Breach of Medical Confidence in Ohio

Fortunately, the patchwork of state and federal statutory, administrative, and case law has greatly limited unrestricted disclosure of medical secrets through the threat of civil and criminal liability. While the law governing the disclosure of medical information sorely lacks a comprehensive approach, one overriding principle emerges from this patchwork: the concern for confidentiality represented in the Hippocratic Oath is alive in Ohio and should guide the release of any medical secrets in the state. There are several statutes that regulate the release of certain types of medical information. For example, information concerning patients suffering from alcohol or drug abuse is covered by Sections 5234 and 5275 of the Public Health Services Act, and the comprehensive regulatory scheme thereunder,6 and information concerning mental illness may be subject to the restrictions of Section 5122.31 of the Ohio Revised Code. The burden of regulating the disclosure of most types of medical information, however, has fallen upon the common law. The common law also acts to close the gaps in statutory schemes seeking to limit the disclosure of a particular type of medical information. This article deals with the development of the common law in this area and the emergence of breach of confidence as a recognized tort in Ohio

The other side of the bridge: A study of social capital in further education provision for young disabled people

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.This thesis is a detailed account and analysis of young disabled people‟s inclusions within one Further Education College. These inclusions were tied to a number of complex interactions between the people who exist there and key reforms to Further Education systems which aim to support an individual‟s capacity to offer entrepreneurial performances. Central to these reforms is alternative provision, which offer places in college to school aged students who risk failing to invest in the work-related skills and knowledge that apparently has measurable consequences for future earnings and social justice. This thesis shows how the inclusion of young disabled people in a contemporary college community has some unintended effects and consequences, and how their lives were differentially affected by social capital arising from social networks based on trust. An emancipatory, qualitative methodology was used to gather data. The findings provide important insights into how young disabled people possess, produce and utilise social capital, to build new relationships, to develop identity, to resist or manipulate pre-assigned social roles, networks and resources and to make the transition from school to college. In their own words, young disabled people question the sense of optimism often attributed to alternative provision and the extent to which their existence in college has overcome the social barriers and closed networks that can be associated with disabled people as a marginalised group. To harness such existences and to further develop social capital theory, my conclusions set out a young disabled person‟s negotiation of college as an ethical project in which everyone - college students, teaching staff and researchers - have work to do on themselves. This makes alternative provision not something that is just done to many young disabled people but a project for which everyone is responsible. This thesis, therefore, re-reads the story of alternative provision with a wary eye, using a critical approach to social capital theory. In doing so, the research not only confirms the significance of social capital as a crucial analytical tool for young disabled people, but also confronts the overly positive underpinnings of the social capital debate in education

Light-mediated catalytic enantioselective difluoroalkylation of β-ketoesters via phase-transfer catalysis

The authors acknowledge funding from the Royal Society (University Research Fellowship URF\\R1\\180017 (CPJ)) and the University of St Andrews (CEA). We thank Yitong Wang for his help in the synthesis of starting materials and Reece Hoogesteger for running scale-up experiments. We thank Prof. Andy Smith, Prof. Allan Watson, and their respective research groups for sharing their lab equipment and chemical inventories.We report a phase-transfer-catalysed asymmetric α-difluoroalkylation of β-ketoesters through visible light-promoted radical generation. This methodology affords quaternary stereocentres with mild enantioenrichment and isolated yields up to 99%. Through mechanistic investigations, we have determined that the reaction proceeds via difluoroalkyl radical generation arising from an in situ electron donor-acceptor complex capable of absorbing visible light. Extensive optimisation of the reaction parameters was carried in an attempt to overcome a facile racemic background reaction.Peer reviewe

Benefits of a snacking intervention as part of a school-based obesity intervention for Mexican American children

Objective: To examine the impact of adherence to a healthy snacking component of a 6 month school-based intervention program for overweight and obese children. Design: Randomized controlled intervention trial Methods: Mexican American children who were ≥ 85th percentile for body mass index (BMI) were recruited between 2005-2012 from three Houston schools. Children participated in a 12-week instructor led intensive intervention program that included nutrition education, physical activity, and a snacking component which consisted of a daily choice of peanuts and/or peanut butter snacks. Children (12±0.6 years) (n= 257) were divided into either low or high snacking adherence groups based on their responses on a peanut food frequency questionnaire. The low adherence group reported consuming peanuts or peanut butter ≤ once per week and the high adherence group \u3e once per week over 6 months. Change of BMI, standardized BMI (zBMI), triceps skinfold, and weight were compared at six months of children reporting high and low levels of adherence to the snacking component. Analysis: T-tests were performed with SPSS version 22 with level of significance set at P \u3c0.05. Results: Children in the high snacking adherence group demonstrated significantly greater decreases in BMI (P= 0.021) and zBMI (P = 0.005) at six months compared to the children in the low snacking adherence group. Although triceps skinfold did not significantly decrease, anthropometric measures trended towards significance. Conclusions and Implications: Peanuts provided an acceptable, healthy snack for children. Although peanuts were relatively high in fat, the weight loss intervention of replacing energy-dense and unhealthy snacks with peanuts and peanut butter helped children maintain a healthy body weight

