Forensic psychiatry and malpractice

This paper concerning the last 87 malpractice cases referred to the Department of Psychiatry and Law, Menninger Clinic, includes 57 suits against mental health practitioners and/or institutions, and 30 nonpsychiatric suits against general hospitals, surgeons, obstetricians, etc. A patient was available for interview in only 12 percent of the psychiatric cases; in 88 percent we reviewed medical records and consulted with attorneys. In the psychiatric cases the crucial question was whether a generally accepted standard of care was breached. The inherent problems of applying appropriate criteria to standards of care by practitioners and institutions are discussed. In half the psychiatric cases we found no significant deviation from acceptable clinical performance; in half we concluded that negligent practice had occurred. We did see a litigant for evaluation in 90 percent of the nonpsychiatric cases. The main issue involving them concerned harm or disability related to presumed negligence by medical personnel. How we evaluate such cases and apply disability criteria is discussed.     

Traffic accidents and drivers suspected for drug influence

All records from the Danish Medicolegal Council concerning drivers suspected for drug influences were examined for the 5 year period 1981-1985. 461 records were included, 62 women and 399 men. In 250 cases drugs from more than one of ten groups had been taken thus making 786 combinations of drug/driving. The major drug group was benzodiazepines, accounting for 65% of all drug intake. Opioids also contributed substantially, found in 38% of the cases. A traffic accident had occurred in 180 (39%) of the records. Drivers who had been taking antidepressives were involved in an accident in 67%, significantly above the mean. For benzodiazepines, the corresponding percentage was 43%, while for opioids it was only 23%, significantly below the mean. This striking difference has been demonstrated in most of the studies concerning drugs in traffic. It may support the hypothesis that opioids do not necessarily make driving dangerous, as do antidepressives, barbiturates and especially benzodiazepines.     

The extent of aspartic acid racemization in dentin: a possible method for a more accurate determination of age at death?

In the current study the objective was to find to what extent a reliable determination of age at death is made possible by establishing the degree of aspartic acid racemization in the dentin of teeth. The results of the investigation of 46 teeth are in agreement with the values found by other authors. The method presented makes a reproducible and accurate estimation of age possible. We intend to elaborate and improve this promising method for determination of age at death. The relevant points are presented here.     

Restoring accountability in pretrial release: the Philadelphia pretrial release supervision experiments

As drug arrests and jail overcrowding added pressure to increase pretrial release in localities during the 1980s and 1990s, the need to manage a larger and higher-risk pretrial population of defendants awaiting adjudication in the community became a high priority for justice agencies. In the late 1990s Philadelphia officials sought to discover the ingredients of a successful supervision strategy through four interlinked field experiments to provide an empirical basis for a major reform of the pretrial release system. The results of the linked randomized experiments question common assumptions about “supervision,” its impact and effectiveness, about the underlying nature of the noncompliant defendant, and deterrence implications. The study emphasizes the importance of interpreting the findings in the context of implementation of the policy reform. Findings suggest that facilitative notification strategies wield little influence on defendant behavior and that deterrent aims are undermined by the system's failure to deliver consequences for defendant noncompliance during pretrial release. The most significant contribution of the article is its illustration of a major evidence-based policy reform undertaken by a major court system.     

THE FUTURE OF PORTUGUESE PUBLIC ADMINISTRATION AND A NEW AGENDA FOR PUBLIC ADMINISTRATION SCIENCES IN THE 21st CENTURY

This paper addresses the changing role of the Portuguese state, the present priority assigned to the process of reform and the new challenges to be overcome by public administration. Such processes are demanding a new agenda for education and research in public administration sciences, shifting from the public law paradigm to an interdisciplinary problem‐solving approach and giving special attention to 10 key areas of study, which we describe in the final section of the paper. It should be noted here that the opinions expressed in this paper do not necessarily reflect the position of their institutions.     

NETWORK REGULATION: THE MANY FACES OF ACCESS

Telecommunications regulation has experienced a fundamentalshift from rate regulation to increased reliance on compelledaccess, perhaps best exemplified by the Telecommunications Actof 1996's imposition of no fewer than four new access requirements.Unfortunately, each access requirement is governed by a separateset of rules for determining both the scope and the price ofaccess. The resulting ad hoc regime has created difficult definitionalproblems and opportunities for regulatory arbitrage. In thisarticle we propose a system inspired by the discipline of mathematicsknown as graph theory that integrates all of the different formsof access into a single analytical framework. This system separatesdifferent access regimes into five categories: (1) retail access,(2) wholesale access, (3) interconnection access, (4) platformaccess, and (5) unbundled access. It also provides insightsinto how each type of access complicates the already difficultproblems of network configuration and management and introducesinefficient biases into decisions about network capacity anddesign. The approach we propose also provides insights intothe transaction cost implications of the different types ofaccess. Drawing on the Coasean theory of the firm, our approachexamines the tradeoffs between internal governance costs andthe external transaction costs of providing access to offera theory of network boundaries. This framework shows how accessregulation distorts networks' natural boundaries and providesa basis for evaluating whether private ordering through marketswould lead to more efficient network design.     

Regime transformation from below: Decentralization,local governance,and democratic reform in Nigeria

How realistic are democratic-governance strategies that emphasize local governance as a key component? Using Nigeria’s experience in local government and primary health care in the 1980s and 1990s as a case example, the article finds there were substantial shortfalls in local participation and program performance. These were caused by problems in the local political environment and local institutional design, in the national policy environment (particularly in the funding system), and by the stresses of structural adjustment, resource shortfalls, the natural physical environment, and weak leadership. These combined to create poor and inappropriate reward structures and lack of accountability. However, even though the Nigerian case was not successful, most of the specific problems that hurt it are remediable through policy changes at the national level. Several of these were under consideration at the time of the coups of 1992 and 1993.     

Do Śrāvakas understand emptiness?

Conclusions The present study has attempted to artriculate a central issue of Mahäyäna soteriology through an examination of the writings of two Mädhyamika masters, Bhävaviveka and Candrakïrti. The purpose here has been to demonstrate a further criterion for the retrospective designation of their respective philosophies with the terms Svtantrika and Prasangika an exhaustive study of the nature of the Hinayäna wisdom according to the Mädhyamika school would entail an analysis of the writings of many other masters, especially those who produced what has been called the Yogäcära-Mädhyamika synthesis. To attempt to determine the position of Maitreyanätha, for example, on this issue would entail an analysis of the famous Five Treatises (the Dharmadharmatävibhaa, the Madhyäntavibhaga, the Mahayanasutrlamkara, the Uttratantra, and the Abhisamayälamkära) as well as the myriad commentaries on these works. It is possible to speculate briefly here on what the position of Nägärjuna may have been on this issue and then go on to discuss the implications and possible motivations of the views of Bhävaviveka and Candrakïrti.     

Effects of positional restraint on oxygen saturation and heart rate following exercise

This report assesses the effects on peripheral oxygen saturation and heart rate that positional restraint induces when a person is prone, handcuffed, and "hog-tied." Peripheral oxygen saturation and heart rate were monitored at rest, during exercise, and during recovery from exercise for 10 adult subjects. The effects of positional restraint produced a mean recovery time that was significantly prolonged. Consequently, the physiological effects produced by positional restraint should be recognized in deaths where such measures are used.