Protecting the Insured From an Adhersion Insurance Policy: The Doctrine of Reasonable Expectations in Utah

Today, the adhesionary insurance contract dominates the consumer insurance industry. The traditional approaches courts use to enforce these contracts do not adequately protect the insured from unbargained-for policy provisions. Furthermore, the courts cannot be confident that the insured assented to all terms of the agreement. The doctrine of reasonable expectations provides a ready remedy for these deficiencies and should be adopted in Utah

Protecting the Insured From an Adhersion Insurance Policy: The Doctrine of Reasonable Expectations in Utah

Today, the adhesionary insurance contract dominates the consumer insurance industry. The traditional approaches courts use to enforce these contracts do not adequately protect the insured from unbargained-for policy provisions. Furthermore, the courts cannot be confident that the insured assented to all terms of the agreement. The doctrine of reasonable expectations provides a ready remedy for these deficiencies and should be adopted in Utah

Kinematic Analysis of Trunk Coordination Throughout the Rowing Stroke Sequence

Rowing at the elite level requires proper sequencing of the rowing stroke so that the rower is able to produce an efficient stroke while protecting oneself from potential injuries. The cyclic motion of the rowing stroke sequence at low loads often results in overuse injuries, specifically in the lower back. Kinematic data of rower’s pelvis-lumbar-thoracic spine were collected using inertial measurement sensors. An incremental step-test was conducted to observe the influence of increasing intensities on the lumbar-pelvis and lumbar-thoracic segments coordination and coordination variability. This study provides a new way of quantifying rowing kinematics using vector coding. The vector coding technique used in this study quantifies the relative motion and variability in lumbar-pelvis and thoracic-lumbar couplings during the rowing stroke. Rowers exhibited greater lumbar-pelvis coupling angle variability during the recovery-drive transition of the stroke sequence with increasing intensities, which may be necessary as the rower prepares for the added load applied when the oar is placed in the water. The findings from this study may also indicate that the low coupling angle variability during the drive and recovery phases of the rowing stroke could increase the demands placed on the lumbar and repeatedly stress the same surrounding tissues, potentially explaining the cause of overuse injuries seen in the sport

Schools in the Midlands of Ireland.

The present study explored satisfaction levels of teachers in three second-level schools in the midlands of Ireland, concentrating on student-teacher relations, pay, contracts of employment, promotional opportunities, staff-relations and finally, examining second-level teachers views on the overall attractiveness of the teaching profession. A total of 124 hard-copy questionnaires were distributed to teachers from three second-level schools in the midlands of Ireland with a response rate of 52%. Most people who took part in this survey were aged between 24-29, female and held either temporary or continuous contracts of indefinite duration (CID). In addition, one second-level school in the midlands of Ireland participated in semi-structured interviews. The interview cohort consisted of six teachers who were divided up into three sub-groups based on experience levels: two teachers with less than five years’ experience, two teachers’ with between five and twenty years’ experience and finally two teachers’ with more than twenty years’ experience. Overall, findings of the present study indicated that teachers were generally satisfied in their teaching profession. According to the results of the analysis, teachers were satisfied with both student-teacher relations and staff-relations in their second-level school. Furthermore, most teachers were satisfied with their contracts of employment, even though only very few teachers held permanent teaching contracts. This could be attributed to the finding that half of teachers held contracts of indefinite duration (CID), which means that teachers have similar privileges as permanent teachers (ASTI, 2017) and they experience a sense of job stability. In addition, one unanticipated finding of the present research indicates that teachers were satisfied with their pay. On the contrary, less than half of teachers agreed that their wages were sufficient to pay their important expenses and bills. In support of this, interviewed teachers cited that a number of teachers in their schools did not having full-time hours and xiv this could result in a below par average weekly wage. In addition, many teachers disagreed that their wage levels reflected the level of effort they provided in their teaching jobs. Teachers views suggested that this could be due to the increase in demand for extra-curricular activities from students and school-management. Most teachers who took part in this study did not hold any promotional posts of responsibility and furthermore they were not satisfied with the level of promotional opportunities available within their school. In addition, findings indicated that ‘career ladder progression’ was the least important benefit associated with second-level teaching. Although teachers were unhappy with the level of promotional opportunities, it seems that it didn’t affect teacher’s overall satisfaction levels as ‘job satisfaction – love of teaching’, followed by ‘holidays’ and finally ‘working with young people ranging in ages from twelve to eighteen’ were the most important benefits associated with the teaching profession. Surprisingly, the present research indicates that just over a third of teachers would recommend teaching as a profession. Some teachers specified in the semi-structured interviews that if the Irish Government improved pay issues and promotional opportunities in the teaching profession only then would they consider recommending teaching as a career

How can private hospitals be used as a solution to provide outflow surge capacity to public hospitals during mass casualty incidents

INTRODUCTION: Private hospitals are not utilised as a part of a solution in Ireland in the event of Mass Casualty Incidents (MCI) in Ireland. While disaster planning is evident in each hospital and there is also a national plan in place, no plan details the difficulties public hospitals are facing on a daily basis with overcrowding in both Emergency Departments (ED) and throughout the hospital. The aim of this study is to look at how private hospitals may be used as part of the greater solution in providing Outflow Surge Capacity (OSC) to the public hospitals, and: are private hospitals able to deliver outflow surge capacity in times of great need. MATERIAL AND METHODS: This study was conducted from October 2018 – May 2019 in a selection of public and private hospitals in the greater Dublin (Ireland) region. Ethics approval was obtained and purposive sampling was employed. Semi-structured interviews following a Straussian Grounded Theory (SGT) design were conducted following the recruitment of 16 high-level key stakeholders in 4 hospitals of interest representing both public and private sectors. No demographic data was collected, ensuring anonymity. Data was analysed manually using grounded theory principles, which involved open, axial and selective coding. RESULTS: All participants were found to be open to utilising private hospitals as OSC. Private hospitals were recognised by public hospitals as having the ability, skills and expertise to assist public hospitals with OSC. High awareness of the need for additional space in acute hospitals was evident. All participants showed concern for current overcrowding hospital wide nationally. CONCLUSIONS: Public hospitals identified a number of approaches to utilise private hospitals as OSC. Private hospitals showed readiness and agreement to provide OSC, however, willingness was not assessed due to the number of private hospitals included in the study Further research is required to ascertain Government willingness to participate and establish financial accountability should this finding be introduced

Assessment of health‐related quality of life as an outcome measure in granulomatosis with polyangiitis (Wegener's)

Objective To assess a generic measure of health‐related quality of life (HRQOL) as an outcome measure in granulomatosis with polyangiitis (Wegener's) (GPA). Methods Subjects were participants in the Wegener's Granulomatosis Etanercept Trial (WGET) or the Vasculitis Clinical Research Consortium Longitudinal Study (VCRC‐LS). HRQOL was assessed with the Short Form 36 (SF‐36) health survey that includes physical and mental component summary scores (PCS and MCS, respectively). Disease activity was assessed with the Birmingham Vasculitis Activity Score for Wegener's Granulomatosis (BVAS/WG). Results The data from 180 subjects in the WGET (median followup 2.3 years, mean number of visits 10) and 237 subjects in the VCRC‐LS (median followup 2.0 years, mean number of visits 8) were analyzed. A 1 unit increase in the BVAS/WG corresponded to a 1.15 unit (95% confidence interval [95% CI] 1.02, 1.29) decrease for the PCS and a 0.93 (95% CI 0.78, 1.07) decrease for the MCS in the WGET, and to a 1.16 unit decrease for the PCS (95% CI 0.94, 1.39) and a 0.79 unit decrease for the MCS (95% CI 0.51, 1.39) in the VCRC‐LS. In both arms of the WGET study, SF‐36 measures improved rapidly during the first 6 weeks of treatment followed by gradual improvement among patients achieving sustained remission (0.5 improvement in PCS per 3 months), but worsened slightly (0.03 decrease in PCS every 3 months) among patients not achieving sustained remission ( P = 0.005). Conclusion HRQOL, as measured by the SF‐36, is reduced among patients with GPA. SF‐36 measures are modestly associated with other disease outcomes and discriminate between disease states of importance in GPA.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90377/1/20649_ftp.pd

Healthcare provider attitudes and beliefs toward family-witnessed resuscitation in Saudi Arabia

Purpose: Healthcare provider attitudes and beliefs towards family witnessed resuscitation (FWR) have been studied extensively in Western cultures1-6. However, the literature shows little evidence of similar studies being conducted in Middle Eastern cultures7-8. The study was undertaken at a medium sized community hospital setting in Saudi Arabia. The authors hypothesize that overall attitudes and beliefs will not be in favor of family witnessed resuscitation as an option. However, there may be significant differences by nationality, unit, length of service, profession, age, gender, years qualified, and previous encounter with family witnessed resuscitation. The researchers sought to determine if healthcare providers in Saudi Arabia had similar attitudes and beliefs to those previously reported in the literature and to guide the healthcare system in developing an institutional FWR policy. Methods: The research design is a quantitative cross sectional descriptive study using a survey method. A convenience sample of nurses, doctors, paramedics, and respiratory therapists working in emergency departments, intensive care units, operating rooms, day surgery areas, and general and pediatric wards were recruited. Recruitment was via blast e-mail with instructions on how to obtain a hard copy of the survey. Paper copies of the survey were provided in each clinical area. A reminder was sent via e-mail at week two. Extra hard copies of the survey were provided in each clinical area. Envelopes were left in pre-designated areas for collection and were collected periodically. Inclusion criteria included all doctors, nurses, paramedics and respiratory therapists working in general and pediatric wards, intensive care units, operating rooms, day surgery units, and emergency departments in all five facilities. Exclusion criteria included all allied healthcare personnel not employed in the aforementioned units.The Emergency Nurses Association s (ENA) Health Care Provider Attitudes and Beliefs Toward Family Presence Assessment Survey9 was used to address the study aims. The latest version of SPSS (23) was utilized for data analysis. Variables included age, gender, nationality, unit, profession, length of qualification, and duration of employment within the hospital system. The survey tool was utilized with permission granted by the ENA. There were 19 questions on the survey. Questions (Q) 1-10 were scored on a 5 point Likert scale with 1 = strongly agree to 5 = strongly disagree. Q s 8 and 9 were reverse coded such that 1 = strongly disagree and 5 = strongly agree . This was done to compensate for the somewhat negative terminology in the questions. Thus analysis and comparisons could be made with the other questions. Q s 11-16 were yes/no answers and Q s 13-19 had free text options although it was not analyzed for this paper. In addition to the ENA tool, seven demographic questions were included before the survey questions. The survey consisted of questions related to feelings and beliefs of healthcare providers in relation to FWR during invasive procedures and resuscitation. This study will focus on only those questions relating to resuscitation, therefore there was no analysis performed on questions relating to invasive procedures (Q3, 5, 12a, 14a and 15a). Four main themes were identified for analysis. Identified themes were feelings (Q1, 2, 4), beliefs (Q6-8), stress (Q9) and fear of litigation (Q10). Dependent variables analyzed were feelings, beliefs, stress, and fear of litigation. Independent variables analyzed were age, gender, nationality, profession, unit, and years qualified. Results: Of the 799 surveys distributed, 393 were returned representing a response rate of 49%. The majority of respondents were female (70.9%), over 40 years of age (69.9%), of Middle Eastern descent (29.1%), and were from emergency rooms and intensive care units (53.2%). The profession which had the most respondents was nursing (82.1%). Most participants were qualified in their professions more than 6 years (87.7%) and had been working in the healthcare organization for 0-15 years (84%). Seventy-eight percent of respondents were in support of family having the option to be present if accompanied by a facilitator. The majority of respondents were Middle Eastern (29%) followed by European (19%), Filipino (15%), Indian (13%) and Sub-Saharan African (11%) with the remaining five nationalities making up slightly more than 12%. Gender was significant across all four themes (p\u3c0.05). Results of the analysis indicated a statistically significant difference between unit worked on and nationality and beliefs (p\u3c0.05) and stress (p\u3c0.05). Profession had a significant association with feeling comfortable providing psycho-social-spiritual support during FWR (p\u3c0.05). Years qualified and age had no significant association with beliefs, feelings, fear, or stress. Conclusion: This study explored the views of nurses, doctors, paramedics, and respiratory therapists providing resuscitative care. Results of the study may be used to develop institutional policy regarding family witnessed resuscitation. Implementation of an FWR policy would enable staff to make informed decisions based on evidence-based practice. Additionally, policy implementation would prevent individual healthcare provider beliefs from impacting patient care decision-making. The organization in question does not currently have an FWR policy. One intention of this study was to provide evidence that a policy was required regardless of the outcome of the study. Policy development would also help reduce fears and tensions among healthcare providers during resuscitation. Implementing a structured policy would ensure healthcare providers were informed and aware of their role in assisting family members as well as the patient in order to improve outcomes

Polymyalgia Rheumatica (PMR) Special Interest Group at OMERACT 11: outcomes of importance for patients with PMR

We worked toward developing a core outcome set for clinical research studies in polymyalgia rheumatica (PMR) by conducting (1) patient consultations using modified nominal group technique; (2) a systematic literature review of outcome measures in PMR; (3) a pilot observational study of patients presenting with untreated PMR, and further discussion with patient research partners; and (4) a qualitative focus group study of patients with PMR on the meaning of stiffness, using thematic analysis. (1) Consultations included 104 patients at 4 centers. Symptoms of PMR included pain, stiffness, fatigue, and sleep disturbance. Function, anxiety, and depression were also often mentioned. Participants expressed concerns about diagnostic delay, adverse effects of glucocorticoids, and fear of relapse. (2) In the systematic review, outcome measures previously used for PMR include pain visual analog scores (VAS), morning stiffness, blood markers, function, and quality of life; standardized effect sizes posttreatment were large. (3) Findings from the observational study indicated that asking about symptom severity at 7 AM, or "on waking," appeared more relevant to disease activity than asking about symptom severity "now" (which depended on the time of assessment). (4) Preliminary results were presented from the focus group qualitative study, encompassing broad themes of stiffness, pain, and the effect of PMR on patients' lives. It was concluded that further validation work is required before a core outcome set in PMR can be recommended. Nevertheless, the large standardized effect sizes suggest that pain VAS is likely to be satisfactory as a primary outcome measure for assessing response to initial therapy of PMR. Dissection of between-patient heterogeneity in the subsequent treatment course may require attention to comorbidity as a potential confounding factor