The medico-legal pitfalls of the medical expert witness

The fastest growing field of law is undoubtedly that of Medical Law with the civil and disciplinary cases flowing from it. Globalization, international communication, development and evolution of Law as well as Medicine, cause this worldwide rising medical litigation. Humanitarian rights, post-modern scepticism and even iconoclastic attitudes contribute to this phenomenon. Medico-legal litigation and disciplinary complaints rise (in South Africa) up to 10 per cent per year. To assist the courts and legal profession, in medico-legal issues, helping the parties where the plaintiff has the burden of proof and the defendant for rebuttal, a medical expert witness must be used. The dilemmas and pitfalls arise, in that although knowledgeable medical experts could be used to guide the courts to the correct decision, the lack of a legal mind setting, court procedure and legal knowledge could affect the relevance, credibility and reliability, making the medical evidence of poor quality. The legal profession, deliberately, could “abuse” medical expert witnesses with demanding and coercion of results, which have unrealistic and unreasonable expectations. “Case building” occurs, especially in the adversarial systems of law, making the medical expert vulnerable under cross-examination, when it is shown that the witness has turned into a “hired gun” or is unfair. Thus, lacunae develop, making reasonable cases difficult and a quagmire of facts have to be evaluated for unreasonableness, credibility and appropriateness, compounded by the fact that seldom, cases are comparable. The danger is that the presiding officer could be misled and with limited medical knowledge and misplaced values, could reach the wrong findings. Several cases arguably show that this has led to wrongful outcomes and even unacceptable jurisprudence. The desire to “win” a case, can make a medical witness lose credibility and reasonableness with loss of objectivity, realism and relevance. With personality traits and subjectivity, the case becomes argumentative, obstinate and could even lead to lies. The miasmatic, hostile witness emerges, leading to embarrassing, unnecessary prolongation of court procedures. The medical expert witness should be well guided by the legal profession and well informed of the issues. Medical witnesses should have legal training and insight into the legal and court procedures. At the time of discovery of documents, via arbitration or mediation, medical experts should strive to reach consensus and then present their unified finding, helping the parties fairly and expediting the legal procedure and processes.Private LawLL

Structural basis for rifamycin resistance of bacterial RNA polymerase by the three most clinically important RpoB mutations found in Mycobacterium tuberculosis

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136512/1/mmi13606.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136512/2/mmi13606_am.pd

XMM-Newton observations of seven soft X-ray excess QSOs

XMM-Newton observations of seven QSOs are presented and the EPIC spectra analysed. Five of the AGN show evidence for Fe K-alpha emission, with three being slightly better fitted by lines of finite width; at the 99 per cent level they are consistent with being intrinsically narrow, though. The broad-band spectra can be well modelled by a combination of different temperature blackbodies with a power-law, with temperatures between kT ~ 100-300 eV. On the whole, these temperatures are too high to be direct thermal emission from the accretion disc, so a Comptonization model was used as a more physical parametrization. The Comptonizing electron population forms the soft excess emission, with an electron temperature of ~ 120-680 eV. Power-law, thermal plasma and disc blackbody models were also fitted to the soft X-ray excess. Of the sample, four of the AGN are radio-quiet and three radio-loud. The radio-quiet QSOs may have slightly stronger soft excesses, although the electron temperatures cover the same range for both groups.Comment: 13 pages, 7 figures, accepted for publication in MNRA