Chandra X-ray Sources in the Collapsed-Core Globular Cluster M30 (NGC 7099)

We report the detection of six discrete, low-luminosity (Lx < 10^33 erg/s) X-ray sources, located within 12 arcsec of the center of the collapsed-core globular cluster M30 (NGC 7099), and a total of 13 sources within the half-mass radius, from a 50 ksec Chandra ACIS-S exposure. Three sources lie within the very small upper limit of 1.9 arcsec on the core radius. The brightest of the three core sources has a luminosity of Lx (0.5-6 keV) = 6x10^32 erg/s and a blackbody-like soft X-ray spectrum, which are both consistent with it being a quiescent low-mass X-ray binary (qLMXB). We have identified optical counterparts to four of the six central sources and a number of the outlying sources, using deep Hubble Space Telescope and ground-based imaging. While the two proposed counterparts that lie within the core may represent chance superpositions, the two identified central sources that lie outside of the core have X-ray and optical properties consistent with being CVs. Two additional sources outside of the core have possible active binary counterparts. We discuss the X-ray source population of M30 in light of its collapsed-core status.Comment: 18 pages, 13 figures (8 color), resubmitted to ApJ after incorporating referee comment

The other side of the bridge : a study of social capital in further education provision for young disabled people

This thesis is a detailed account and analysis of young disabled people‟s inclusions within one Further Education College. These inclusions were tied to a number of complex interactions between the people who exist there and key reforms to Further Education systems which aim to support an individual‟s capacity to offer entrepreneurial performances. Central to these reforms is alternative provision, which offer places in college to school aged students who risk failing to invest in the work-related skills and knowledge that apparently has measurable consequences for future earnings and social justice. This thesis shows how the inclusion of young disabled people in a contemporary college community has some unintended effects and consequences, and how their lives were differentially affected by social capital arising from social networks based on trust. An emancipatory, qualitative methodology was used to gather data. The findings provide important insights into how young disabled people possess, produce and utilise social capital, to build new relationships, to develop identity, to resist or manipulate pre-assigned social roles, networks and resources and to make the transition from school to college. In their own words, young disabled people question the sense of optimism often attributed to alternative provision and the extent to which their existence in college has overcome the social barriers and closed networks that can be associated with disabled people as a marginalised group. To harness such existences and to further develop social capital theory, my conclusions set out a young disabled person‟s negotiation of college as an ethical project in which everyone - college students, teaching staff and researchers - have work to do on themselves. This makes alternative provision not something that is just done to many young disabled people but a project for which everyone is responsible. This thesis, therefore, re-reads the story of alternative provision with a wary eye, using a critical approach to social capital theory. In doing so, the research not only confirms the significance of social capital as a crucial analytical tool for young disabled people, but also confronts the overly positive underpinnings of the social capital debate in education.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

A polygenic basis for birth weight in a wild population of red deer ( Cervus elaphus )

The genetic architecture of traits under selection has important consequences for the response to selection and potentially for population viability. Early QTL mapping studies in wild populations have reported loci with large effect on trait variation. However, these results are contradicted by more recent genome-wide association analyses, which strongly support the idea that most quantitative traits have a polygenic basis. This study aims to re-evaluate the genetic architecture of a key morphological trait, birth weight, in a wild population of red deer (Cervus elaphus), using genomic approaches. A previous study using 93 microsatellite and allozyme markers and linkage mapping on a kindred of 364 deer detected a pronounced QTL on chromosome 21 explaining 29% of the variance in birth weight, suggesting that this trait is partly controlled by genes with large effects. Here, we used data for more than 2,300 calves genotyped at >39,000 SNP markers and two approaches to characterise the genetic architecture of birth weight. First, we performed a genome-wide association (GWA) analysis, using a genomic relatedness matrix to account for population structure. We found no SNPs significantly associated with birth weight. Second, we used genomic prediction to estimate the proportion of variance explained by each SNP and chromosome. This analysis confirmed that most genetic variance in birth weight was explained by loci with very small effect sizes. Third, we found that the proportion of variance explained by each chromosome was slightly positively correlated with its size. These three findings highlight a highly polygenic architecture for birth weight, which contradicts the previous QTL study. These results are probably explained by the differences in how associations are modelled between QTL mapping and GWA. Our study suggests that models of polygenic adaptation are the most appropriate to study the evolutionary trajectory of this trait

