Nonincremental Policy Change: Lessons from Michigan's Medicaid Managed Care Initiative

Studies of policy implementation have focused primarily on incremental policy change, yet policy change is sometimes implemented quickly and comprehensively. Such is the case with Michigan's recent implementation of a statewide Medicaid managed care initiative. This article analyzes Michigan's quick implementation and highlights the importance of political support, organizational change, and a supportive policy and administrative environment in affecting successful implementation. It also notes the price paid for quick implementation—namely, stakeholder dissatisfaction, mistakes, and lack of public involvement.     

Comparison of daily urine,sweat, and skin swabs among cocaine users

This study (1) compares urine, skin swabs, and PharmChek sweat patches for monitoring drug use; (2) measures possible environmental contamination in recent cocaine (COC) users; and (3) evaluates various immunoassays (IA) for screening COC in diverse matrices. Unique aspects include daily urine monitoring of 10 participants for 4 weeks, multiple monitoring methods, analysis for all specimens by IA and gas chromatography (GC)/mass spectrometry (MS), and the potential for continued illicit drug use by participants. Urine served as the "gold standard" specimen for determining drug use. Only cocaine and related substances were detected.Trace amounts of drugs were found on the skin (<50 ng per swab) of urine-negative participants' hands or forehead. In contrast, larger quantities of COC were found on the skin of individuals with BE-positive urines or individuals living with drug users (up to 20 microg per swab). Patch COC amounts among the three regular users (250-9000, 0-240, 160-22,000 ng per patch) exceeded BE (50-950, none, 30-2200 ng per patch). Pre-swabs, valuable for interpreting the source or time frame of positive patch results, contained substantial COC (38-1160, 0-152, 34-762 ng per swab) prior to patch application; therefore, patch results may represent current use, prior use, contamination, or a combination. In three individuals with no indication of cocaine use, false positives (defined as sweat patch positive when urine specimens were <300ng BE/ml) occurred at a 7% rate. Proposed cut-off concentrations of 75 ng cocaine per patch and 300 ng BE/ml urine curtail the incidence of false positives in this limited population. Three immunoassays were compared to screen specimens for cocaine: a modified, manual Microgenics CEDIA; a Cozart ELISA; and an OraSure ELISA. CEDIA's limit of detection (LOD) was 81ng/ml, compared with LODs of 4 ng/ml for the Cozart ELISA and 1.5 ng/ml for the OraSure ELISA. Cozart correlated with OraSure results for COC concentrations <2000 ng per swab (n=117), r(2)=0.79.     

Chinese dragon or toothless tiger? Regulating the professional competence of traditional Chinese medicine practitioners

The escalation in popularity of complementary and alternative medicine (CAM) has begun to stimulate regulatory responses to ensure the safety and efficacy of different modalities. The Therapeutic Goods Authority in Australia oversees a scheme of listing and registration, said to lead the world. Established CAM courses now confer recognised bachelor degrees. Victoria has recently regulated Traditional Chinese Medicine (TCM) practitioners, through the Chinese Medicine Registration Act 2000 (Vic), modelled on legislation regulating medical practitioners. CAM is being integrated into conventional medical (especially general) practice, and calls for the "mainstreaming" of CAM are increasing. Integrating CAM, however, involves a critical incoherence, well illustrated by the Victorian legislation. Clinical competence can only be properly assessed against standards established through scientific validation. If CAM systems, which purport to offer alternatives to science-based medicine, are regulated through conventional instruments, they may well be relinquishing the very identities which set them apart.     

District planning and local government in Kenya

In many ways the autonomy of local government in Kenya has declined in the last twenty years. After reviewing the various tendencies towards centralization which can be observed and looking at some of the reforms which have occurred, the current district planning approach, known as the District Focus for Rural Development Strategy, is analysed in order to explore the roles played within it by local government. Policy documents and other official statements are discussed, as are the attitudes of political and administrative leaders. Whilst the new strategy is supposed to bring about greater decentralization, it has led to a continuing reduction of local government autonomy especially for the county councils. However, pessimistic conclusions can not be easily drawn. Local government is not likely to be abolished, the new approach may enable it to play a more effective planning role—even if a less autonomous one—and there are other forms of local participation (especially through community development) which partly compensate for the erosion of formal local government.     

A differential survey of the problems of privileged and underprivileged adolescents

The problems of adjustment during the midadolescent years were examined in 1298 privileged and underprivileged adolescents from the Sydney Metropolitan Area, Australia. Girls reported more problems than boys in all areas of adjustment and underprivileged adolescents more problems than the privileged group; however, a significant interaction effect was also found. Whether high-income or low-income group, the overwhelming number of problems were associated with educational adjustment and were interpreted as the reaction to pressures to achieve imposed on adolescents of this age.Received her M.A. (Hons.) and Ph.D. from Macquarie University. Member of Australian Psychological Society. Principal research interests are child psychopathology and psychology of adolescence.Received his M.A.(Hons.) and Ph.D. from Sydney University. Fellow of Australian Psychological Society. Principal research interest is psychology of adolescence.     

Enhancing Title IX Due Process Standards in Campus Sexual Assault Adjudication: Considering the Roles of Distributive,Procedural, and Restorative Justice

ABSTRACT

Title IX prohibits sex discrimination—including sexual assault—in higher education. The Department of Education Office for Civil Rights’ 2011 “Dear Colleague Letter” outlines recommendations for campus sexual assault adjudication allowing a variety of procedures that fail to protect accused students’ due process rights and victims’ rights under Title IX. This article reviews two diminished due process rights in campus adjudication: cross-examination and the preponderance of the evidence standard. We use an organizational justice theoretical framework to show that limitations on due process rights reduce fair outcomes for both victims and the accused. We provide recommendations for a restorative justice approach to campus adjudication that operates within this theoretical framework to increase fair outcomes in adjudication, bolster perceptions of adjudicatory system legitimacy, and reduce campus sexual assault.     

The National Press and Party Voting in the UK

The difficulty with resolving the classic problem of whether newspapers influence voting patterns is self-selection: readers select a paper to fit their politics, and newspapers select particular types of readers. One way round this chicken-and-egg problem is to compare the voting behaviour of individuals whose politics are reinforced by their paper, with those who are cross-pressured by their paper, and to compare both with those who do not regularly read a paper. Using the British Household Panel study to analyse voting patterns in 1992 and 1997, this study suggest that newspapers have a statistically significant effect on voting, larger for Labour than Conservative sympathizers, and larger for the 1992 than the 1997 election. The broader implications of these findings for British politics and democracy are discussed.