Prospective payment in perspective

Prospective payment promises improvement for a health care system plagued by inefficiency and rising costs, but is likely to disappoint. Serious efforts to control costs threaten the system's access and quality objectives and will be resisted. Moreover, serious cost containment, whether the result of all-payer regulation or competition, requires a stronger civil service than America seems capable of providing. A comparison with the experience in defense demonstrates the important limitations in applying incentive-based models in policy areas with conflicting goals. The search for panaceas will go on, but there are none.     

Evaluation and treatment of insanity acquittees in the community

This paper describes the monitored outpatient treatment program for Psychiatry Security Review Board (PSRB) clients in the largest single community treatment agency in the Oregon system. We describe 161 persons referred to this agency for evaluation and treatment. Ninety-one PSRB clients received treatment and of this group 51% had their conditional release revoked by the PSRB. The most frequent cause of revocation was noncompliance with treatment. There were only 11 crimes committed during the study period, four of which were in the felony range. The majority of PSRB clients are chronically mentally ill persons. We discuss both the treatment approach and our results in light of a recently published research agenda for insanity acquittees.     

Detection of bullet residue in bone using proton-induced X-ray emission (PIXE) analysis

External beam proton-induced X-ray emission (PIXE) analysis has been used to verify the presence of lead in the finger bone of a murder victim. The deceased, who had been buried several years, was known to have suffered a bullet wound to his right hand several years before death. X-ray radiographs of the right second proximal phalanx revealed the possible presence of metal fragments below the surface of the bone. To verify the presence of lead in a nondestructive manner, the bone was scanned with a 1.5-MeV proton beam. PIXE analysis showed that lead was present only in the vicinity of the fragments previously detected in the radiographs. A study of gunshot residue in bone shows that the distribution of lead around the bullet hole is independent of the firing distance for distances greater than 0.6 m.     

Reproduction of atypical bullet exit wounds

Contradictory findings from experiments designed for the reconstruction of the circumstances in crimes committed with firearms induced us to systematically investigate the conditions leading to the occurrence of non-typical bullet exit wounds. For this purpose, skin samples and pig heads were fired at with different types of small arms and, on the exit side, the skin was brought into contact with various materials. The bullet exits were investigated morphologically and by means of emission spectrum analysis. The results from these investigations are classified and discussed.     

Quantitative cross-national studies of economic development: A comparison of the economics and sociology literatures

For more than two decades, economists and sociologists have pursued parallel cross-national quantitative investigations of the determinants of economic development. These investigations have proceeded in mutual ignorance despite the often large overlap in statistical methods and data employed. Apparently contradictory findings have resulted, especially regarding the impacts of international trade and foreign direct investment. We find that there are two factors that account for these inconsistent results. One key factor is the use of different variables to measure international trade and investment, the choice of which is in turn driven by underlying differences in theoretical motivations. A second important difference involves sociologists’ greater preoccupation with more complex multivariate models versus economists’ greater willingness to focus on individual variables in multivariate regressions while viewing others as “controls.” A major finding of our survey is that when thesame variables are used, the results of economists and sociologists tend to be consistent, rather than contradictory (as might have occurred, for example, because of the use of different samples of countries or time periods, or the use of other variables included in the regression equations). We also consider some studies whose purviews go beyond economic growth to consider factors such as income inequality, physical quality of life, demographic change, and basic needs provisioning. Angela Martin Crowly is at the Department of Sociology, University of California, Irvine, Irvine, California 92717. James Rauch is at the department of Economics, University of California, San Diego, La Jolla, California 92093. Susanna Seagrave is at the U.S. General Accounting Office, Washington, D.C. 20548. David A. Smith is at the Department of Sociology, University of California, Irvine, Irvine, California 92717.     

Detection of cocaine metabolite in perspiration stain, menstrual bloodstain, and hair

Low nanogram and picogram quantities of cocaine metabolite equivalents were detected in extracts from perspiration stains, menstrual bloodstains, and hair using radioimmunoassay. The theory of drug inclusion in hair and its significance are discussed.     

Acute effects of carbon monoxide and cyanide on hepatic mitochondrial function

The effects of carbon monoxide and cyanide on the hepatic redox state and energy charge were investigated. Rats were used for the experiment under pentobarbital anesthesia. Immediately after laparotomy, a rat was placed in an animal chamber made of a transparent plastic box and exposed to a test gas for 3 min. Every test gas was produced in a gas chamber connected to the animal chamber with a flexible tube. HCN was produced from NaCN and H2SO4. In the CO inhalation experiment, various amounts of CO were introduced into the gas chamber. Immediately after an exposure, about 2 g liver was frozen in situ with a precooled clamp. Oozed blood from the wound surface was sampled. Concentrations of ATP, ADP, AMP, acetoacetate, and beta-hydroxybutyrate in hepatic mitochondria were determined, and the redox state and the energy charge were calculated. For cyanide as well as CO, significant negative correlations were found between the concentration in the blood and the redox state. The same held true for the energy charge. The redox state showed a slight increase at low concentrations of both gases; however, thereafter it began to decrease sharply with increases in concentrations. When concentrations of the toxicant in the blood reached certain levels, a kind of turning point, beyond which the redox state does not decrease any more, was observed. It was about 40% for HbCO and about 2.0 micrograms/ml for cyanide, and the points seemed to be related to the concentrations, beyond which cells are irreversibly damaged. On the other hand, the energy charge did not change at low concentrations. With an increase in toxicant concentrations, the energy charge decreased drastically. The rate of decrease in the energy charge became higher when blood concentrations exceeded certain levels. It was about 40% for HbCO and 2.0 micrograms/ml for cyanide. The presence of low levels of blood cyanide did not affect the relationship between the energy charge and the HbCO concentration.     

Apprenticeship and the transfer of technical know-how

This paper is based on a study of apprenticeship, a long renowned institution for transferring technical know-how. Case studies of apprenticeship led us to define know-how as: a commercially viable integration of proficient technique gained by practicing the work process of an expert and contextual knowledge gained by observing and questioning other workers. One implication of this definition is its stress on know-how transfer teams that consist of work process designers, practice tutors, and transfer manager. A second implication calls for explicit planning of know-how adaptation when new technology makes work processes obsolete. A final implication for researchers in technology transfer stresses the integration of individual know-how into community systems that put technology to work.