The Pharmacist's Obligations to Patients: Dependent or Independent of the Physician's Obligations?

It has been 40 years since the seminal papers on pharmacy's status as a profession sparked debate about the pharmacist's role in health care, yet the questions they raised are just as poignant today as they were then. Questions about whether pharmacists are the experts when it comes to drug therapy information can be answered practically by assessing the perception of pharmacists' obligations to patients as being dependent on or independent of physicians' responsibilities. Both options have important implications for pharmacy's status as a profession, the value that pharmacists can add to health care, and a pharmacist's right to deny a patient emergency contraception.     

Getting One's Way in Policy Debates: Influence Tactics Used in Group Decision-Making Settings

This study moves beyond traditional approaches to public administration and public policy decision making to consider how interpersonal influence tactics affect policy decisions in group decision-making settings. Decision makers reported their own use of interpersonal influence tactics to achieve policy objectives, as well as those used against them. Responses were compared to individual decisions made over the course of policy-formulation meetings. The results indicate that the most popular techniques were inspirational appeals and rational persuasion. The most effective techniques for influencing participants varied according to the type of decision to be made: During the visioning process, coalition tactics and inspirational appeals proved most effective; for more concrete decisions about current issues, rational persuasion, inspirational appeals, and consultation influenced decisions.     

A "politically robust" experimental design for public policy evaluation, with application to the Mexican universal health insurance program.

We develop an approach to conducting large-scale randomized public policy experiments intended to be more robust to the political interventions that have ruined some or all parts of many similar previous efforts. Our proposed design is insulated from selection bias in some circumstances even if we lose observations; our inferences can still be unbiased even if politics disrupts any two of the three steps in our analytical procedures; and other empirical checks are available to validate the overall design. We illustrate with a design and empirical validation of an evaluation of the Mexican Seguro Popular de Salud (Universal Health Insurance)program we are conducting. Seguro Popular, which is intended to grow to provide medical care, drugs, preventative services, and financial health protection to the 50 million Mexicans without health insurance, is one of the largest health reforms of any country in the last two decades. The evaluation is also large scale, constituting one of the largest policy experiments to date and what may be the largest randomized health policy experiment ever.     

An epidemiological assessment of problematic contacts to members of Congress

In order to assess the nature of threat assessment activity pertaining to members of Congress, 4387 cases involving threatening and other problematic contact were analyzed. The cases were studied regarding subject characteristics, articulated motives, as well as several aspects of contact behavior in relation to approach behavior. Approachers were significantly less likely to have articulated threat language prior to or during their contacts and were also less likely to have stated a policy grievance (foreign or domestic) as the source of their concern. Further, approachers were substantially more likely to have expressed help seeking requests as part of their prior and approach-related contacts and were less likely to have had racial or sexualized content within their contacts. Approachers were also significantly more likely to have had a criminal record as well as displayed symptoms suggestive of major mental illness. Subjects engaging in approach behavior were also less likely to have used an alias, were less likely to be a direct constituent of the target and were more likely to have contacted multiple congressional targets. The implications for threat assessment activity are discussed.     

Are Active Shootings Temporally Contagious? An Empirical Assessment

“Active Shootings,” which include shootings in public, confined areas such as schools, often traumatize communities and attract intense media coverage. Proposed policy responses to the phenomenon, such as concealing information as to casualty counts and even the identities of shooters, often suppose that active shootings are “contagious,” in that previous occurrences can enhance the likelihood of subsequent occurrences. This study marks the first attempt at assessment of the contagiousness of the active shooting phenomenon, and deploys a statistical model—the series hazard model—that is well-suited to the substantive issue of contagion as well as the fine-grained nature of the active shooting data. Results indicate that the hazard of observed active shootings was a function of the number of active shootings that preceded them in the previous two weeks.     

A Proposed Scheme for Classifying Pediatric Rib Head Fractures Using Case Examples

Pediatric rib head fractures are typically described as “posterior” or “costovertebral,” terms lacking specificity. To resolve this issue, a scheme was developed to describe the location of rib head fractures observed in a pediatric forensic population. The scheme uses three anatomical landmarks, terminus (tip), tubercle, and costovertebral articular surface to divide the rib head into two subregions, costovertebral and costotransverse. Examples of five cases of infants with rib head fractures are presented using this scheme. Forty‐eight rib head fractures were observed in these infants with the following frequencies: 56% (three infants) at the terminus; 21% (three infants) in the costovertebral subregion; 21% (one infant) at the costovertebral articular facet; and 2% (one infant) in the costotransverse subregion. Due to the small number of cases assessed, statistical analyses could not be performed; however, the data demonstrate the variation in distribution of pediatric rib head fractures.     

Microscopic Saw Mark Analysis: An Empirical Approach

Microscopic saw mark analysis is a well published and generally accepted qualitative analytical method. However, little research has focused on identifying and mitigating potential sources of error associated with the method. The presented study proposes the use of classification trees and random forest classifiers as an optimal, statistically sound approach to mitigate the potential for error of variability and outcome error in microscopic saw mark analysis. The statistical model was applied to 58 experimental saw marks created with four types of saws. The saw marks were made in fresh human femurs obtained through anatomical gift and were analyzed using a Keyence digital microscope. The statistical approach weighed the variables based on discriminatory value and produced decision trees with an associated outcome error rate of 8.62–17.82%.