Cutting Costs - Cutting Care: Can Texas Managed Health Care Systems and HMOs Be Liable for the Medical Malpractice of Physicians.

One of the most common forms of managed health care is the health maintenance organization (HMO). An HMO is a quasi-insurance arrangement which provides health care to subscribers for a prepaid monthly fee. These have been attractive as they offer health care at lower cost to consumers. Health care brokers have developed four standard models of HMOs— “staff model,” “group model,” “network model,” and “independent practice association” (IPA) model. Given the degree of control HMOs exercise over member-physicians under any of the above models, Texas courts should hold HMOs liable for their member-physicians’ malpractice under the doctrine of vicarious liability, including respondeat superior, apparent agency, agency by estoppel, and nondelegable duties. In addition to vicarious liability for member-physicians\u27 malpractice, Texas HMOs should face direct liability for their own tortious conduct under the doctrine of corporate negligence. Texas courts use many legal tools to protect citizens from unreasonable risk of harm. Texans looking to medical brokers for health care face greater risks of harm from medical malpractice than patients in hospitals. Further, given the high degree of control HMOs exercise over patient care, subscribers face additional threats of harm due to improper action by the HMO itself. Texas courts have been vigilant in their efforts to protect hospital patients from the malpractice of physicians practicing in hospitals and the wrongful actions of the hospital itself. Implicitly, Texas courts have determined the minor financial burden on health care costs created by finding liability for medical negligence is vastly outweighed by the deterrent effects of such liability and the need to compensate victims. Therefore, no reason exists for refusing to protect Texans simply because they are receiving care from an HMO

High-throughput gene discovery in the rat

The rat is an important animal model for human diseases and is widely used in physiology. In this article we present a new strategy for gene discovery based on the production of ESTs from serially subtracted and normalized cDNA libraries, and we describe its application for the development of a comprehensive nonredundant collection of rat ESTs. Our new strategy appears to yield substantially more EST clusters per ESTs sequenced than do previous approaches that did not use serial subtraction. However, multiple rounds of library subtraction resulted in high frequencies of otherwise rare internally primed cDNAs, defining the limits of this powerful approach. To date, we have generated >200,000 3′ ESTs from >100 cDNA libraries representing a wide range of tissues and developmental stages of the laboratory rat. Most importantly, we have contributed to ∼50,000 rat UniGene clusters. We have identified, arrayed, and derived 5′ ESTs from >30,000 unique rat cDNA clones. Complete information, including radiation hybrid mapping data, is also maintained locally at http://genome.uiowa.edu/clcg.html. All of the sequences described in this article have been submitted to the dbEST division of the NCBI

The DUNE Far Detector Interim Design Report, Volume 3: Dual-Phase Module

The DUNE IDR describes the proposed physics program and technical designs of the DUNE far detector modules in preparation for the full TDR to be published in 2019. It is intended as an intermediate milestone on the path to a full TDR, justifying the technical choices that flow down from the high-level physics goals through requirements at all levels of the Project. These design choices will enable the DUNE experiment to make the ground-breaking discoveries that will help to answer fundamental physics questions. Volume 3 describes the dual-phase module's subsystems, the technical coordination required for its design, construction, installation, and integration, and its organizational structure

A Roadmap for HEP Software and Computing R&D for the 2020s

Particle physics has an ambitious and broad experimental programme for the coming decades. This programme requires large investments in detector hardware, either to build new facilities and experiments, or to upgrade existing ones. Similarly, it requires commensurate investment in the R&D of software to acquire, manage, process, and analyse the shear amounts of data to be recorded. In planning for the HL-LHC in particular, it is critical that all of the collaborating stakeholders agree on the software goals and priorities, and that the efforts complement each other. In this spirit, this white paper describes the R&D activities required to prepare for this software upgrade.Peer reviewe

Medical Malpractice 1987: New Faces, New Facts, New Fundamentals

Abstract Forthcomin

Gallbladder Cancer Incidence Among American Indians and Alaska Natives, US, 1999–2004

BACKGROUND. Gallbladder cancer (GBC) is rare; however, it disproportionately affects the American Indian and Alaska Natives (AI/AN) population. The purpose of the study was to characterize GBC among AI/AN in the US population. METHODS. Cases of GBC diagnosed between 1999 and 2004 and collected by state-based cancer registries were included. Registry records were linked with Indian Health Service (IHS) administration records to decrease race misclassification of AI/AN. GBC rates and/or percent distributions for AI/AN and non-Hispanic whites (NHW) were calculated by sex, IHS region, age, and stage for all US counties and IHS Contract Health Service Delivery Area (CHSDA) counties, in which approximately 56% of US AI/AN individuals reside. RESULTS. In CHSDA counties, the GBC incidence rate among AI/AN was 3.3 per 100,000, which was significantly higher than that among NHW (P \u3c .05). Rates varied widely among IHS regions and ranged from 1.5 in the East to 5.5 in Alaska. Rates were higher among AI/AN females than males in all regions, except the Northern Plains. Higher percentages of GBC were diagnosed among AI/AN aged CONCLUSIONS. To the authors’ knowledge to date, this is the most comprehensive study of GBC incidence among AI/AN in the US. The accurate characterization of GBC in this population could help inform the development of interventions aimed at reducing morbidity and mortality from this diseas

How are acid-base properties of "DOC" measured and modeled and how do they affect aquatic ecosystems? : group report

Dissolved organic carbon (DOC) undergoes an extensive number and variety of interactions in aquatic ecosystems. It exchanges protons, metals, and nutrients, it inhibits or stimulates microorganism growth, it attaches to colloid surfaces, etc. These interactions may appear at equilibrium within observation time scales or may appear reactive. They are studied to understand the basic character and function of DOC and to make predictions about its behavior under a wide range of environmental conditions such as concentration, temperature, pH, alkalinity, and ionic strength. (...