Naha sügelustunne psoriaasihaigetel

Psoriaasi korral on isikule kannatuste põhjustajaks nii nahalööbe esinemine kui samaaegne naha sügelemine. Psoriaasihaige elukvaliteeti mõjutavate negatiivsete faktorite korrelatsioonanalüüsil oli naha intensiivne sügelemine haigele kannatuste põhjustajana teisel kohal. Kõige rohkem kannatusi põhjustas haigetele nahalööbe segav mõju inimestevahelises suhtlemises. Sügelustunde häirivat mõju konstateeris 85% psoriaasihaigetest

Health Care Fraud Means Never Having to Say You\u27re Sorry

For decades, the Department of Justice (DOJ) has issued a steady flood of press releases announcing False Claims Act (FCA) settlements against health care entities and extolling the purportedly sharp message sent to the industry through these settlements about the consequences of engaging in wrongdoing. The FCA is the primary mechanism for government enforcement against health care entities engaged in wrongdoing, and it is expected to be DOJ’s key tool for addressing fraud arising out of government programs in response to the COVID-19 pandemic. DOJ has pointed to three key goals of its enforcement efforts (deterrence, incentivizing cooperation, and building a culture of compliance in the health care industry). However, careful examination of the settlements touted in those DOJ press releases calls into question whether DOJ’s settlement practices are conveying the message DOJ seeks to impart or having the impact it hopes to achieve. Virtually all FCA cases resolve without requiring the defendant to admit wrongdoing, and many defendants issue explicit public denials of wrongdoing when the resolution is announced. The absence of any need to admit wrongdoing has fueled a cost-of-doing-business narrative in which health care entities are required periodically to pay inconsequential settlements to the government regardless of their conduct. DOJ thereby risks both diminishing the general deterrence value of resolutions and lending credence to the vocal skepticism among industry and the defense bar that DOJ could, in fact, prevail at trial. DOJ’s willingness to allow settlements in health care fraud cases without admissions is diametrically contrary to DOJ’s policy in criminal cases, which is against permitting resolutions without defendants’ clear and unequivocal acceptance of responsibility for violating the law. Permitting no-responsibility settlements in the civil FCA context suggests both that DOJ pursues, illegitimately, weak cases it cannot prove at trial, and potentially weakens the general deterrence value of civil FCA claims in general. New defendants may be left with cover that they are not wrongdoers but are merely ensnared in an illegitimate money grab. Even defendants who frankly recognize that they are in violation of the statute may be comforted that they likely face paying little more than restitution, and no significant penalties or social opprobrium. These practices suggest that DOJ rewards willingness to settle, and the monetary recovery it brings, above all other factors. DOJ’s focus on settling and monetary recoveries in turn lends credence to the widespread belief that civil health care fraud settlements simply do not signal wrongdoing. There is no law, policy, or practice that prevents DOJ from requiring admissions in FCA settlements. Yet an in-depth review of nearly 200 FCA resolutions involving health care entities over the past two years reveals that approximately 92% did not include defendants’ clear acceptance of responsibility, and approximately 37% involved defendants actively denying responsibility. The absence of any DOJ policy favoring admissions has important negative consequences, undermining DOJ’s goals of deterrence, incentivizing cooperation, and building a culture of compliance. First, when corporate actors believe DOJ will pursue claims regardless of wrongdoing and the consequences of even a settlement will be relatively painless from a financial and reputational perspective, those actors have reduced incentive to put in place compliance structures dedicated to preventing wrongdoing. Second, and perhaps more importantly, when corporate actors diminish the force of settlements with DOJ by denying responsibility, they undermine the system’s legitimacy vital for DOJ to encourage cooperation and for the government and well-meaning corporate actors to cultivate an industry-wide culture of compliance. This Article examines DOJ policy both from an economic incentive perspective and in light of research surrounding the psychology of legal authority, concluding that under both lenses DOJ undercuts its own goals. With DOJ actively reforming FCA policy and the FCA poised to take center stage in the government’s fight against COVID-19 program abuse, it is beyond time to address this gap in DOJ’s enforcement policy

