The judicial role in life-sustaining medical treatment decisions.

Although there has been speculation regarding the pervasiveness and nature of judicial decisions regarding life-sustaining medical treatment (LSMT), no attempt has been made to empirically assess their prevalence or the issues they address. An exploratory study utilizing a mail survey of a nationwide random sample (N = 905) of state trial court judges was conducted to provide initial information regarding this decision-making process. Twenty-two percent of the responding judges had heard at least one LSMT case, and judicial review did not appear endemic to particular states. The number of judges hearing LSMT cases dropped from 1975 to 1981 but has increased since then. Three major issues predominate: patient competency, appointment of a surrogate decisionmaker, and resolution of the ultimate issue of forgoing LSMT. Relatively few cases either contested a prior directive's validity or involved imposing sanctions for instituting or forgoing LSMT. Although subject to different interpretations, the results suggest the courts are having a significant impact on certain aspects of the LSMT decision-making process. However, the infrequency with which any one judge is called upon to make an LSMT decision causes concern about the judiciary's ability to respond in a timely and appropriate manner. With their potential for a profound effect on the actions of health care providers, greater attention to this decision-making process is warranted.     

A unique case of congenital bilateral absence of parietal bones in a neonate

The remains of an unidentified female neonate were discovered in a field in central Missouri. Examination revealed bilateral absence of the parietal bones. A search of the literature describing similar defects suggests that the present case represents a unique condition, described here for the first time.     

Poppy seed ingestion as a contributing factor to opiate-positive urinalysis results: the Pacific perspective.

The possible contribution of poppy seed foods to positive opiate urinalysis results, especially from foods available in the Pacific Rim area, has recently become an issue for the U.S. Army Forensic Toxicology Drug Testing Laboratory in Hawaii. To assess the likelihood of this possible contribution, seven different poppy seed food products were consumed by male and female volunteers, and urine specimens were collected at time increments up to either 24 or 72 h. Specimens were evaluated for opiates using Roche Abuscreen radioimmunoassay (RIA), and all RIA positive specimens were analyzed for morphine and codeine using gas chromatography/mass spectrometry (GC-MS). Poppy seed cake, bagels, muffins, and rolls did not contain sufficient quantities of poppy seeds to give rise to opiate positive specimens by U.S. Department of Defense (DOD) GC-MS cutoff levels (morphine = 4000 ng/mL, codeine = 2000 ng/mL), although a number of specimens were positive by National Institute on Drug Abuse (NIDA) cutoff levels (morphine and codeine = 300 ng/mL). However, ingestion of poppy seed streusel or Danish pastry led to confirmed morphine and codeine positive specimens, irrespective of the use of DOD or NIDA confirmation cutoff values. In addition, significant amounts of codeine were observed in a number of these specimens. These findings argue against the unqualified application of previously published quantitative guidelines for eliminating poppy seed ingestion as a possible cause for a positive opiate urinalysis result.     

SCHOOLS AS COMMUNITIES: THE RELATIONSHIPS AMONG COMMUNAL SCHOOL ORGANIZATION,STUDENT BONDING,AND SCHOOL DISORDER*

Research has indicated that school factors such as communal school organization and student bonding are predictive of school disorder, with greater communal organization and greater student bonding leading to less delinquency and victimization. Data from a nationally representative sample of 254 public, nonalternative, secondary schools were used to examine structural equation models representing hypothesized relationships among communal school organization, student bonding, and school disorder. The hypothesis that communally organized schools would have less disorder held true for teacher victimization and student delinquency, but not for student victimization. In addition, the hypothesis that the relationship between communal school organization and school disorder would be mediated by student bonding was supported for student delinquency, but not for teacher victimization.     

Has PPS increased Medicare expenditures on physicians?

We use data from 1983 and 1985 on the volume of Medicare physician services to analyze whether Medicare's Prospective Payment System (PPS), which resulted in a significant decline in hospital spending, led to a partially offsetting increase in real expenditures for physician services. We also analyze the effect of increases in assignment rates, increasing incomes of the elderly, and other factors on real expenditures during this period. Our main conclusion is that PPS has at most a small positive effect on real physician expenditures. Because people spent less time in the hospital, Medicare physician spending declined; but because of incentives to shift radiology and other services out of the hospital, some of this decline was offset. We also conclude that the sharp increase in Medicare assignment rates over this period, along with the rising incomes of the elderly during this period, contributed to the observed growth.     

R before D: the case of post conflict reintegration in Tajikistan1

Reintegration was prioritised over demobilisation and disarmament in Tajikistan's peace process. Inadequate disarmament rates were disregarded, but integration of opposition fighters into military and law enforcement units was relatively swift. This created high levels of trust among the former fighters and commanders. The quick provision of incentives, such as comprehensive amnesties and the offer of government positions and economic assets created stakes in the peace process for a number of actors. Transitional justice was largely overlooked. In this way, the case of Tajikistan runs counter to key elements of what has been termed the ‘post-conflict reconstruction orthodoxy’. At the same time, Tajikistan is a rare example of the emergence of post-war stability. This article provides a detailed account of the DDR process and outlines the incentives that it created for the warring parties. It also assesses the emergence of spoilers and the government's counter strategies. The article concludes by highlighting the consolidation of President Rakhmonov's power since 2001, but also raises some questions regarding the viability of Tajikistan's long-term political and economic development.