A Short and Plain Solution to the Medical Malpractice Crisis: Why Charles E. Clark Remains Prophetically Correct about Special Pleading and the Big Case

Antitrust. Patent infringement. Civil rights. Employment discrimination. And now, medical malpractice. The common thread among each of these categories of cases is that judges and advocates have, at one time or another, sought to elevate the pleading requirements in federal court for these so-called big cases. To date, every such effort has failed.6 But none of the previous attempts have garnered the wide range of support now coming from such influential sources as the majority of physicians, Congress, and the President of the United States.Our country is in the middle of a similar predicament-a medical malpractice crisis that is influencing, and attempting to alter, the rules of pleading in federal court. Essentially, doctors and their advocates assert that without stiff and immediate limitations on medical malpractice litigation, doctors will be unable to afford the escalating costs of medical malpractice insurance coverage and will eventually be run out of town or at least out of business, leaving many of us without the aid of a physician when we need medical care. Although many reforms have already been enacted, those challenging the reforms assert that medical malpractice continues to occur and that victims continue to need access to a forum for judicial relief.\u27 Without seeking to embrace or advance the merits of either camp\u27s arguments, this Article will instead seek to respond to the residual quandary posed by the current national crisis-how pleading requirements in medical malpractice cases are infringing upon the Federal Rules in diversity actions.Because there are very few instances where medical malpractice issues arise under federal statute, invariably, the majority of medical malpractice cases filed in federal court will enter via diversity jurisdiction. Thus, while doctors and plaintiffs lawyers debate the finer points of the medical malpractice crisis, this Article focuses on resolving the impending Erie question regarding heightened pleading in federally filed medical malpractice actions. Part II of this Article provides a brief overview of the medical malpractice crisis and its impact on litigation. Part III evaluates the proffered solution-heightened pleading-and assesses the various approaches taken by federal courts in resolving the Erie issue presented by heightened pleading. Part IV critiques the proffered solution from the perspective of history, the Federal Rules, and precedent. In doing so, Part IV will trace the evolution of notice pleading and underscore the lasting and unchanging nature of Rule 8 from Dioguardi to Conley to Leatherman to Swierkiewicz. Finally, Part V offers an improved solution to the medical malpractice crisis that more fully addresses the concerns of overburdened physicians while more closely meeting the equally important needs of injured patients and keeping intact the important procedural design of the Federal Rules. For now, it appears the big case is once again upon us

A report highlighting the experiences of peer supporters who deliver, and parents who receive, one-to-one perinatal peer support through Connected CIC

