The Independent Medicare Advisory Committee: death panel or smart governing?

This comment explores whether health care reform legislation establishes an administrative body effectively charged with the rationing of health care resources; insofar as it establishes a presidentially appointed Independent Medicare Advisory Committee (IMAC). IMAC would be charged with "making two annual reports dictating updated rates for Medicare providers including physicians, hospitals, skilled nursing facilities, home health, and durable medical equipment." IMAC's recommendations would be implemented nationally, subject to a Congressional vote. Congress would be granted a thirty-day window to achieve a simple majority for or against the IMAC recommendations. Part I is an introduction. Part II of this article covers the history of American health care. It lays out the federal government's evolving role in the arena of public health and health care, starting in the mid-nineteenth century and continues up to the present day. Part III examines the existing process by which Medicare spending is controlled. This part focuses on the administrative procedures that control Medicare reimbursements. Part IV examines IMAC. This part discusses IMAC's statutory provisions and the administrative transparency laws IMAC would be bound to follow. The close of this part, draws on three analogies as a gauge for how IMAC will operate: Senator Tom Daschle's Federal Health Board (FHB) proposal; the administrative oversight of the Federal Reserve; and the United Kingdom's National Institute for Health and Clinical Excellence (NICE). Part V creates a snapshot of the U.S. health care system as it operates today. This part emphasizes cost, quality, and accessibility of health care, with comparisons to international and state-run health care systems. Throughout this article there are a number of words, phrases, and agencies that have been given acronyms. For convenience, an index of these acronyms is provided in an appendix following the article.     

Opportunity Lost? Victorian Labor's Enactment of Community Development 1999–2006

The idea of community development has been evoked by Australian governments over many decades. The expressions of community have differed widely, often as a result of politics rather than informed policy. In 1999, after seven years of radical neo‐liberal restructuring in Victoria, the Bracks government found itself unexpectedly elected to power. They faced new challenges such as a diminished public sector, growing social inequality and climate change. The first two terms of Victorian Labor were a seminal period in terms of the role they would invoke for ‘community’. Did grass roots participation take a central place, or did rhetoric rule over substance? The evidence points to a government maintaining a neo‐liberal trajectory, and thereby losing an opportunity to enable an active citizenry.     

Segmental determination of ethyl glucuronide in hair: a pilot study

Ethyl glucuronide (EtG) is a minor metabolite of ethanol. Its detection in hair is more and more studied in both clinical and forensic context for the purpose of alcohol abuse monitoring. In this pilot study, hair specimens from 15 patients included in a treatment program after alcohol abuse cessation, were segmented and analyzed for EtG. The results were then compared to their self-reported past alcohol consumption and to their blood biomarkers values (GGT, MCV, ASAT, ALAT). EtG concentrations measured in hair varied from 8 to 261 pg/mg. The pattern of EtG concentration detected in the different hair segments matched with the drinking history of patients, displaying variations (increase and decrease) in alcohol consumption and also time of cessation. Results also demonstrated the existence of a significant correlation (r(p)=0.5357; p=0.0390) between EtG concentration in hair and the amount of alcohol intake. Variations in the EtG concentrations with respect to hair segments may provide an overview of the drinking history of patients. Moreover, EtG concentration in hair may help to estimate the daily alcohol intake.     

Knocking at the wrong door: insured workers' inadequate psychiatric care and workers' compensation claims

ObjectiveTo describe the prevalence of inadequately evaluated and treated psychopathology among insured workers making workers' compensation claims for psychiatric disability whose cases were reviewed by one forensic psychiatrist. To assess the relationship of inadequate evaluation and treatment to the outcomes of these workers' compensation claims.MethodsRecords of a series of 185 workers' compensation cases reviewed in 1998 and 1999 by a California forensic psychiatrist were abstracted. Patient factors (gender, Axis II pathology, psychosocial circumstances, substance abuse), case factors (psychiatric injury secondary to physical injury, or secondary to psychological stresses), type of provider (mental health, or other), adequacy of evaluation and treatment, forensic psychiatrist's recommendation, and claim outcome were categorized. The relationships between case characteristics, adequacy of care, and claim outcome were described.Results22% of cases had adequate evaluation, 48% superficial, and 30% had no evaluation. 11% had adequate treatment, 67% superficial, and 22% had no treatment. Compared to claims for psychiatric disability related to a physical injury, claims related to psychosocial stresses more often had superficial diagnostic evaluations and treatments. Those with superficial treatment were less likely to have their claim granted (19.3%) than those with no treatment (47.5%) or those with adequate treatment (36.8%). Success of claim was not related to provider type.ConclusionsThe majority of the studied workers with employer-provided health insurance who sought workers' compensation for disability due to mental illness did so inappropriately, in that the workplace did not cause the psychopathology. Their seeking workers' compensation was plausibly due to the observed inadequate evaluation and treatment available through their employer-provided health insurance. The adequacy of their care influenced the likelihood their claim would be granted. The relations observed here merit further research to establish their generality and to determine their causes.     

