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Selected AbstractsWhy Are There Differences in the Perceived Safety of Office-Based Surgery?DERMATOLOGIC SURGERY, Issue 11 2004John G. Hancox MD Background. Office-based surgery has become an important method of health-care delivery, but there is controversy about its safety and which practitioners should perform it. Several states have already or are preparing to enact legislation regulating office-based surgery. Objective. The objective was to discuss recent literature pertaining to the safety of office surgery and to discuss reasons why there are perceived differences in its safety. Methods. The pertinent literature is reviewed. Results. The majority of studies suggest that office surgery is safe. A recent study that found to the contrary may have methodologic flaws. Conclusion. The medical and legislative community should seek to scientifically examine office surgery. Overregulation or loss of office surgery would have a tremendous impact on the management of skin cancers and the delivery of quality cosmetic and laser surgery. [source] A Just Measure of Forgiveness: Reforming Occupational Licensing Regulations for Ex-Offenders Using BFOQ AnalysisLAW & POLICY, Issue 1 2008KAROL LUCKEN In the United States, over 600,000 offenders rejoin society annually, though little has been done to facilitate their transition from the prison to the community. Offender reentry into the workplace has emerged as a particular concern, given that many statutes prohibit public employment for ex-offenders and create obstacles to private-sector employment through occupational licensing requirements. These mandates may explicitly reject ex-offenders, or require "good moral character" or job/relationship tests that all but eliminate meaningful employment options. Several states are reconsidering the implications of these prohibitions, but a clear framework for assessing the validity of exclusionary occupational mandates is often lacking. This article proposes that the bona fide occupational qualification (BFOQ) defense found in employment discrimination law provides a helpful framework for guiding these reform efforts. [source] Candidate's Thesis: Universal Newborn Hearing Screening in an Inner-City, Managed Care Environment ,THE LARYNGOSCOPE, Issue 6 2000Glenn Isaacson MD Abstract Objectives/Hypothesis Universal neonatal hearing screening (UNHS) programs aim to identify and treat educationally significant hearing loss in the first months of life. Several states have mandated UNHS for all newborns. Such programs have been successful in small, homogeneous populations. As larger states attempt to implement such programs, important obstacles have arisen, particularly in sparsely populated rural environments and in the inner city, where poverty, unstable living situations, and inadequate access to health care make follow-up of infants failing initial testing difficult. Study Design We performed a prospective longitudinal study e-amining the effects of increasingly comple- and e-pensive interventions designed to ensure that children failing initial hearing screening returned for complete evaluation and habilitation. Methods A UNHS program based on transient evoked otoacoustic emissions testing was implemented at Temple University Hospital, with 2,000 births per year. At 6 months into the program, efficacy was assessed and modifications in follow-up methodology were made in an attempt to improved rate of return of infants failing newborn screening. The effect of these interventions was reassessed 6 months later. Results In its first 12 months, the Temple University Infant and Young Child Hearing Intervention Initiative successfully screened 95% (2,031) of all newborns using transient evoked otoacoustic emissions. Collecting a complete database profile for each newborn, establishing rapport with the family, and offering immediate follow-up appointments yielded a 61% return rate after discharge. The addition of a dedicated project secretary, free day-care for siblings, and cab vouchers for transportation and the elimination of a requirement for health maintenance organization referrals increased follow-up yield to 75%. Conclusion Given adequate resources and planning, UNHS can be successful, even in economically depressed environments. [source] The ethics of cloning and creating embryonic stem cells as a source of tissue for transplantation: time to change the law in AustraliaINTERNAL MEDICINE JOURNAL, Issue 4 2000J. Savulescu Abstract Every day, people die because there are insufficient tissues available for transplantation. The development of cloning and embryonic stem (ES) cell line technologies offers real hope for developing better sources of tissues for transplantation. Moreover, these new technologies may mean that damaged tissue (for example, after a stroke or heart attack) can be replaced with normal functioning tissue rather than scar tissue. Research into ,therapeutic cloning' and the development of ES cell lines is illegal in several States in Australia. It is time to review that legislation in order to allow destructive embryo research. My argument is that at least research should be allowed on