence that charges are lower for larger centers was found. The authors conclude that the evidence implies that using volume as the provider characteristic upon which to base designation of transplantation centers is problematic, at least for kidney transplants. Steps policymakers might take to ensure quality of transplantation services is discussed in the final section.     

A suicide using a homemade carbon monoxide "death machine"

Deaths related to carbon monoxide (CO) poisoning are common. Most represent accidents and suicides, and most result from CO production via the incomplete combustion of carbon-containing substances. Suicide via CO toxicity is not uncommon and typically involves the use of motor-vehicle exhaust as a source of CO. Presented herein is a case of suicidal CO poisoning in which the CO was produced via a chemical reaction between formic acid and sulfuric acid within a homemade device.     

Conceiving of Telecom: The Politics of Australian Telecommunications Reform 1967–1972

This article explores the politics of telecommunications reform between 1967 and 1972, during which time Labor developed a new policy approach that included committing to reconstitute the Postmaster‐General's Department as a relatively independent statutory authority. This represented the first serious attempt to reconcile the conflicting objectives of Australian policy: to provide affordable universal services by a government department expected to operate as a “business‐like” enterprise, and ended the political consensus about how national telecommunications should be delivered. The paper contrasts Labor's policy with the Liberal‐Country government's more incremental approach; and highlights a significant public policy shift that has received insufficient attention.     

Legal developments and industry issues relevant to IT,media and telecommunications law in key jurisdictions across the Asia Pacific

This column provides a country by country analysis of the latest legal developments, cases and issues relevant to the IT, media and telecommunications' industries in key jurisdictions across the Asia Pacific region. The articles appearing in this column are intended to serve as ‘alerts’ and are not submitted as detailed analyses of cases or legal developments.     

Responding to young people responsible for harm: a comparative study of restorative and conventional approaches

Research investigating the impact of restorative responses on offenders has increased in sophistication and complexity over the last decade. Extending beyond earlier studies documenting satisfaction with restorative justice, investigators have considered its relationship with recidivism, reparation compliance and perception of fairness. A few experimental studies have compared conventional and restorative approaches, with results generally favoring the latter. This study focuses on intermediate outcomes of justice approaches on adolescents responsible for harm. These outcomes represent benefits of restorative justice often theoretically argued but rarely empirically evaluated. The study employed a quasi‐experimental design and scales developed through previous qualitative research and consultation with stakeholders. Adolescents participating in conventional vs restorative responses, in both court and school contexts, were compared on eight variables in three areas: accountability, relationship repair and closure. While some variation in outcome depends on context, the results add to the growing literature documenting the benefits of restorative approaches.     

Manx Law: A Contribution from the Isle of Man*

This article provides a rare insight into the legal system and jurisprudence of the Isle of Man by the island's Second Deemster.

The author describes, inter alia, the judicial structure, sentencing and impact of international jurisprudence on the work of the judiciary of the Isle of Man, before outlining the island's constitutional position with the United Kingdom and with England and Wales.

The author argues against intellectual and judicial insularity: ‘Laws should be developed and problems solved by reaching out for knowledge and solutions that may be provided by approaches from jurisdictions beyond our local frontiers’. However, in reaching out to foreign jurisdictions, it is emphasised that account must be taken of local history, traditions, laws and needs.     

Evaluation of preliminary isotopic analysis (13C and 15N) of explosives A likelihood ratio approach to assess the links between semtex samples

Currently, the use of isotopic ratio as corroborative evidence in criminal trials is explored. Beyond the analytical challenges that have been reported elsewhere, the crucial issue of the interpretation of analytical results in a fair and balanced way remains poorly documented. The aim of this paper is to propose a likelihood ratio approach for the evaluation of stable isotope data acquired from semtex samples. It will also lead to recommendations in relation to the acquisition of normalised international data.