Hospital selective contracting without consumer choice: What can we learn from Medi‐Cal?

In the selective contracting era, consumer choice has generally been absent in most state Medicaid programs, including California's (called Medi-Cal). In a setting where beneficiary exit is not a threat, a large payer may have both the incentives and the ability to exercise undue market power, potentially exposing an already vulnerable population to further harm. The analyses presented here of Medi-Cal contracting data, however, do not yield compelling evidence in favor of the undue market power hypothesis. Instead, hospital competition appears to explain with greater consistency why certain hospitals choose to contract with Medi-Cal while others do not, the trends in inpatient prices paid by Medi-Cal over time, and the effect of price competition on service cutbacks, such as emergency room closures. Copyright 2003 by the Association for Public Policy Analysis and Management.     

Shame and Non-suicidal Self-injury: Conceptualization and Preliminary Test of a Novel Developmental Model among Emerging Adults

Journal of Youth and Adolescence - Non-suicidal self-injury (NSSI) is particularly prevalent during adolescence and emerging adulthood. The salience of shame during these developmental periods...     

Results of the 2018 Rapid DNA Maturity Assessment

Three commercially available integrated rapid DNA instruments were tested as a part of a rapid DNA maturity assessment in July of 2018. The assessment was conducted with sets of blinded single-source reference samples provided to participants for testing on the individual rapid platforms within their laboratories. The data were returned to the National Institute of Standards and Technology (NIST) for review and analysis. Both FBI-defined automated review (Rapid DNA Analysis) and manual review (Modified Rapid DNA Analysis) of the datasets were conducted to assess the success of genotyping the 20 Combined DNA Index System (CODIS) core STR loci and full profiles generated by the instruments. Genotype results from the multiple platforms, participating laboratories, and STR typing chemistries were combined into a single analysis. The Rapid DNA Analysis resulted in a success rate of 80% for full profiles (85% for the 20 CODIS core loci) with automated analysis. Modified Rapid DNA Analysis resulted in a success rate of 90% for both the CODIS 20 core loci and full profiles (all attempted loci per chemistry). An analysis of the peak height ratios demonstrated that 95% of all heterozygous alleles were above 59% heterozygote balance. For base-pair sizing precision, the precision was below the standard 0.5 bp deviation for both the ANDE 6C System and the RapidHIT 200.     

Identifying Fatal Head Injuries on Postmortem Computed Tomography Using Convolutional Neural Network/Deep Learning: A Feasibility Study

Postmortem computed tomography (PMCT) is a relatively recent advancement in forensic pathology practice that has been increasingly used as an ancillary investigation and screening tool. One area of clinical CT imaging that has garnered a lot of research interest recently is the area of “artificial intelligence” (AI), such as in screening and computer-assisted diagnostics. This feasibility study investigated the application of convolutional neural network, a form of deep learning AI, to PMCT head imaging in differentiating fatal head injury from controls. PMCT images of a transverse section of the head at the level of the frontal sinus from 25 cases of fatal head injury were combined with 25 nonhead-injury controls and divided into training and testing datasets. A convolutional neural network was constructed using Keras and was trained against the training data before being assessed against the testing dataset. The results of this study demonstrated an accuracy of between 70% and 92.5%, with difficulties in recognizing subarachnoid hemorrhage and in distinguishing congested vessels and prominent falx from head injury. These results are promising for potential applications as a screening tool or in computer-assisted diagnostics in the future.     