spare embryos from assisted reproduction; that it is only one moral view (of several plausible ones) of the status of the embryo which precludes producing embryos for research; that this view is mistaken and so it is morally permissible to produce embryos for research into therapeutic cloning. [source] The Supreme Court and the Interstate Slave Trade: A Study in Evasion, Anarchy, and ExtremismJOURNAL OF SUPREME COURT HISTORY, Issue 3 2004DAVID L. LIGHTNER Opponents of slavery often argued that the federal government possessed the constitutional authority to outlaw the interstate slave trade. At its founding in 1833, the American Anti-Slavery Society declared that Congress "has a right, and is solemnly bound, to suppress the domestic slave trade between the several States." The idea had been endorsed earlier, during the Missouri controversy of 1819,1820, by both John Jay and Daniel Webster. Later on, in the 1840s and 1850s, it was supported by such prominent politicians as John Quincy Adams, Salmon P. Chase, and Charles Sumner. Defenders of slavery were, of course, horrified by the suggestion that the South's peculiar institution might be attacked in this way, and they vehemently denied that the Constitution permitted any such action. The prolonged debate over the issue focused on two key provisions of the Constitution. One was the Commerce Clause (Article I, Section 8, Clause 3), which says that Congress has the power to "regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes." The other was the 1808 Clause (Article I, Section 9, Clause 1), which says that the "Migration or Importation of such Persons as any of the States now existing shall think proper to admit, shall not be prohibited by the Congress prior to the Year one thousand eight hundred and eight." Abolitionists held that the Constitution sanctioned congressional interference in the domestic slave trade both generally, by virtue of the Commerce Clause, and specifically, by virtue of the 1808 Clause. They argued that since slaves were routinely bought and sold, they obviously were articles of commerce, and therefore Congress had unlimited authority over interstate slave trafficking. Furthermore, they said, the words "migration or importation" in the 1808 Clause meant that as of January 1, 1808 Congress had acquired the right not only to ban the importation of slaves, but also to prohibit their migration from one state to another. Defenders of slavery replied that Congress could not interfere in property rights and that the power to regulate commerce did not include the power to destroy it. They also said that the word "migration" in the 1808 Clause referred, not to the domestic movement of slaves, but to the entry into the United States of white immigrants from abroad.1 [source] The Success of Sharing Societies: Lessons from HistoryHISTORY COMPASS (ELECTRONIC), Issue 3 2007Trevor Getz Global history is often viewed as a competitive battleground in which civilizations, nations, or peoples repeatedly clash over resources or ideology. Correspondingly, victory in the global arena is often seen as belonging to the most inventive or innovative societies. Yet a more complex look at innovation reveals that it is often the result of a gradual and widely collaborative process, often involving the efforts or contributions of citizens of several states or societies. This article suggests that the myths surrounding invention and the reification of innovation as a cultural trait have distracted social scientists and policy makers from recognizing the significance of imported technologies, ideas, strategies, and products in helping societies overcome a wide range of challenges. It illustrates this contention with evidence from several historical episodes that suggest that successful societies are not only open to innovation from among their own populace, but also to contributions from abroad. [source] Juror Beliefs About Police Interrogations, False Confessions, and Expert TestimonyJOURNAL OF EMPIRICAL LEGAL STUDIES, Issue 2 2010Mark Costanzo Although there has been a rapid expansion in research on police interrogations and false confessions, little is known about the beliefs of potential jurors as to these issues. In collaboration with a trial research firm, we recruited 461 jury-eligible men and women who matched the demographic characteristics of jury pools in several states. Surrogate jurors responded to questions and statements in five areas: likely rates of false confessions for different crimes, the ability to discern true from false confessions, beliefs about false confessions, beliefs about permissible interrogation tactics, and beliefs about expert testimony on police interrogations. Results indicated that jurors believed that police interrogators are better than ordinary people at identifying lies and that this ability improves with experience. Jurors believed that they would be able to differentiate a true confession from a false confession by watching a videotape, but were less confident about making such a differentiation from an audio recording. A large majority of the sample reported that it would be helpful to hear expert testimony about interrogation techniques and