Allowing Patients to Waive the Right to Sue for Medical Malpractice: A Response to Thaler and Sunstein

This essay critically evaluates Richard Thaler and Cass Sunstein’s proposal to allow patients to prospectively waive their rights to bring a malpractice claim, presented in their recent, much acclaimed book, Nudge: Improving Decisions about Health, Wealth and Happiness. We show that the behavioral insights that undergird Nudge do not support the waiver proposal. In addition, we demonstrate that Thaler and Sunstein have not provided a persuasive cost-benefit justification for the proposal. Finally, we argue that their liberty-based defense of waivers rests on misleading analogies and polemical rhetoric that ignore the liberty and other interests served by patients’ tort law rights. There are many ways in which nudges could be part of reforming medical malpractice litigation and improving the quality of medical care. Thaler and Sunstein’s use of behavioral economics to explore new ways of addressing persistent problems is an invitation to innovative and meaningful policy reform. Our criticisms of their medical malpractice waiver proposal are designed not to disparage this effort, but to remind policymakers of the importance of careful consideration of the facts before choosing a path for change

Passive fetal monitoring sensor

An ambulatory, passive sensor for use in a fetal monitoring system is discussed. The invention is comprised of a piezoelectric polymer film, combined with a metallic mounting plate fastened to a belt, and electrically connected to a signal processing unit by means of a shielded cable. The purpose of the sensor is to receive pressure pulses emitted by a fetus inside an expectant mother. Additionally, the monitor will filter out pressure pulses arising from other sources, such as the maternal heart

Atmospheric trace metal concentrations, solubility and deposition fluxes in remote marine air over the south-east Atlantic

Total and soluble trace metal concentrations were determined in atmospheric aerosol and rainwater samples collected during seven cruises in the south-east Atlantic. Back trajectories indicated the samples all represented remote marine air masses, consistent with climatological expectations. Aerosol trace metal loadings were similar to previous measurements in clean, marine air masses. Median total Fe, Al, Mn, V, Co and Zn concentrations were 206, 346, 5, 3, 0.7 and 11 pmol m-3 respectively. Solubility was operationally defined as the fraction extractable using a pH4.7 ammonium acetate leach. Median soluble Fe, Al, Mn, V, Co, Zn, Cu, Ni, Cd and Pb concentrations were 6, 55, 1, 0.7, 0.06, 24, 2, 1, 0.05 and 0.3 pmol m-3 respectively. Large ranges in fractional solubility were observed for all elements except Co; median solubility values for Fe, Al and Mn were below 20% while the median for Zn was 74%. Volume weighted mean rainwater concentrations were 704, 792, 32, 10, 3, 686, 25, 0.02, 0.3 and 10 nmol L-1 for Fe, Al, Mn, V, Co, Zn, Cu, Ni, Cd and Pb respectively (n = 6). Wet deposition fluxes calculated from these values suggest rain makes a significant contribution to total deposition in the study area for all elements except perhaps Ni

MicroRNA regulation of bovine monocyte inflammatory and metabolic networks in an in vivo infection model.

peer-reviewedBovine mastitis is an inflammation-driven disease of the bovine mammary gland that costs the global dairy industry several billion dollars per annum. Because disease susceptibility is a multi-factorial complex phenotype, an integrative biology approach is required to dissect the molecular networks involved. Here, we report such an approach, using next generation sequencing combined with advanced network and pathway biology methods to simultaneously profile mRNA and miRNA expression at multiple time-points (0, 12, 24, 36 and 48h) in both milk and blood FACS-isolated CD14+ monocytes from animals infected in vivo with Streptococcus uberis. More than 3,700 differentially expressed (DE) genes were identified in milk-isolated monocytes (MIMs), a key immune cell recruited to the site of infection during mastitis. Up-regulated genes were significantly enriched for inflammatory pathways, while down-regulated genes were enriched for non-glycolytic metabolic pathways. Monocyte transcriptional changes in the blood, however, were more subtle but highlighted the impact of this infection systemically. Genes up-regulated in blood-isolated-monocytes (BIMs) showed a significant association with interferon and chemokine signalling. Furthermore, twenty-six miRNAs were differentially expressed in MIMs and three in BIMs. Pathway analysis revealed that predicted targets of down-regulated miRNAs were highly enriched for roles in innate immunity (FDR < 3.4E-8) in particular TLR signalling, while up-regulated miRNAs preferentially targeted genes involved in metabolism. We conclude that during S. uberis infection miRNAs are key amplifiers of monocyte inflammatory response networks and repressors of several metabolic pathways.This study was funded in part by Teagasc RMIS 6018 and United States Department of Agriculture ARS funding 3625-32000-102-00. NL is supported by a Teagasc Walsh Fellowship

