Comparative effectiveness research under the Patient Protection and Affordable Care Act: can new bottles accommodate old wine?

The Patient Protection and Affordable Care Act (PPACA), as amended by the Health Care and Education Reconciliation Act of 2010, initiated comprehensive health reform for the healthcare sector of the United States. PPACA includes strategies to make the American healthcare sector more efficient and effective. PPACA's comparative effectiveness research initiative and the establishment of the Patient-Centered Outcomes Research Institute are major strategies in this regard. PPACA's comparative effectiveness research initiative is one in a long line of federal initiatives to address the rising costs of healthcare as well as to obtain better value for healthcare expenditures. The key question is whether the governance and design features of the institute that will oversee the initiative will enable it to succeed where other federal efforts have faltered. This Article analyzes the federal government's quest to ensure value for money expended in publically funded healthcare programs and the health sector generally. This Article will also analyze what factors contribute to the possible success or failure of the comparative effectiveness research initiative. Success can be defined as the use of the findings of comparative effectiveness to make medical practice less costly, more efficient and effective, and ultimately, to bend the cost curve.     

Recovery of DNA and fingermarks following deployment of render-safe tools for vehicle-borne improvised explosive devices (VBIED)

Improvised explosive devices (IED) are responsible for a significant proportion of combat and civilian deaths around the world. Given the ease with which IEDs can be made, the large quantity of explosive which can be contained within or on a vehicle, and the use of VBIED in the past (for example the 2002 Bali bombing) in terrorist activities, VBIED are an ongoing concern for Defence and law enforcement agencies. Fingermark and DNA analyses are routinely used by police and forensic analysts to identify suspects involved in illegal activities. There is limited information available on the feasibility of obtaining fingermarks, fibres, hair and DNA samples following an explosive incident, or a situation whereby an IED has been rendered safe following the utilisation of an appropriate defeat or render-safe tool. The main objective of this study was to determine if fingermarks and/or DNA (from saliva and hair samples) placed on the interior and exterior of road vehicles, and on inanimate objects (such as plastic or glass bottles), are able to be obtained and analysed following the use of a vehicle-borne IED (VBIED) render-safe tool on a vehicle containing simulated explosives. The identification of fingermarks on the exterior (67.2±8.5%) and interior (43.8±17.8%) of the vehicles was possible following the use of the render-safe tool, though this was more challenging in the latter than the former. Fingermarks were also able to be identified from both plastic and glass bottles placed inside the vehicles. Polymerase chain reaction (PCR) techniques yielded DNA profiles that were able to be identified from saliva and hair samples. These preliminary results suggest that both fingermarks and DNA profiles, obtained from vehicles that have been subjected to a VBIED render-safe tool, may be used to identify persons of interest.