Competitive pricing and the challenge of cost control in medicare

The Medicare program faces a serious challenge: it must find ways to control costs but must do so through a system of congressional oversight that necessarily limits its choices. We look at one approach to prudent purchasing - competitive pricing - that Medicare has attempted many times and in various ways since the beginning of the program, and in all but one case unsuccessfully due to the politics of provider opposition working through Congress and the courts. We look at some related efforts to change Medicare pricing to explore when the program has been successful in making dramatic changes in how it pays for health care. A set of recommendations emerges for ways to respond to the impediments of law and politics that have obstructed change to more efficient payment methods. Except in unusual cases, competitive pricing threatens too many stakeholders in too many ways for key political actors to support it. But an unusual case may arise in the coming Medicare fiscal crisis, a crisis related in part to the prices Medicare pays. At that point, competitive pricing may look less like a problem and more like a solution coming at a time when the system badly needs one.     

Recent trends in suicides utilizing helium

Retrospective review of cases of suicide involving helium inhalation was undertaken at Forensic Science South Australia over a 25-year period from 1985 to 2009. No cases of helium-related suicides were identified in the first 15 years of the study, with one case between 2000 and 2004 and eight cases between 2005 and 2009. Australian data were also reviewed from 2001 to 2009 that showed 30 cases between January 2001 and June 2005, compared to 79 cases between July 2005 and December 2009, an increase of 163%. A review of Swedish data between 2001 and 2009 showed no cases between January 2001 and June 2005, compared to seven cases between July 2005 and December 2009. Thus, all three areas showed recent and striking increases in cases of suicide involving helium inhalation. Given the availability of helium and the recent promotion of this method of suicide, it is quite possible that this may represent a newly emerging trend in suicide deaths.     

Intimate yet dysfunctional? The relationship between governance and conflict resolution in India and the European Union

The rise of India and the EU as global actors has sparked growing interest in their peace-building approaches. This paper compares the objectives and effects of the EU's and India's engagement in different conflict contexts within and alongside their borders. It examines whether their practices of conflict resolution or peace-building strive for more than conflict management or ‘governmentality’. This article asks whether there is sufficient consistency across either actors' governance interventions to even speak of a distinct ‘strategy’ or ‘governance culture’. It illustrates the close relationship between governance and conflict response initiatives but finds that the relationship is often dysfunctional.     

A Comparison of Hypothermic Deaths in South Australia and Sweden

Case files from Forensic Science South Australia and the Swedish National Forensic Database were reviewed over a 6‐year period from 2006 to 2011 for cases where hypothermia either caused, or significantly contributed to, death. Data were analyzed for age, sex, time of year/season, place of discovery, circumstances of death, and underlying medical conditions. Despite the considerable demographic, geographic, and climatological differences, hypothermic deaths occurred at very similar rates in South Australia (3.9/100,000) and Sweden (3.3/100,000). Deaths from hypothermia in South Australia occurred predominantly indoors at home addresses, involving elderly females with multiple underlying illnesses and limited outside contacts. In contrast, Swedish hypothermic deaths generally occurred outdoors and involved middle‐aged elderly males. These data show that hypothermia may be a risk in warmer climates particularly for elderly, socially isolated individuals.     

The regulation of civilian drones' impacts on behavioural privacy

Surveillance technologies have burgeoned during the last several decades. To surveillance's promises and threats, drones add a new dimension, both figuratively and literally. An assessment of the impacts of drones on behavioural privacy identifies a set of specific threats that are created or exacerbated. Natural controls, organisational and industry self-regulation, co-regulation and formal laws are reviewed, both general and specific to various forms of surveillance. Serious shortfalls in the regulatory framework are identified. Remedies are suggested, together with means whereby they may come into being.     

Corporations and the Presumption of Innocence

Corporate behaviour is often regulated through the criminal law by means of reverse onus offences. Such offences are alleged to involve violations of the Presumption of Innocence. Such allegations almost always assume natural persons as defendants. The arguments supporting reverse onus offences are typically instrumental, to do with the importance of the social goals promoted and the ease of proof. The Presumption of Innocence is taken to be an autonomy right of natural persons and so not subject to being sidelined for reasons of law enforcement expediency. Corporations, however, are not natural persons: they have no autonomy right not to be treated as means. It may well be, then, that reverse onus offences are justified in the case of corporate defendants. I argue that the Presumption is not violated by such offences in the case of corporate defendants. I develop a broad concept of the criminal justice system as an allocative system, and argue that reverse onus offences properly allocate the burden of proof for corporations. Specifically, I argue that the normative demand for legal innocence is sufficiently met by the availability of a due diligence defence; that the responsibility of corporations when prohibited harms occur is properly a form of outcome-responsibility; and that taking into account issues of reciprocity, legitimacy and power reverse onus offences justly allocate the burden of proof in the case of corporate defendants.     

Alcohol intoxication may exacerbate the effects of blunt cranial trauma through changes in brain free magnesium levels

Moderate to high levels of alcohol decrease brain intracellular free magnesium concentration, a factor known to be critical in brain injury. Phosphorus magnetic resonance spectroscopy was used to examine changes to brain free magnesium concentration after blunt cranial trauma in alcohol-intoxicated rats. Rats exposed acutely or chronically to alcohol sufficient to increase blood alcohol levels to between 150 and 350 mg/dL demonstrated a brain free magnesium level that was 20-50% less than in nonintoxicated animals (p < 0.01). After injury, brain free magnesium levels declined more rapidly and to a greater extent in alcohol-affected animals than in nonintoxicated control animals (p < 0.001). As both preinjury depletion of magnesium and degree of magnesium decline after brain injury have been associated with poor recovery, these findings suggest that moderate to severe alcohol intoxication may predispose the brain to a worse outcome by reducing brain free magnesium levels, both before and after injury.     

Circumstances of death and diagnostic difficulties in brushfire fatalities

The deaths of 10 bushfire (brushfire) victims (aged 2-59 years; M/F 1:1) from the files of Forensic Science SA in Adelaide, South Australia, over an 8-year period (January 2002 to December 2009) are reported. Nine of the victims were found in or near motor vehicles. Death was attributed to incineration (N = 5), trauma from bushfire-related vehicle crashes (N = 2), inhalation of products of combustion with hyperthermia (N = 1), inhalation of products of combustion (N = 1), and undetermined (N = 1). Death scenes covered large areas and involved many victims. Loss of infrastructure and closure of local roads owing to debris limited access and made the finding of bodies difficult. Bodies in such fires may be exposed to the damaging effects of weather and animal predation. Heat damage hindered pathological assessment with resultant delays in identification. Assessment of antemortem injuries and determination of causes of death were also complicated by the condition of some of the bodies.     

Animal-related fatalities--part I: characteristic autopsy findings and variable causes of death associated with blunt and sharp trauma

Animals may be responsible for an array of potentially lethal injuries. Blunt force injuries characteristically involve larger animals such as cattle or horses that may kick, crush, or trample a victim causing head and facial injuries. Farm workers in particular are at high risk of lethal injuries involving the head and torso. Significant blunt trauma may be found in vehicle occupants after collisions with large animals such as camels or moose. Rarely, zookeepers may be crushed by particularly massive animals such as elephants. Sharp force injuries usually involve carnivore bites, most often from dogs with a "hole and tear" pattern of wounding. Injuries from animals such as alligators and sharks may have a significant component of crushing. Incised wounds may result in death from exsanguination and air embolism. On occasion, blunt or sharp trauma from animal activity may be confused with postmortem damage or with inflicted injury from an assault.