Books in review

He is currently on leave and is visiting professor at the University of Maryland-Europe.     

La responsabilisation du patient dans un contexte de télésoins à domicile

Sommaire: La volonté de transformation du système de santé est propice à une recrudescence du discours public sur la responsabilisation du patient. Les technologies d'information et de communication (tic ) sont régulièrement envisagées comme moyens pouvant permettre au patient d'exercer un rôle accru dans la prise en charge des questions de santé. Ce texte vise à cerner le sens de la responsabilisation dans un contexte de télésoins à domicile. L‘étude d'un service de suivi à domicile met en lumière l'un des quatre paradigmes d'interprétation de la responsabilisation du patient: le paradigme professionnel qui est orienté vers l'habilitation en matière de santé. Par une double lecture représentant les approches sociologique et psychologique, cette étude montre les possibilités et les limites d'une technologie de télésoins à domicile par rapport à six principales variables: accès aux connaissances; développement d'une réflexion argumentée; influence sur l'action ou la décision; compétence perçue; contrôle perçu; et intériorisation des buts. Les résultats permettent d'observer le haut niveau d'exigence que représenterait une initiative visant l’émergence de patients informés et compétents. Surtout des patients “experts” dans une vision de la responsabilisation fondée sur la reconnaissance du caractère holistique des connaissances, du principe d'autonomie de pensée et du potentiel d'influence du patient sur une variété de décisions. En conclusion, sont précisées les implications qu'ont ces résultats sur la gestion du système public de santé. Abstract: The willingness to transform the health care system is conducive to a new wave of public discourse on patient empowerment. Information and communications technologies (ict ) are regularly considered as means that allow the patient to exercise increased control in addressing health issues. This text aims at examining this phenomenon within the tele‐homecare context. The study of a follow‐up home‐care service highlights one of the four paradigms of the interpretation of patient empowerment: the professional paradigm that is health empowerment‐oriented. By using both a sociological and a psychological approach, the study identifies the possibilities and limitations of tele‐homecare technology, based on six major variables: access to knowledge, development of critical thinking, personal impact on action or decision, perceived competency, perceived control, and internalization of goals. The results show the high level of requirements needed for an initiative that would produce informed, competent and, most importantly, “expert” patients according to a vision of empowerment based on the recognition of the holistic nature of knowledge, the principle of autonomous thinking, and the patient's potential impact on a variety of decisions. In conclusion, the article defines the implications of these results in terms of the management of the public health system.     

Le Vérificateur général du Québec et la vérification d'optimisation des ressources: évolution et perspectives

Sommaire: Le Vérificateur général du Québec (VGQ) par ses vérifications d'optimisation des ressources (VOR) exerce, une influence croissante sur l'administration publique québécoise. La pertinence et la crédibilité sont les pierres d'assise de ses décisions. Pour être pertinent, le VGQ a adopté l'approche de la déficience appréhendée, qui cible des situations problématiques au lieu de cibler des entités. Tout au cours du processus de vérification, cette approche amène le VGQ à s'assurer que la déficience est réelle, sinon il interrompt la VOR La vérification implique notamment la comparaison de la situation avec une norme. Afin d'être crédible le vérificateur en réalisant une VOR, développe sa norme par une approche d'étalonnage. Nous avons constaté que le VGQ s'adapte à l'évolution de l'administration publique. La nouvelle Loi stir l'administration publique québécoise exige des rapports de performance des entités publiques. Si ces dernière jouent le rôe prévu par la loi, le VGQ devra probablement les certifier. Cette tâche, vu son arnpleur, constituera un véritable défi pour le VGQ. Abstract: The Quebec Auditor General (QAG), through value‐for‐money audits (VFMA), is having a growing impact on the Quebec public administration, with relevance and credibility being the cornerstones of its decisions. To be relevant, the QAG has adopted the “apprehended deficiency” approach that targets problem situations instead of entities. Accordingly, throughout the audit process, the QAG must ensure that the deficiency is real otherwise the VFMA must be terminated. The audit process includes a comparison of the situation against a standard. In addition, to be credible when conducting a VFMA, the auditor must develop a standard by means of benchmarking. We have found that the QAG is adapting to the changes taking place in public administration. Quebec's new Public Administration Act requires performance reports from public entities. If these reports play their statutory role, they will probably need to be certified by the QAG. This task, given its scope, will represent a real challenge for the QAG.     

Towards a relationship with the Mediterranean countries

Fifteen years ago, the European Union (EU) launched a Common European Security and Defence Policy (CSDP). Since then, the CSDP has been the focus of a growing body of political and scholarly evaluations. While most commentators have acknowledged shortfalls in European military capabilities, many remain cautiously optimistic about the CSDP’s future. This article uses economic alliance theory to explain why EU member states have failed, so far, to create a potent common defence policy and to evaluate the policy’s future prospects. It demonstrates, through theoretical, case study-based and statistical analysis, that CSDP is more prone to collective action problems than relevant institutional alternatives, and concludes that the best option for Europeans is to refocus attention fully on cooperation within a NATO framework.     

Assessing programs designed to improve outcomes for children exposed to violence: Results from nine randomized controlled trials

Objectives

The study tests whether participation in interventions offered by a subset of sites from the National Safe Start Promising Approaches for Children Exposed to Violence initiative improved outcomes for children relative to controls.

Methods

The study pools data from the nine Safe Start sites that randomized families to intervention and control groups, using a within-site block randomization strategy based on child age at baseline. Caregiver-reported outcomes, assessed at baseline, 6 and 12 months, included caregiver personal problems, caregiver resource problems, parenting stress, child and caregiver victimization, child trauma symptoms, child behavior problems, and social-emotional competence.

