Managers of Medicine: The Interplay Between MCOs, Quality of Care, and Tort Reform

This paper examines Corporate Health and argues the policy wisdom of imposing malpractice liability on MCOs. Part II chronicles the effective control MCOs exercise over medical care decisions. Part III discusses states\u27 non-tort regulations of MCOs and their ineffectiveness in making MCOs accountable for that control. Part IV then argues that the policy behind MCO tort liability makes sense and that Congress should clearly authorize states to impose malpractice liability on MCOs whose decisions negatively impact patients\u27 medical treatment. Tort liability forces MCOs to consider the nonmonetary costs of negligent medical necessity decisions borne by man- aged care consumers and then incorporate them into their assessment of the trade-offs between health care cost and quality. It also makes MCOs respect and adhere to the treatment quality levels demanded by society. The public has evidenced its desire to contain the rise in health care costs through its embrace of managed care. Nonetheless, by society\u27s continued enforcement of standards of care through the imposition of malpractice liability on physicians and other providers, it has also revealed the level below which it does not want-and will not tolerate-health care quality to fall. Though critics can debate whether custom-based standards of care make sense and whether a tort regime is effective, no reason exists to exempt MCOs-the decisions of which affect patient care levelsfrom adhering to them while enforcing them against physicians and other providers. Tort liability forces MCOs to respect those levels as they work to make health care more efficient and will not lead to unreasonable increases in malpractice litigation and health insurance costs. Part V reflects the recent trends in state legislation to address accountability and liability of HMOs. Part VI explains the Texas tortbased approach to MCO accountability for medical determinations, discussing the THCLA and its evaluation in Corporate Health. Part VII concludes the paper with a call for Congress to enact legislation or amend ERISA so that states can unreservedly enforce medical negligence standards against MCOs. While courts have narrowed the extent of ERISA\u27s preemption of state law, federal and state decisions on ERISA\u27s implication for state MCO tort liability are inconsistent. Undoubtedly, the resulting uncertainty makes some state legislatures wary of imposing malpractice liability on MCOs. Clarification from Congress would likely embolden mores states to follow Texas\u27 lead

Confidentiality in Mediation

As mediation has become a more widely practiced method of dispute resolution, many jurisdictions have enacted rules forbidding participants to divulge information discussed during the mediation. Two recent cases, Paranzino v. Barnett Bank and Bernard v. Galen Group, are among the first to deal with the enforcement of such rules by judicial sanction. In both cases, participants in judicially required mediations were severely sanctioned for breaching confidentiality in violation of mediation rules and/or court orders

Confidentiality in Mediation

As mediation has become a more widely practiced method of dispute resolution, many jurisdictions have enacted rules forbidding participants to divulge information discussed during the mediation. Two recent cases, Paranzino v. Barnett Bank and Bernard v. Galen Group, are among the first to deal with the enforcement of such rules by judicial sanction. In both cases, participants in judicially required mediations were severely sanctioned for breaching confidentiality in violation of mediation rules and/or court orders

Catchment characteristics control boreal mire nutrient regime and vegetation patterns over ~5000 years of landscape development

Vegetation holds the key to many properties that make natural mires unique, such as surface microtopography, high biodiversity values, effective carbon sequestration and regulation of water and nutrient fluxes across the landscape. Despite this, landscape controls behind mire vegetation patterns have previously been poorly described at large spatial scales, which limits the understanding of basic drivers underpinning mire ecosystem services. We studied catchment controls on mire nutrient regimes and vegetation patterns using a geographically constrained natural mire chronosequence along the isostatically rising coastline in Northern Sweden. By comparing mires of different ages, we can partition vegetation patterns caused by long-term mire succession

Ecology and diversity of culturable fungal species associated with soybean seedling diseases in the Midwestern United States

