Promoting a "good death": determinants of pain-management policies in the United States

Many Americans do not experience a good death. The inadequate treatment of pain at the end of life has been associated with a lack of supportive public policies more than a lack of evidence-based clinical practices or organizational efforts. Given a widespread lack of understanding about pain policies, we examine the critical role played by state medical boards in developing pain policies and then apply event history analysis to identify the variables most critical to the formation of these policies. We develop an integrated model and evaluate the adoption of eight different types of pain policies. The analytic models incorporate fifteen years of observational data and test the impact of contextual, political, extrinsic, and institutional variables. They reveal that the presence of legal counselors on state medical boards has consistently increased the likelihood that state boards adopt policies associated with progressive pain management. Further, policy has been negatively influenced by historical activity: boards that previously adopted one pain policy have been less likely to subsequently adopt additional pain policies. This work illuminates mechanisms behind state pain-policy adoption and provides valuable information for advocates who seek to improve pain-management policy and reduce the amount of pain at the end of life.     

The characterization of automobile body fillers

Body fillers are sometimes encountered with paint evidence from hit-and-run accidents. Little forensic research has been conducted and published on the subject since 1986. The objective of this study was to determine if chemical and physical differences in body fillers from various manufacturers existed and could be identified. Thirty-three samples of light-weight automobile body fillers and spot putties were obtained. The fillers and putties were compared using light microscopy, infrared spectroscopy, scanning electron microscopy with energy dispersive X-ray spectrometry (SEM-EDX), and pyrolysis gas chromatography (pyGC). Results from fourier transform infrared spectroscopy analysis placed the samples into five groups and differentiated six samples. Light microscopy placed the samples into one of five color groups. PyGC placed the samples into three groups and differentiated one sample. SEM-EDX placed the samples into four groups and differentiated 13 samples. Using these analysis methods, 19 of the 33 samples could be discriminated. The best discriminatory tool was found to be SEM-EDX.     

Insurance Discrimination on the Basis of Health Status: An Overview of Discrimination Practices, Federal Law, and Federal Reform Options

Actuarial underwriting, or discrimination based on an individual's health status, is a business feature of the voluntary private insurance market. The term "discrimination" in this paper is not intended to convey the concept of unfair treatment, but rather how the insurance industry differentiates among individuals in designing and administering health insurance and employee health benefit products. Discrimination can occur at the point of enrollment, coverage design, or decisions regarding scope of coverage. Several major federal laws aimed at regulating insurance discrimination based on health status focus at the point of enrollment. However, because of multiple exceptions and loopholes, these laws offer relatively limited protections. This paper provides a brief overview of discrimination practices, the federal law, and federal reform options to manage discriminatory practices in the insurance and employee health benefit markets.     

Certifying a state forestry agency in Quebec: Complementarity and conflict around government responsibilities,indigenous rights,and certification of the state as forest manager

As voluntary third‐party certification systems become an increasingly accepted part of international frameworks for forest governance, some state forestry agencies are following the private sector in seeking certification of their forest management activities. We ask how the roles and responsibilities of state forest management agencies interact with the processes and mechanisms established by certification systems. To answer this question, we review existing research to propose a conceptual framework composed of eight issues of particular relevance to states: regulation, transnationalism, sovereignty disputes, partnerships and competition, mainstreaming, effectiveness, equity, and legitimacy and trust. We then use this framework to analyze experience in Quebec, Canada, where the state agency initially sought certification and then abandoned this plan after facing difficulties meeting the requirements pertaining to indigenous rights. Our framework helps to understand possible complementarities between state and non‐state systems, but also highlights challenges for reconciling state roles and responsibilities under certification.     

Teachers’ perspectives on educating for peace in Bosnia and Herzegovina

What does it mean to educate for peace after witnessing one’s community being devastated by war? And what impact, if any, does educating for peace have amidst the complexity of post-war reconstruction? To explore these questions, a phenomenological study was conducted in Bosnia and Herzegovina in 2012 with eight ethnically diverse educators who participated in a programme of Education for Peace (EFP) which began a decade earlier in the cities of Sarajevo, Mostar, Banja Luka and Zenica. Through semi-structured interviews, the study (1) explores meanings and experiences associated by participants with their role as post-conflict peace educators, (2) examines the extent and limits of their sense of peacebuilding agency and (3) elicits evaluations of the longer term impacts of educating for peace in the Bosnian context. The study finds that meanings associated with educating for peace are nuanced by educators’ personal histories of conflict, professional identities and the country’s wider socio-political dynamics. Benefits, risks and challenges stemming from peace education engagement are found in four domains (personal, social, educational and political). Conclusions recommend greater focus to the subjectivities of teachers in conflict-affected contexts as a key site for evaluating peacebuilding impact, for revising theories of change and improving planning and provision.     

Institutional Trust in Contemporary Moscow

Levels of institutional trust in Russia are amongst the lowest in the world. As yet, however, little research has focused on this phenomenon at the sub-national level. The current study examines trust in social and political institutions among citizens in Moscow in 2004. Results showed that levels of institutional trust are extremely low and that there were only three institutions (the church, president and hospitals) that were more trusted than distrusted. Moreover, although the effects of some demographic and other independent variables on trust stretched across institutions, several variables had a unique impact in terms of trust in the president.     

Rape of the Congo: Understanding sexual violence in the conflict in the Democratic Republic of Congo

Though the occurrence of rape in the conduct of war is by no means historically new, research into its causes and functions has only really begun in the past couple of decades. War rape is a difficult phenomenon about which to generalise, considering the variances in context and actors involved. This article, however, attempts to synthesise existing literature through the analysis of a case study that can enhance our understanding of rape as a weapon of war and the contextual conditions that facilitate its use. Applying this theoretical framework to the extreme war rape occurring in the Democratic Republic of Congo (DRC), this article offers insight into understanding the function of sexual violence in the ongoing conflict in the DRC. In particular, this article argues that the use of rape as a weapon in the Congo's bloody war must be understood in relation to both social constructs of masculinity and the politics of exploitation that have shaped much of the country's history.