Crop Responses to AmiSorb in the North Central Region

Originally used to prevent scale in boilers, carpramid or thermal polyaspartate (copoly[(3-carboxypropionamide)( 2-carboxylmethyl) acetamide)] was brought to agriculture under the trade names AmiSorb and Magnet. It claimed to increase nutrient uptake through artificially increasing the volume of soil occupied by roots through increased root branching and root hair development. Under controlled hydroponic or greenhouse conditions, the use of carpramid increased nutrient uptake, some yield determining factors such as wheat tillering and in some cases, crop yield. Extensive field testing from 1996 to 1998 under various nutrient regimes, placements, forms, and timings resulted in very inconsistent performance. Averaged across all experiments for which data were available, small yield increases were observed for corn (+1.75 bushels/acre), soybean (+0.63 bushel/acre), wheat (+1.07 bushels/acre), and grain sorghum (+0.32 bushel/acre), but at best only about one-fourth of the experiments (27 percent for corn and wheat) showed statistically significant yield increases. Across all crops, only three experiments showed an economic advantage to using carpramid. An attempt was made to better define the conditions when responses were observed but no clear pattern emerged that would allow improved probability of predicting a positive response.https://lib.dr.iastate.edu/extension_pubs/1225/thumbnail.jp

A Highly-Conserved Residue of the HIV-1-gp120 Inner Domain is Important for ADCC Responses Mediated by Anti-Cluster A Antibodies

Previous studies have shown that sera from HIV-1-infected individuals contain antibodies able to mediate antibody-dependent cellular cytotoxicity (ADCC). These antibodies preferentially recognize envelope glycoprotein (Env) epitopes induced upon CD4 binding. Here, we show that a highly conserved tryptophan at position 69 of the gp120 inner domain is important for ADCC mediated by anti-cluster A antibodies and sera from HIV-1-infected individuals

The multi-modality cardiac imaging approach to the Athlete's heart: an expert consensus of the European Association of Cardiovascular Imaging

The term 'athlete's heart' refers to a clinical picture characterized by a slow heart rate and enlargement of the heart. A multi-modality imaging approach to the athlete's heart aims to differentiate physiological changes due to intensive training in the athlete's heart from serious cardiac diseases with similar morphological features. Imaging assessment of the athlete's heart should begin with a thorough echocardiographic examination. Left ventricular (LV) wall thickness by echocardiography can contribute to the distinction between athlete's LV hypertrophy and hypertrophic cardiomyopathy (HCM). LV end-diastolic diameter becomes larger (>55 mm) than the normal limits only in end-stage HCM patients when the LV ejection fraction is <50%. Patients with HCM also show early impairment of LV diastolic function, whereas athletes have normal diastolic function. When echocardiography cannot provide a clear differential diagnosis, cardiac magnetic resonance (CMR) imaging should be performed. With CMR, accurate morphological and functional assessment can be made. Tissue characterization by late gadolinium enhancement may show a distinctive, non-ischaemic pattern in HCM and a variety of other myocardial conditions such as idiopathic dilated cardiomyopathy or myocarditis. The work-up of athletes with suspected coronary artery disease should start with an exercise ECG. In athletes with inconclusive exercise ECG results, exercise stress echocardiography should be considered. Nuclear cardiology techniques, coronary cardiac tomography (CCT) and/or CMR may be performed in selected cases. Owing to radiation exposure and the young age of most athletes, the use of CCT and nuclear cardiology techniques should be restricted to athletes with unclear stress echocardiography or CMR

Cysticercosis-related Deaths, California

Cysticercosis is an increasingly important disease in the United States, but information on the occurrence of related deaths is limited. We examined data from California death certificates for the 12-year period 1989–2000. A total of 124 cysticercosis deaths were identified, representing a crude 12-year death rate of 3.9 per million population (95% confidence interval [CI] 3.2 to 4.6). Eighty-two (66%) of the case-patients were male; 42 (34%) were female. The median age at death was 34.5 years (range 7–81 years). Most patients (107, 86.3%) were foreign-born, and 90 (72.6%) had emigrated from Mexico. Seventeen (13.7%) deaths occurred in U.S.-born residents. Cysticercosis death rates were higher in Latino residents of California (13.0/106) than in other racial/ethnic groups (0.4/106), in males (5.2/106) than in females (2.7/106), and in persons >14 years of age (5.0/106). Cysticercosis is a preventable cause of premature death, particularly among young Latino persons in California and may be a more common cause of death in the United States than previously recognized