The dilemmas of incrementalism: logical and political constraints in the design of health insurance reforms.

Health care reform became a premier issue on the U.S. policy agenda in the 1990s. While the comprehensive proposal put forth by President Clinton failed, states and the federal government successfully pursued a variety of lesser initiatives. This article focuses on a set of reforms intended to make private health insurance more accessible and affordable to individuals and workers in small firms. It outlines the key arguments made by experts to justify stronger regulation of health insurance and the options and difficult tradeoffs that must be considered in policy design. It then examines the scope and strength of legislation adopted by 45 states and the federal government from 1990 to 1996. The substantial variation in state policies demonstrates that even though insurance market reform was the one issue that commanded nearly universal support in the health care debate, few design features were universally accepted by those who crafted the reforms. The article concludes by assessing the pattern of state and federal action. The reforms represent some progress on nominal access to insurance but little progress on the affordability of insurance for individuals and small groups. Few of the reforms present a serious challenge to existing practices and interests of the insurance industry. This pattern of policy design reflects the logical and political constraints of incrementalism. In a system where insurance coverage is voluntary, changes to increase access for one group tend to increase costs and thereby decrease access for another segment of the population. In addition, because incremental reforms will not attract sustained attention and support from the general public, it is politically difficult to impose substantial new regulation on a powerful industry.     

Attachment as an Organizational Construct for Affect,Appraisals, and Coping of Late Adolescent Females

The purpose of this study was to 1) compare general affective dispositions (depression and anxiety) and negative affect during interpersonal conflict as a function of attachment security, 2) examine appraisals as a function of attachment style and as predictors of coping, 3) compare strategies of coping with interpersonal conflict as a function of attachment style, and 4) investigate the roles of attachment style, affect, and appraisals in predicting coping in the context of interpersonal conflict. Seventy-three late adolescent females participated. Insecure participants reported higher levels of depression, anxiety, and negative affect during interpersonal conflicts. Insecure participants were more likely to cope with interpersonal conflicts through support seeking or avoidance. Hierarchical regression analysis indicated that general and specific attachment style, affect, and appraisals significantly predict coping strategies. Implications for general and specific models of attachment as organizational constructs and attachment as a predictor of coping with interpersonal and non-interpersonal stressors are discussed.     

In Search of the Rosetta Stone of the Mediation Profession

Although people have their choice today of an ever-growing number of how-to books and articles about the mediation process, this plenitude was hardly always the case. In fact, back in the early 1950s in the United States, three young mediators with the Federal Mediation and Conciliation Service (FMCS) drafted a 62-page memo on the subject of their work which included 120 different techniques of mediation, many of which would be familiar and useful to practitioners today. Their pioneering work, however, was neither recognized nor encouraged by the FMCS; in fact, it was suppressed. This article focuses on the reasons for the suppression of that work, providing an overview of the vast changes that have taken place in mediation's history and the federal labor-management mediation agency over the past half-century.     

Electrospray and MALDI mass spectrometry in the identification of spermicides in criminal investigations.

Electrospray ionization (ESI) and matrix-assisted laser desorption/ionization (MALDI) mass spectrometry have been used to examine evidence in a sexual assault investigation. Because condoms are being used increasingly by sexual assailants and some condom brands include the spermicide nonoxynol-9 (nonylphenoxy polyethoxyethanol) in the lubricant formulation, the recovery, and identification of nonoxynol-9 from evidence items may assist in proving corpus delicti. A method was developed for the recovery of nonoxynol-9 from internal vaginal swabs and for its identification by reverse phase liquid chromatography/electrospray ionization mass spectrometry (LC ESI-MS), nanoelectrospray ionization (nanoESI) mass spectrometry, and high resolution MALDI Fourier transform mass spectrometry (MALDI-FTMS). The method was tested on extracts from precoitus, immediate postcoitus, and four-hours postcoitus vaginal swabs provided by a volunteer whose partner does not normally use condoms, but for this trial used a condom having a water-soluble gel-type lubricant that includes 5% nonoxynol-9 in its formulation. Subsequently, LC ESI-MS was used to identify traces of nonoxynol-9 from the internal vaginal swab of a victim of a sexual assault.     

Another death due to ingestion of Nicotiana glauca

Deaths attributed to ingestion of Nicotiana glauca are extremely rare. We report here a case where a 43-year-old man was found dead after apparently drinking a water extract of Nicotiana glauca. The primary alkaloid in the plant is anabasine. Toxicological analysis by capillary gas chromatography showed the deceased had a blood anabasine concentration of 2.2 mg/L. Clinically, the features of poisoning are nicotine-like and if death occurs it results from respiratory paralysis. The case further supports the view that, in the human, anabasine is considerably more toxic than nicotine.