A Path to Data-Driven Health Care Enforcement

The Department of Justice (“DOJ”) has a long-stated goal of encouraging companies to engage in what the author refers to as “compliant behaviors”—maintenance of an effective pre-existing compliance program, post-enforcement adoption of an effective compliance program, cooperation with a government investigation, and self-disclosure of misconduct. Substantial DOJ guidance over the past two decades, along with the concrete incentive structure of the United States Sentencing Guidelines, have increasingly made clear to organizations when and how such behaviors will be rewarded in criminal matters. Recently, DOJ has made transparency and clarity regarding the benefit of compliant behaviors a priority in calculating and announcing criminal resolutions. With respect to civil False Claims Act (“FCA”) settlements, however, meaningful formal DOJ guidance on the effect of compliant behavior only arrived in 2019. More significantly, DOJ’s treatment of compliant behavior in civil cases, in contrast to that in the case of criminal resolutions, has appeared inconsistent and certainly opaque. This lack of clear implementation philosophy is particularly problematic in the area of health care, an industry for which the FCA is the primary tool for government action in response to misconduct. While much has been written on the systemic efficiencies—or lack thereof—that DOJ’s enforcement practices bring to the activities of regulated industries, this is the first article to use data to ask whether DOJ has a governing practice concerning civil settlements, or whether instead, its settlement practices fail to match its stated principles. For decades, even as resources devoted to health care compliance by market participants have skyrocketed and DOJ has pressed corporate entities to engage in compliant behaviors, the health care industry and the defense bar have expressed skepticism regarding the actual payoff they might realize by engaging in those behaviors. DOJ’s response has been a series of public statements amounting to, “trust us, they matter.” Until now, the health care industry has been without any mechanism to test those assurances. In response to changes in the tax code, however, DOJ made adjustments in 2018 to its practice of disclosing information regarding FCA settlements—changes that have shaken loose data that provides an opportunity to test DOJ’s claims of rewarding compliant behaviors in civil cases. The author is the first and thus far the only person to have identified and analyzed this newly available data. Examination of this data demonstrates that wide-ranging, structural changes are necessary. The data raises substantial questions about: the quantum of credit given for cooperation; conduct DOJ values in resolving FCA cases; and the degree of consistency in cases settled by U.S. Attorney’s Offices across the country. For example, analysis of the data reveals inconsistent benefits for cooperation. Cases where defendants self-disclosed misconduct or cooperated were often not treated more leniently than cases where defendants did not self-disclose or cooperate, and a review of more than 100 settlements did not find a single instance in which DOJ purported to give an entity a reduction based on its pre-existing compliance program. At the same time, DOJ appears to be greatly rewarding defendants for agreeing to settle—highlighting concerns both with regard to whether DOJ is achieving adequate deterrence and with regard to whether the FCA’s potential penalties are coercing settlements. And the data appears to show significant variation in settlement positions depending on the identity of enforcing DOJ component, with cases handled by DOJ’s Civil Division in Washington, D.C. treated more leniently than cases handled solely by U.S. Attorney’s Offices across the country. With the data now public—and at a moment in time when DOJ is emphasizing transparency and clarity in rewarding compliant behaviors in the resolution of criminal cases—DOJ’s corporate health care enforcement regime is at a crossroads. Without change in this area, DOJ risks undercutting its efforts at encouraging compliant behaviors in one of DOJ’s primary enforcement areas. No longer left in the dark about the impact of compliant behaviors in calculating FCA resolutions, the health care industry may be less likely to continue investing in compliance programs at the same rate, to cooperate with government investigations, and especially to self-disclose misconduct to the government. The analysis reveals that a detailed structure of DOJ’s calculations in FCA settlements, with calculations transparent in each FCA resolution, is needed to accomplish DOJ’s goal of encouraging cooperation and investment in compliance programs, as well as to provide an assurance that like cases are treated alike

Psoriaasi patogeneesi psühhosotsiaalseid aspekte

http://www.ester.ee/record=b1062319*es

Psoriaatilise artriidi esinemisest psoriaasi korral

Psoriaas (Ps) on põletikuline, geneetilise eelsoodumusega ja kroonilise kuluga dermatoos, mille puhul etendavad olulist osa haigust soodustavad/provotseerivad tegurid ning immunoloogilised protsessid (1, 2). Psoriaatiline artriit (PsA) on psoriaasiga assotsieeruv artriit, mis kuulub spondüloartropaatiate hulka (2, 3). 70%-l psoriaasihaigetest ilmneb artriit alles aastaid pärast nahakahjustuse vallandumist ning 1/10-l haigetest ägenevad ühel ajal nii nahanähud kui ka artriit. Artriidi vallandumine psoriaasi korral viib sageli invaliidsuse kujunemiseni ning selle vältimiseks on vajalik pidev süsteemne ravi (2)

Essays on the Economics of Electricity Markets

The thesis at hand includes three distinct essays that analyze economic issues related to liberalized electricity markets. In the first essay, the effects of capacity mechanisms on the market structure in electricity markets are investigated. We consider a model with dominant firms and a competitive fringe and analyze the impact of price caps and capacity mechanisms on investments and market concentration. Whereas in static models lower price caps reduce the potential to exercise market power, we show that in our two stage model with endogenous investments, lower price caps result in an increase in market concentration, a higher frequency of capacity withholding and larger profits for the dominant firms. The second essay analyzes cross-border effects of capacity mechanisms. We consider a model with two connected countries that only differ in their capacity mechanisms, namely strategic reserves or capacity payments. In both countries, competitive firms invest in generation capacity before selling electricity on the spot market. We show that different capacity mechanisms lead to redistribution effects such that the country with strategic reserves is worse off, meaning the consumer costs are higher in this country. The third essay deals with the value of wind power and, more specifically, with the impact of the spatial dependence of wind power on its market value. We create a stochastic simulation model for electricity spot prices that captures the full spatial dependence structure of wind power by using copulas. We then calibrate the model with German data. We show that the specific location of a turbine, i.e., its spatial dependence with respect to the aggregated wind power in the market, is extremely important in determining its value. Many of the locations analyzed show an upper tail dependence that adversely impacts the market value

The Drosophilidae (Diptera) of Estonia

Until recently, no published records on drosophilids from the Baltic countries existed, except for an unpublished species list for Estonia. We made two collecting trips through the three Baltic countries in the summer of 2000. The first trip was made in early summer to get spring species and the second in late August to get the fungivorous species. We used baiting methods for collecting Drosophila, while the earlier results were obtained e.g. using net sweeping. In general, the drosophilid fauna of Estonia resembles the well-known fauna of the Nordic countries. The single most interesting result was that Chymomyza amoena, a recent American invader of central Europe, was found. Another interesting finding was the relative rarity of D. subobscura and the virtual absence of D. virilis group species