Health care in Canada: patterns of funding and regulation

During the 1970s the share of health care expenditure in Canadian GNP remained roughly stable, in the range of 7-71/2 percent of GNP, in marked contrast to its escalation in most other countries (the U.S. in particular) and to previous Canadian experience. The shift to a stable pattern coincided with the completion of the Canadian system of universal comprehensive public hospital and medical care insurance. This paper explores how and why the public insurance system served to contain cost escalation. It then discusses the inadequacy of expenditure experience per se as a basis for health system evaluation--the same data will support claims of both "underfunding" and "spiralling costs." More serious questions involve the influence of alternative patterns of health care funding and delivery on the effectiveness and efficiency of care provision, and the resulting distributional patterns of care and income. A brief sketch is given of the present situation and future possibilities of Canadian health care under these heads.     

Refining the definition of death for Australian legislation

In the article Mr. Smith considers the need for reform in the area of defining when death occurs and the various approaches that exist to define death. He then analyses the stages of the developments in the various Australian jurisdictions and discusses the substantive content of the basic definition adopted and the practical implications of any enactment. The author suggests that the concept of death should be legislatively enacted in relevant pieces of legislation which call for a resolution of the question at the present time and a more general separate statement defining death should be avoided at the moment. Conceptually death should be defined as the permanent and irreversible loss of consciousness of the individual as determined by irreversible cessation of the brain stem function. The actual operational criteria of death should form the subject of a circular published by the relevant statutory health authority for the guidance of medical practitioners in relation to the specific problems they face.     

Genetic markers in human bone: I. Deoxyribonucleic acid (DNA) analysis.

Deoxyribonucleic acid (DNA) was isolated from a number of spongy and compact human bone tissue specimens, and the yield was estimated on a "per milligram of starting tissue" basis. DNA was, in addition, isolated from a number of corresponding blood and bone tissue specimens. Spectrophotofluorometry and ethidium bromide visualization on minigels were used to estimate the quantity and degree of degradation of DNA. The DNA from several blood-bone pairs is shown to give concordant restriction fragment length polymorphism (RFLP) typing results by two different typing protocols with five different single-locus probes. DNA from several additional blood-bone pairs is shown to give concordant results for human leucocyte antigen (HLA)-DQ alpha phenotypes following polymerase chain reaction (PCR) amplification and hybridization to specific allele-specific oligonucleotide (ASO) probes, and for the variable numbers of tandem repeats (VNTR) length polymorphisms 3' to the human apolipoprotein B (APOB) gene following PCR amplification with specific primers and analysis of the products by electrophoresis and ethidium bromide visualization.     

Technological, economic, and political feasibility in OSHA's Air Contaminants Standard

In 1989, after almost two decades of substance-by-substance standard setting, the Occupational Safety and Health Administration (OSHA) promulgated its Air Contaminants Standard, imposing new exposure limits for 376 toxic substances encountered in U.S. industry. In marked contrast to earlier regulations, the Air Contaminants Standard has generated relatively little industry opposition. This paper analyzes the standard in the context of the twenty-year debate over the appropriate role for technological feasibility and economic compliance costs in occupational health policy. The political feasibility of the new standard is traced to OSHA's abandonment of "technology forcing" in favor of reliance on "off-the-shelf" technologies already in use in major firms. While important as an embodiment of OSHA's new "generic" approach to regulation, the Air Contaminants Standard cannot serve as a model for future occupational health policy, due to its reliance on informal, closed-door mechanisms for establishing regulatory priorities and permissible exposure limits.     

"Beaten to death". An autopsy series of homicidal blunt force injuries

Although gunshot is by far the most common means of homicide in the United States, significant numbers of homicides are also perpetrated by other means. Blunt-force injuries are produced by a variety of objects, including hands and feet and many different weapons. Some of these objects produce distinctive patterns of injury of potential evidentiary value. This paper presents a series of 20 consecutive blunt-force homicides in adults. Seventy percent (14 cases) of the victims were men. Thirty percent (six cases) followed an argument or altercation. A number of the weapons used were "weapons of opportunity" seized in the course of the incidents. Sixty-nine percent (nine cases) of known assailants were acquainted with their victims. Few characteristic patterned injuries were seen. Not surprisingly, craniocerebral trauma was the most common cause of death. One half (10 cases) the victims survived their assaults for varying periods of time. Homicides due to blunt-force injury still pose a significant challenge for the forensic pathologist, who must obtain a complete and accurate history of the fatal incident, interpret patterns of injury and other findings at autopsy, and correlate all of the findings to make an accurate ruling of the cause and manner of death.     

Contribution à une analyse narrative de la théorie institutionnelle

Conclusion Que faut-il penser de la co-existence de trois modèles différents pour interpréter l'élément central de la théorie institutionnelle de MacCormick? Cette pluralité de modèles n'est source de perturbations que pour ceux qui tiennent à défendre l'idée selon laquelle il n'y a qu'une seule forme possible de discours juridique. Dès qu'il est accepté — comme hypothèse de base — que les formes d'organisation de ce type de discours peuvent être multiples, la perspective est inversée.C'est le schéma explicatif — dit schéma narratif — qui est alors unique. Quant aux différentes variantes de la formule de MacCormick, elles représentent les altérations de cette définition en fonction de paramètres identifiables — et identifiés — comme le statut des différents actants et acteurs, la définition de l'objet de valeur final dont ils cherchent à s'emparer et les objets de valeur d'usage dont ils se servent.L'éclatement de la formule de Maccormick ne correspond alors plus à un rejet mais bien à une mise en question. Cette remise en question débouchant sur la reconnaissance de plusieurs schémas narratifs, nous devons nous demander dans quelle mesure notre perception de la phasep correspond à l'idée que s'en fait MacCormick. S'agit-il seulement de la procédure au sens juridique du mot ou de tout un ensemble d'actes permettant de persuader un destinateur comme un juge ou une administration de la coïncidence entre un parcours narratif effectif et le type idéal de parcours narratif qu'ils tirent de la lecture des normes juridiques?S'il s'agit bien de la procédure au sens juridique de ce mot, il faut alors préciser au terme de cette analyse sémio-narrative que l'ensemble des phénomènes pragmatiques — comme les interactions dans le cas d'une procédure orale — ne sont pris en compte ni par la formule de MacCormick, ni par la présente discussion mais qu'ils relèvent d'une recherche particulière sur cette dimension supplémentaire, certes compatible avec la théorie sémiotique mais pas avec la théorie institutionnelle de MacCormick. Pour conclure, nous dirons donc qu'il est possible d'intégrer certains éléments de cette dernière théorie dans un cadre plus général mais qu'elle sera vite transformée à la fois de l'intérieur par la reconnaissance d'une pluralité des formes du discours et de l'extérieur par son intégration partielle dans un schéma plus large qui vise à décrire un phénomène dans son intégralité.