Choosing Healthplans All Together: a deliberative exercise for allocating limited health care resources

CHAT (Choosing Healthplans All Together) is an exercise in participatory decision making designed to engage the public in health care priority setting. Participants work individually and then in groups to distribute a limited number of pegs on a board as they select from a wide range of insurance options. Randomly distributed health events illustrate the consequences of insurance choices. In 1999-2000, the authors conducted fifty sessions of CHAT involving 592 residents of North Carolina. The exercise was rated highly regarding ease of use, informativeness, and enjoyment. Participants found the information believable and complete, thought the group decision-making process was fair, and were willing to abide by group decisions. CHAT holds promise as a tool to foster group deliberation, generate collective choices, and incorporate the preferences and values of consumers into allocation decisions. It can serve to inform and stimulate public dialogue about limited health care resources.     

Perianal and vulvar Crohn's disease presenting as suspected abuse

Misdiagnosis of sexual abuse may arise in cases of vulvar and/or perianal diseases such as lichen sclerosus et atrophicus, Behcet's syndrome, bullous diseases, contact dermatitis, or neoplastic lesions. We present the case of a 7-year-old girl who was referred by her general paediatrician to the local hospital for perianal fissures and swelling of the labia majora. A report to the judicial authorities was made, for suspected sexual abuse, and the patient was transferred to the department of paediatric surgery. Here, histopathologic examination of vulvar and rectal biopsies revealed multiple non-caseating and non-confluent epithelioid-gigantocellular granulomas, consistent with a diagnosis of Crohn's disease, with cutaneous involvement of the genitalia. In cases of suspected sexual abuse, examination of children should be performed by a specialist in legal medicine in collaboration with a gynaecologist or paediatric surgeon. If the patient is hospitalised and the question of protection does not arise, physicians should exclude dermatological diseases before reporting to the judicial authorities.     

Medical study: aspiring parents, genotypes and phenotypes: the unexamined myth of the perfect baby

Although many have argued that assisted reproductive technologies ("ARTs") attract those with a desire to genetically engineer their offspring, this claim has yet to be verified. To address this question, we surveyed three groups: the general public, people enrolling in an in vitro fertilization ("IVF") program, and pregnant couples. We asked subject which traits they would select in their children if it were possible to use a magic wand to do so and to value genetic relatedness. In our sample, the potential parents who were using ARTs were less likely to express a desire to select traits in their offspring than were the general public, and just as likely as the pregnant couples, Those using ARTs , however, place greater importance on having genetically related children than the others. Thus, the widely held view that reproductive technology is utilized by those most likely to favor genetic engineering is falsified by out findings.     

Predictions of Future Dangerousness in Capital Murder Trials: Is It Time to “Disinvent the Wheel?”

Although recent U.S. Supreme Court decisions regarding the death penalty (e.g., Atkins v. Virginia, 2002) have renewed interest in mental health issues, one topic that has not received much attention recently is the ongoing use of expert testimony to support claims that defendants represent a continuing threat to society. In this article, we (a) review prior research relevant to determining the accuracy of clinical predictions that capital defendants will commit future acts of criminal violence; (b) summarize new data from current and former death row inmates in Texas that bolster the claim that such predictions are gross overestimates of risk; and (c) review extant research addressing the potential utility of various risk assessment instruments that increasingly are being used to reinforce clinical predictions in capital trials. Despite significant recent advances in the field of risk assessment, clinical assertions that a defendant is likely to commit future violent acts appear to be highly inaccurate and ethically questionable at best. Moreover, available research offers little support for the claim that the accuracy of these predictions will be appreciably improved by relying on more structured risk assessment measures that have some demonstrated predictive validity in other contexts.Portions of this article were written while the first author was a member of the Department of Psychology at Sam Houston State University. The prison inmate data reported in this study also are described in a report by the Texas Defender Service, available at:     

Suicide risk in patients with somatization disorder

The aim of the study was to assess suicide risk in psychiatric outpatients with and without somatization disorder. A total sample of 120 psychiatric outpatients was used in the study, 29 of whom met diagnostic criteria for somatization disorder. The results indicated that somatization disorder was significantly associated with suicide attempts even when the effects of both a comorbid major depressive disorder and a comorbid personality disorder were statistically controlled for. The results suggest that, although a patient meets the criteria for a principal diagnosis of major depressive disorder and/or a personality disorder, it is still of significant importance to decide whether or not the patient also meets the criteria for a somatization disorder in order to more optimally assess suicide risk. The findings highlight the fact that the potential for suicide in patients with somatization disorder should not be overlooked when a diagnosable depressive disorder or personality disorder is not present.     

External injuries to the neck after free fall from great height

Falls from great height are suicidal in most cases. Any antecedent trauma that would indicate an involvement of a third party should, however, be excluded in each case. Herein lies the difficulty in such cases since injuries prior to the fall which could be of criminal nature may be masked by the impact injuries. Injuries on unexposed parts of the body should always raise the suspicion of an involvement of a third party. This applies especially for neck injuries. By a retrospective analysis of 132 cases of falls from great height, the authors conclude, however, that neck injuries may occur after free fall from great height on a flat surface without antecedent trauma.     

Exploratory study on classification and individualisation of earprints

The FearID research project is aimed at the individualisation of earprints for the purpose of forensic research. The study presented here was carried out within the framework of this project. It intends to combine a review of what is known from literature on the classification and individualisation of earprints with results from a preliminary study of earprints. Possibilities for, and limitations to, the use of earprints in forensic investigation are addressed. Differences between eliminating a suspect, placing a suspect at a crime scene, and linking crimes by prints left at different scenes are considered.     

Observations from practice: support group membership as a process of social capital formation among female survivors of domestic violence

This article explores the authors' practice observations of female domestic violence survivors' journey from first agency contact to active participation in a support group process. The authors have witnessed female victims of domestic violence challenging the social isolation imposed by their dominant partners as they search for meaning in their lives. As practitioners, they have observed women building trustful relationships and establishing supportive networks during the group process. In this article, the authors suggest that the support group process facilitates trust and network formation indicative of social capital.     

International Organisation as Coordination in N-Person Games

One major problem in global governance is the specification of decision-making rules for international and regional organisations to coordinate the states of the world. Various organisations use different decision-making rules, and the properties of these rules may be compared systematically in terms of the power index approach. The power index solution concept of N-person games may be employed to display a basic problem in global governance, namely, the fundamental trade-off between state veto on the one hand and the capacity of the organisation or groups of states to act, meaning its decisiveness, on the other hand. Thus, when states coordinate through the setting up and running of international organisations, they then face a trade-off between their own control over the organisation and the capacity of the organisation to act. States make this trade-off in different ways depending upon the nature of the international or regional organisation as they reflect upon what is most important, to wit, own control or the capacity of the group to act.     

Genetic attributes of 15 autosomal STRs in the population of two patagonian provinces of Argentina

Allele frequencies of 15 short tandem repeats (STRs) loci included in the PowerPlex 16 kit (Promega Corp., Madison, WI, USA) were obtained from a sample set of unrelated individuals inhabiting Rio Negro (N=593) and Chubut (N=320) provinces of the Argentinean Patagonia. Comparative analyses between our population data and other Patagonian Province (Neuquen) are presented.