Between the Scylla and Charybdis: physicians and the clash of liability standards and cost cutting goals within accountable care organizations

This article seeks to examine the conflict between non-cost-conscious medical malpractice liability standards and health care cost cutting measures within the context of Accountable Care Organizations ("ACOs") under the new health care reform law. This article begins by providing an overview of the high level of health care spending within the United States health care system in order to provide a context for better understanding policymakers' push for cost cutting measures, including ACOs. This article then examines the tension between cost containment efforts and medical liability standards through an examination of the "stuck in the middle" mentality that physicians face when they are forced to meet both liability standards that do not take into account cost concerns and cost cutting standards imposed by or through managed care organizations, pay-for-performance programs and consumer-driven healthcare. This article then introduces the concept of the ACO and describes elements of the ACOs envisioned under the new health care reform legislation. This article concludes by examining and analyzing whether and how ACOs will exacerbate the cost containment/liability standard tension, and how that tension may impact the effectiveness of ACOs.     

The Evidence-Based Policing Matrix

The next phase of evidence-based policing requires both scholars and practitioners to move from lists of specific studies about “what works” to using that information strategically. This requires developing generalizations or principles on the nature of effective police strategies and translating the field of police evaluation research into digestible forms that can be used to alter police tactics, strategies, accountability systems, and training. In this article, we present a tool intended for such use: the Evidence-Based Policing Matrix. The Matrix is a consistently updated, research-to-practice translation tool that categorizes and visually bins all experimental and quasi-experimental research on police and crime reduction into intersections between three common dimensions of crime prevention—the nature of the target, the extent to which the strategy is proactive or reactive, and the specificity or generality of the strategy. Our mapping and visualization of 97 police evaluation studies conducted through December 31, 2009, indicate that proactive, place-based, and specific policing approaches appear much more promising in reducing crime than individual-based, reactive, and general ones. We conclude by discussing how the Matrix can be used to guide future research and facilitate the adoption of evidence-based policing.     

The Residual Career Patterns of Police Misconduct

Purpose

To explore the extent to which patterns of police misconduct, particularly residual career length (RCL) and residual number of offenses (RNO), change over time in theoretically expected ways, and to determine whether such career features can adequately predict future misconduct when compared to traditional Early Intervention (EI) system criteria.

Methods

This study employs retrospective, longitudinal data gathered for a large cohort of police officers followed for a significant portion of their career and uses personnel complaints as the primary indicator of police misconduct.

Results

Distributions of RCL and RNO are presented according to 4 criteria: year of experience, complaint number, time since the last complaint, and onset of first complaint. There was a decline in RCL and RNO with experience and onset of first complaint. While RCL declined by complaint number, RNO remained steady. This is also true of time since last complaint. Risk scores derived from RCL and RNO were moderately predictive of future misconduct, but fared better than those derived from standard EI system criteria.

Conclusion

EI systems do not adequately predict future misconduct, but there appears to be value in taking a broader view of complaint patterns of officers as a way of increasing predicative validity.     

Using subsampling to estimate the strength of handwriting evidence via score-based likelihood ratios

The likelihood ratio paradigm has been studied as a means for quantifying the strength of evidence for a variety of forensic evidence types. Although the concept of a likelihood ratio as a comparison of the plausibility of evidence under two propositions (or hypotheses) is straightforward, a number of issues arise when one considers how to go about estimating a likelihood ratio. In this paper, we illustrate one possible approach to estimating a likelihood ratio in comparative handwriting analysis. The novelty of our proposed approach relies on generating simulated writing samples from a collection of writing samples from a known source to form a database for estimating the distribution associated with the numerator of a likelihood ratio. We illustrate this approach using documents collected from 432 writers under controlled conditions.     

Examining What Makes Violent Crime Victims Unique: Extending Statistical Methods for Studying Specialization to the Analysis of Crime Victims

Objectives

Much victimization research focuses on specific types of crime victims, which implies that the factors responsible for some victimization outcomes are distinct from others. Recent developments in victimization theory, however, take a more general approach, postulating that victimization regardless of type will share a similar basic etiology. This research examines how and whether the risk factors that are associated with violent victimization significantly differ from those that predict nonviolent victimization.

Methods

Using data from 3,682 Kentucky youth, we employ Osgood and Schreck??s (2007) Item Response Theory-based statistical approach for detecting specialization to determine the properties and predictors of tendencies for individuals to fall victim to specific types of crime.

Results

Findings show that victims typically experience varied outcomes, but some victims have a clear tendency toward violent victimization and that it is possible to predict this tendency.

Conclusions

The findings indicate that a more nuanced general approach, one that accounts for tendencies toward specific victimization outcomes, might add insight about the causes of victimization. This research also shows how statistical methods designed to examine offense specialization can add value for research on victimization.     

Moderators of Response to Motivational Interviewing for Partner-violent Men

Careful attention to motivation for change may enhance the effects of interventions for partner-violent men. The present study tested predictions about differential response to a two-session motivational intake (MI) for partner-violent men, which was compared to a structured intake (SI) control. For those who were initially reluctant to change, MI produced greater forward movement in stage of change. For those who claimed to have already solved their problems with partner abuse, MI produced greater backward movement in stage of change and greater homework compliance in subsequent group cognitive-behavioral therapy (CBT). MI led to a stronger collaborative working alliance for those high in contemplation of change, and greater group session attendance for those with high trait anger. Contrary to hypotheses, analyses of post-CBT partner assault revealed a differentially greater benefit of MI for participants with lower levels of pretreatment contemplation and trait anger. The findings provide qualified support for the expectation that MI has the greatest beneficial effects on those who appear initially reluctant to change.     

What is Left of the Law and Society Paradigm after Critique? Revisiting Gordon's “Critical Legal Histories”

For more than twenty‐five years, Robert Gordon's “Critical Legal Histories” has been savored by legal historians as one of the most incisive explanations available of what legal history can and should be. Gordon's essay, however, is of significance to the course of sociolegal studies in general. This commentary offers an appreciation, and a critique, of “Critical Legal Histories.” It explores Gordon's articulation of the central themes of critical legal studies, in particular his corrosion of functionalism and embrace of the indeterminacy thesis, and assesses the consequences for sociolegal and legal‐historical analysis of the resultant stress on the contingency and complexity of social life.     

Violence against women in video games: a prequel or sequel to rape myth acceptance?

Current research suggests a link between negative attitudes toward women and violence against women, and it also suggests that media may condition such negative attitudes. When considering the tremendous and continued growth of video game sales, and the resulting proliferation of sexual objectification and violence against women in some video games, it is lamentable that there is a dearth of research exploring the effect of such imagery on attitudes toward women. This study is the first study to use actual video game playing and control for causal order, when exploring the effect of sexual exploitation and violence against women in video games on attitudes toward women. By employing a Solomon Four-Group experimental research design, this exploratory study found that a video game depicting sexual objectification of women and violence against women resulted in statistically significant increased rape myths acceptance (rape-supportive attitudes) for male study participants but not for female participants.