Interpersonal Aspects of Justice in Relationships Between Consumers and Service Providers: A Confirmatory Factor Analysis

There is a controversy in the justice literature as to whether interpersonal aspects of justice are best represented as one construct (interactional justice) or two (interpersonal justice and informational justice). Using confirmatory factor analysis, we tested competing models of these constructs on a sample of healthcare consumers (n = 1919) with respect to their justice judgments of primary care physicians. We found that the single factor model (interactional justice) represented a better fit to the data. Our results do not necessarily contradict those of prior studies that have found a better fit for a bi-dimensional model in organizational settings, however. Instead, we are suggesting a contingency approach: the results may be due in part to the halo effect, which may manifest itself where consumers are unfamiliar with the service provider and with the complexities of that person’s role.     

Detection of intimate partner violence in a general medicine practice

In this study, an assessment phase is undertaken to determine intimate partner violence (IPV) prevalence. An anonymous survey is followed by a chart review documenting identification of IPV. Two methods are attempted to increase assessment/documentation of IPV: a physician educational intervention and a nursing routine inquiry intervention in one quadrant of the practice. The IPV physician educational intervention includes didactic sessions, an IPV counselor, and resource information. The routine inquiry intervention involves nurses screening female patients for IPV at check-in. IPV is found to be prevalent in a general medicine clinic. An enhanced educational intervention does not increase IPV documentation. A routine inquiry intervention significantly increases documentation of lifetime IPV but does not impact current IPV identification.     

Police confirmation of use of force in Australia: ‘To be or not to be?’

Despite significant transgressions during encounters with Indigenous peoples and marginalised groups, all six state police organisations in Australia espouse the principle of minimum force and identify service and crime prevention as paramount in community interaction and intervention. This article offers some insight and perspective of police talk and thinking about the potential use or avoidance of force. The four Victoria Police focus groups, when confronted by the specific police use of force scenario, speak of the adrenalin rush and the need to achieve results, if reasonable and necessary by force, but also of the desire to control the situation and follow proper police procedures. Officers support ‘Safety First’ principles that advocate a cautionary and suspicious approach to the scenario combined with rational and methodical tactics rather than emotional responses. The reflective talk of individual officers about the hypothetical situation parallels actual behaviour when police collectively and visibly confront public disorder. Control and containment of the situation—whether the scenario or a major crowd disturbance—are paramount while time, in the form of acting slowly and adopting a low-key approach, can be seen as assets in achieving objectives. In both the scenario and police planning for collective action, a readiness to threaten force, rather than actually employ it, appears central to police thinking. Police justification of non-coercive tactics in certain situations can be revealing about their thinking processes in justifying force in other circumstances.

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Reduced punishment in Israel in the case of murder: bridging the medico-legal gap

The psychiatrist's assessment of criminal responsibility of an accused in court for an act of crime has always been a matter of great difficulty. In 1997, clause 300a was incorporated into the Penal Code of Israel, thereby permitting a more lenient punishment for murder than mandatory life imprisonment. The clause includes the definition of what is meant by "severe mental disorder" and "significantly restricted capacity" by the defendant to understand the criminal nature of his or her act and to refrain from committing it. Usage of the concepts "disorder" and "significantly restricted capacity" in addressing the issue of diminished responsibility of the mentally ill is new to the Israeli legal code. The emergence and evolvement of the above concepts are presented through a historical review of the Israeli encoded law concerning mental illness, analyzed from a psychiatric perspective.     

DNA typing: an accessory evidence in doping control

A clear positive case for anabolic steroids doping was confounded by alleged urine tampering during doping control procedures. Review of the chain of custody showed no flaws, but nevertheless the athlete was adamant that the urine sample should be analyzed for DNA in order to support her contention that she was not the donor of the sample. The results obtained showed that the urine sample that scored positive for steroids contained nuclear DNA that could not be matched to the DNA obtained from the athlete's blood. On the other hand, the same urine sample contained mitochondrial DNA whose nucleotide sequences spanning the hyper variable regions HV1 and HV2 proved to be identical to those determined in mitochondrial DNA amplified from the athlete's blood. The occurrence of an extraneous genotype is compatible with exogenous nuclear DNA admixture to the athlete's urine. Alternatively, taking in consideration the mitochondrial DNA, we could not exclude that a sibling or a maternal relative of the athlete could have acted as a donor of the urine utilized for doping control and DNA analysis. Both situations point to possible tampering of the urine by the athlete. Adjudication at CAS maintained previous national and international federation decision that there was no proof of a chain of custody flaw to justify the athlete's allegation of urine substitution after collection.     

Acute selenium poisoning: suicide by ingestion

Selenium is a ubiquitous element in the environment essential to the human diet and widely utilized in industrial processes. Fatal human selenium intoxication is rare. The authors report a case in which investigators recovered a bottle of gun-bluing agent beside a 24-year-old man. He exhibited signs and symptoms typical of acute selenium intoxication presenting with nausea and vomiting, followed by pulmonary edema and rapid cardiovascular collapse approximately 3 to 4 h after ingestion. Classic electrocardiographic (EKG) changes, which have been reported to occur in acute selenium intoxication, included sinus tachycardia with ST wave alteration. Toxicological results confirmed elevated blood and tissue concentrations. The cause of death was ascribed to acute selenium intoxication, which ensued rapidly after oral consumption. The manner of death was suicide. This case report, which presents an overview of acute and chronic selenium poisoning, underscores the value of thorough toxicologic analyses of tissue and body fluids in humans.     

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.     

The effects of skeletal preparation techniques on DNA from human and non-human bone

The forensic pathologist increasingly relies on the forensic anthropologist to be the consulting expert in human identification. Likewise, if identification is not possible from visual inspection of skeletal remains, the forensic biologist may be called upon to conduct DNA analysis. The possibility of downstream DNA testing needs to be considered when skeletal preparation techniques are employed to deflesh human remains, as they have the potential to strongly impact genetic analyses and subsequent identification. In this study, three cleaning techniques, boiling bone in water, in bleach, and in powdered detergent/sodium carbonate, were tested for their effect on nuclear and mtDNA recovery from a variety of human and non-human bones. A statistically significant reduction in DNA yields occurred in non-human bones cleaned with bleach, and DNA degradation was apparent electrophoretically. The human bones also showed much lower yields from bleach cleaning, while the detergent/carbonate method allowed the largest segments of DNA to be amplified, indicating it may have a less degradative effect on bone DNA than either of the other cleaning processes.