Development of an Early Identification and Response Model of Malpractice Prevention

The dramatic rise in the incidence of malpractice claims over the past thirty years has revealed several problems with the U.S. system of medical dispute resolution. First, the sudden and unexpected increase in claims has created an insurance crisis wherein various medical specialists have had difficulty obtaining affordable insurance coverage. One such crisis occurred in Florida in the mid-1980\u27s, when an inability of many physicians to procure medical malpractice coverage caused some to limit or curtail their practice. This resulted in access problems for the public. This phenomenon has disproportionately befallen physicians practicing obstetric medicine. Second, besides contributing to periodic crises of access, the current medical dispute resolution system is often responsible for long delays in resolving claims and in compensating victims. Third, compensation is sometimes inequitable, encouraging frivolous suits and making the system expensive to operate. Finally, while there is no evidence that the system reduces bad care, it clearly contributes to increased cost by encouraging unjustified defensive medicine

Comment on ``Evidence for Narrow Baryon Resonances in Inelastic pp Scattering''

Compton scattering data are sensitive to the existence of low-mass resonances reported by Tatischeff et al. We show that such states, with their reported properties, are excluded by previous Compton scattering experiments.Comment: One page, submitted to PR

Which Aortic Valve Can Be Surgically Reconstructed?

Purpose of Review Preservation or repair of the aortic valve has evolved dynamically in the past 20 years. It leads to a high freedom from valve-related complications if an adequate valve durability can be achieved; it may possibly also improve survival. To date, little structured information is available about which valves can be repaired and which should better be replaced. Recent Findings For surgical decision-making, the size of the aortic root is important and the anatomy of the aortic valve must be considered. In the presence of root aneurysm, most tricuspid and bicuspid aortic valves can be preserved. In aortic regurgitation and normal aortic dimensions, the majority of tricuspid and bicuspid aortic valves can be repaired with good long-term durability. In bicuspid aortic valves, the morphologic characteristics must be taken into consideration. Unicuspid and quadricuspid aortic valves can be repaired in selected cases. Generally, cusp calcification is a sign of a poor substrate for repair; the same is true for cusp retraction and cusp destruction due to active endocarditis. They are associated with limited valve durability. Summary Using current concepts, many non-calcified aortic valves can be repaired. Modern imaging, in particular three-dimensional transesophageal echocardiography (TEE), should be able to define repairable aortic valves with a high probability

Endoscopic Resection of Sinonasal Malignancy: A Systematic Review and Meta-analysis

OBJECTIVES: The use of endoscopic approaches for sinonasal malignancy resection has increased, but survival data are limited secondary to disease rarity and new surgical technique. Here we present a systematic review and meta-analysis of endoscopic endonasal resection of sinonasal malignancy. DATA SOURCES: MEDLINE, PubMed Central, NCBI Bookshelf, Cochrane Library, clinicaltrials.gov, National Guideline Clearinghouse. REVIEW METHODS: PRISMA/MOOSE guidelines were followed. MeSH terms were "endoscopic" AND ("esthesioneuroblastoma" OR "sinonasal adenocarcinoma" OR "squamous cell carcinoma" OR "sinonasal undifferentiated carcinoma"). For studies in which individual-level data were available, results were obtained by direct pooling. For studies in which only summary Kaplan-Meier curves were available, numerical data were extracted, traced, and aggregated by fitting a Weibull model. RESULTS: Of 320 studies identified, 35 case series were included (n = 952 patients), with 15 studies analyzed via aggregate modeling and 20 studies analyzed via direct pooling. Two- and 5-year survival rates for patients in aggregate modeling were 87.5% and 72.3%, respectively (mean follow-up: 32.9 months). Two- and 5-year survival for patients in direct pooling were 85.8% and 83.5%, respectively (mean follow-up: 43.0 ± 19.5 months). Significant overall survival difference was found between low- and high-grade cancers (P = .015) but not between low- and high-stage cancers (P = .79). CONCLUSION: Overall 2- and 5-year survival rates are comparable and sometimes greater than those from open craniofacial resection. Survival rates significantly differ by cancer grade but not stage. Journals and investigators should be encouraged to publish retrospective and prospective case series with staged survival updates based on established guidelines

Rethinking Peer Review: Detecting and Addressing Medical Malpractice Claims Risk

A medical center department chair has just been notified that a physician in his department, Dr. G, is being sued for the fifth time in seven years. The CEO of co-defendant hospital wants the chair to solve Dr. G\u27s claims problems. At the chair\u27s request, the hospital peer review committee evaluates Dr. G\u27s malpractice cases. While committee members note some minor concerns in the cases, they conclude that in each circumstance he has met the standard of care. They cannot identify any specific technical or educational need, nor can they supply justification for a disciplinary action. The chair is in a vexing situation. Is Dr. G. the victim of bad luck, or is something more systematic at work? Is there some failure or deficiency other than technical incompetence which is making this physician vulnerable to malpractice suits? If so, is it remediable? In this Article, we analyze the ability of peer review to recognize and reduce physicians\u27 risk of medical malpractice claims. Critics argue that peer review neither consistently identifies substandard physicians, nor ensures their removal, while it unfairly targets colleagues for reasons such as economic competition. They suggest that the solution may be to modify statutes governing privilege and immunity, or to increase penalties for healthcare institutions that violate reporting statutes. Critics\u27 concerns may be misplaced. We will argue that peer review is not deficient in its basic conception, but rather aspects of its design and implementation which often do not directly link it to an institution\u27s risk management activities. We assert that peer review can effectively identify a physician\u27s risk of generating a disproportionate share of medical malpractice claims ex ante, and present a sample methodology which allows peer review to more effectively help physicians address that risk. Part I of this Article discusses the background and authority for peer review. Part II outlines common criticisms of peer review and discusses shortcomings in these analyses. Part III describes background medical malpractice research and introduces the Patient Advocacy Reporting System ( PARSSM ) program for peer review. In Part IV we conclude with a discussion of programmatic elements which, if incorporated into the legal framework for peer review, may allow peer review committees to systematically evaluate, monitor, and, potentially reduce physicians\u27 medical malpractice claims risk

