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

The perception and use of cover crops within the island of Ireland

Publication history: Accepted - 14 December 2020; Published - 26 January 2021.The integration of cover crops within arable rotations is becoming increasingly popular due to their widely acknowledged benefits. Subsidisation of cover cropping is available to eligible farmers in the Republic of Ireland (ROI) but not to Northern Ireland (NI) farmers. There has been little research focus on ROI and NI growers' perceptions about the husbandry associated with cover crops and the benefits of growing them. Surveys to gauge farmer use and perception of cover crops were conducted at two arable conferences, with 55 respondents in NI and 77 in ROI (132 respondents in total). Growers used cover crops mainly to improve and maintain soil structure in an overall bid to enhance soil health in ROI, whereas in NI it was predominantly for forage. The impact of subsidies provided by Ireland and its stipulated policy influences species choice, and farmers were more likely to plant cover crops after later harvested commercial crops, for example, September. Compared to growers in NI, they were found predominantly to plant after crops harvested in August. In ROI, 63% of respondents receiving subsidies would continue to use cover crops if this monetary incentive ceased

Disparities in rheumatoid arthritis disease activity according to gross domestic product in 25 countries in the QUEST-RA database

Objective: To analyse associations between the clinical status of patients with rheumatoid arthritis ( RA) and the gross domestic product (GDP) of their resident country. Methods: The Quantitative Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST-RA) cohort includes clinical and questionnaire data from 6004 patients who were seen in usual care at 70 rheumatology clinics in 25 countries as of April 2008, including 18 European countries. Demographic variables, clinical characteristics, RA disease activity measures, including the disease activity score in 28 joints (DAS28), and treatment-related variables were analysed according to GDP per capita, including 14 high GDP countries with GDP per capita greater than US$24 000 and 11 low GDP countries with GDP per capita less than US$ 11 000. Results: Disease activity DAS28 ranged between 3.1 and 6.0 among the 25 countries and was significantly associated with GDP (r = -0.78, 95% CI -0.56 to -0.90, r(2) = 61%). Disease activity levels differed substantially between high GDP and low GDP countries at much greater levels than according to whether patients were currently taking or not taking methotrexate, prednisone and/or biological agents. Conclusions: The clinical status of patients with RA was correlated significantly with GDP among 25 mostly European countries according to all disease measures, associated only modestly with the current use of antirheumatic medications. The burden of arthritis appears substantially greater in low GDP than in high GDP countries. These findings may alert healthcare professionals and designers of health policy towards improving the clinical status of patients with RA in all countries

Prospective, multicentre study of screening, investigation and management of hyponatraemia after subarachnoid haemorrhage in the UK and Ireland

Background Hyponatraemia often occurs after subarachnoid haemorrhage (SAH). However, its clinical significance and optimal management are uncertain. We audited the screening, investigation and management of hyponatraemia after SAH. Methods We prospectively identified consecutive patients with spontaneous SAH admitted to neurosurgical units in the United Kingdom or Ireland. We reviewed medical records daily from admission to discharge, 21 days or death and extracted all measurements of serum sodium to identify hyponatraemia (10 days. Associations of hyponatraemia with outcome were assessed using logistic regression with adjustment for predictors of outcome after SAH and admission duration. We assessed hyponatraemia-free survival using multivariable Cox regression. Results 175/407 (43%) patients admitted to 24 neurosurgical units developed hyponatraemia. 5976 serum sodium measurements were made. Serum osmolality, urine osmolality and urine sodium were measured in 30/166 (18%) hyponatraemic patients with complete data. The most frequently target daily fluid intake was >3 L and this did not differ during hyponatraemic or non-hyponatraemic episodes. 26% (n/N=42/164) patients with hyponatraemia received sodium supplementation. 133 (35%) patients were dead or dependent within the study period and 240 (68%) patients had hospital admission for over 10 days. In the multivariable analyses, hyponatraemia was associated with less dependency (adjusted OR (aOR)=0.35 (95% CI 0.17 to 0.69)) but longer admissions (aOR=3.2 (1.8 to 5.7)). World Federation of Neurosurgical Societies grade I–III, modified Fisher 2–4 and posterior circulation aneurysms were associated with greater hazards of hyponatraemia. Conclusions In this comprehensive multicentre prospective-adjusted analysis of patients with SAH, hyponatraemia was investigated inconsistently and, for most patients, was not associated with changes in management or clinical outcome. This work establishes a basis for the development of evidence-based SAH-specific guidance for targeted screening, investigation and management of high-risk patients to minimise the impact of hyponatraemia on admission duration and to improve consistency of patient care

Using risk factors and quantitative ultrasound to identify postmenopausal caucasian women at risk of osteoporosis

There is a need to prescreen large numbers of individuals for osteoporosis due to current demands on clinical resources. Some previous attempts to predict individuals at risk have used simple indices based on patient information, or Quantitative Ultrasound (QUS) and have shown good sensitivity but also demonstrated low specificity, which means that many individuals with good bone mineral density were also selected. The aim of this study was to determine if a tool based on a combination of risk factors and QUS measurements could also be made to provide improved specificity. A risk factors measurement questionnaire was created and completed for a sample of Caucasian postmenopausal women (n = 235) who had undergone Dual-energy X-ray absorptiometry scanning. QUS measurements were also taken at various skeletal sites. Assessment tools were generated using stepwise regression to predict osteoporosis, evaluated by receiver operating characteristic curves, and assessed using area under the curve values. Specificity values were determined at a sensitivity of 0.90 to establish the comparative utility of each assessment tool. Using only a risk factors model the specificities were 0.28 at the lumbar spine, 0.45 for the femoral neck and 0.68 for the total hip. In a risk factors + QUS data model the specificities measured were 0.44 for the lumbar spine, 0.78 for the femoral neck, and 0.84 for the total hip. These novel assessment tools can identify those with low bone mineral density at a number of skeletal sites and help towards avoiding many unnecessary investigations in the future