Results

Results revealed no measurable intervention impact in intent-to-treat analyses at either 6- or 12-month post-baseline. In 6-month as-treated analyses, a medium to high intervention dose was associated with improvement on two measures of child social-emotional competence: cooperation and assertion. Overall, there is no reliable evidence of significant site-to-site effect variability, even in the two cases of significant intervention effect.

Conclusions

Since families in both the intervention and control groups received some degree of case management and both groups improved over time, it may be advantageous to explore the potential impacts of crisis and case management separately from mental health interventions. It may be that, on average, children in families whose basic needs are being attended to improve substantially on their own.     

Fluorescent TiO2 powders prepared using a new perylene diimide dye: applications in latent fingermark detection

A new, highly fluorescent dye was synthesised using oleylamine combined with a perylene dianhydride compound. The new dye was characterised by 1H NMR, UV-vis spectroscopy and fluorescence spectroscopy as well as quantum yield. The dye was absorbed onto titanium dioxide nanoparticles for use as a fingerprint detection powder. The new fluorescent powder was applied to latent fingermarks deposited onto different non-porous surfaces and compared with commercial fluorescent powders. The powder exhibits strong fluorescence at 650-700 nm under excitation at 505 nm. On glass surfaces, the new powder gave images showing tertiary-level detail of the fingermark ridges with almost no background development. Compared with current magnetic fluorescent powders, the new powder was slightly weaker in fluorescence intensity but produced significantly less background development, resulting in good contrast between the fingermark and the substrate.     

Optimisation and evaluation of 1,2-indanedione for use as a fingermark reagent and its application to real samples

1,2-indanedione is an emerging fingermark reagent used on porous surfaces. The general consensus is that this reagent is at least as sensitive as DFO, with some research showing higher sensitivity for 1,2-indanedione as opposed to DFO. However, a number of discrepancies existed in the literature as to which formulation and which development procedure produces optimal results. This project set out to investigate the best formulation and development procedure under Australian conditions, encompassing all published recommendations as well as some novel approaches. 1,2-indanedione formulations were compared with respect to initial colour, fluorescence, concentration of reagent, acetic acid concentration, and the effect of different carrier solvents. Numerous development conditions were investigated, including a conventional oven, a heat press and humidity. Further enhancement using metal salt treatment and liquid nitrogen was also evaluated. The heat press set at 165 degrees C for 10s proved to give the best initial colour and most intense luminescence. Secondary metal salt treatment improved initial colour and luminescence. The Polilight, the VSC 2000, and the Condor Chemical Imaging macroscope have been used to detect the fingerprints developed with 1,2-indanedione on a variety of high- and low-quality porous and semi-porous surfaces, with impressive results overall. Laboratory and field tests were conducted to compare 1,2-indanedione with DFO and ninhydrin as well as to investigate the position of 1,2-indanedione in the sequence of reagents for fingermark detection on porous surfaces. Overall, 1,2-indanedione proved to be a viable alternative to traditional methods for the detection of fingermarks on porous surfaces, with more fingermarks being developed using this reagent on real samples than both DFO and ninhydrin and a combination of the two reagents.     

The population of coloured textile fibres in domestic washing machines.

A population survey was carried out to analyse examples of the coloured fibre population that may be expected to exist in both front- and top-loading domestic washing machines during Spring, in Sydney, Australia. White cotton T-shirts were washed both individually, and with a normal household wash load, then taped to recover extraneous fibres transferred during the wash cycle. Twelve thousand one hundred and seventy-eight fibres were classified according to length, colour and generic class. Cotton fibres were most prevalent (69.4%), followed by man-made fibres (24.2%). The most common colour/generic class combinations were black/grey cotton (27%), blue cotton (20%) and red cotton (15.6%). Other combinations generally represented under 2% of the total fibre population. Two thirds (65.9%) of the recovered fibres were under 2 mm in length, the proportion of fibres decreasing with increasing fibre length. Variations in machine type did not affect the distribution of fibres with respect to fibre type, colour or length.     

Investigation of hydrogen cyanide generation from the cyanoacrylate fuming process used for latent fingermark detection

Cyanoacrylate fuming is one of the most common techniques employed for the detection of latent fingermarks on non-porous surfaces such as plastic and glass. The technique is generally applied by exposing items of interest to the vapours generated by heating a suitable quantity of commercial cyanoacrylate adhesive. In this study, the potential for highly toxic hydrogen cyanide (HCN) to be generated from the overheating of cyanoacrylate was investigated. Two commercial cyanoacrylate adhesives and two quantitative methods for the determination of HCN were employed: (i) the sodium picrate method; and (ii) the picrate-resorcinol method. (13)C nuclear magnetic resonance (NMR) analysis was used to confirm the presence of cyanide. In addition, the thermal decomposition of cyanoacrylate was studied using simultaneous thermogravimetric and differential thermal analysis (TGA-DTA). It was determined that detectable and quantifiable amounts of HCN were generated from the thermal decomposition of cyanoacrylate monomer and polymer at temperatures as low as 200 °C. Using an optimised picrate-resorcinol method, it was shown that around 10 μg of HCN could be generated from the heating of 1g of cyanoacrylate monomer at 200 °C. For one of the adhesives tested, this increased to above 100 μg of HCN when 1g of cyanoacrylate monomer was heated at 280 °C. Recommendations are provided that, if followed, should ensure that the cyanoacrylate fuming process can be safely applied with minimal risk to the operator.