The who, what, and why of risk adjustment: a technology on the cusp of adoption

Risk adjustment (RA) consists of a series of techniques that account for the health status of patients when predicting or explaining costs of health care for defined populations or for evaluating retrospectively the performance of providers who care for them. Although the federal government seems to have settled on an approach to RA for Medicare Advantage programs, adoption and implementation of RA techniques elsewhere have proceeded much more slowly than was anticipated. This article examines factors affecting the adoption and use of RA outside the Medicare program using case studies in six U.S. health care markets (Baltimore, Seattle, Denver, Cleveland, Phoenix, and Atlanta) as of 2001. We found that for purchasing decisions, RA was used exclusively by public agencies. In the private sector, use of risk adjustment was uncommon and scattered and assumed informal and unexpected forms. The most common private sector use of RA was by health plans, which occasionally employed RA in negotiations with purchasers or to allocate resources internally among providers. The article uses classic technology diffusion theory to explain the adoption and use of RA in these six markets and derives lessons for health policy generally and for the future of RA in particular. For health policy generally, the differing experiences of public and private actors with RA serve as markers of the divergent paths that public and private health care sectors are pursuing with respect to managed care and risk sharing. For the future of RA in particular, its history suggests the need for health service researchers to consider barriers to use adoption and new analytic technologies as they develop them.     

The criminal justice system in a social justice society would look very different from the current system

I learned my most important lessons about criminal justice reform more than 30 years ago while working on what has become known as the Attica Prison rebellion. The Attica Prison rebellion took place in September 1971 in the maximum security prison in upstate New York. Led by prisoners with a broad social justice agenda, the prisoners’ demands were focused on basic human rights, including the right to organise, the right to be free from abuse from prison guards and the right to basic living conditions – health and sanitary conditions among others. The rebellion was ended when then Governor Nelson Rockefeller sent in state troopers to retake the prison by force, resulting in the death of 39 prisoners and prison guards. A political and legal struggle to defend prisoners charged in the uprising ensued, eventually resulting in the dismissal of the charges against the prisoners. In 2000, the people who had been prisoners at Attica during the 1971 rebellion were awarded an $8m settlement from the State of New York.     

DEET (N,N‐Diethyl‐meta‐toluamide) Induced Delay of Blowfly Landing and Oviposition Rates on Treated Pig Carrion (Sus scrofa L.)

Abstract: The question of whether the insect repellent N,N‐Diethyl‐meta‐toluamide (DEET) affected fly attraction, oviposition, and larval development was investigated; in part, to determine whether the common habit of wearing DEET as a repellent could affect the rate of human decomposition. Experiments using pig surrogates of human decedents were carried out in a rural environment. Dead piglets were sprayed with DEET, and fly behavior, colonization levels, and maggot development were compared with those in nonsprayed controls. Piglets treated with DEET experienced significant delays in fly visitation and oviposition and delayed appearance of each larval instar, as well as reduced total larval numbers (p < 0.01 for all variables), with subsequently reduced decomposition (p < 0.05). Such changes in fly behavior and larval population development would significantly impact the estimation of the period following the death from entomological evidence in decedents wearing DEET at the time of their death.     

Evaluation of canine training aids containment for homemade explosive and components by headspace analysis and canine testing

While canines are most commonly trained to detect traditional explosives, such as nitroaromatics and smokeless powders, homemade explosives (HMEs), such as fuel–oxidizer mixtures, are arguably a greater threat. As such, it is imperative that canines are sufficiently trained in the detection of such HMEs. The training aid delivery device (TADD) is a primary containment device that has been used to house HMEs and HME components for canine detection training purposes. This research assesses the odor release from HME components, ammonium nitrate (AN), urea nitrate (UN), and potassium chlorate (PC), housed in TADDs. Canine odor recognition tests (ORTs) were used with analytical data to determine the detectability of TADDs containing AN, UN, or PC. Headspace analysis by gas chromatography/mass spectrometry (GC/MS) with solid-phase microextraction (SPME) or online cryotrapping were used to measure ammonia or chlorine, as well as other unwanted odorants, emanating from bulk AN, UN, and PC in TADDs over 28 weeks. The analytical data showed variation in the amount of ammonia and chlorine over time, with ammonia from AN and UN decreasing slowly over time and the abundance of chlorine from PC TADDs dependent on the frequency of exposure to ambient air. Even with these variations in odor abundance, canines previously trained to detect bulk explosive HME components were able to detect all three targets in glass and plastic TADDs for at least 18 months after loading. Detection proficiency ranged from 64% to 100% and was not found to be dependent on either age of material.     

LIFE AFTER DEATH: THE NEED TO ADDRESS THE LEGAL STATUS OF POSTHUMOUSLY CONCEIVED CHILDREN

The advance of reproductive technology, coupled with a legal system that cannot keep up, has had a detrimental effect on posthumously conceived children. There is controversy over whether a child conceived after the death of one parent, by way of reproductive technology, is considered a child of that parent for inheritance purposes. An overwhelming majority of state legislatures have not given consideration to the unique question that posthumously conceived children pose. Legislative inaction has forced state courts to apply antiquated laws in the midst of a technological revolution. The result: children are being denied inheritance rights to their deceased parent's estate solely because of the way they were conceived. This Note advocates that all children should be given the same rights and benefits regardless of how they are conceived. To accomplish that goal, this Note proposes a model state statute to be adopted in all states. The model statute deems a posthumously conceived child to be the child of his or her deceased parent, and thus entitled to inheritance rights, if 1) the posthumously conceived child was provided for by will, or 2) the deceased parent intended to be a parent; there is a genetic relationship between parent and child; the child is born within three years from the death of his or her deceased parent; and the child's best interest, balanced against the state's interests, exceeds the state's interest. The desired effect of the statute is to put posthumously conceived children on equal footing with naturally conceived children.