Connected Perinatal Support CIC (from hereon in Connected) provides perinatal peer support services across Derby. It offers families assistance in a range of ways, from one-to-one peer support, and in-person and online community groups, including a support group for fathers, provided by volunteers (from hereon in peer supporters). In 2022 - following funding from Public Health at Derby City Council, Connected and the European Development Fund (ERDF) - the University of Derby were invited to evaluate the experiences of peer supporters who deliver one-to-one peer support and the parents who receive it. The evaluation forms part of a wider piece of work and a PhD conducted by Angela Dace; supervised by Drs Christopher Barnes and Jane Montague at the University. In this report, we document the findings from interviews conducted between November 2022 and February 2023. The results offer readers an insight into how peer support was conceptualised by participants and the importance it played in their lives; this includes what peer support looked like in practice, what they gained from peer support and any challenges they experienced. Peer-supporter experiences Our findings show that, for those who deliver one-to-one perinatal peer support, it is a predominantly positive experience with multiple clear benefits. When referring to their role, peer supporters positioned themselves as being both a friend and a professional. The training delivered by Connected, and the robustness of the support received, was seen as being pivotal to the success and quality of the support they, in turn, could offer to parents. Peer supporters placed a strong emphasis on skill development during training; in particular, they highlighted the importance of personal reflection and knowledge development. Peer supporters felt valued by Connected; they gained confidence, a sense of accomplishment, and for some it had facilitated a positive change in their own lives, making changes to partner relationships, and equipped them with the skills and experience when transitioning to paid employment both within Connected and external organisations. It was clear that peer support, for the vast majority, was about responding to parents in a way that would empower them to successfully manage their own lives. However, there were some differences in the way this was viewed by peer supporters. For example, some believed that empowerment was facilitated best when the peer supporter had their own relatable and shared experiences of parenthood. Others felt that empathy and understanding was a key attribute, whilst some thought that relationship development and listening skills were crucial. There were some challenges to the role of peer supporters. For example, managing professional boundaries in the peer supporter-parent relationship: gauging the extent and limit of support provided, managing how support ended, and balancing their own commitments against being available for parents as needed. Parental Experiences Parents who took part in this study spoke about the broad range of support they received, including: (i) preparing for birth and parenthood, e.g., information on labour; (ii) supporting with perinatal mental health experiences, e.g., normalising experiences: (iii) getting out and about with confidence, e.g., being alongside parents and going out together, including to community groups to meet other parents. When parents spoke about the peer support they had received a majority described feeling doubtful initially about the potential value it would give them. A small number of parents also viewed the acceptance of help as questioning their ability to be a good parent. Despite feeling this way at the outset, all parents went on to subsequently report that peer support far exceeded their expectations. They felt their peer supporter was someone who approached them without an agenda and who listened attentively to their needs. Parents generally thought that a peer supporter’s experience of parenthood was useful to fulfil their role, though a small number did not hold this view. Importantly, the parenthood experience is wide-ranging and the experiences that parents valued within peer support differed according to their own needs and circumstances, e.g., having a peer supporter with perinatal mental health experience or who had given birth via C-Section. In a similar way to peer supporters, parents also found it difficult when managing the end of the support relationship. Indeed, for parents, this was because of the close relationships they had formed with their peer supporters. At the time, all parents were made aware that the end of support was approaching, but many said that this still did not prepare them emotionally when the final day arrived. It is important to note that, even though parents felt this way, they also felt that the strategies that had been used by peer supporters to help manage the end were transparent and they had been successfully supported with further onward signposting for any ongoing needs. Furthermore, the opportunity to attend Connected community groups following one-to-one support was available and was helpful for some parents in buffering the end of one-to-one support. A minority raised concerns relating to a perceived lack of professional involvement within these groups, though this is most likely the result of the change in the type of support rather than the quality of support received. The findings section of this report provides a full analysis of the interview data and explores the one-to-one perinatal peer support service received through the Connected. Furthermore, we make several recommendations: · To further explore the importance that peer supporters with experience of parenthood has on the parent-peer supporter relationship. · To put processes in place during training or ongoing monitoring that ensures peer supporters fully meet parents’ support needs. · To develop peer-support skills in managing endings. · To consider whether there are appropriate times when peer supporters can shadow experienced ones. · To ensure that professionals at all levels are aware of the existence of Connected’s support provision for professional services where support agreements are in place. In conclusion, all of those who participated, either providing or receiving Connected one-to-one perinatal peer support, reported a positive and beneficial experience. Participants’ experiences have given insight into how one-to-one support may be further developed. Although not part of the research itself, feedback on providing hospital and community group support also provided useful considerations for relationship development between services and management of Connected community groups

Rotavirus-associated seizures and reversible corpus callosum lesion

Rotavirus is a non-enveloped double-stranded RNA virus that causes severe gastroenteritis in children, but complications are rarely reported. Some reports have shown that rotavirus can induce diverse complications of the central nervous system, such as seizures, encephalopathy with a reversible splenial lesion, encephalitis, cerebral white matter abnormalities, and cerebellitis. Here, we present a 2-year-old patient with seizures, who had an isolated splenial lesion in the corpus callosum on neuroimaging, and the rotavirus antigen detected in faeces. © Lietuvos mokslu akademija, 2019. Other Abstract: ROTAVIRUSO SUKELTI TRAUKULIAI IR LAIKINAS DIDZIOSIOS SMEGENU JUNGTIES PAZEIDIMAS: SantraukaRotavirusas yra dvigrandes RNR virusas be apvalkalo, sukeliantis sunku vaiku gastroenterita, taciau apie komplikacijas pranesama retai. Kai kurie atveju aprasymai rodo, kad rotavirusas gali sukelti ivairias centrines nervu sistemos komplikacijas, tokias kaip traukuliai, encefalopatija su trumpalaikiu didziosios smegenu jungties pazeidimu, encefalitas, smegenu baltosios medziagos anomalijos ir cerebelitas. Cia pristatome dveju metu pacienta su traukuliais, kuriam laikinas didziosios smegenu jungties pazeidimas buvo nustatytas neurovaizdinimo metu, o rotaviruso antigenas aptiktas ismatose.Raktazodziai: rotavirusas, vaiku traukuliai, rotaviruso komplikacijos.publishersversionPeer reviewe

Variation in clinical presentation of childhood group A streptococcal pharyngitis in four countries