Politics,leadership, and experience in designing Ontario's cabinet

Abstract: Why are cabinet decision‐making systems designed the way they are? Traditional approaches to this question stress the importance of representational imperatives (i.e., region, language and gender), the need for managerial capacity and collegiality in complex organizations, or a particular government's fiscal or policy program. While these approaches have merit, they fail to pay sufficient attention to the fact that cabinet decision‐making systems are in the first instance very intimate reflections and extensions of the political instincts, personal aptitudes, and governing experience of first ministers. The author sets out to understand recent reforms to Ontario cabinet decision‐making in precisely this way ‐ how did Premier Michael Harris' sense of his government's mandate, his personal approach to decision‐making, and the practical lessons learned over the course of his government's first mandate influence the design of Ontario's cabinet decision‐making system between 1995 and 1999? This article begins with a short history of Ontario's cabinet decision‐making system, focusing on the period from 1968 to 1995. It then provides details of reforms introduced between 1995 and 1999 and concludes with some thoughts on how Premier Harris' political instincts, personal aptitudes, and governing experience influenced these reforms. Sommaire: Pourquoi les systèmes de prise de décisions du Cabinet sont‐ils conçus comme ils le sont? Les réponses traditionnelles à cette question soulignent l'impor‐tance des impératifs de représentation (c.‐à‐d. la région, la langue et le sexe), le besoin de compétence en matière de gestion et la collégialité dans les organismes complexes, ou bien un programme politique ou budgétaire particulier du gouvernement. Ces approches sont valables, mais elles ne tiennent pas suffisamment compte du fait que les systemes de prise de décisions du Cabinet sont, avant tout, le fruit de reflexions très approfondies et d'instincts politiques, d'aptitudes personnelles, et de l'expérience gouvernementale des premiers ministres. L'auteur de cet article essaie de comprendre, précisément dans ce sens, les récentes réformes en matière de prise de décisions au Cabinet de 1'Ontario: comment est‐ce que l'idée qu'a Michael Harris du mandat de son gouvernement, son approche personnelle face à la prise de décisions, et les leçons pratiques tirées de son premier mandat (1995–1999) ont‐elles influencé la conception du système de prise de décisions du Cabinet de l'Ontario? L'auteur commence par brosser un bref historique du système de prise de décisions du Cabinet de l'Ontario, en se penchant tout particulièrement sur la période allant de 1968 A 1995. Ensuite, il présente en détail les réformes introduites de 1995 à 1999 et conclut par quelques réflexions sur la manière dont les instincts politiques du Premier ministre Harris, ses aptitudes personnelles et son expérience du gouvernement ont influencé ces réformes.     

DIVORCE EDUCATION FOR PARENTS AND CHILDREN IN JACKSON COUNTY, MISSOURI

This article outlines the implementation of a children's component of a court-connected, mandatory divorce education program in Jackson County, Missouri. The efforts made to include significant stakeholders in the planning and implementation process are described. The curriculum for adults and children is summarized, and the structure and administration of the program are presented. Class provider recruitment and teacher qualifications are presented, as well as an overview of the initial responses to the children's classes. The difficulties and successes described may give direction to others considering the inclusion of children in mandatory divorce education classes.     

Use of bleach to eliminate contaminating DNA from the surface of bones and teeth

The extraction of DNA from archaeological or forensic skeletal remains can provide quite powerful data for analysis, but is plagued by a unique set of methodological problems. One of the most important methodological problems to overcome in such analyses is the presence of modern contamination on the surfaces of bones and teeth, which can lead to false positives and erroneous results unless it is removed before DNA extraction is initiated. Ancient DNA (aDNA) researchers and forensic scientists have employed a number of techniques to minimize such contamination. One such technique is the use of bleach (sodium hypochlorite--NaOCl) to "destroy" contaminating DNA. However, a consensus on the optimum concentration of sodium hypochlorite to be used and the amount of time the bone or tooth should be exposed to it has not emerged. The present study systematically approaches the issue by introducing contamination to ancient bones (from approximately 500 BP) and determining which of several sodium hypochlorite treatments best eliminates surface contamination. The elimination of surface contamination from bone requires immersion in at least 3.0% (w/v) sodium hypochlorite (approximately equal parts of commercial bleach and water) for at least 15 min. Endogenous DNA proved to be quite stable to even extreme sodium hypochlorite treatments (6% for 21 h), suggesting that DNA adsorbs to hydroxyapatite in the bone and that this process facilitates the preservation of DNA in ancient skeletal remains.     

Intra-country regulation of share markets: does one size fit all?

A large body of evidence suggests that financial development is greater in countries that impose stricter regulatory requirements on their major stock exchanges, but this leaves open the question of whether or not such regulation should be uniformly applied to all equity trading platforms within a country. On the one hand, regulatory variation permits a wider choice of investment opportunities for investors, lowers the cost of capital for some firms, and enhances price discovery and efficiency. On the other hand, the presence of lightly regulated exchanges can potentially have adverse spillover implications for a country’s other financial markets.