Hilbert Spaces from Path Integrals

It is shown that a Hilbert space can be constructed for a quantum system starting from a framework in which histories are fundamental. The Decoherence Functional provides the inner product on this "History Hilbert space". It is also shown that the History Hilbert space is the standard Hilbert space in the case of non-relativistic quantum mechanics.Comment: 22 pages. Minor updates to match published versio

Comparison of the two most commonly used treatments for pyoderma gangrenosum: results of the STOP GAP randomised controlled trial

Objective To determine whether ciclosporin is superior to prednisolone for the treatment of pyoderma gangrenosum, a painful, ulcerating skin disease with a poor evidence base for management. Design Multicentre, parallel group, observer blind, randomised controlled trial. Setting 39 UK hospitals, recruiting from June 2009 to November 2012. Participants 121 patients (73 women, mean age 54 years) with clinician diagnosed pyoderma gangrenosum. Clinical diagnosis was revised in nine participants after randomisation, leaving 112 participants in the analysis set (59 ciclosporin; 53 rednisolone). Intervention Oral prednisolone 0.75 mg/kg/day compared with ciclosporin 4 mg/kg/day, to a maximum dose of 75 and 400 mg/day, respectively. Main outcome measures The primary outcome was speed of healing over six weeks, captured using digital images and assessed by blinded investigators. Secondary outcomes were time to healing, global treatment response, resolution of inflammation, self reported pain, quality of life, number of treatment failures, adverse reactions, and time to recurrence. Outcomes were assessed at baseline and six weeks and when the ulcer had healed (to a maximum of six months). Results Of the 112 participants, 108 had complete primary outcome data at baseline and six weeks (57 ciclosporin; 51 rednisolone). Groups were balanced at baseline. The mean (SD) speed of healing at six weeks was −0.21 (1.00) cm2/day in the ciclosporin group compared with −0.14 (0.42) cm2/day in the prednisolone group. The adjusted mean difference showed no between group difference (0.003 cm2/day, 95% confidence interval −0.20 to 0.21; P=0.97). By six months, ulcers had healed in 28/59 (47%) participants in the ciclosporin group compared with 25/53 (47%) in the prednisolone group. In those with healed ulcers, eight (30%) receiving ciclosporin and seven (28%) receiving prednisolone had a recurrence. Adverse reactions were similar for the two groups (68% ciclosporin and 66% prednisolone), but serious adverse reactions, especially infections, were more common in the prednisolone group. Conclusion Prednisolone and ciclosporin did not differ across a range of objective and patient reported outcomes. Treatment decisions for individual patients may be guided by the different side effect profiles of the two drugs and patient preference. Trial registration Current Controlled Trials ISRCTN35898459

The Great Lakes Hydrography Dataset: Consistent, Binational Watersheds for the Laurentian Great Lakes Basin

Ecosystem‐based management of the Laurentian Great Lakes, which spans both the United States and Canada, is hampered by the lack of consistent binational watersheds for the entire Basin. Using comparable data sources and consistent methods, we developed spatially equivalent watershed boundaries for the binational extent of the Basin to create the Great Lakes Hydrography Dataset (GLHD). The GLHD consists of 5,589 watersheds for the entire Basin, covering a total area of approximately 547,967 km2, or about twice the 247,003 km2 surface water area of the Great Lakes. The GLHD improves upon existing watershed efforts by delineating watersheds for the entire Basin using consistent methods; enhancing the precision of watershed delineation using recently developed flow direction grids that have been hydrologically enforced and vetted by provincial and federal water resource agencies; and increasing the accuracy of watershed boundaries by enforcing embayments, delineating watersheds on islands, and delineating watersheds for all tributaries draining to connecting channels. In addition, the GLHD is packaged in a publically available geodatabase that includes synthetic stream networks, reach catchments, watershed boundaries, a broad set of attribute data for each tributary, and metadata documenting methodology. The GLHD provides a common set of watersheds and associated hydrography data for the Basin that will enhance binational efforts to protect and restore the Great Lakes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134077/1/jawr12435_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134077/2/jawr12435.pd