A Consent Theory of Unconscionability: An Empirical Study of Law in Action

This Article provides the findings of an empirical study of 187 court cases in which the issue of the unconscionability of a contract or a contract term was addressed by the courts. The cases were drawn from two time periods. The first set of cases can be viewed as the first generation of Uniform Commercial Code (U.C.C.)-style unconscionability cases from 1968-1980. The second generation of unconscionability cases were from the time period of 1991-2003. The two groups of cases allow us to not only analyze a series of questions and factors, but also to make intergenerational or longitudinal observations. The analysis is directed at answering four questions: (1) What are the standards used by courts in making unconscionability decisions?, (2) What type of evidence is considered by courts in making their decisions?, (3) What are the operative facts or factors that are most predictive of unconscionability decisions?, and (4) How do these findings inform us on the doctrine of unconscionability both as to its reflection in the law (expressed doctrine) and in application (law in fact)

The therapeutic effects of the physician-older patient relationship: Effective communication with vulnerable older patients

There is growing evidence that the outcomes of health care for seniors are dependent not only upon patients’ physical health status and the administration of care for their biomedical needs, but also upon care for patients’ psychosocial needs and attention to their social, economic, cultural, and psychological vulnerabilities. Even when older patients have appropriate access to medical services, they also need effective and empathic communication as an essential part of their treatment. Older patients who are socially isolated, emotionally vulnerable, and economically disadvantaged are particularly in need of the social, emotional, and practical support that sensitive provider-patient communication can provide. In this review paper, we examine the complexities of communication between physicians and their older patients, and consider some of the particular challenges that manifest in providers’ interactions with their older patients, particularly those who are socially isolated, suffering from depression, or of minority status or low income. This review offers guidelines for improved physician-older patient communication in medical practice, and examines interventions to coordinate care for older patients on multiple dimensions of a biopsychosocial model of health care

The Doha Declaration and Beyond: Giving a Voice to Non-Trade Concerns Within the WTO Trade Regime

The World Trade Organization (WTO) has been a significant force in the liberalization of trade across international borders since its inception in 1995. Commentators suggest that its reforms have converted the focus of international trade policy from removal of barriers to positive policy-making--a field historically occupied by domestic authorities. And although largely successful in the promotion of international trade, the Authors suggest that the binding provisions of the WTO ignore non-trade concerns such as environmental protection, consumer rights, labor rights, and state sovereignty. The Agreement\u27s inattention to these related concerns is the primary locus of criticism of the WTO, culminating in the breakdown of the 1999 Ministerial Meeting in Seattle, Washington. The Article examines the relationship between the Agreement and environmental, consumer protection, and labor policy, as well as the implications of WTO membership on state sovereignty. The Authors conclude that to improve the WTO\u27s treatment of non-trade concerns, the WTO must increase participation to include non-trade stakeholders, develop and support expertise within the WTO to address non-trade concerns, and follow the blueprint articulated in the Ministerial Declaration at the Fourth Ministerial Conference in Doha. The Declaration recognizes the importance of non-trade concerns and suggests a course of action that is likely to require the WTO to more squarely address the relationship between trade and non-trade policy

New experimental limit on the Pauli Exclusion Principle violation by electrons

The Pauli Exclusion Principle (PEP) is one of the basic principles of modern physics and, even if there are no compelling reasons to doubt its validity, it is still debated today because an intuitive, elementary explanation is still missing, and because of its unique stand among the basic symmetries of physics. The present paper reports a new limit on the probability that PEP is violated by electrons, in a search for a shifted K$_\alpha$ line in copper: the presence of this line in the soft X-ray copper fluorescence would signal a transition to a ground state already occupied by 2 electrons. The obtained value, ${1/2} \beta^{2} \leq 4.5\times 10^{-28}$, improves the existing limit by almost two orders of magnitude.Comment: submitted to Phys. Lett.

Primacy of effective communication and its influence on adherence to artemether-lumefantrine treatment for children under five years of age: a qualitative study.

BACKGROUND\ud \ud Prompt access to artemesinin-combination therapy (ACT) is not adequate unless the drug is taken according to treatment guidelines. Adherence to the treatment schedule is important to preserve efficacy of the drug. Although some community based studies have reported fairly high levels of adherence, data on factors influencing adherence to artemether-lumefantrine (AL) treatment schedule remain inadequate. This study was carried-out to explore the provider's instructions to caretakers, caretakers' understanding of the instructions and how that understanding was likely to influence their practice with regard to adhering to AL treatment schedule.\ud \ud METHODS\ud \ud A qualitative study was conducted in five villages in Kilosa district, Tanzania. In-depth interviews were held with providers that included prescribers and dispensers; and caretakers whose children had just received AL treatment. Information was collected on providers' instructions to caretakers regarding dose timing and how to administer AL; and caretakers' understanding of providers' instructions.\ud \ud RESULTS\ud \ud Mismatch was found on providers' instructions as regards to dose timing. Some providers' (dogmatists) instructions were based on strict hourly schedule (conventional) which was likely to lead to administering some doses in awkward hours and completing treatment several hours before the scheduled time. Other providers (pragmatists) based their instruction on the existing circumstances (contextual) which was likely to lead to delays in administering the initial dose with serious treatment outcomes. Findings suggest that, the national treatment guidelines do not provide explicit information on how to address the various scenarios found in the field. A communication gap was also noted in which some important instructions on how to administer the doses were sometimes not provided or were given with false reasons.\ud \ud CONCLUSIONS\ud \ud There is need for a review of the national malaria treatment guidelines to address local context. In the review, emphasis should be put on on-the-job training to address practical problems faced by providers in the course of their work. Further research is needed to determine the implication of completing AL treatment prior to scheduled time

