Health Care, Markets, and Democratic Values

Proposals to restructure the health care industry by increasing market competition currently have much political and academic momentum. Whether such proposals will work necessarily depends in part upon the criteria for success that are applied. Viewed from the market perspective, the question is whether procompetitive reforms will achieve their stated goals of containing costs, increasing efficiency, and enhancing consumer sovereignty over health care decisions. From a broader perspective, other questions are also of concern: whether increased competition in health care will actually improve people\u27s health, and whether the operations and effects of health care competition are consistent with important values such as individual dignity, democracy, and equality. These questions need to be seriously addressed, if not finally answered, before the federal and state governments embark on a policy of widespread market reform. To contribute to the resolution of these issues, this Article briefly surveys the market advocates\u27 articulated goals and their somewhat disparate means for achieving them. The Article then argues that the major market proposals are flawed seriously by internal contradictions, so that in all likelihood they will not be able to realize their goals even if their assumptions about human nature and the consumption of health care services are accepted

Slow Isotope Turnover Rates and Low Discrimination Values in the American Alligator: Implications for Interpretation of Ectotherm Stable Isotope Data

Stable isotope analysis has become a standard ecological tool for elucidating feeding relationships of organisms and determining food web structure and connectivity. There remain important questions concerning rates at which stable isotope values are incorporated into tissues (turnover rates) and the change in isotope value between a tissue and a food source (discrimination values). These gaps in our understanding necessitate experimental studies to adequately interpret field data. Tissue turnover rates and discrimination values vary among species and have been investigated in a broad array of taxa. However, little attention has been paid to ectothermic top predators in this regard. We quantified the turnover rates and discrimination values for three tissues (scutes, red blood cells, and plasma) in American alligators (Alligator mississippiensis). Plasma turned over faster than scutes or red blood cells, but turnover rates of all three tissues were very slow in comparison to those in endothermic species. Alligator δ15N discrimination values were surprisingly low in comparison to those of other top predators and varied between experimental and control alligators. The variability of δ15N discrimination values highlights the difficulties in using δ15N to assign absolute and possibly even relative trophic levels in field studies. Our results suggest that interpreting stable isotope data based on parameter estimates from other species can be problematic and that large ectothermic tetrapod tissues may be characterized by unique stable isotope dynamics relative to species occupying lower trophic levels and endothermic tetrapods

What do alligators eat on golf courses?

Urbanization is an ever-increasing threat to wildlife and their natural habitats, yet research has been limited to a small number of taxa and very few large predator species. The American alligator (Alligator mississippiensis) is an apex predator across the southeast U.S. and has surprisingly received minimal attention within urban areas. To investigate the potential effects of land development on alligator trophic ecology, we performed gut content analysis on golf course alligators found on Jekyll Island, Georgia. We then made comparisons with alligators found in more natural areas on Sapelo Island, Georgia. In total, we collected stomach content samples from 25 alligators on Jekyll Island golf courses, of which only one had an empty stomach. Data provided from Sapelo Island consisted of 93 alligators within our alligator size range, of which only one had an empty stomach. While analysis of similarity, non-metric multidimensional scaling, and simplified Morisita index analyses show no significant difference in diets between the two areas (possibly because of a low sample size from Jekyll Island), %IRI values for prey items reveal that there may be functional differences in prey choice or availability. Further land development and increasing human activity may therefore shift diets toward reliance on prey items usually of lesser importance. These trophic effects could possibly lead to local population declines, if paired with habitat degradation or other stressors

Generation of measures on the torus with good sequences of integers

Let $S= (s_1<s_2<\dots)$ be a strictly increasing sequence of positive integers and denote $\mathbf{e}(\beta)=\mathrm{e}^{2\pi i \beta}$. We say $S$ is good if for every real $\alpha$ the limit $\lim_N \frac1N\sum_{n\le N} \mathbf{e}(s_n\alpha)$ exists. By the Riesz representation theorem, a sequence $S$ is good iff for every real $\alpha$ the sequence $(s_n\alpha)$ possesses an asymptotic distribution modulo 1. Another characterization of a good sequence follows from the spectral theorem: the sequence $S$ is good iff in any probability measure preserving system $(X,\mathbf{m},T)$ the limit $\lim_N \frac1N\sum_{n\le N}f\left(T^{s_n}x\right)$ exists in $L^2$-norm for $f\in L^2(X)$. Of these three characterization of a good set, the one about limit measures is the most suitable for us, and we are interested in finding out what the limit measure $\mu_{S,\alpha}= \lim_N\frac1N\sum_{n\le N} \delta_{s_n\alpha}$ on the torus can be. In this first paper on the subject, we investigate the case of a single irrational $\alpha$. We show that if $S$ is a good set then for every irrational $\alpha$ the limit measure $\mu_{S,\alpha}$ must be a continuous Borel probability measure. Using random methods, we show that the limit measure $\mu_{S,\alpha}$ can be any measure which is absolutely continuous with respect to the Haar-Lebesgue probability measure on the torus. On the other hand, if $\nu$ is the uniform probability measure supported on the Cantor set, there are some irrational $\alpha$ so that for no good sequence $S$ can we have the limit measure $\mu_{S,\alpha}$ equal $\nu$. We leave open the question whether for any continuous Borel probability measure $\nu$ on the torus there is an irrational $\alpha$ and a good sequence $S$ so that $\mu_{S,\alpha}=\nu$.Comment: 44 page

Reporting Mistreatment of Older Adults: The Role of Physicians

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111194/1/j.1532-5415.1996.tb05640.x.pd