Does the Incidence of Public Official Liability Claims Increase in Years Following a Mayoral Election?

Elected and appointed public officials at every level of government face a growing number of lawsuits relating to countless activities such as zoning, budgets, administration, distributing permits and more. Public official (PO) liability claims alleging failure to promote employees, discrimination, and sexual harassment continue to skyrocket. It is critical to the vitality of American cities to protect officials who have chosen public service so that they can continue to focus on serving their communities. The Kentucky League of Cities Insurance Services (KLCIS), a member-owned insurance pool of Kentucky municipalities, offers general liability, public official liability, law enforcement liability, automobile coverage including liability and property damage, worker’s compensation, crime, K-9 mortality and unemployment insurance. Insurance claims data of all types are used to analyze why a provider is paying on certain types of claims more than others and how they can predict future trends. An analysis of PO liability claims makes for an interesting case because local public officials who hold positions of power in a municipality often times misuse or abuse their power for dishonest or unlawful gain. KLCIS PO liability coverage is designed to cover claims for errors, omissions, neglect or breach of duty, violation of civil rights, wrongful termination or sexual harassment claims brought against municipalities. On a superficial level, KLCIS has speculated that PO claims filed with their agency increase or decrease depending on Kentucky’s mayoral election cycle due to unfair employment practices. KLCIS has asked that I perform a statistical analysis of this presumption. Therefore, the question this analysis seeks to answer is: “Does the Incidence of Public Official Liability Claims Increase in Years Following a Mayoral Election?” To answer this question, I analyzed data provided by the Kentucky League of Cities Insurance Services to establish whether there was a clear causal relationship between the number of PO liability claims and the years following a mayoral election. I found no significant effect of mayoral election year trends in PO liability claims. I did, however, find that time contributes to the increase of PO liability claims and the dollar amount incurred associated with those claims. Applying claims as the dependent variable, rather than the amount incurred, also produces a stronger regression model. It seems only natural that if the number of cities who purchase a PO liability policy increases over the years, so too will the dollar amount incurred because it takes money to settle those claims. Despite finding no significant relationship between PO liability claims and mayoral election years in Kentucky, it is important to identify, quantify and deliver insurance claims data analyses because it provides the ability to detect trends over time. Non-profit membership organizations resembling the Kentucky League of Cities which also provide insurance products and services through a self-insured pool may find claims data analysis beneficial. Cities, their agencies, boards, commissions, units of local government, and other non-profit public purpose organizations can learn valuable lessons from factors that may or may not contribute to the increase in the number of claims filed

Extreme morning chronotypes are often familial and not exceedingly rare: the estimated prevalence of advanced sleep phase, familial advanced sleep phase, and advanced sleep-wake phase disorder in a sleep clinic population.

Study objectivesReport the first prevalence estimates of advanced sleep phase (ASP), familial advanced sleep phase (FASP), and advanced sleep-wake phase disorder (ASWPD). This can guide clinicians on the utility of screening for extreme chronotypes both for clinical decision-making and to flag prospective participants in the study of the genetics and biology of FASP.MethodsData on morning or evening sleep schedule preference (chronotype) were collected from 2422 new patients presenting to a North American sleep center over 9.8 years. FASP was determined using a severity criterion that has previously identified dominant circadian mutations in humans. All patients were personally seen and evaluated by one of the authors (C.R.J.).ResultsOur results demonstrate an ASP prevalence of 0.33%, an FASP prevalence of 0.21%, and an ASWPD prevalence of at least 0.04%. Most cases of young-onset ASP were familial.ConclusionsAmong patients presenting to a sleep clinic, conservatively 1 out of every 300 patients will have ASP, 1 out of every 475 will have FASP, and 1 out of every 2500 will have ASWPD. This supports obtaining a routine circadian history and, for those with extreme chronotypes, obtaining a family history of circadian preference. This can optimize treatment for evening sleepiness and early morning awakening and lead to additional circadian gene discovery. We hope these findings will lead to improved treatment options for a wide range of sleep and medical disorders in the future

Craniosacral therapy for migraine: Protocol development for an exploratory controlled clinical trial

Abstract Background Migraine affects approximately 20% of the population. Conventional care for migraine is suboptimal; overuse of medications for the treatment of episodic migraines is a risk factor for developing chronic daily headache. The study of non-pharmaceutical approaches for prevention of migraine headaches is therefore warranted. Craniosacral therapy (CST) is a popular non-pharmacological approach to the treatment or prevention of migraine headaches for which there is limited evidence of safety and efficacy. In this paper, we describe an ongoing feasibility study to assess the safety and efficacy of CST in the treatment of migraine, using a rigorous and innovative randomized controlled study design involving low-strength static magnets (LSSM) as an attention control intervention. Methods The trial is designed to test the hypothesis that, compared to those receiving usual care plus a treatment with low-strength static magnets (attention-control complementary therapy), subjects receiving usual medical care plus CST will demonstrate significant improvement in: quality-of-life as measured by the Headache Impact Test (HIT-6); reduced frequency of migraine; and a perception of clinical benefit. Criteria for inclusion are either gender, age > 11, English or Spanish speaking, meeting the International Classification of Headache Disorders (ICHD) criteria for migraine with or without aura, a headache frequency of 5 to 15 per month over at least two years. After an 8 week baseline phase, eligible subjects are randomized to either CST or an attention control intervention, low strength static magnets (LSSM). To evaluate possible therapist bias, videotaped encounters are analyzed to assess for any systematic group differences in interactions with subjects. Results 169 individuals have been screened for eligibility, of which 109 were eligible for the study. Five did not qualify during the baseline phase because of inadequate headache frequency. Nineteen have withdrawn from the study after giving consent. Conclusion This report endorses the feasibility of undertaking a rigorous randomized clinical trial of CST for migraine using a standardized CST protocol and an innovative control protocol developed for the study. Subjects are able and willing to complete detailed headache diaries during an 8-week baseline period, with few dropouts during the study period, indicating the acceptability of both interventions. Trial Registration ClinicalTrials.gov NCT0066523