reasons why a defendant might falsely confess to a crime. There were no significant gender differences. Compared to whites, nonwhite jurors had significantly less confidence in the abilities of the police and gave significantly higher estimates of false confession rates. Results are discussed in light of prior research and implications for jury decision making and expert testimony. [source] Why do some hospital leaders "speak no evil" about their organizations' medical errors?JOURNAL OF LEADERSHIP STUDIES, Issue 3 2008Ruby A. Rouse Sentinel events, preventable medical errors resulting in serious disability or death, are a significant problem for hospital leaders. Accreditation agencies, such as the Joint Commission, urge hospitals to voluntarily disclose information about medical errors. However, some healthcare leaders "speak no evil" by choosing not to release sentinel-event data. In an effort to increase the reporting of medical errors, several states passed laws mandating disclosure of sentinel events to the government. The state-reported medical error rates of Indiana hospitals were compared with their leaders' perceptions of quality of care. Regardless of the number of sentinel events occurring at their hospitals, leaders consistently claimed their organizations provided high-quality care. Two theories, rationalization and gaming, are presented to explain why leaders do not acknowledge the presence of serious quality-management problems in their organizations. [source] Integrated modeling environment for statewide assessment of groundwater vulnerability from pesticide use in agriculture,PEST MANAGEMENT SCIENCE (FORMERLY: PESTICIDE SCIENCE), Issue 8 2004Audra Eason Abstract Atrazine, a herbicide widely used for corn production in the Midwest, has been detected in groundwater of several states, and has been identified as a possible human carcinogen. With the widespread use of pesticides in crop production, and the frequent detection of these chemicals in groundwater, large-scale risk assessments would help water resource managers to identify areas that are more susceptible to contamination and implement practices to ameliorate the problem. This paper presents an integrated, visual and interactive system for predicting potential environmental risks associated with pesticide contamination at spatial scales ranging from fields to landscapes and regions. The interactive system extends the predictive ability of the Pesticide Root Zone Model Release 2.0 (PRZM-2) to a landscape and statewide scale through integration with a geographic information system (GIS), graphical user interface and environmental databases. Predictions of statewide (Iowa) vulnerability of groundwater from atrazine leaching below the unsaturated zone were made to demonstrate the utility of the system, and the results were used in risk assessment. In the example application, atrazine fate and transport were evaluated using long-term climatic data (1980,1989) in combination with several environmental databases (eg STATSGO soils database) and exposure risks were expressed in terms of the probability of the predicted pesticide concentrations exceeding the maximum contaminant level (MCL) for drinking water. The results indicate that the predicted pesticide concentrations were significantly lower than the EPA-established MCL. In addition to providing an interactive environment for landscape-level assessment of potential risks from pesticide leaching, the system significantly reduces the time and resources needed to organize and manipulate data for use with PRZM-2, and provides an analytical framework for evaluating groundwater-leaching impacts of pesticide management practices. Copyright © 2004 Society of Chemical Industry [source] Estimating Tax Evasion Losses: The Road Fund CasePUBLIC BUDGETING AND FINANCE, Issue 1 2001Merl Hackbart Federal, state, and local government concern about the loss of state revenues from tax evasion has increased in recent years. In order for policymakers to address this issue effectively, more information regarding the nature and magnitude of the problem is needed. This article reports on research that focuses on estimating the level of road fund tax evasion for several states. Estimates of road fund tax evasion are developed from previous research regarding individual state evasion levels, perceptions of road fund tax evasion by state revenue officials, and a statistical estimate of road fund tax evasion. [source] The hyporheic zone: Linking groundwater and surface water,understanding the paradigmREMEDIATION, Issue 1 2001Thomas M. Biksey The hyporheic zone, the transition region between groundwater and surface water, represents an important interface between terrestrial and aquatic ecosystems. When groundwater combines with surface water in this zone, the characteristics of each are blended and new gradients are established, especially for contaminants. Therefore, the hyporheic zone is important in considering the "big ecological picture" as the hydrologic continuum connecting groundwater and surface water. The importance is reflected by the current focus of this zone in ecological risk assessments conducted under the Resource Conservation