From Research Evidence to “Evidence by Proxy”? Organizational Enactment of Evidence‐Based Health Care in Four High‐Income Countries

Drawing on multiple qualitative case studies of evidence‐based health care conducted in Sweden, Canada, Australia, and the United Kingdom, the authors systematically explore the composition, circulation, and role of codified knowledge deployed in the organizational enactment of evidence‐based practice. The article describes the “chain of codified knowledge,” which reflects the institutionalization of evidence‐based practice as organizational business as usual, and shows that it is dominated by performance standards, policies and procedures, and locally collected (improvement and audit) data. These interconnected forms of “evidence by proxy,” which are informed by research partly or indirectly, enable simplification, selective reinforcement, and contextualization of scientific knowledge. The analysis reveals the dual effects of this codification dynamic on evidence‐based practice and highlights the influence of macro‐level ideological, historical, and technological factors on the composition and circulation of codified knowledge in the organizational enactment of evidence‐based health care in different countries.     

An Algebraic Analysis of Normative Systems

In the present paper we study how subsystems of a normative system can be combined, and the role of such combinations for the understanding of hypothetical legal consequences. A combination of two subsystems is often accomplished by a normative correlation or an intermediate concept. To obtain a detailed analysis of such phenomena we use an algebraic framework. Normative systems are represented as algebraic structures over sets of conditions. This representation makes it possible to study normative systems using an extension of the theory of Boolean algebras, called the theory of Boolean quasi-orderings.     

The European constitution project from the perspective of constitutional political economy

Three topics of a European constitution are discussed. First, basic arguments from constitutional political economy that aim at restricting representatives’ potential misuse of powers in a European Union with extended competencies are summarized. Since a European demos does not yet exist, an extension of competencies of the European Parliament is not sufficient in order to legitimate political decisions at the EU level. The introduction of elements of direct democracy in the European constitution would shape the creation of such a demos and lead to a stronger control of the European legislature and executive. Second, the introduction of direct democracy in the European constitution is proposed in order to reduce the European democratic deficit. Third, the creation of a European federation requires a more transparent assignment of competencies and rules to resolve conflicts between different centers of power. A European federation should be organized according to the principles of competitive federalism.     

Esophageal injury in fatal rear-impact collisions

Neck injuries resulting from motor vehicle collisions (MVC), often referred to as whiplash trauma and injury, often demonstrate little or no evidence of significant tissue damage. In rare instances, however, serious injury to the anterior neck organ injuries can result from such trauma. The present study describes esophageal injury associated with rear-impact collisions, based on a unique case report, review of the scientific literature and a query in the National Automotive Sampling System (NASS) database of the US National Highway Traffic Safety Administration. The Medline search and present case study totaled five cases of rear-impact collision-related serious esophageal injury (laceration or rupture). In the four published cases all patients survived, whereas in the presented case study, the patient died due to mediastinitis and sepsis. The NASS query revealed an additional three cases out of a total of 55,926 investigated crashes. All three cases were associated with fatalities. Although no anatomical or bioengineering studies have presented data on the behavior of the esophagus during rear-impact whiplash loading, sudden tensile and/or compressive forces is the likely explanation of injury, often in combination with a local fracture of a vertebral body. In these 8 cases significant esophageal injury carried a substantial (50%) risk of mortality. Clinicians should be aware of the potential for significant complications in the whiplash trauma-exposed patient who complains of chest pain, mid-thoracic pain, discomfort in the neck and throat, respiratory distress, or hoarseness. For those forensic specialists involved in whiplash cases these study results highlight the need to consider esophageal injuries as a rare but potential consequence of whiplash trauma.     

Human trafficking and drug distribution in Sweden from a market perspective—similarities and differences

Based on several studies, the aim of the article is to compare trafficking in women for the purpose of sexual exploitation to trafficking in drugs. Women are recruited and drugs are bought in other countries and transported to Sweden. What are the similarities and differences between the recruitment phase (women) and the purchases (drugs)? Both sexual services and drugs are sold in local markets. This requires marketing, contacts and access to customers. Women need accommodation and often a place to sell the services, drugs must be stored somewhere and prepared for sale. Procurement, trafficking and the purchase of sexual services are illegal and in the case of drugs even consumption and possession for personal use is illegal and prosecuted. Facilitators often play an important role in connecting customers and providers. This article will further describe what kind of organizational structure is needed to arrange these logistics and some different strategies used by organizers and distributors.     

Forensic Informativity of ~3000 bp of Coding Sequence of Domestic Dog mtDNA

The discriminatory power of the noncoding control region (CR) of domestic dog mitochondrial DNA alone is relatively low. The extent to which the discriminatory power could be increased by analyzing additional highly variable coding regions of the mitochondrial genome (mtGenome) was therefore investigated. Genetic variability across the mtGenome was evaluated by phylogenetic analysis, and the three most variable ~1 kb coding regions identified. We then sampled 100 Swedish dogs to represent breeds in accordance with their frequency in the Swedish population. A previously published dataset of 59 dog mtGenomes collected in the United States was also analyzed. Inclusion of the three coding regions increased the exclusion capacity considerably for the Swedish sample, from 0.920 for the CR alone to 0.964 for all four regions. The number of mtDNA types among all 159 dogs increased from 41 to 72, the four most frequent CR haplotypes being resolved into 22 different haplotypes.