Estimating the administrative cost of regulatory noncompliance: a pilot method for quantifying the value of prevention.

Routine regulatory inspections provide a valuable independent quality assurance review of radiation protection programs that ultimately serves to improve overall program performance. But when an item of non-compliance is noted, regardless of its significance or severity the ensuing notice of violation (NOV) results in an added cost to both the permit holder and the regulatory authority. Such added costs may be tangible, in the form of added work to process and resolve the NOV, or intangible, in the form of damage to organizational reputation or worker morale. If the portion of the tangible costs incurred by a regulatory agency for issuing NOVs could be quantified, the analysis could aid in the identification of agency resources that might be dedicated to other areas such as prevention. Ideally, any prevention activities would reduce the overall number of NOVs issued without impacting the routine inspection process. In this study, the administrative costs of NOV issuance and resolution was estimated by obtaining data from the professional staff of the Texas Department of Health, Bureau of Radiation Control (TDH-BRC). Based a focus group model, the data indicate that approximately $106,000 in TDH-BRC personnel resources were expended to process and resolve the 6,800 NOVs issued in Texas during 1997 inspection activities. The study's findings imply that an incremental decrease in the number of NOVs issued would result in corresponding savings of agency resources. Suggested prevention activities that might be financed through any resource savings include the dissemination of common violation data to permit holders or training for improving correspondence with regulatory agencies. The significance of this exercise is that any savings experienced by an agency could enhance permittee compliance without impacting the routine inspection process.

Psychiatric diagnoses: a continuing controversy.

Psychiatric Medicine has been accused justly of making its diagnoses on the patient's report of symptoms and the physician's subjective observations of the patient. The main problem has been the lack of reliable data compounded by the stigma of a mental diagnosis. More recently, third-party pressures have become an added threat to objectivity. New knowledge of brain function, especially neurotransmitters, and more specific and effective medication have made the need for accurate diagnoses more acute. Psychiatry has responded by frequent and often controversial changes in its diagnostic criteria. Much of the controversy stems from a lack of accurate measurements to validate the diagnoses, thereby allowing for differences of opinion of a highly subjective nature. The problem is complicated by the chronic, but irrational, belief that there is a separation between mental and somatic illness.

Insomnia.

Insomnia is a symptom requiring medical investigation and the elimination of external and physical causes. Anxiety and/or depression have been shown to be present in most of the patients complaining of inability to sleep. Antidepressant medication with sedating potential is very effective in patients with depressive symptoms when most of the dose is given at bed-time. Most of the sedative-hypnotic drugs disturb the qualitative aspects of sleep and many rapidly produce tolerance. Flurazepam has been shown to be the drug of choice for purely symptomatic insomnia. Except in very transient situational stresses, a psychotherapeutic relationship to investigate the causes of the insomnia may be the most important aspect of the treatment program.

Adolescent sexuality and societal change.

Social changes have occurred so rapidly and in such magnitude as to invalidate previously effective coping mechanisms and to reduce the supporting factors in the social milieu. Concomitant with these changes has been an increase in adolescent sexual behavior. Psychoanalytic theory indicates that this behavior will warp or retard psychosexual maturity, but other authorities disagree with this stance. Present evidence does not allow a definitive statement, but indicates the need for more attention to those adolescents who escape psychic damage.

A bacteriological study of craniocerebral missile wounds from Vietnam.

Bacteriological studies were performed on 45 craniocerebral missile wounds incurred in Vietnam within 2 to 4 hours of occurrence. All missiles had penetrated into the brain. Aerobic and anaerobic cultures were taken of the skin wound, brain, and indriven bone fragments. Forty-four of the skin wounds were contaminated, predominantly with staphylococcus. Only five brain wounds showed bacterial contamination 2 to 4 hours after wounding, indicating that many missile tracks within the brain are initially sterile. Of the patients who had early debridement, 45% had contaminated bone within the brain; possibly up to 75% of all indriven bone chips were sterile. The authors draw the following conclusions. Complete brain debridement with removal of all indriven bone is ideal. Accessible retained bone should be removed by reoperation. Multiple reoperations for an inaccessible retained fragment are inadvisable, however, as fatalities or severe neurologic residua may result. An individual indriven bone chip has a small likelihood of bacterial contamination provided initial debridement was done early. This knowledge may justify an expectant policy in certain individuals harboring an inaccessible retained bone fragment. The retained fragment would be removed only if untoward difficulties develop.