The who, what, and why of risk adjustment: a technology on the cusp of adoption

Risk adjustment (RA) consists of a series of techniques that account for the health status of patients when predicting or explaining costs of health care for defined populations or for evaluating retrospectively the performance of providers who care for them. Although the federal government seems to have settled on an approach to RA for Medicare Advantage programs, adoption and implementation of RA techniques elsewhere have proceeded much more slowly than was anticipated. This article examines factors affecting the adoption and use of RA outside the Medicare program using case studies in six U.S. health care markets (Baltimore, Seattle, Denver, Cleveland, Phoenix, and Atlanta) as of 2001. We found that for purchasing decisions, RA was used exclusively by public agencies. In the private sector, use of risk adjustment was uncommon and scattered and assumed informal and unexpected forms. The most common private sector use of RA was by health plans, which occasionally employed RA in negotiations with purchasers or to allocate resources internally among providers. The article uses classic technology diffusion theory to explain the adoption and use of RA in these six markets and derives lessons for health policy generally and for the future of RA in particular. For health policy generally, the differing experiences of public and private actors with RA serve as markers of the divergent paths that public and private health care sectors are pursuing with respect to managed care and risk sharing. For the future of RA in particular, its history suggests the need for health service researchers to consider barriers to use adoption and new analytic technologies as they develop them.     

The effect of the ageing of crime scene objects on the results of scent identification line-ups using trained dogs

In a scent identification line-up, a trained dog matches the scent trace left by a perpetrator at the crime scene to the odour of a suspect in a line-up of different odours. The procedures are strictly defined and the results are routinely used by the police and as evidence in court in a number of European countries. This paper describes the effect of ageing of the odour trace collected at the crime scene on the performance of the dogs in recognising the perpetrator in a line-up. The results show that whilst the dogs perform faultlessly in matching odours collected on the same day, the results drop to a lower level and become more variable in the period studied (2 weeks to 6 months). However, the results do not show a systematic decrease in performance. A possible explanation is the development of a steady state in the glass jars containing the perpetrator odour trace after initial differential evaporation of components of the residue or break down of unsaturated components into saturated ones. Prevention of this initial change may prevent the drop in performance observed in this study, thus increasing the reliability of these scent identifications.     

A new retrieval system for a database of 3D facial images

A new retrieval system for a 3D facial image database was designed and its reliability was experimentally examined. This system has two steps, firstly to automatically adjust the orientation of all 3D facial images in a database to that of the 2D facial image of a target person, and then to identify the facial image of the target person from the adjusted 3D facial images in the database using a graph-matching method. From the experimental study [M. Yoshino, K. Imaizumi, T. Tanijiri, J.G. Clement, Automatic adjustment of facial orientation in 3D face image database, Jpn. J. Sci. Tech. Iden. 8 (2003) 41-47], it is concluded that the software developed for the first step will be applicable to the automatic adjustment of facial orientation in the 3D facial image database. In 28 out of 110 sets (25.5%), the 3D image of the target person was chosen as the best match (from a database of 132 3D facial images) according to the similarity of the facial image characteristics based on the graph matching. The 3D facial image of the target person was ranked in the top of 10 of the database in 75 out of 110 sets (68.2%). These results suggest that this system is inadequate for the identification level, but may be feasible for screening method in a small database. It will be necessary to further pursue the possibility of realization of a facial image retrieval system for a large database such as suspects' facial images in future.     

Mitochondrial DNA error prophylaxis: assessing the causes of errors in the GEP'02-03 proficiency testing trial

A qualitative and quantitative analytical method was developed and validated for the determination of 49 licit and illicit drugs in oral fluid. Small oral fluid samples, volume 1mL, were collected from volunteers using a modified Omni-Sal device and the analytes were extracted from an oral fluid/buffer mixture using a single Bond Elut Certify solid phase extraction cartridge. Liquid chromatography-tandem mass spectrometry (LC-MS-MS) and gas chromatography-repetitive full scan mass spectrometry (GC-MS) were used in parallel to analyze the extracts for the targeted drugs. Extracts were analyzed by GC-MS in their underivatized form and as their pentafluoropropionyl derivatives. Deuterated internal standards were used for quantification of drugs of abuse by LC-MS-MS to minimize matrix effects. Methadone-d(9) and tumoxetine were used as the internal standards for quantification of non-derivatized and derivatized analytes respectively by GC-MS. Linearity was demonstrated over the range 5-200 ng/mL and limits of detection were less than 4 ng/mL for each drug analyzed. The method demonstrated acceptable recoveries for most of the analytes and good intra- and inter-day precision. Acquisition of data by repetitive full scan GC-MS allows the addition of further analytes to the target menu.     