Review: The Journal of Dramaturgy, volume 23, issue 2

Contents include: Editor\u27s Note; LMDA Conference 2013 Re-defining Risk, A Keynote Address; Ellliott Hayes Award for Outstanding Achievement in Dramaturgy Introduction; Ellliott Hayes Award for Outstanding Achievement in Dramaturgy Staging Latina/o Classrooms and Culture: DNA and Dangerous Dramaturgy at the U.S.-Mexico Border; Early Career Dramaturgs Envision the Future of Dramaturgy: An Ensemble-Created Manifesto; What is the Future of Dramaturgy? A Manifesto; Juan Radigan and the Gringo, or Why Chilean Theatre Deserves our Attention; Behind the Scenes in Bollywood: An Interview with Brian Quirt; National Theatre: Center Stage\u27s My America Project; Crowdsourcing a New Hamburg Dramaturgy, A Preview of The Hamburg Dramaturgy: A New & Complete English Translation. Issue editors: Sydney Cheek-O\u27Donnell, Debra Cardona, Janine Sobeckhttps://soundideas.pugetsound.edu/lmdareview/1046/thumbnail.jp

Francisella tularensis Transmission by Solid Organ Transplantation, 20171.

In July 2017, fever and sepsis developed in 3 recipients of solid organs (1 heart and 2 kidneys) from a common donor in the United States; 1 of the kidney recipients died. Tularemia was suspected only after blood cultures from the surviving kidney recipient grew Francisella species. The organ donor, a middle-aged man from the southwestern United States, had been hospitalized for acute alcohol withdrawal syndrome, pneumonia, and multiorgan failure. F. tularensis subsp. tularensis (clade A2) was cultured from archived spleen tissue from the donor and blood from both kidney recipients. Whole-genome multilocus sequence typing indicated that the isolated strains were indistinguishable. The heart recipient remained seronegative with negative blood cultures but had been receiving antimicrobial drugs for a medical device infection before transplant. Two lagomorph carcasses collected near the donor's residence were positive by PCR for F. tularensis subsp. tularensis (clade A2). This investigation documents F. tularensis transmission by solid organ transplantation

Credibility of Low-Strength Static Magnet Therapy as an Attention Control Intervention for a Randomized Controlled Study of CranioSacral Therapy for Migraine Headaches

Developing valid control groups that generate similar perceptions and expectations to experimental complementary and alternative (CAM) treatments can be challenging. The perceived credibility of treatment and outcome expectancy often contributes to positive clinical responses to CAM therapies, thereby confounding efficacy data. As part of a clinical feasibility study, credibility and expectancy data were obtained from subjects suffering from migraine who received either CranioSacral therapy (CST) or an attention-control, sham, and low-strength magnet (LSSM) intervention

Targeting resistance to radiation-immunotherapy in cold HNSCCs by modulating the Treg-dendritic cell axis.

BACKGROUND: Numerous trials combining radiation therapy (RT) and immunotherapy in head and neck squamous cell carcinoma (HNSCC) are failing. Using preclinical immune cold models of HNSCC resistant to RT-immune checkpoint inhibitors, we investigate therapeutic approaches of overcoming such resistance by examining the differential microenvironmental response to RT. METHODS: We subjected two HPV-negative orthotopic mouse models of HNSCC to combination RT, regulatory T cells (Treg) depletion, and/or CD137 agonism. Tumor growth was measured and intratumorous and lymph node immune populations were compared among treatment groups. Human gene sets, genetically engineered mouse models DEREG and BATF3-/-, flow and time-of-flight cytometry, RNA-Seq, Treg adoptive transfer studies, and in vitro experiments were used to further evaluate the role of dendritic cells (DCs) and Tregs in these treatments. RESULTS: In MOC2 orthotopic tumors, we find no therapeutic benefit to targeting classically defined immunosuppressive myeloids, which increase with RT. In these radioresistant tumors, supplementing combination RT and Treg depletion with anti-CD137 agonism stimulates CD103+ DC activation in tumor-draining lymph nodes as characterized by increases in CD80+ and CCR7+ DCs, resulting in a CD8 T cell-dependent response. Simultaneously, Tregs are reprogrammed to an effector phenotype demonstrated by increases in interferonγ+, tumor necrosis factorα+, PI3K+, pAKT+ and Eomes+ populations as well as decreases in CTLA4+ and NRP-1+ populations. Tumor eradication is observed when RT is increased to an 8 Gy x 5 hypofractionated regimen and combined with anti-CD25+ anti-CD137 treatment. In a human gene set from oral squamous cell carcinoma tumors, high Treg number is associated with earlier recurrence. CONCLUSIONS: Regulating Treg functionality and DC activation status within the lymph node is critical for generating a T cell effector response in these highly radioresistant tumors. These findings underscore the plasticity of Tregs and represent a new therapeutic opportunity for reprogramming the tumor microenvironment in HNSCCs resistant to conventional radioimmunotherapy approaches

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder