Claims-Made and Reported Policies and Insurer Profitability in Medical Malpractice

The liability crisis of the 1970s led to the introduction of a new type of insurance policy designed, according to Doherty (1991), to reduce the un-diversifiable uncertainty associated with writing long-tail liability lines. These new claims-made and reported policies gained favor in place of the traditional occurrence coverage in the early eighties not only in medical malpractice, but also in the general liability arena. Under occurrence coverage, a loss incurred in a given year is covered by the contract for that year, regardless of when the claim is reported. In contrast, a claims-made policy pays only the claims reported in the policy year. Our paper presents a structure, conduct, and performance analysis à la Joskow (1973) of the medical malpractice insurance industry by focusing on the differences between the two contracts. The main question we want to address is why there are two types of contracts that cover the same risk exposure in the medical malpractice insurance industry whereas in other lines of insurance, only one exists primarily. La crise de la responsabilité civile des années 70 a mené à la création d’un nouveau type de contrat d’assurance qui avait pour but, selon Doherty (1991), de réduire le risque systématique associé aux polices d’assurance à longue durée. Ces contrats CMR (Claims-Made and Reported) ont obtenu la faveur du public dans les années 80 particulièrement pour ce qui est de l’assurance de la responsabilité civile des professionnels de la médecine. Nous présentons ainsi une étude de la structure et de la performance de l’industrie de l’assurance de la responsabilité civile des professionnels de la médecine en mettant en relief les deux types de contrats dans ce marché. La question à laquelle nous voudrions ultimement répondre est la suivante : pourquoi dans le marché de l’assurance de la responsabilité civile des professionnels de la médecine retrouvons-nous les deux types de contrats alors qu’un seul type est généralement offert dans les autres marchés?medical malpractice insurance, industry structure and performance analysis, claims-made contracts, assurance de la responsabilité civile des professionnels de la médecine, analyse de la structure et de la performance de l’industrie, contrats CMR

The effectiveness of the use of the picture exchange communication system (PECS) on the development of functional communication skills in preschool children with autism

The purpose of this study was to determine the effectiveness of the use of the Picture Exchange Communication System (PECS) on the development of functional communication skills in four preschool children with autism. The students involved in this study were enrolled in two preschool disabilities-autism classrooms. The classrooms were very similar in the routine and schedule they followed in addition to the teaching and behavioral techniques that were used with each student. Three students were pretested in September 1998, the fourth student was pretested in November 1998. All four students were posttested in March 1999 to measure their individual growth in the use of functional communication skills. A visual inspection of the data collected revealed that overall, all of the students in the study had developed some functional communication skills that would allow them to appropriately communicate their basic wants and needs. The degree of mastery of these skills varied from student to student based on their developmental and functioning levels

Antibiotic prescribing on two medical wards at St Luke’s Hospital : what scope for improvement?

Antibiotics are frequently prescribed drugs and form a significant part of the hospital budget. The literature suggests that prescribing is not without problems and may need constant review. We have no data relating to our hospital. This study aims to explore some aspects of antibiotic use in our setting. Records of all patients prescribed antibiotics on two medical wards over a 4 month period were analysed for indication, choice of antibiotic, outcome and cost. There were 126 patients: 54% males; 75.4%, >60 years old; 62% were admitted because of infection. Of the whole group, 8.7% received antibiotics with no evidence of infection and no indication for prophylaxis. There were 118 infections, 64% respiratory, 13.5% urinary and the rest of miscellaneous sites; 14% of infections were nosocomial. Microbiological studies were available in only 29% of infections. For 6 patients, the antibiotics prescribed were relatively contraindicated because of impaired hepatic and renal function. There was one adverse drug reaction. The total drug cost was Lm2181.79; i.v. treatment accounted for 93% of this cost and ceftazidime for 60%. There is room for improvement in the selection of antibiotics and their route of administration. The hospital microbiologists and the Antibiotic Policy should be consulted more often. Laboratory diagnosis of infection and biochemical patient monitoring are inadequate. Restricting i.v. treatment could reduce cost very substantially.peer-reviewe

Effects of Supernova Feedback on the Formation of Galaxies

We study the effects of Supernova (SN) feedback on the formation of galaxies using hydrodynamical simulations in a Lambda-CDM cosmology. We use an extended version of the code GADGET-2 which includes chemical enrichment and energy feedback by Type II and Type Ia SN, metal-dependent cooling and a multiphase model for the gas component. We focus on the effects of SN feedback on the star formation process, galaxy morphology, evolution of the specific angular momentum and chemical properties. We find that SN feedback plays a fundamental role in galaxy evolution, producing a self-regulated cycle for star formation, preventing the early consumption of gas and allowing disks to form at late times. The SN feedback model is able to reproduce the expected dependence on virial mass, with less massive systems being more strongly affected.Comment: To appear in "The Galaxy Disk in Cosmological Context"; Proceedings of IAU254; 9-13 June 2008; Copenhagen; v2: typo corrected; uses iaus.cl

Connexin communication compartments and wound repair in epithelial tissue

Epithelial tissues line the lumen of tracts and ducts connecting to the external environment. They are critical in forming an interface between the internal and external environment and, following assault from environmental factors and pathogens, they must rapidly repair to maintain cellular homeostasis. These tissue networks, that range from a single cell layer, such as in airway epithelium, to highly stratified and differentiated epithelial surfaces, such as the epidermis, are held together by a junctional nexus of proteins including adherens, tight and gap junctions, often forming unique and localised communication compartments activated for localised tissue repair. This review focuses on the dynamic changes that occur in connexins, the constituent proteins of the intercellular gap junction channel, during wound-healing processes and in localised inflammation, with an emphasis on the lung and skin. Current developments in targeting connexins as corrective therapies to improve wound closure and resolve localised inflammation are also discussed. Finally, we consider the emergence of the zebrafish as a concerted whole-animal model to study, visualise and track the events of wound repair and regeneration in real-time living model systems

Witnessing Engaged Voices: A Feminist Pedagogy of Inclusion

When student perspectives, needs, and wants are left out of academic discourse, the discursive structures necessary to encourage, organize, and evaluate their voice are absent. Students then become ambivalent, instead of exercising their voice and decisively assessing the value of their contributions. This original teaching activity targets the problematics that constrain voices in the classroom, inviting readers and listeners to consider their positionality and action as a commitment to a Feminist Pedagogy of Inclusion (FPoI). This method allows students and professors to deliberately hold a space where the act of witnessing is more than simply observing voices. The intended result is a comprehensive way of engaging inclusively