Causes of death of patients in an institution for the developmentally disabled

The causes of death of 53 severely to profoundly developmentally disabled patients who died in an intermediate care facility were reviewed. Respiratory disease, predominantly pneumonia and aspiration, accounted for 72% of deaths. Seven patients died of nonrespiratory causes, and in 8 patients, no cause of death could be determined, even after a complete autopsy or investigation. The median age at death was 20 years. The weights of these patients' organs at autopsy were lower than those for normal individuals of the same age. The lifespan of these severely impaired individuals continues to be significantly shortened, even with improved methods of care.     

The paradoxical politics of provider reempowerment

The recent decline, indeed perhaps dismantling, of managed care is sometimes treated as both consequence and cause of the political reempowerment of medical providers, whose professional dominance managed care had challenged. Drawing evidence from Round III of the Community Tracking Study of the Center for Studying Health System Change, this article reviews the politics of four "arenas" of managed care regulation--prompt payment, mandated benefits, external appeals, and financial solvency--and concludes that the power of providers is contingent on patterns of coalition and conflict that differ across the discrete arenas. The zero-sum connotations of the "de" and "re" empowerment of providers under managed care fail to capture the subtlety of providers' search for fresh cultural, economic, and political resources in shifting policy contexts.     

Occupational safety and health in Poland in the 1990s: A regulatory system adapting to societal transformation

The societal transformation underway in Poland createda fundamental challenge to the occupational health and safety system, as the ideological and administrative principles on which it was founded vanished along with the communist-dominated regime. This paper examines the regulatory reform in Poland during the 1990s: its structural elements, implementation record and future prospects. Drawing on five case studies of privatized firms, a mailed questionnaire, and policy and institutional analysis, we find that Poland had considerable success in developing an effective regulatory system for managing occupational health hazards in privatized sector while also achieving considerable socioeconomic progress. The fundamental legitimacy of the regulators and regulatory process, the availability of information about firms and regulatory intents, and the capacity for case-specific decision making, are among the key explanatory factors. The case-specific implementation in Poland is consistent with models advocated by several authors in relation to other industrialized European economies (termed variously as negotiated compliance, tit-for-tat, cooperation-deterrence), despite a uniquely Polish context related to the continuing legacy of the communist era. The study also shows how in Poland a good fit between regulatory institutions and policies on the one hand, and their social context on the other hand, contributes to the effectiveness of the regulatory system.     

Et Tu, Counselor: may an in-house attorney file a qui tam action against the attorney's employer?

Most corporations probably do not consider their in-house counsel to be potential qui tam threats. That may be a naive assumption. Case law provides an illustrative view of the legal ramifications involved when an attorney brings a qui tam suit. In general, there is no prohibition on attorneys who wish to bring these actions. Nevertheless, a corporation can take preventive steps to eliminate the likelihood of attorney qui tam actions. In addition, the corporation can take advantage of state professional ethics laws to mount a defensive action against the attorney who files any such action.     

Image analysis of gunshot residue on entry wounds. II--A statistical estimation of firing range.

A statistical investigation of the relationship between firing range and the amount and distribution of gunshot residue (GSR), used automated image analysis (IA) to quantify GSR deposit resulting from firings into pig skin, from distances ranging between contact and 45 cm. Overall, for a Ruger .22 semi-automatic rifle using CCI solid point, high velocity ammunition, the total area of GSR deposit on the skin sections decreased in a non-linear fashion with firing range. More specifically there were significant differences in the amount of GSR deposited from shots fired at contact compared with shots fired from distances between 2.5 and 45 cm; and between shots fired from a distance of 20 cm or less, with shots fired at a distance of 30 cm or more. In addition, GSR particles were heavily concentrated in the wound tract only for contact and close range shots at 2.5 cm, while the particle distribution was more uniform between the wound tract and the skin surfaces for shots fired from distances greater than 2.5 cm. Consequently, for future scientific investigations of gunshot fatalities, once standards have been established for the weapon and ammunition type in question, image analysis quantification of GSR deposited in and around the gunshot wound may be capable of providing a reliable, statistical basis for estimating firing range.     

The linguistic fault: The case of Foucault's archaeology

It is argued that the concept of discursive formation presented by Foucault provides the means whereby conventional treatments of ‘discourse’ can be criticized. These would include historical, linguistic and epistemological forms of investigation. But it is also argued that Foucault does not sufficiently displace linguistic categories. As a result his account of the theoretical problems of ‘conditions of existence’ of discourses cannot be sustained.