No-fault compensation schemes: A rapid realist review

What do we want to know? At present in the UK, compensation for medical injuries can be sought through tort litigation, with payouts made through court or out-of-court settlements. No-fault compensation schemes (NFCSs) can provide an alternative method to redress claims resulting from medical injury. To inform consideration of an administrative compensation scheme relevant to birth injuries, we sought to develop preliminary theoretical frameworks describing the mechanisms that might influence engagement in such schemes and lead to improvements in outcomes for affected individuals and families. We conducted the first part of a realist review, which seeks to identify empirically and theoretically-based contextual, mechanism and outcome (CMO) configurations. We did not test the CMO configurations, so no causal claims are made. Thus, the findings should be read in this light, and should not be interpreted as definitive evidence that the CMO configurations presented below do influence engagement or outcomes. What did we find? We drew on 44 papers relating to medical and non-medical injury, to present a summary of possible mechanisms entailed in no-fault compensation and tort reform that are thought to lead to patient and clinical practice outcomes. Overall, we found varied conceptualisations of NFCSs in different geographical contexts, and papers that discussed the effects of tort reform with comparable effects. Liability was the key variable in schemes, with the concept of ‘blame’ shaping those schemes within certain countries. There is evidence to suggest that the schemes were a product of their jurisdictions. The empirical research attempted to test the effect of no-fault schemes and tort reform as outlined in Table A. The findings from this research underpinned propositions to explain the observed effects of no-fault schemes and tort reform. However, the schemes should not be considered a panacea, as doubts remained as to their contribution to patient safety and provider accountability (Wallis 2013). What are the implications? The CMO configurations generated from the studies contribute to our understanding of how compensation schemes can benefit patients and health professionals. Benefits of schemes include improved targeting of compensation to those most deserving of it, and speedier physical recovery after injury. However, the complexity of the interactions between compensation processes, individual circumstances and context-specific health systems make it difficult to establish strong potential causal pathways, most notably regarding health outcomes. Overall, the shape of compensation schemes will be highly influenced by the health system context and the prevailing political opinion about the role of the state in health care. How did we get these results? Papers were sought via iterative searching and included if they focused on compensation schemes relevant to iatrogenic injuries occurring at birth or in the early years (under five years of age), or sought to compensate injuries in two out of three of the following cases: i) resulted high-value claims; ii) had high long-term costs; iii) were highly emotive to victims. Papers were assessed for their relevance: the quality of the research reports lies in the richness of the descriptions of CMO interactions. Descriptive and empirical data were extracted and analysed from individual reports by two reviewers. They met to discuss the findings and agree the final set of CMO configurations, and text to justify them, as presented

Non-Locality and Theories of Causation

The aim of the paper is to investigate the characterization of an unambiguous notion of causation linking single space-llike separated events in EPR-Bell frameworks. This issue is investigated in ordinary quantum mechanics, with some hints to no collapse formulations of the theory such as Bohmian mechanics.Comment: Presented at the NATO Advanced Research Workshop on Modality, Probability and Bell's Theorems, Cracow, Poland, August 19-23, 200

Psychological Targets for Lung Cancer Screening Uptake: A Prospective Longitudinal Cohort Study

Introduction: Low uptake of low-dose computed tomography lung cancer screening by high-risk groups compromises its effectiveness and equity as a population-level early detection strategy. Numerous psychological factors are implicated qualitatively or retrospectively, but prospective data are needed to validate their associations with uptake behavior and specify psychological targets for intervention. / Methods: This is a prospective, longitudinal cohort study evaluating psychological correlates of lung cancer screening uptake. Ever-smokers (aged 55–77 y) were invited to a lung health check, at which low-dose computed tomography screening was offered through the SUMMIT Study—a multicenter screening implementation trial. One week after their screening invitation, 44,000 invitees were mailed the self-regulatory questionnaire for lung cancer screening. Regression analyses evaluated the constructs’ associations with uptake (telephoning for an appointment) and sociodemographic characteristics. / Results: Higher odds of uptake were associated with both positive and negative perceptions. Positive perceptions included lung cancer controllability, benefits of early diagnosis, improved survival when lung cancer is detected early, willingness to be treated, and believing smoking cessation is effective in reducing risk. Negative perceptions included a higher lung cancer risk perception, negative beliefs about the consequences of lung cancer, perceiving lung cancer as stigmatized, and a negative emotional response. Although current smokers held the highest risk perceptions, they also reported negative perceptions that could undermine how they behave in response to their risk. / Conclusions: Interventions to improve uptake should focus on changing perceptions that affect how an individual reacts when they believe their risk of lung cancer is high