Sex Differences in Semantic Processing: Event-Related Brain Potentials Distinguish between Lower and Higher Order Semantic Analysis during Word Reading

Behavioral studies suggest that women and men differ in the strategic elaboration of verbally encoded information especially in the absence of external task demand. However, measuring such covert processing requires other than behavioral data. The present study used event-related potentials to compare sexes in lower and higher order semantic processing during the passive reading of semantically related and unrelated word pairs. Women and men showed the same early context effect in the P1-N1 transition period. This finding indicates that the initial lexical-semantic access is similar in men and women. In contrast, sexes differed in higher order semantic processing. Women showed an earlier and longer lasting context effect in the N400 accompanied by larger signal strength in temporal networks similarly recruited by men and women. The results suggest that women spontaneously conduct a deeper semantic analysis. This leads to faster processing of related words in the active neural networks as reflected in a shorter stability of the N400 map in women. Taken together, the findings demonstrate that there is a selective sex difference in the controlled semantic analysis during passive word reading that is not reflected in different functional organization but in the depth of processin

Chronic allograft nephropathy: expression and localization of PAI-1 and PPAR-c

Abstract Background. Chronic allograft nephropathy (CAN) is a major cause of loss of renal allografts. Mechanisms postulated to be involved include sequelae of rejection, warm ischaemia time, drug toxicity, ongoing hypertension and dyslipidaemia. Plasminogen activator inhibitor-1 (PAI-1) is implicated not only in thrombo

Deeply Virtual Compton Scattering

We study in QCD the physics of deeply-virtual Compton scattering (DVCS)---the virtual Compton process in the large s and small t kinematic region. We show that DVCS can probe a new type of off-forward parton distributions. We derive an Altarelli-Parisi type of evolution equations for these distributions. We also derive their sum rules in terms of nucleon form-factors of the twist-two quark and gluon operators. In particular, we find that the second sum rule is related to fractions of the nucleon spin carried separately by quarks and gluons. We estimate the cross section for DVCS and compare it with the accompanying Bethe-Heitler process at CEBAF and HERMES kinematics.Comment: 20 pages, 2 figures, replaced with the version to appear in Phys. Rev.

Cepheid Calibration of the Peak Brightness of SNe Ia -- IX. SN 1989B in NGC 3627

(Abridged) Repeated imaging observations have been made of NGC 3627 with the HST in 1997/98, over an interval of 58 days. Images were obtained on 12 epochs in the F555W band and on five epochs in the F814W band. The galaxy hosted the prototypical, `Branch normal', type Ia supernova SN 1989B. A total of 83 variables have been found, of which 68 are definite Cepheid variables with periods ranging from 75 days to 3.85 days. The de-reddened distance modulus is determined to be (m-M)_0= 30.22+/-0.12 (internal uncertainty) using a subset of the Cepheid data whose reddening and error parameters are secure. The photometric data of Wells et al. (1994), combined with the Cepheid data for NGC 3627 give M_B(max)= -19.36+/-0.18 and M_V(max)= -19.34+/-0.16 for SN 1989B. Combined with the previous six calibrations in this program, plus two additional calibrations determined by others gives the mean absolute magnitudes at maximum of = -19.48+/-0.07 and = -19.48 +/-0.07 for `Branch normal' SNe Ia at this interim stage in the calibration program. The second parameter correlations of M(max) of blue SNe Ia with decay rate, color at maximum, and Hubble type are re-investigated. The dependence of on decay rate is non-linear, showing a minimum for decay rates between 1.0< Delta m_15 <1.6. Magnitudes corrected for decay rate show no dependence on Hubble type, but a dependence on color remains. Correcting both the fiducial sample of 34 SNe Ia with decay-rate data and the current 8 calibrating SNe Ia for the correlation with decay rate as well as color gives H_0= 60+/-2 (internal) km/s/Mpc, in both B and V. The same value to within 4% is obtained if only the SNe Ia in spirals (without second parameter corrections) are considered.Comment: 32 pages (with 7 tables and 14 figures) LaTeX, uses emulateapj.sty; a full-resolution version with complete figs. 4 and 5 is available at http://www.astro.unibas.ch/cosmology/papers.html ; accepted for publication in Ap

Spillway discharge capacity upgrade at Gloriettes dam

In many countries dams are found to have insufficient flood discharge capacity with respect to updated design floods. Upgradig of spillway discharge capacity has therefore become a significant issue for operators of hydropower plants. The Gloriettes concrete arch dam in the French Pyrenees, operated by EDF, shows a deficit of 80m3/s for the new design flood of 150m3/s. Therefore a complementary spillway on the right bank is to be implemented. The type of labyrinth weir known as the Piano Key Weir (PKW) was selected