Funding Information: This study was supported by USAID. The Croatian and Latvian site was funded by the Department of Child and Adolescent Health and Development, World Health Organization, Geneva.We conducted a cross-sectional study from September 2001 to August 2003 during which children between 2 and 12 years of age presenting with complaint of sore throat were recruited from urban pediatric clinics in Brazil, Croatia, Egypt and Latvia. The objective of the study was to compare clinical signs and symptoms of children presenting to urban pediatric clinics with sore throat in and between countries and to identify common clinical criteria predicting group A beta hemolytic streptococcal (GAS) pharyngitis. Using a single standard protocol in all four sites, clinical data were recorded and throat swabs obtained for standard GAS culture in 2040 children. Signs and symptoms were tested for statistical association with GAS positive/negative pharyngitis, and were compared using X2 tests, ANOVA and Odds Ratios. Clinical signs of GAS pharyngitis in children presenting to clinics varied significantly between countries, and there were few signs or symptom that could statistically be associated with GAS pharyngitis in all four countries, though several were useful in two or three countries. Our results indicate that the clinical manifestations of pharyngitis in clinics may vary by region. It is therefore critical that clinical decision rules for management of pharyngitis should have local validation.publishersversionPeer reviewe

Differential Requirement of Gata2a and Gata2b for Primitive and Definitive Myeloid Development in Zebrafish

Germline loss or mutation of one copy of the transcription factor GATA2 in humans leads to a range of clinical phenotypes affecting hematopoietic, lymphatic and vascular systems. GATA2 heterozygous mice show only a limited repertoire of the features observed in humans. Zebrafish have two copies of the Gata2 gene as a result of an additional round of ancestral whole genome duplication. These genes, Gata2a and Gata2b, show distinct but overlapping expression patterns, and between them, highlight a significantly broader range of the phenotypes observed in GATA2 deficient syndromes, than each one alone. In this manuscript, we use mutants for Gata2a and Gata2b to interrogate the effects on hematopoiesis of these two ohnologs, alone and in combination, during development in order to further define the role of GATA2 in developmental hematopoiesis. We define unique roles for each ohnolog at different stages of developmental myelopoiesis and for the emergence of hematopoietic stem and progenitor cells. These effects are not additive in the haploinsufficient state suggesting a redundancy between these two genes in hematopoietic stem and progenitor cells. Rescue studies additionally support that Gata2b can compensate for the effects of Gata2a loss. Finally we show that adults with loss of combined heterozygosity show defects in the myeloid compartment consistent with GATA2 loss in humans. These results build on existing knowledge from other models of GATA2 deficiency and refine our understanding of the early developmental effects of GATA2. In addition, these studies shed light on the complexity and potential structure-function relationships as well as sub-functionalization of Gata2 genes in the zebrafish model

Hybrid immunity expands the functional humoral footprint of both mRNA and vector-based SARS-CoV-2 vaccines

Funding Information: We thank Nancy Zimmerman, Mark and Lisa Schwartz, an anonymous donor (financial support), Terry and Susan Ragon, and the SAMANA Kay MGH Research Scholars award for support. We acknowledge support from the Ragon Institute of Mass General, MIT, and Harvard (to G.A.) the Massachusetts Consortium on Pathogen Readiness (MassCPR) (to G.A.), and the National Institutes of Health ( 3R37AI080289-11S1 , R01AI146785 , U19AI42790–01 , U19AI135995–02 , U19AI42790-01 , 1U01CA260476 – 01 , and CIVIC75N93019C00052 ) (to G.A.). Publisher Copyright: © 2023Despite the successes of current coronavirus disease 2019 (COVID-19) vaccines, waning immunity, the emergence of variants of concern, and breakthrough infections among vaccinees have begun to highlight opportunities to improve vaccine platforms. Real-world vaccine efficacy studies have highlighted the reduced risk of breakthrough infections and diseases among individuals infected and vaccinated, referred to as hybrid immunity. Thus, we sought to define whether hybrid immunity shapes the humoral immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) following Pfizer/BNT162b2, Moderna mRNA-1273, ChadOx1/AZD1222, and Ad26.COV2.S vaccination. Each vaccine exhibits a unique functional humoral profile in vaccination only or hybrid immunity. However, hybrid immunity shows a unique augmentation of S2-domain-specific functional immunity that was poorly induced for the vaccination only. These data highlight the importance of natural infection in breaking the immunodominance away from the evolutionarily unstable S1 domain and potentially affording enhanced cross-variant protection by targeting the more highly conserved S2 domain of SARS-CoV-2.publishersversionPeer reviewe