Multiscale analyses of solar‐induced florescence and gross primary production

Solar‐induced fluorescence (SIF) has shown great promise for probing spatiotemporal variations in terrestrial gross primary production (GPP), the largest component flux of the global carbon cycle. However, scale mismatches between SIF and ground‐based GPP have posed challenges toward fully exploiting these data. We used SIF obtained at high spatial sampling rates and resolution by NASA’s Orbiting Carbon Observatory‐2 satellite to elucidate GPP‐SIF relationships across space and time in the U.S. Corn Belt. Strong linear scaling functions (R2 ≥ 0.79) that were consistent across instantaneous to monthly time scales were obtained for corn ecosystems and for a heterogeneous landscape based on tall tower observations. Although the slope of the corn function was ~56% higher than for the landscape, SIF was similar for corn (C4) and soybean (C3). Taken together, there is strong observational evidence showing robust linear GPP‐SIF scaling that is sensitive to plant physiology but insensitive to the spatial or temporal scale.Key PointsGPP scales linearly with SIF from instantaneous to monthly time scalesAggregating ecosystem GPP‐SIF functions yield a representative landscape relation that matched one obtained directly using tall tower GPPGPP‐SIF relations showed sensitivity to plant physiology but not spatiotemporal scalePeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135999/1/grl55274_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135999/2/grl55274.pd

Comparing crop growth and carbon budgets simulated across AmeriFlux agricultural sites using the Community Land Model (CLM)

Improvement of process-based crop models is needed to achieve high fidelity forecasts of regional energy, water, and carbon exchanges. However, most state-of-the-art Land Surface Models (LSMs) assessed in the fifth phase of the Coupled Model Inter-comparison project (CMIP5) simulated crops as unmanaged C3 or C4 grasses. This study evaluated the crop-enabled version of one of the most widely used LSMs, the Community Land Model (CLM4- Crop), for simulating corn and soybean agro-ecosystems at relatively long-time scales (up to 11 years) using 54 site-years of data. We found that CLM4-Crop had a biased phenology during the early growing season and that carbon emissions from corn and soybean were underestimated. The model adopts universal physiological parameters for all crop types neglecting the fact that different crops have different specific leaf area, leaf nitrogen content and vcmax25, etc. As a result, model performance varied considerably according to crop type. Overall, the energy and carbon exchange of corn systems were better simulated than soybean systems. Long-term simulations at multiple sites showed that gross primary production (GPP) was consistently over-estimated at soybean sites leading to very large short and long-term biases. A modified model, CLM4-CropM’, with optimized phenology and calibrated crop physiological parameters yielded significantly better simulations of gross primary production (GPP), ecosystem respiration (ER) and leaf area index (LAI) at both short (hourly) and long-term (annual to decadal) timescales for both soybean and corn

Hip Anatomy and Ontogeny of Lower Limb Musculature in Three Species of Nonhuman Primates

The hip region is examined to determine what aspects of musculoskeletal anatomy are precociously developed in primate species with highly specialized modes of locomotion. Muscles of the hind limb were removed and weighed in each specimen, and the hip joint of selected specimens was studied in stained serial sections. No perinatal differences among species are evident, but in adults, the hip joint of Galago moholi (a leaping specialist) appears to have proportionally thick articular cartilage (relative to the subchondral plate) compared to two species of cheirogaleids. Muscle mass distribution in the hind limbs confirms previous observations that the quadriceps femoris muscle is especially large in Galago (in percent mass of the entire hind limb), while the hip region is smaller compared to the more quadrupedal cheirogaleids. Across age groups, the species with the least specialized locomotion as adults, Cheirogaleus medius, shows little or no change in proximal to distal percentage distribution of muscle mass. Galago has a larger percentage mass gain in the thigh. We suggest that muscle mass gain to specific limb segments may be a critical milestone for primates with extremely specialized modes of locomotion