Health care report cards: implications for vulnerable patient groups and the organizations providing them care

Standardized public reporting on the quality of health care (report cards) offers an opportunity to empower purchasers and consumers so that they can make choices that can result in better health care for less money. However, not all population subgroups are equally well served by the publication of such data. In particular, vulnerable patient groups such as the poor, the less educated, the chronically sick, and members of ethnic or linguistic minorities may find issues of importance to them largely neglected. In addition, the way that report card data are collected, analyzed, and presented may further marginalize the experiences of these groups who in any case are already underserved by the health system. This observation also has important implications for health care providers who serve primarily large numbers of vulnerable patients. The differential impacts of report card data on vulnerable patient groups (and their providers) need to be addressed by researchers and policy makers if access issues are not to be damaged further by the providers' pursuit of quality and value.     

Subformal warning systems in the species Homo politicus

A political activist needs to pick up early warning signals that something is happening which might require his attention. The something could be an emergent danger or opportunity. An ideal-typical warning system is postulated to account for what is believed to be the extraordinary infrequency of activists being caught off guard under most routine conditions. Such a system would ideally meet four criteria: rapidity, comprehensiveness, validity, and selectivity. The postulated system rests on what Anthony Downs has called subformal communications channels among individuals and groups interrelated by principles of specialization and the division of labor.I am very grateful to Janice Holve for her valuable assistance in gathering data and in helping to sharpen my ideas. In the early stages of this project, Gene Bretton helped conduct a review of the literature. Aaron Wildavsky, David Kirp, Marcel Teitler, and Jack Citrin read and commented on various drafts. Financial support from the National Institute of Mental Health is also gratefully acknowledged.     

Familial correlates of identity formation in late adolescence: A study of the predictive utility of connectedness and individuality in family relations

Past investigations have documented that late adolescence is associated with developmental changes in identity formation resulting in individual differences in identity statuses. Particular attention has been given to the identification and study of diffusion, foreclosure, moratorium, and identity achievement statuses. Drawing from the recent theoretical speculations by Cooper and Grotevant, an investigation was completed to assess the predictive utility of measures of family connectedness and individuality in differentiating among the four identity statuses. Data were obtained from male and female late adolescents and their mothers and fathers on perceptions of independence (individuality), communication, and emotional affection (connectedness). Differences among adolescents grouped into the four identity formation statuses were assessed using analysis of variance techniques comparing gender and identity status on measures of connectedness and individuality within a parent-adolescent relationship. Evidence consistent with the notion that a combination of emotional attachment to parents and the encouragement of independence striving by parents is associated with healthy identity development emerges from our data.This research was funded in part by the W144 Western Regional Research Project, Development of Social Competency in Children, with funding provided by the Science and Education Administration/Cooperative Research of the USDA and the Utah State Agricultural Experiment Station, Logan.Completed his doctoral work at Utah State University under the direction of the second and third authors. Interested in counseling and clinical psychology, therapy, and adolescent/child psychology.Interested in personality and social development during childhood and adolescence.Interested in clinical and counseling psychology, therapy, and psychological adjustment.     

The wall socket theory of learning

Teachers of policy analysis lack a theory of how students actually learn. Applying “lessons” of general validity to specific circumstances is the essential skill to be mastered. It may be taught by emphasizing lessons of universal rather than conditional relevance, “coding” them so as to improve their memorability, and adjusting the codes to match the environmental cues that students are likely to encounter on the job. Because wall sockets are everywhere in the policy analyst's environment, they symbolize the ubiquitous cue that can help the analyst draw on the coded lessons.     

Accuracy of comparison decisions by forensic firearms examiners

This black box study assessed the performance of forensic firearms examiners in the United States. It involved three different types of firearms and 173 volunteers who performed a total of 8640 comparisons of both bullets and cartridge cases. The overall false-positive error rate was estimated as 0.656% and 0.933% for bullets and cartridge cases, respectively, while the rate of false negatives was estimated as 2.87% and 1.87% for bullets and cartridge cases, respectively. The majority of errors were made by a limited number of examiners. Because chi-square tests of independence strongly suggest that error probabilities are not the same for each examiner, these are maximum-likelihood estimates based on the beta-binomial probability model and do not depend on an assumption of equal examiner-specific error rates. Corresponding 95% confidence intervals are (0.305%, 1.42%) and (0.548%, 1.57%) for false positives for bullets and cartridge cases, respectively, and (1.89%, 4.26%) and (1.16%, 2.99%) for false negatives for bullets and cartridge cases, respectively. The results of this study are consistent with prior studies, despite its comprehensive design and challenging specimens.     

Inter-observer error for area of origin analysis using FARO Zone 3D

In a bloodletting incident, the area of origin (AO) of an impact bloodstain pattern is crucial when establishing the sequence of events. The use of laser scanners and other three-dimensional (3D) technologies to document and analyse bloodstains have been the subject of previous papers, especially where AO analysis is concerned. FARO Zone 3D (FZ3D) is a relatively new software programme that can be used for bloodstain AO analysis. FZ3D requires a greater understanding of inter-observer errors associated with AO. This study looked at the inter-observer variation between 21 examiners when repeatedly calculating the AO six times for a single impact pattern on a plain white wall. An impact rig which consisted of a spring tension arm was positioned and fixed 45 cm from the X wall (right wall), and 45 cm from the Y wall (left wall). This experimental design resembles an impact blow for a bloodletting event. The AO was unknown to all examiners, making it a blind study. The collected results were documented in a Microsoft Excel datasheet and later analysed. From previous literature, a 30 cm acceptable allowance was utilised for AO analysis; however, there is currently no accepted standard error for this type of analysis. The overall total 3D mean error for all examiners was 5.62 cm. The maximum error for any one impact analysis was 24.27 cm. The variation of the data, which was collected by all examiners, was documented as X = 1.14 cm, Y = 1.24 cm, Z = 1.68 cm, and the total 3D error = 2.28 cm. The total 3D error for any one examiner and the variance between examiners did not exceed the 30 cm acceptable allowance utilised in previous literature.     

Developmental Validation of the ANDE 6C System for Rapid DNA Analysis of Forensic Casework and DVI Samples

A developmental validation was performed to demonstrate reliability, reproducibility, and robustness of the ANDE Rapid DNA Identification System for processing of crime scene and disaster victim identification (DVI) samples. A total of 1705 samples were evaluated, including blood, oral epithelial samples from drinking containers, samples on FTA and untreated paper, semen, bone, and soft tissues. This study was conducted to address the FBI’s Quality Assurance Standards on developmental validation and to accumulate data from a sufficient number of unique donors and sample types to meet NDIS submission requirements for acceptance of the ANDE Expert System for casework use. To date, no Expert System has been approved for such samples, but the results of this study demonstrated that the automated Expert System performs similarly to conventional laboratory data analysis. Furthermore, Rapid DNA analysis demonstrated accuracy, precision, resolution, concordance, and reproducibility that were comparable to conventional processing along with appropriate species specificity, limit of detection, performance in the presence of inhibitors. No lane-to-lane or run-to-run contamination was observed, and the system correctly identified the presence of mixtures. Taken together, the ANDE instrument, I-Chip consumable, FlexPlex chemistry (a 27-locus STR assay compatible with all widely used global loci, including the CODIS core 20 loci), and automated Expert System successfully processed and interpreted more than 1200 unique samples with over 99.99% concordant CODIS alleles. This extensive developmental validation data provides support for broad use of the system by agencies and accredited forensic laboratories in single-source suspect-evidence comparisons, local database searches, and DVI.