The Expanding Role of the West Virginia Supreme Court of Appeals in the Review of Workmen\u27s Compensation Appeals

The November elections of 1976 brought about a major change in the composition of the West Virginia Supreme Court of Appeals. Three new justices, a majority of the court, were elected. The consequences of the election have been widely felt throughout the State. In no area has its impact been greater, however, than in the area of workmen\u27s compensation law. The court has shown a great willingness to hear workmen\u27s compensation appeals. In reviewing such appeals, the court has chosen to play an active role in the review of evidence, something generally avoided by prior courts. There has been little reluctance to substitute the majority\u27s assessment of the evidence for the factual findings of the Workmen\u27s Compensation Appeal Board. In substantive law the court has likewise had great impact, and in certain areas has taken action which would normally be considered within the purview of the legislature. Most significantly, the statutory immunity to suit granted to employers by the West Virginia Workmen\u27s Compensation Act, except in cases of intentional injury, has been altered to an extent which will only be finally determined by later cases. Other decisions have: liberalized the continuous exposure requirements of the occupational pneumoconiosis provisions of the Act; removed the requirement of demonstrating aggravation of an existing occupational pneumoconiosis condition with a particular employer in order to be entitled to benefits; extended the protection of a legislatively lengthened statute of limitations to claimants whose occupational pneumoconiosis claims were not yet barred when the new limitation period became effective; permitted concurrent recovery of benefits in separate claims even though the total amount of benefits paid exceeded statutory limits; liberalized requirements for reopening claims; and provided protection for innocent victims of horseplay. This article will assess the new court\u27s role in reviewing both substantive and procedural aspects of workmen\u27s compensation law. The discussion is divided into two broad areas: substantive changes in West Virginia workmen\u27s compensation law; and scope of the court\u27s review

Sub-Subgiants in the Old Open Cluster M67?

We report the discovery of two spectroscopic binaries in the field of the old open cluster M67 -- S1063 and S1113 -- whose positions in the color-magnitude diagram place them approximately 1 mag below the subgiant branch. A ROSAT study of M67 independently discovered these stars to be X-ray sources. Both have proper-motion membership probabilities greater than 97%; precise center-of-mass velocities are consistent with the cluster mean radial velocity. S1063 is also projected within one core radius of the cluster center. S1063 is a single-lined binary with a period of 18.396 days and an orbital eccentricity of 0.206. S1113 is a double-lined system with a circular orbit having a period of 2.823094 days. The primary stars of both binaries are subgiants. The secondary of S1113 is likely a 0.9 Mo main-sequence star, which implies a 1.3 Mo primary star. We have been unable to explain securely the low apparent luminosities of the primary stars; neither binary contain stars presently limited in radius by their Roche lobes. We speculate that S1063 and S1113 may be the products of close stellar encounters involving binaries in the cluster environment, and may define alternative stellar evolutionary tracks associated with mass-transfer episodes, mergers, and/or dynamical stellar exchanges

N-Methylimidazole Promotes The Reaction Of Homophthalic Anhydride With Imines

The addition of N-methylimidazole (NMI) to the reaction of homophthalic anhydride with imines such as pyridine-3-carboxaldehyde-N-trifluoroethylimine (9) reduces the amount of elimination byproduct and improves the yield of the formal cycloadduct, tetrahydroisoquinolonic carboxylate 10. Carboxanilides of such compounds are of interest as potential antimalarial agents. A mechanism that rationalizes the role of NMI is proposed, and a gram-scale procedure for the synthesis and resolution of 10 is also described

Efficacy and Safety of Vancomycin Loading Doses in Critically Ill Patients with Methicillin-Resistant \u3ci\u3eStaphylococcus aureus\u3c/i\u3e Infection

Background: While vancomycin loading doses may facilitate earlier pharmacokinetic–pharmacodynamic target attainment, the impact of loading doses on clinical outcomes remains understudied. Critically ill patients are at highest risk of morbidity and mortality from methicillin resistant Staphylococcus aureus (MRSA) infection and hypothesized to most likely benefit from a loading dose. We sought to determine the association between receipt of a vancomycin loading dose and clinical outcomes in a cohort of critically ill adults. Methods: Four hundred and forty-nine critically ill patients with MRSA cultures isolated from blood or respiratory specimens were eligible for the study. Cohorts were established by receipt of a loading dose (⩾20 mg/kg actual body weight) or not. The primary outcome was clinical failure, a composite outcome of death within 30 days of first MRSA culture, blood cultures positive ⩾7 days, white blood cell count up to 5 days from vancomycin initiation, temperature up to 5 days from vancomycin initiation, or substitution (or addition) of another MRSA agent. Results: There was no difference in the percentage of patients experiencing clinical failure between the loading dose and no loading dose groups (74.8% versus 72.8%; p = 0.698). Secondary outcomes were also similar between groups, including mortality and acute kidney injury, as was subgroup analysis based on site of infection. Exploratory analyses, including assessment of loading dose based on quartiles and a multivariable logistic regression model showed no differences. Conclusion: Use of vancomycin loading doses was not associated with improved clinical outcomes in critically ill patients with MRSA infection

A comparison of vaginal versus buccal misoprostol for cervical ripening in women for labor induction at term (the IMPROVE trial): a triple-masked randomized controlled trial

Background Cervical ripening is commonly needed for labor induction. Finding an optimal route of misoprostol dosing for efficacy, safety, and patient satisfaction is important and not well studied for the buccal route. Objective To compare the efficacy and safety of vaginal and buccal misoprostol for women undergoing labor induction at term. Study Design The IMPROVE trial was an institutional review board–approved, triple-masked, placebo-controlled randomized noninferiority trial for women undergoing labor induction at term with a Bishop score ≤6. Enrolled women received 25 mcg (first dose), then 50 mcg (subsequent doses) of misoprostol by assigned route (vaginal or buccal) and a matching placebo tablet by the opposite route. The primary outcomes were time to delivery and the rate of cesarean delivery performed urgently for fetal nonreassurance. A sample size of 300 was planned to test the noninferiority hypothesis. Results The trial enrolled 319 women, with 300 available for analysis, 152 in the vaginal misoprostol group and 148 in the buccal. Groups had similar baseline characteristics. We were unable to demonstrate noninferiority. The time to vaginal delivery was lower for the vaginal misoprostol group (median [95% confidence interval] in hours: vaginal: 20.1 [18.2, 22.8] vs buccal: 28.1 [24.1, 31.4], log-rank test P = .006, Pnoninferiority = .663). The rate of cesarean deliveries for nonreassuring fetal status was 3.3% for the vaginal misoprostol group and 9.5% for the buccal misoprostol group (P = .033). The rate of vaginal delivery in <24 hours was higher in the vaginal group (58.6% vs 39.2%, P = .001). Conclusion We were unable to demonstrate noninferiority. In leading to a higher rate of vaginal deliveries, more rapid vaginal delivery, and fewer cesareans for fetal issues, vaginal misoprostol may be superior to buccal misoprostol for cervical ripening at term