The null hypothesis is not called that for nothing: statistical tests in randomized trials

This article aims to update readers on different ways to arrange one’s thinking about conventional null hypotheses in randomized trials. It covers basic criticism of conventional hypotheses and, beyond this, covers relevant developments in methodological, organizational, and science policy arenas. This article includes coverage of new ways to frame null hypotheses, new technical resources, standards for registering trials and reporting on them, cumulating results, common mistakes, and post-trial analysis of null results. The paper includes ideas for research and development on each topic.

Political marketing in untraditional campaigns: the case of David Cameron's Conservative Party leadership victory

• This study investigates the concept of political market orientation (PMO) in an untraditional setting, namely the 2005 contest for the leadership of the British Conservative Party. Based on a collective case‐study method, a content analysis of candidates' speeches and manifestos is provided. We operationalize four attitudinal constructs of a conceptual PMO model and adapt them to suit the novel campaign context. Our findings show further evidence for the existance of a ‘gravitational centre’ effect hypothesized in earlier studies. Furthermore, we qualify the concept of PMO through a long‐term focus and a context‐specific evaluation of the merits of alternative PMO profiles. Thus, the generic conceptual model of political market orientatation, which previously has only been used in the content of parties contesting a general election campaign, can be adapted to alternative campaign situations without a reduction in its explanatory power.

Copyright © 2007 John Wiley & Sons, Ltd.     

Gunshot residue in Chicago police vehicles and facilities: an empirical study

Suspects in shooting investigations in Chicago are routinely transported in department vehicles and detained in department facilities prior to gunshot residue (GSR) evidence collection. The GSR test results are used to associate the suspect with primary exposure to GSR. The potential for these vehicles and facilities being sources of secondary GSR contamination needed to be determined. A total of 201 samples were collected from randomly selected vehicles and detention facilities. The sampling collected trace materials from surfaces that suspects' hands may contact during the arrest process. These samples were examined for the presence of GSR particles using scanning electron microscopy. Upon completion of the automated analysis, those particles that met an initial GSR screening criterion were relocated and reanalyzed. The locations where GSR particles were recovered allowed us to make recommendations to the Chicago Police Department with regard to transporting and detaining these suspects. The low number of GSR particles recovered suggests that the potential for secondary contamination, although present, is relatively low.     

High Resolution Imaging of Latent Fingerprints by Localized Corrosion on Brass Surfaces

Abstract:  The Atomic Force Microscope (AFM) is capable of imaging fingerprint ridges on polished brass substrates at an unprecedented level of detail. While exposure to elevated humidity at ambient or slightly raised temperatures does not change the image appreciably, subsequent brief heating in a flame results in complete loss of the sweat deposit and the appearance of pits and trenches. Localized elemental analysis (using EDAX, coupled with SEM imaging) shows the presence of the constituents of salt in the initial deposits. Together with water and atmospheric oxygen—and with thermal enhancement—these are capable of driving a surface corrosion process. This process is sufficiently localized that it has the potential to generate a durable negative topographical image of the fingerprint. AFM examination of surface regions between ridges revealed small deposits (probably microscopic "spatter" of sweat components or transferred particulates) that may ultimately limit the level of ridge detail analysis.     

A Comparison of Cleaning Regimes for the Effective Removal of Fingerprint Deposits from Brass

Abstract:  Effective removal of fingerprint deposits is crucial for experimentation related to the corrosion of metals by fingerprint deposits. Such removal is also necessary prior to deposition of test fingerprints. The effectiveness of four regimes in removing fingerprint deposits from brass is considered. Sustained wiping of the deposit with a tissue at applied pressures of up to c . 1430 Pa or rubbing while the brass was immersed in acetone both failed to remove completely all traces of fingerprint deposits. Heating the brass to 600°C was an effective remover; however, this also oxidized the surface of the metal except where inhibited by fingerprint deposits. The most effective regime, and the only one of the four that removed all traces of deposit without affecting the properties of the metal surface, was immersion in warm soapy water while rubbing with a tissue. We propose this as the preferred method for fingerprint removal.