Disease acceptance and adherence to imatinib in Taiwanese chronic myeloid leukaemia outpatients

Background The launch of imatinib has turned chronic myeloid leukaemia (CML) into a chronic illness due to the dramatic improvement in survival. Several recent studies have demonstrated that poor adherence to imatinib may hamper the therapeutic outcomes and result in increased medical expenditures, whilst research on exploring the reasons for non-adherence to imatinib is still limited. Objective This study aimed to explore the experience of patients as they journey through their CML treatments and associated imatinib utilisation in order to understand the perceptions, attitudes and concerns that may influence adherence to imatinib treatment. Setting This study was conducted at oncology outpatient clinics in a medical centre in southern Taiwan. Methods CML patients who regularly attended the oncology outpatient clinics to receive imatinib treatment from October 2011 to March 2012 were invited to participate in the study. Semi-structured face-to-face interviews were used to explore patients’ experiences and views of their treatment, their current CML status and CML-related health conditions, their concerns about imatinib treatment and imatinib-taking behaviours. Patient interviews were recorded, transcribed verbatim and thematically analysed using the constant comparison approach. Main outcome measure Themes related to patients’ views of the disease and health conditions, worries and concerns influencing imatinib utilisation behaviours are reported. Results Forty-two CML patients participated in the interviews. The emerging themes included: acceptance of current disease and health status, misconceptions about disease progression, factors associated with adherence to imatinib, concerns and management of adverse drug effects. Participants regarded CML as a chronic disease but had misconceptions about disease progression, therapeutic monitoring, resistance to imatinib and symptoms of side effects. Participants were generally adherent to imatinib and favoured long-term prescriptions to avoid regular outpatient visits for medication refills. Experiencing adverse effect was the main reason influencing adherence and led to polypharmacy. Most participants altered medicine-taking behaviours to maintain long-term use of imatinib. Conclusion Taiwanese CML patients are adherent to imatinib but report changing their medication-taking behaviour due to adverse drug effects and associated polypharmacy. Patients’ misconceptions of the disease and medication suggests that it is necessary to improve communication between patients and healthcare professionals. Routinely providing updated information as part of the patient counselling process should be considered as a means of improving this communication

Cystic Fibrosis Foundation and European Cystic Fibrosis Society Survey of cystic fibrosis mental health care delivery

Background: Psychological morbidity in individuals with cystic fibrosis (CF) and their caregivers is common. The Cystic Fibrosis Foundation (CFF) and European Cystic Fibrosis Society (ECFS) Guidelines Committee on Mental Health sought the views of CF health care professionals concerning mental health care delivery. Methods: An online survey which focused on the current provision and barriers to mental health care was distributed to CF health care professionals. Results: Of the 1454 respondents, many did not have a colleague trained in mental health issues and 20% had no one on their team whose primary role was focused on assessing or treating these issues. Insufficient resources and a lack of competency were reported in relation to mental health referrals. Seventy-three percent of respondents had no experience with mental health screening. Of those who did, they utilized 48 different, validated scales. Conclusions: These data have informed the decision-making, dissemination and implementation strategies of the Mental Health Guidelines Committee sponsored by the CFF and ECFS

Graphene-based photovoltaic cells for near-field thermal energy conversion

Thermophotovoltaic devices are energy-conversion systems generating an electric current from the thermal photons radiated by a hot body. In far field, the efficiency of these systems is limited by the thermodynamic Schockley-Queisser limit corresponding to the case where the source is a black body. On the other hand, in near field, the heat flux which can be transferred to a photovoltaic cell can be several orders of magnitude larger because of the contribution of evanescent photons. This is particularly true when the source supports surface polaritons. Unfortunately, in the infrared where these systems operate, the mismatch between the surface-mode frequency and the semiconductor gap reduces drastically the potential of this technology. Here we show that graphene-based hybrid photovoltaic cells can significantly enhance the generated power paving the way to a promising technology for an intensive production of electricity from waste heat.Comment: 5 pages, 4 figure