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The American health care system appears to suffer from higher costs and less access than the health care systems of other industrialized nations. This perception has set social scientists searching for "lessons from abroad." This paper places the dialogue about health system lessons within the context of American political culture. It sketches out some of the distinctive dynamics in the American policymaking process. Those dynamics help explain the problems we face, the programs we have pursued, and the alternatives we have foregone. The same political process which shaped past policies is likely to frame any lessons we try to import from abroad.  相似文献   
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The case of the death by arsenic poisoning of a 62-year-old white man is presented. One year prior to death, he developed intermittent bouts of severe gastroenteritis with vomiting and diarrhea, hyperpigmentation and keratosis of the skin, neutropenia, and Guillain-Barré-like neuropathy for which he was hospitalized several times. Urine test results 6 months prior to death indicating 36 mg/L arsenic were believed to be in error. At the patient's last admission, he appeared in the emergency room with severe gastroenteritis, hypotension, and dehydration. He died 3 days later. Antemortem as well as autopsy specimens revealed elevated arsenic concentrations. Arsenic micrograms/g analysis by neutron activation of hair pulled from the man's head revealed by centimeter segmental analysis proximal to distal: 226, 104, 28, 56, 41, 40, and 74. The wife of the decedent was charged with murder by arsenic poisoning of this, her fifth, husband. The defense alleged that the decedent had committed suicide. The judge awarded a directed verdict of "not guilty." Particulars of the medical, toxicological, and investigative findings are presented.  相似文献   
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In the summer of 1984, police in Pinellas County, Florida, confiscated six identically colored imported Asian skulls (in a shipping case) from a private citizen. In May 1988, in nearby Hillsborough County, police confiscated a very similar skull from another private citizen, who allegedly had found it in an abandoned house. Aside from slight color differences between the six found in Pinellas County and the one found in Hillsborough County, the skulls are virtually identical in their osteological characteristics and condition and in the vital statistics derived from each. Each skull is as clean and dry as those typically sold by commercial scientific supply outlets in the United States. Each is edentulous (primarily premortem), between approximately 20 and 60 years of age at death, and morphologically Asian. Five of the seven are morphologically male, one is morphologically female, and one is a mosaic with respect to gender-related features. Police, medical examiners, coroners, and forensic anthropologists should be aware of such "souvenir" specimens, in the event that they encounter similar skulls. Discriminant function analyses for race and sex yield considerably conflicting results, which underscores the need for using extreme caution when interpreting forensic science estimates based on such techniques.  相似文献   
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The authors developed a method of malathion insecticide determination in the cadaveric material (blood and wall of the stomach) including extraction of 5 ml of blood (5 g of fragmented tissue of stomach wall) by hexan; preparative chromatographic purification of extract on silicagel layer L 5/40 mkm in hexan-diethyl ether system 10:2; Gas-liquid chromatographic investigation on column with 5% SE-30 and 5% XE-60 (Chromatograph "Colour-106" with thermionic detector). This method makes it possible to detect 72-76% of malathion added.  相似文献   
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This paper examines the process by which R&D results funded by the Office of Conservation and Renewable Energy (CE) of the US Department of Energy (DOE) have generated commercial applications. It looks at examples of technology-transfer procedures and activitees across three of CE's component offices that correspond to the major energy end-use sectors: transportation, buildings, and industry. On the surface, the conservation programs would appear to have little strategic consistency and, therefore, lack the clear leadership many seek in a technology-transfer program. However, as an alternative to strategic consistency, one may tailor the technology-transfer approach of each program to its unique circumstances. This paper presents case studies of such tailoring, in which the diversity of approaches mirrors the complexity of the energy end-use markets and the private-public interests that must be negotiated to successfully commercialize energy-saving innovations. The paper discusses the lessons learned about the conditions requiring adaptive design and the structures and practices that have been proven effective.  相似文献   
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