Aims: To isolate and characterize fungi associated with diseased soybean seedlings in Midwestern soybean production fields and to determine the influence of environmental and edaphic factors on their incidence. Methods and Results: Seedlings were collected from fields with seedling disease history in 2012 and 2013 for fungal isolation. Environmental and edaphic data associated with each field was collected. 3036 fungal isolates were obtained and assigned to 76 species. The most abundant genera recovered were Fusarium (73%) and Trichoderma (11.2%). Other genera included Mortierella, Clonostachys, Rhizoctonia, Alternaria, Mucor, Phoma, Macrophomina and Phomopsis. Most recovered species are known soybean pathogens. However, non-pathogenic organisms were also isolated. Crop history, soil density, water source, precipitation and temperature were the main factors influencing the abundance of fungal species. Conclusion: Key fungal species associated with soybean seedling diseases occurring in several US production regions were characterized. This work also identified major environment and edaphic factors affecting the abundance and occurrence of these species. Significance and Impact of the Study: The identification and characterization of the main pathogens associated with seedling diseases across major soybean-producing areas could help manage those pathogens, and devise more effective and sustainable practices to reduce the damage they cause

Neonicotinoid seed treatments of soybean provide negligible benefits to US farmers

Neonicotinoids are the most widely used insecticides worldwide and are typically deployed as seed treatments (hereafter NST) in many grain and oilseed crops, including soybeans. However, there is a surprising dearth of information regarding NST effectiveness in increasing soybean seed yield, and most published data suggest weak, or inconsistent yield benefit. The US is the key soybean-producing nation worldwide and this work includes soybean yield data from 194 randomized and replicated field studies conducted specifically to evaluate the effect of NSTs on soybean seed yield at sites within 14 states from 2006 through 2017. Here we show that across the principal soybean-growing region of the country, there are negligible and management-specific yield benefits attributed to NSTs. Across the entire region, the maximum observed yield benefits due to fungicide (FST = fungicide seed treatment) + neonicotinoid use (FST + NST) reached 0.13 Mg/ha. Across the entire region, combinations of management practices affected the effectiveness of FST + N ST to increase yield but benefits were minimal ranging between 0.01 to 0.22 Mg/ha. Despite widespread use, this practice appears to have little benefit for most of soybean producers; across the entire region, a partial economic analysis further showed inconsistent evidence of a break-even cost of FST or FST + N ST. These results demonstrate that the current widespread prophylactic use of NST in the key soybean-producing areas of the US should be re-evaluated by producers and regulators alike

Neonicotinoid seed treatments of soybean provide negligible benefits to US farmers

Neonicotinoids are the most widely used insecticides worldwide and are typically deployed as seed treatments (hereafter NST) in many grain and oilseed crops, including soybeans. However, there is a surprising dearth of information regarding NST effectiveness in increasing soybean seed yield, and most published data suggest weak, or inconsistent yield benefit. The US is the key soybean-producing nation worldwide and this work includes soybean yield data from 194 randomized and replicated field studies conducted specifically to evaluate the effect of NSTs on soybean seed yield at sites within 14 states from 2006 through 2017. Here we show that across the principal soybean-growing region of the country, there are negligible and management-specific yield benefits attributed to NSTs. Across the entire region, the maximum observed yield benefits due to fungicide (FST = fungicide seed treatment) + neonicotinoid use (FST + NST) reached 0.13 Mg/ha. Across the entire region, combinations of management practices affected the effectiveness of FST + N ST to increase yield but benefits were minimal ranging between 0.01 to 0.22 Mg/ha. Despite widespread use, this practice appears to have little benefit for most of soybean producers; across the entire region, a partial economic analysis further showed inconsistent evidence of a break-even cost of FST or FST + N ST. These results demonstrate that the current widespread prophylactic use of NST in the key soybean-producing areas of the US should be re-evaluated by producers and regulators alike

AI is a viable alternative to high throughput screening: a 318-target study

: High throughput screening (HTS) is routinely used to identify bioactive small molecules. This requires physical compounds, which limits coverage of accessible chemical space. Computational approaches combined with vast on-demand chemical libraries can access far greater chemical space, provided that the predictive accuracy is sufficient to identify useful molecules. Through the largest and most diverse virtual HTS campaign reported to date, comprising 318 individual projects, we demonstrate that our AtomNet® convolutional neural network successfully finds novel hits across every major therapeutic area and protein class. We address historical limitations of computational screening by demonstrating success for target proteins without known binders, high-quality X-ray crystal structures, or manual cherry-picking of compounds. We show that the molecules selected by the AtomNet® model are novel drug-like scaffolds rather than minor modifications to known bioactive compounds. Our empirical results suggest that computational methods can substantially replace HTS as the first step of small-molecule drug discovery

Let us see – data quality. Making the support process at Tunga Maskiner AB more efficient

