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.     

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.     

An end to a rumour

Mardin, is a city in the southeastern part of Turkey where people from different cultures and religions have been living together peacefully for centuries. The province hosted many valuable historical constructions representing different civilizations. Kasimiye Medresse, one of the most important educational centers of its times, has a sacred value for people in Mardin. The reason is that the stain on the wall of Kasimiye Medresse is considered to be Sultan Kasim's blood. Our study aims to analyze if the stain in question is blood. Serological tests are performed by using "Kastle-Meyer" and "Luminol" reactives on the scrapped samples taken from stained and unstained parts of the wall. At the end of the analysis, the stain is turned out to be a dye made of herbal roots ending the rumour of centuries.     

Simple Bayesian Inference for Qualitative Political Research

In political science and related disciplines in the social andbehavioral sciences, there exists an unfortunate de facto dividebetween qualitative and quantitative empirical research. Sometimesthis divide is purely a function of training and disciplinarysocialization, but often it reflects a valid dispute over thephilosophical foundations of inquiry. I argue here that theBayesian approach to quantitative empirical modeling is an amenablestarting point for building a rapprochement between qualitativeand quantitative research, and I introduce as an example a straightforwardmodel that allows for the Bayesian estimation of the differencebetween means of very small samples with unknown and possiblyunequal variances. I then extend this approach to consider nonnormalvariates, informative priors, and a multivariate test of thedifference of means useful for the researcher who is interestedin determining whether two small samples are different on severaldimensions simultaneously.     

Persecution of Jewish forensic pathologists

Not even forensic pathologists were spared by the anti-Jewish laws of the Third Reich. Fritz Strassmann and Paul Fraenckel were among more than 140 faculty of the Berlin Department of Medicine persecuted by the national socialist dictatorship. It was because of their Jewish background that Georg Strassmann was expelled from university in Breslau, and Leone Lattes was forced to leave in Pavia. Miklós Nyiszli was deported from Oradea to Auschwitz and forced to perform forensic autopsies. Stefan Jellinek in Vienna, Ludwik Hirszfeld in Warsaw and Friedrich Schiff in Berlin were other medical professionals whose achievements had enriched legal medicine before they became victims of anti-Jewish persecution.     

Expert evaluation of the gunshot distance based on the volume of wound canal in flat bones

Different-distance experimental shots were made from a rifled gun at flat bones. Those shot distances were established, at which the wound canal had the smallest volume, and, at which entry and exit holes were virtually identical and matched the bullet diameter. A bigger shot distance was associated with an increasing volume of the wound canal caused by a bigger exit hole. A smaller shot distance led, also, to an increasing volume of the wound canal caused by bigger entry and exit holes. The volume of the wound canal in flat bones can be used as a reliable criterion in assessing the shot distance.