Mirror, mirror on the wall: reflections from failure to establish a truly uniform national health care policy

When the author gazed into the proverbial mirror and asked if the U.S. health care system was the fairest of them all, it shattered. In this article, Thompson tells why the system is broken and what failure to fix it means to physician executives. He suggests that we, as Americans, must reinvent ourselves by realigning our value systems and and stifling our obsession with profit before trying to reinvent health care.     

Finite mixture models with concomitant information: assessing diagnostic criteria for diabetes

The World Health Organization (WHO) diagnostic criteria for diabetes mellitus were determined in part by evidence that in some populations the plasma glucose level 2 h after an oral glucose load is a mixture of two distinct distributions. We present a finite mixture model that allows the two component densities to be generalized linear models and the mixture probability to be a logistic regression model. The model allows us to estimate the prevalence of diabetes and sensitivity and specificity of the diagnostic criteria as a function of covariates and to estimate them in the absence of an external standard. Sensitivity is the probability that a test indicates disease conditionally on disease being present. Specificity is the probability that a test indicates no disease conditionally on no disease being present. We obtained maximum likelihood estimates via the EM algorithm and derived the standard errors from the information matrix and by the bootstrap. In the application to data from the diabetes in Egypt project a two-component mixture model fits well and the two components are interpreted as normal and diabetes. The means and variances are similar to results found in other populations. The minimum misclassification cutpoints decrease with age, are lower in urban areas and are higher in rural areas than the 200 mg dl^-1 cutpoint recommended by the WHO. These differences are modest and our results generally support the WHO criterion. Our methods allow the direct inclusion of concomitant data whereas past analyses were based on partitioning the data.     

Physician perceptions of medical malpractice and defensive medicine

Using judgments obtained in interviews with 33 Massachusetts physicians, the annual statewide volume of expenditures incurred for defensive medical reasons in 1982 was estimated to be $1.0 billion, 12% of all medical care expenditures. Estimates for the nation were $37 billion, 14% of expenditures. Nationally, 180,000 cesarean deliveries were thought to be performed for defensive motives. In their own institutions, respondents judged 43% of all skull x-rays following injury to be medically justified, 30% to be defensive medicine, 16% to be placebos, and 11% to be physician misjudgments. In considering the economic and noneconomic costs of medical malpractice procedures, the dollar costs of insurance were considered most serious, followed closely by defensive medicine, unfairness, and poorer relations with patients. Thirty-two percent of the responsibility for the negative aspects of malpractice processes was assigned to lawyers, 21% to physicians, 18% to legislatures and courts, 16% to patients, and 13% to insurance companies.     

Associations of Marital Conflict With Emotional and Physiological Stress: Evidence for Different Patterns of Dysregulation

The goal of this study was to explore theoretically suggested but untested links between interparental conflict and stress physiology in late adolescence. A multi‐method study was conducted involving families (n = 42) who previously participated in the University California, Irvine site of the NICHD Study of Early Child Care and Youth Development; adolescents were 17½ years of age on average. Parent report and observer ratings of conflict, adolescent participation in a robust social‐evaluative stressor, and assessment of cortisol, cardiovascular, and emotional functioning were included. Marital conflict was associated with dampened physiological stress responses in adolescence but sensitized emotional responses, suggesting that conflict may be associated with problems integrating and coordinating emotional and physiological responses to stress.     

Teaching Children With Autism Spectrum Disorder to Report Past Behavior With the Use of a Speech-Generating Device

The Analysis of Verbal Behavior -     

Filmic public relations for a global audience: The United Nations and The Blue Vanguard

The project investigates the use of documentary film as a public relations tool by the United Nations (UN) for worldwide promotion of its first peacekeeping intervention in response to the Suez crisis of 1956. Specifically, it undertakes a historical investigation into the communicative purpose of the 1957 documentary film, The Blue Vanguard, which was made by the UN Department of Public Information (UNDPI). Beyond the interest connected with the intervention in the Suez crisis, the film is significant in the history of the UN’s global public relations since it was one of the first films made for the UN by UK film director, Thorold Dickinson, who arrived as Chief of Film at the UN in October 1956.The author argues that Thorold Dickinson used the documentary to make a radical public information proposition to a global audience on behalf of the United Nations. Specifically, the public relations discourse and cinematicity in The Blue Vanguard reminded a global audience that achieving peace required a new level of cultural tolerance and global co-operation, involving codes of judgement beyond the nationalistically-determined registers of the time.