Bristfällig datakvalité har negativ effekt för en organisation, samtidigt kan utnyttjande av modern teknik och dataanalys skapa nya värden för organisationen. Vår forskning har visat att kvalitén på information i fältrapporter varierar kraftigt, vid flera tillfällen kan informationen vara så bristfällig att fältrapporten behöver kompletteras med mer information ifrån avsändaren av fältrapporten. Ledtider i felrapporteringsärenden riskerar därmed att bli utdragna. Med dagens teknik finns goda möjligheter till effektivare hantering av information. Med en empirisk studie som grund, har vi utvecklat CARO-konceptet som hämtar hälsostatus direkt ifrån en produkt, skapar en fältrapport och sänder fältrapporten till mottagaren, tillgänglig för mottagaren via ett sökbart gränssnitt. Därmed påvisar vi hur man med hjälp av smartphone-teknologi förenklar upprättande av fältrapport för användaren, effektiviserar felrapporteringsprocessen samt förbättrar datakvalitén, utan att nämnvärt öka produktionskostnaden för den ursprungliga produkten. Vid utveckling av systemet har hänsyn tagits till användare och med användbarhetstester som grund har designprinciper och mönster valts för att designa grafiska gränssnitt som guidar användaren genom felrapporteringsprocessen.Inadequate data quality has a negative effect for organizations, however utilization of modern technology and data analysis may shape new values for organizations. Our research has found that the quality of information in field reports for error reporting varies significantly. In many cases, the information in the field reports are deficient in such way that the field report need additional information from the sender, thus risking prolonging lead times in the error reporting process. More efficient use of information has become possible with today’s technology. We have developed the CARO-concept which fetches a health report directly from an embedded system, establishes a field report and sends it to the recipient. The field report is available to the recipient by a searchable web interface. Trials with an empirical partner have shown that our concept makes it easier for users to establish a field report, thus making the error reporting process more effective. Also, with health status being fetched and added to the field report directly, we significantly increase the overall data quality in the collected field reports. Furthermore, no additional hardware is required for the product which mean that the cost of the product remains the same, but the value of the product increases. The CARO-concept has been developed with regard to the domain of its use and with great consideration for users and user experience. Keywords: data quality, information flow, health check, error report, usability, smart phone, embedded system

Managers of Medicine: The Interplay Between MCOs, Quality of Care, and Tort Reform

This paper examines Corporate Health and argues the policy wisdom of imposing malpractice liability on MCOs. Part II chronicles the effective control MCOs exercise over medical care decisions. Part III discusses states\u27 non-tort regulations of MCOs and their ineffectiveness in making MCOs accountable for that control. Part IV then argues that the policy behind MCO tort liability makes sense and that Congress should clearly authorize states to impose malpractice liability on MCOs whose decisions negatively impact patients\u27 medical treatment. Tort liability forces MCOs to consider the nonmonetary costs of negligent medical necessity decisions borne by man- aged care consumers and then incorporate them into their assessment of the trade-offs between health care cost and quality. It also makes MCOs respect and adhere to the treatment quality levels demanded by society. The public has evidenced its desire to contain the rise in health care costs through its embrace of managed care. Nonetheless, by society\u27s continued enforcement of standards of care through the imposition of malpractice liability on physicians and other providers, it has also revealed the level below which it does not want-and will not tolerate-health care quality to fall. Though critics can debate whether custom-based standards of care make sense and whether a tort regime is effective, no reason exists to exempt MCOs-the decisions of which affect patient care levelsfrom adhering to them while enforcing them against physicians and other providers. Tort liability forces MCOs to respect those levels as they work to make health care more efficient and will not lead to unreasonable increases in malpractice litigation and health insurance costs. Part V reflects the recent trends in state legislation to address accountability and liability of HMOs. Part VI explains the Texas tortbased approach to MCO accountability for medical determinations, discussing the THCLA and its evaluation in Corporate Health. Part VII concludes the paper with a call for Congress to enact legislation or amend ERISA so that states can unreservedly enforce medical negligence standards against MCOs. While courts have narrowed the extent of ERISA\u27s preemption of state law, federal and state decisions on ERISA\u27s implication for state MCO tort liability are inconsistent. Undoubtedly, the resulting uncertainty makes some state legislatures wary of imposing malpractice liability on MCOs. Clarification from Congress would likely embolden mores states to follow Texas\u27 lead