Reliability of the methods applied to assess age minority in living subjects around 18 years old. A survey on a Moroccan origin population

We present a review of a population of 114 immigrant Moroccan males for which an age estimation was requested. The subjects' real chronological age was confirmed by the Moroccan Embassy in Spain. The confirmed age range was between 13 and 25, with an average age of 18.1 years and a standard deviation of 2.03. The following tests were performed to arrive at the forensic estimation of age: general physical examination, carpus X-ray (Greulich and Pyle method) and dental orthopantomography to determine the degree of maturity of the third inferior molars (Demirjian's method). Carpus X-ray (skeletal age) was the most useful method, followed by Demirjian's method (dental age), as prediction factors of a chronological age of over or under 18. The combination of skeletal and dental age variables represented a significant improvement in the prediction of the chronological age of the subjects in this population, reducing the number of ethically unacceptable test errors to a minimum.     

Validation of a 21-locus autosomal SNP multiplex for forensic identification purposes

A single nucleotide polymorphism (SNP) multiplex has been developed to analyse highly degraded and low copy number (LCN) DNA template, i.e. <100 pg, for scenarios including mass disaster identification. The multiplex consists of 20 autosomal non-coding loci plus Amelogenin for sex determination, amplified in a single tube PCR reaction and visualised on the Applied Biosystems 3100 capillary electrophoresis (CE) system. Allele-specific primers tailed with shared universal tag sequences were designed to speed multiplex design and balance the amplification efficiencies of all loci through the use of a single reverse and two differentially labelled allele denoting forward universal primers. As the multiplex is intended for use with samples too degraded for conventional profiling, a computer program was specifically developed to aid interpretation. Critical factors taken into account by the software include empirically determined extremes of heterozygous imbalance (Hb) and the drop-out threshold (Ht) defined as the maximum peak height of a surviving heterozygous allele, where its partner may have dropped out. The discrimination power of the system is estimated at 1 in 4.5 million, using a White Caucasian population database. Comparisons using artificially degraded samples profiled with both the SNP multiplex and AMPFISTR SGM plus (Applied Biosystems) demonstrated a greater likelihood of obtaining a profile using SNPs for certain sample types. Saliva stains degraded for 147 days generated an 81% complete SNP profile whilst short tandem repeats (STRs) were only 18% complete; similarly blood degraded for 243 days produced full SNP profiles but only 9% with STRs. Reproducibility studies showed concordance between SNP profiles for different sample types, such as blood, saliva, semen and hairs, for the same individual, both within and between different DNA extracts.     

Information,apprehension, and deterrence: Exploring the limits of police productivity

The capacity of police departments to solve crimes and apprehend offenders is low for many types of crime, particularly crimes of profit. This article reviews a variety of studies of police apprehension and hypothesizes that an important determinant of the ability of the police to apprehend criminals is information. The complete absence of information for many types of crime places fairly clear upper bounds on the ability of the police to effect solutions.To discover whether these boundaries are high or low we analyzed data from the 1973 National Crime Panel about the types and amount of information potentially available to police through victim reports and patrol activities. The evidence suggests that if the police rely on information made readily available to them, they will never do much better than they are doing now. On the other hand, there appears to be more information available to bystanders and passing patrols than currently is being used, which suggests that surveillance strategies and improved police methods for eliciting, recording, and analyzing information supplied by victims and witnesses might increase the probability of solving crimes and making arrests. In light of this we review a few possibly helpful innovations suggested in the literature on police productivity and procedure.