The Institute of Medicine (IOM) has released the latest publication in its campaign to curtail medical error: Leadership by Example: Coordinating Government Roles in Improving Health Care Quality. In this publication, the IOM recommends that the government utilize its position as the country's largest purchaser of healthcare to institute unified performance standards, create appropriate incentives to improve quality of care, and develop a system to disseminate provider-specific quality information to the public. The author examines these recommendations and the contents of IOM's prior publications and concludes that necessary predicates of IOM's vision are rationing of care and a two-tiered system of healthcare. Thus, if the IOM's recommendations are carried out, the author envisions a healthcare system in which truly state-of-the-art care can only be purchased out of pocket. He concludes that, although Leadership by Example is a rational plan to address escalating healthcare costs, it is unclear both whether the American public would support it if the IOM were explicit about its ultimate impact, and whether the recommendations, in the long run, will prove to be a good thing. 相似文献
In the medicolegal literature reports on homicides followed by suicide, especially in elderly people, are rare. In the present case, the victim, a 79-year-old woman, showed a rather unusual injury pattern: 3 gunshots to the head (with only 2 entrance wounds and 3 intracranial projectiles) and 2 stabs from a knife. The tools used for inflicting the stab wounds (a hunting knife and a double-edged dagger) were left in the victim's body after the offense. The 89-year-old husband hanged himself with an aerial cable after killing his wife. The police investigations and the autopsy findings suggested a combined homicide-suicide. The motive for the offense could be a so-called delusion of poverty associated with symptoms of depression. 相似文献
Stalking is the technical term for the systematic, excessive and sometimes offensive molestation in order to seek personal contact with a target person, mostly of the contrary sex. This phenomenon seems to have increased recently and concerns above all celebrities of several kinds. In some cases, stalking behavior can culminate in acts of violence. However, the pathological fixation onto an often unattainable person is not a modern phenomenon, since it was studied and described under the term erotomania in former centuries. The author presents and discusses the case of a young man, who displayed his stalking behavior exclusively by telephone calls. 相似文献
Does prior representation of a state on a Congressional defense committee lead to higher levels of per capita defense contracts, or do higher levels of prior per capita contract awards to a state increase its probability of being represented on a defense committee? To solve this puzzle, we estimate a cross-lagged three-equation model on data from all 50 states from 1963 to 1989 using maximum likelihood within LISREL. We find a substantial reciprocal but non-confounding relationship between representation and the allocation of benefits for the House, but not for the Senate. Thus, for the House, this more appropriate model of distributive politics in Congress supports both the committee-induced benefits hypothesis and the recruitment hypothesis. Further, the paper elaborates on how this reciprocal relationship plays out over time.