Divorce Law—Defective Mexican Divorce Decree Accorded New York Recognition Due to Subsequent Appearance, Through an Attorney, of Party Absent from the Mexican Action

Ramm v. Ramm, 34 App. Div. 2d 667, 310 N.Y.S.2d 111 (2d Dep\u27t 1970)

Non-monotonic variation with salt concentration of the second virial coefficient in protein solutions

The osmotic virial coefficient $B_2$ of globular protein solutions is calculated as a function of added salt concentration at fixed pH by computer simulations of the ``primitive model''. The salt and counter-ions as well as a discrete charge pattern on the protein surface are explicitly incorporated. For parameters roughly corresponding to lysozyme, we find that $B_2$ first decreases with added salt concentration up to a threshold concentration, then increases to a maximum, and then decreases again upon further raising the ionic strength. Our studies demonstrate that the existence of a discrete charge pattern on the protein surface profoundly influences the effective interactions and that non-linear Poisson Boltzmann and Derjaguin-Landau-Verwey-Overbeek (DLVO) theory fail for large ionic strength. The observed non-monotonicity of $B_2$ is compared to experiments. Implications for protein crystallization are discussed.Comment: 43 pages, including 17 figure

Behavioral Inhibition as a Risk Factor for the Development of Childhood Anxiety Disorders: A Longitudinal Study

This longitudinal study examined the additive and interactive effects of behavioral inhibition and a wide range of other vulnerability factors in the development of anxiety problems in youths. A sample of 261 children, aged 5 to 8 years, 124 behaviorally inhibited and 137 control children, were followed during a 3-year period. Assessments took place on three occasions to measure children’s level of behavioral inhibition, anxiety disorder symptoms, other psychopathological symptoms, and a number of other vulnerability factors such as insecure attachment, negative parenting styles, adverse life events, and parental anxiety. Results obtained with Structural Equation Modeling indicated that behavioral inhibition primarily acted as a specific risk factor for the development of social anxiety symptoms. Furthermore, the longitudinal model showed additive as well as interactive effects for various vulnerability factors on the development of anxiety symptoms. That is, main effects of anxious rearing and parental trait anxiety were found, whereas behavioral inhibition and attachment had an interactive effect on anxiety symptomatology. Moreover, behavioral inhibition itself was also influenced by some of the vulnerability factors. These results provide support for dynamic, multifactorial models for the etiology of child anxiety problems

Evaluation of agreements between managed care organizations and providers of community-based mental illness and addiction disorder treatments

Research Objective: This study, which builds on an ongoing body of research into the policy framework of managed care, analyzes contracts between managed care organizations (MCOs) and community-based mental illness and addiction disorder treatment and prevention service providers (MI/AD providers), focusing on implications for both managed care policy and health services research. Study Design: A purposive 50-state sample of 505 MI/AD providers was contacted for study participation in fall of 1998. The database, analyzed in 1999, consisted of 107 provider contracts from 17 states. The low response rate (a potential artifact of the penalties attached to contract disclosure) was offset by the striking similarity in terms. Data were aggregated on MCO and provider demographics, scope of MI/AD services, contractual obligations, and financial reimbursement mechanisms using a review instrument developed with the advice of MI/AD experts.Population Studied: 107 MI/AD provider contracts from 17 states involving MCOs that both directly insure and act as third-party administrators.Principal Findings: MCOs purchase relatively few services from providers, omitting many services that would be integral to the proper ambulatory management of MI/AD disorders. Network provider service duties tend to be ambiguously described (particularly in the case of emergency care), leading to potentially significant and unanticipated financial risk in the case of capitated providers. MCOs exert strong control over treatment decision-making and the allocation of plan resources to individual patients. Capitation and case rate payment arrangements are increasingly common, although 80% of contracts show the use of fee-for-service reimbursement mechanisms for one or more services. Contracts are structured to remove provider bargaining power; they allow MCOs to unilaterally amend all provisions upon notice and without negotiation and to permit termination at will. Conclusions: Managed care contracts favor the needs of the managed care industry and are constructed to: 1) shift significant amounts of financial risk onto individual health professionals; and 2) manage and restrain providers\u27 discretionary choices over the use of health plan benefits through both close oversight and financial controls and incentives. Because a signed contract is a precondition to access to patients and insurance revenues, health professionals must sign them and indicate a general inability to negotiate their terms. Key issues for health services research are: the effects of contractual terms on patient management choices; provider knowledge of contract implications; access to non-contractual services; provider compensation experiences under different contractual arrangements; and the effects of physician practice management companies on contract terms. Implications for Policy, Delivery or Practice: These contracts are products of deliberate policy choices made by courts and legislative bodies alike in the face of demands for change by health care providers. A series of lawsuits have sought to have the agreements either completely or partially voided, as void for public policy, as unlawful restraint on trade, or for other reasons. These challenges have mostly failed, as have national and state-level efforts to legislatively outlaw the use of contracts-at-will that create substantial financial risk and control treatment decision-making. These losses underscore how resistant judges and policymakers may be to the notion of interfering with the workings of the market, particularly given the lack of data on the consequences of such agreements for patient health. Primary Funding Source: The Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services