and Recovery Act (RCRA), Comprehensive Environmental Response, Compensation and Liability Act (CERCLA), and Clean Water Act (CWA) programs. A variety of tools can be used to measure, analyze, and predict the physical, chemical, and biological processes that occur within the hyporheic zone. Directly measuring the flux of water across the interface between groundwater and surface water determines whether surface water enters the streambed at downwelling zones or groundwater discharges from the streambed in upwelling zones. In addition to direct measurements of the flux of water, several states have developed models to characterize the interaction of groundwater and surface water. The variability in physical and chemical characteristics between upwelling and downwelling zones influences the local ecology within the zone. The study of the species within the hyporheic zone includes ecological surveys and ecotoxicological investigations. The evolving study of the hyporheic zone will necessitate an increase in basic research into hydraulic considerations, an identification of regional representative sites with contaminated hyporheic zones, and a better understanding of the ecology of the species within the zone. © 2001 John Wiley & Sons, Inc. [source] The State of Diabetes Care Provided to Medicare Beneficiaries Living in Rural AmericaTHE JOURNAL OF RURAL HEALTH, Issue 4 2006Joseph P. Weingarten Jr PhD ABSTRACT:,Context: Diabetes poses a growing health burden in the United States, but much of the research to date has been at the state and local level. Purpose: To present a national profile of diabetes care provided to Medicare beneficiaries living in urban, semirural, and rural communities. Methods: Medicare beneficiaries with diabetes aged 18-75 were identified from Part A and Part B claims data from 1999 to 2001. A composite of 3 diabetes care indicators was assessed (annual hemoglobin A1c test, biennial lipid profile, and biennial eye examination). Findings: Over 77% had a hemoglobin A1c test, 74% a lipid profile, and 69% an eye examination. Patterns of care were considerably different across the urban-rural continuum at the state, Census division, and regional levels. States in the northern and eastern portions of the country had higher indicator rates for rural than for urban residents. States in the South had much lower rates for rural residents than their urban counterparts. Despite these within-state differences, across-state comparisons found that several states tended to have low indicator rates in every level of the urban-rural continuum. A common feature of these states was the relatively high concentration of nonwhite beneficiaries. For example, southern states had much higher concentrations of nonwhite beneficiaries relative to other areas in the country and demonstrated low rates in every level of the urban-rural continuum. Conclusions: Urban-rural quality of care differences may be a function not just of geography but also of the presence of a large nonwhite population. [source] Covariate Adjustment of Event Histories Estimated from Markov Chains: The Additive ApproachBIOMETRICS, Issue 4 2001Odd O. Aalen Summary. Markov chain models are frequently used for studying event histories that include transitions between several states. An empirical transition matrix for nonhomogeneous Markov chains has previously been developed, including a detailed statistical theory based on counting processes and martingales. In this article, we show how to estimate transition probabilities dependent on covariates. This technique may, e.g., be used for making estimates of individual prognosis in epidemiological or clinical studies. The covariates are included through nonparametric additive models on the transition intensities of the Markov chain. The additive model allows for estimation of covariate-dependent transition intensities, and again a detailed theory exists based on counting processes. The martingale setting now allows for a very natural combination of the empirical transition matrix and the additive model, resulting in estimates that can be expressed as stochastic integrals, and hence their properties are easily evaluated. Two medical examples will be given. In the first example, we study how the lung cancer mortality of uranium miners depends on smoking and radon exposure. In the second example, we study how the probability of being in response depends on patient group and prophylactic treatment for leukemia patients who have had a bone marrow transplantation. A program in R and S-PLUS that can carry out the analyses described here has been developed and is freely available on the Internet. [source] Quantum Diffusion of Hydrogen and Isotopes in MetalsCHEMPHYSCHEM, Issue 9 2005Matthew Dyer Quantum diffusion constants of H and its isotopes in Pd and Nb are computed using Kubo theory applied on potential-energy surfaces obtained from density functional theory. The figure shows an excited state of H in Pd. This state is among several states which are below the classical barrier but are also delocalised between the octahedral and tetrahedral sites that contribute to quantum diffusion at low temperatures. [source] | ||||||||||||||||||||||