Strategies to enhance price and quality competition in health care: lessons learned from tracking local markets

Drawing on observations from tracking changes in local health care markets over the past ten years, this article critiques two Federal Trade Commission and Department of Justice recommendations to enhance price and quality competition. First, we take issue with the notion that consumers, acting independently, will drive greater competition in health care markets. Rather we suggest an important role remains for trusted agents who can analyze inherently complex price and quality information and negotiate on consumers' behalf. With aggregated information identifying providers who deliver cost-effective care, consumers would be better positioned to respond to financial incentives about where to seek care and thereby drive more meaningful competition among providers to reduce costs and improve quality. Second, we take issue with the FTC/DOJ recommendation to provide more direct subsidies to prevent distortions in competition. In the current political environment, it is not practical to provide direct subsidies for all of the unfunded care that exists in health care markets today; instead, some interference with competition may be necessary to protect cross subsidies. Barriers can be reduced, though, by revising pricing policies that have resulted in marked disparities in the relative profitability of different services.     

Validities and abilities in criminal profiling: a critique of the studies conducted by Richard Kocsis and his colleagues

In a recent issue of this journal, Kocsis reviewed the criminal profiling research that he and his colleagues have conducted during the past 4 years. Their research examines the correlates of profile accuracy with respect to the skills of the individual constructing the profile, and it has led Kocsis to draw conclusions that are important to the profiling field. In this article, the authors review the contributions of the Kocsis studies and critique their methodological and conceptual foundations. The authors raise a number of concerns and argue that data from the Kocsis studies fail to support many of the conclusions presented in his recent review. The authors present evidence in support of their assertions and provide recommendations that will allow future research in the area to generate data that are more meaningful and generalizable.     

Computerized craniofacial reconstruction using CT-derived implicit surface representations

In forensic craniofacial reconstruction, facial features of an unknown individual are estimated from an unidentified skull, based on a mixture of experimentally obtained guidelines on the relationship between soft tissues and the underlying skeleton. In this paper, we investigate the possibility of using full 3D cross-sectional CT images for establishing a reference database of densely sampled distances between the external surfaces of the skull and head for automated craniofacial reconstruction. For each CT image in the reference database, the hard tissue (skull) and soft tissue (head) volumes are automatically segmented and transformed into signed distance transform (sDT) images, representing for each voxel in this image the Euclidean distance to the closest point on the skull and head surface, respectively, distances being positive (negative) for voxels inside (outside) the skull/head. Multiple craniofacial reconstructions are obtained by first warping each reference skull sDT maps to the target skull sDT using a B-spline based free form deformation algorithm and subsequently applying these warps to the reference head sDT maps. A single reconstruction of the target head surface is defined as the zero level set of the arithmetic average of all warped reference head sDT maps, but other reconstructions are possible, biasing the result to subject specific attributes (age, BMI, gender). Both qualitative and quantitative tests (measuring the similarity between the 3D reconstructed and corresponding original head surface) on a small (N = 20) database are presented to proof the validity of the concept.     

The relationship between attachment styles and Cluster B personality disorders in prisoners and forensic inpatients

The relationship between attachment styles and Cluster B personality disorders were examined among prisoners, forensic inpatients and controls from the general population. Forensic inpatients and prisoners reported significantly less frequently the secure attachment style (Relationship Questionnaire) and significantly more the fearful attachment style compared to the normal controls. Both forensic groups could not be distinguished from each other. Further, prisoners, forensic inpatients and controls could not be differentiated on the basis of the dismissing nor the preoccupied attachment style. With respect to personality pathology, almost all relationships between Cluster C pathology, on the one hand, and attachment styles, on the other, were significant. Cluster A pathology was clearly related to the secure and fearful attachment style. With respect to cluster B pathology, the results were more specific but also less clear. The results were strongly dependent on the way the personality pathology variables were treated, as either categorical or dimensional. None of the cluster B personality pathology variables were associated with the fearful attachment style and histrionic personality pathology was negatively associated with the dismissing attachment style. Antisocial personality features were associated with a dismissing attachment style. Borderline personality pathology, when treated as a categorical variable, was significantly related to the preoccupied attachment style. These results show that (1) cluster A and cluster C pathology are more strongly associated with attachment than cluster B, (2) treating personality data as either dimensional or categorical is of major importance to the conclusions that can be drawn, (3) it is important to control for the influence of co-morbid personality pathology when examining the relationship between (Cluster B) personality pathology and attachment.     

Testing the Trauma Model of Violence

The present study sought to explore the relationship between trauma and violence, as measured by the Traumatic Events Questionnaire and the Conflict Tactics Scale. Using Multiple Regression Analysis, several types of traumatic experiences were studied as predictors to violent behavior in 55 graduate students. Results suggest that trauma as a set, as well as being the victim of a violent crime, are significantly related to future violent behavior. However, no other individual predictor variable, including being the victim of childhood physical abuse, significantly predicted future violence. Implications of the findings are discussed.     

The Background and Causes of the Genocide in Rwanda

This article begins with an account of significant events andsocio-political relationships in the history of Rwanda, leadingto mass murder and genocide in 1994. An explanation is thenoffered of these crimes, based on an analysis of certain ecological,economic, cultural and political factors specific to Rwanda,but shared to an important extent by much of East Africa.     

Bringing Political Science to Bear on Tropical Conservation

With the renewed international emphasis on governance for sustainable development, political scientists wishing to have an impact on global environmental problems will find significant opportunities to collaborate with practitioners. These collaborations can be very rewarding, but academics should enter them with their eyes open to the associated challenges. Bridging the worlds of research and practice entails tensions between what is true according to the research, and what is possible given the constraints of specific organizations; between the problems that practitioners need solved and the puzzles that researchers find appealing; and, importantly, between the divergent cultures that shape the expectations and incentives of academics and their counterparts.