A short-term in situ CO2 enrichment experiment on Heron Island (GBR)

Ocean acidification poses multiple challenges for coral reefs on molecular to ecological scales, yet previous experimental studies of the impact of projected CO2 concentrations have mostly been done in aquarium systems with corals removed from their natural ecosystem and placed under artificial light and seawater conditions. The Coral–Proto Free Ocean Carbon Enrichment System (CP-FOCE) uses a network of sensors to monitor conditions within each flume and maintain experimental pH as an offset from environmental pH using feedback control on the injection of low pH seawater. Carbonate chemistry conditions maintained in the −0.06 and −0.22 pH offset treatments were significantly different than environmental conditions. The results from this short-term experiment suggest that the CP-FOCE is an important new experimental system to study in situ impacts of ocean acidification on coral reef ecosystems

Bestrophin1: A Gene that Causes Many Diseases

Bestrophinopathies are a group of clinically distinct inherited retinal dystrophies that lead to the gradual loss of vision in and around the macular area. There are no treatments for patients suffering from bestrophinopathies, and no measures can be taken to prevent visual deterioration in those who have inherited disease-causing mutations. Bestrophinopathies are caused by mutations in the Bestrophin1 gene (BEST1), a protein found exclusively in the retinal pigment epithelial (RPE) cells of the eye. Mutations in BEST1 affect the function of the RPE leading to the death of overlying retinal cells and subsequent vision loss. The pathogenic mechanisms arising from BEST1 mutations are still not fully understood, and it is not clear how mutations in BEST1 lead to diseases with distinct clinical features. This chapter discusses BEST1, the use of model systems to investigate the effects of mutations and the potential to investigate individual bestrophinopathies using induced pluripotent stem cells

Fluorescence excitation and imaging of single molecules near dielectric‐coated and bare surfaces: a theoretical study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92412/1/j.1365-2818.2012.03625.x.pd

P-hydroxyphenylpyruvate, an intermediate of the Phe/Tyr catabolism, improves mitochondrial oxidative metabolism under stressing conditions and prolongs survival in rats subjected to profound hemorrhagic shock

The aim of this study was to test the effect of a small volume administration of p-hydroxyphenylpyruvate (pHPP) in a rat model of profound hemorrhagic shock and to assess a possible metabolic mechanism of action of the compound. The results obtained show that hemorrhaged rats treated with 2-4% of the estimated blood volume of pHPP survived significantly longer (p<0.001) than rats treated with vehicle. In vitro analysis on cultured EA.hy 926 cells demonstrated that pHPP improved cell growth rate and promoted cell survival under stressing conditions. Moreover, pHPP stimulated mitochondria-related respiration under ATP-synthesizing conditions and exhibited antioxidant activity toward mitochondria-generated reactive oxygen species. The compound effects reported in the in vitro and in vivo analyses were obtained in the same millimolar concentration range. These data disclose pHPP as an efficient energetic substrates-supplier to the mitochondrial respiratory chain as well as an antioxidant supporting the view that the compound warrants further evaluation as a therapeutic agent. © 2014 Cotoia et al

Ocean acidification reduces demersal zooplankton that reside in tropical coral reefs

The in situ effects of ocean acidification on zooplankton communities remain largely unexplored. Using natural volcanic CO2 seep sites around tropical coral communities, we show a threefold reduction in the biomass of demersal zooplankton in high-CO2 sites compared with sites with ambient CO2. Differences were consistent across two reefs and three expeditions. Abundances were reduced in most taxonomic groups. There were no regime shifts in zooplankton community composition and no differences in fatty acid composition between CO2 levels, suggesting that ocean acidification affects the food quantity but not the quality for nocturnal plankton feeders. Emergence trap data show that the observed reduction in demersal plankton may be partly attributable to altered habitat. Ocean acidification changes coral community composition from branching to massive bouldering coral species, and our data suggest that bouldering corals represent inferior daytime shelter for demersal zooplankton. Since zooplankton represent a major source of nutrients for corals, fish and other planktivores, this ecological feedback may represent an additional mechanism of how coral reefs will be affected by ocean acidification