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The article discusses the lessons taught by the Arab uprisings in countries such as Tunisia and Egypt to theorists of democratization and discusses the possibility of future democratization in the Arab world. Topics include the divergent trajectories taken by Tunisia and Egypt in their quest for democracy, the dynamics of democratization in Tunisia and Egypt, and why Tunisia is considered to be a case of successful democratic transition and Egypt is viewed to be a case of authoritarian reversion.

To control the upward spiral of healthcare costs, hospitals seek to implement efficiency interventions whose benefits are frequently assessed by reductions in average inpatient length of stay (LOS). However, average hospital LOS is a crude metric when trying to assess the utility of an intervention focussed on a particular service or over a specific time window. It cannot isolate the time or place of the intervention from the full duration of a patient's hospital visit, which may include more than 1 hospital service or extend beyond the intervention's time window. At Montefiore Medical Center, a new analytic method was used to describe a month-long effort to improve care efficiency in a hospital teaching service. Using an extension of the Cox proportional hazard model (S-plus), we were able to analyze the contribution of only those patient-days that took place during the time window of interest on the service of interest, eliminating the contamination of the 'non intervention days.' Having built the appropriate model, we were then able to graph the behavior of the groups with and without the intervention and calculate the model's expected average LOS, controlling for the appropriate variables. By comparing this method with a conventional average LOS analysis, we demonstrate the superiority of using this 'time slice' method over the conventional analysis of LOS. [ABSTRACT FROM AUTHOR]

Historically, quality assurance studies have received scant ethical attention.The advent of information systems capable of supporting research-grade continuous quality improvement projects demands that we clearly define how these projects differ from research and when they require external review. The ethical obligation for the performance of quality assurance projects, with its emphasis on identifiable immediate action for a served population, is a critical distinction.The obligation to perform continuous quality improvement is a deliverable of the social contract entered into implicitly by patients and health care providers and systems. In this article, the authors review the ethical framework that requires these studies, evaluate the differences between quality assurance studies and classic research, and propose criteria for requiring external review. [ABSTRACT FROM AUTHOR]

Background: Trichomonas vaginalis is a common pathogen that is associated with adverse pregnancy outcomes and may serve as a cofactor in human immunodeficiency virus (HIV) transmission.Goal: To define the epidemiology of trichomoniasis in a population of newly incarcerated pregnant women in New York City.Study Design: Prospective study of 213 pregnant prisoners attending prenatal clinic. Patients participated in an interview regarding sexual and drug-related behaviors, and underwent direct culture for T. vaginalis in addition to routine testing for syphilis, gonorrhea, and chlamydia.Results: The prevalence of trichomoniasis was 46.9%. On univariate analysis, there was a significant association between trichomoniasis and older age, crack use, prostitution, known HIV infection, and positive serological test for syphilis. Multivariate analysis showed a significant association of trichomoniasis with crack use and positive serological test for syphilis.Conclusion: Trichomoniasis is highly prevalent in pregnant prisoners in New York City. The extent of disease observed may justify a formal program of testing and treatment and emphasizes the urgent need for harm reduction education and expanded HIV counseling and testing services in this high-risk population. [ABSTRACT FROM AUTHOR]

Patients request health care for reasons that transcend the management of medical disease. Patients seek to create an "alliance" with the physician which "compensates" for conflict or deficit in the family system. This is particularly true for "problem," "difficult," or "hateful" patients who have significant psychosocial problems. When such a compensatory alliance evolves, it may become dysfunctional, limiting the physician's ability to make necessary medical interventions. By not explicitly including other family members, the traditional dyadic model of the doctor-patient relationship predisposes towards the formation of a compensatory alliance. The nature of the dysfunctional compensatory alliance may even remain obscure because the patient presents a distorted picture of the family situation. Therefore, to manage the compensatory alliance, the physician must perform a simple family assessment, including direct communication with other family members, early in the formation of the doctor-patient relationship. The physician should be alert to the formation of a dysfunctional compensatory alliance and the need to perform a family assessment whenever a patient explicitly or implicitly makes a request that engages the doctor with another family member. Recognition that a patient is "difficult" or awareness of a sense of helplessness, and frustration in caring for a patient may also indicate formation of a dysfunctional compensatory alliance and the need for family assessment. Recognizing key aspects of the doctor-patient-family relationship will enable the clinician to manage the compensatory alliance in a productive and therapeutic fashion. When family dysfunction requiring significant change is discovered, involvement of a family therapist should be offered. [ABSTRACT FROM AUTHOR]

Anergy may occur in groups at high risk for tuberculosis, compromising tuberculin skin testing. Within New York City's correctional system, anergy prevalence was 25% among opiate users referred to detoxification programs and 3% in the general population. Correlates of anergy were recent weight loss and needle sharing. The high prevalence of anergy among opiate users compromises the utility of tuberculosis screening and suggests the need for routine chest x-rays to detect pulmonary tuberculosis in some high-risk populations. [ABSTRACT FROM AUTHOR]