Practice and Malpractice: Physician Responses to the Liability \u27Crisis\u27

Mississippi is a largely rural state with many poor and unhealthy residents who are chronically underserved by the smallest per capita physician workforce in the nation. Anecdotal reports claimed Mississippi‘s medical malpractice climate jeopardized patient access to health care even further. Using survey data from Mississippi physicians, we document how medical liability perceptions shaped their practices at the height of the Mississippi malpractice crisis. Our findings show that physicians‘ risk profiles strongly influenced the extent to which physicians reported practicing defensive medicine or considered relocating or retiring early in response to malpractice conditions. This raises the specter of further compromising access to physician care in an already underserved state

Altruism or Self-interest? Social Spending and the Life Course

The primacy of self-interested individuals is often regarded as the appropriate basis for US social spending decisions. One thread of this argument has advanced age-based self-interest and politically powerful elderly to explain why Social Security and Medicare have thrived in a policy environment that has seen retrenchment in other programs. We argue that crude self-interest and individual programs considered in isolation are insufficient to understand social spending preferences. We use General Social Survey data to contrast conventional and critical explanations for understanding the role of age in preferences for social spending. Factor analyses demonstrate that social spending preferences cluster into conceptually distinctive domains. This supports our argument that social spending orientations are more complex than conventional analyses of age-based preferences for single-issue discrete programs like education, welfare or Social Security suggest. Overemphasis on age group differences misconstrues the role of age in spending orientations and whether preferences are more plausibly labeled as selfinterested or altruistic. Considering how age, period and cohorts dfferences impact social spending domains improves understanding of how the life course influences social spending preferences

KELT-6b: A P~7.9 d Hot Saturn Transiting a Metal-Poor Star with a Long-Period Companion

We report the discovery of KELT-6b, a mildly-inflated Saturn-mass planet transiting a metal-poor host. The initial transit signal was identified in KELT-North survey data, and the planetary nature of the occulter was established using a combination of follow-up photometry, high-resolution imaging, high-resolution spectroscopy, and precise radial velocity measurements. The fiducial model from a global analysis including constraints from isochrones indicates that the V=10.38 host star (BD+31 2447) is a mildly evolved, late-F star with T_eff=6102 \pm 43 K, log(g_*)=4.07_{-0.07}^{+0.04} and [Fe/H]=-0.28 \pm 0.04, with an inferred mass M_*=1.09 \pm 0.04 M_sun and radius R_star=1.58_{-0.09}^{+0.16} R_sun. The planetary companion has mass M_P=0.43 \pm 0.05 M_J, radius R_P=1.19_{-0.08}^{+0.13} R_J, surface gravity log(g_P)=2.86_{-0.08}^{+0.06}, and density rho_P=0.31_{-0.08}^{+0.07} g~cm^{-3}. The planet is on an orbit with semimajor axis a=0.079 \pm 0.001 AU and eccentricity e=0.22_{-0.10}^{+0.12}, which is roughly consistent with circular, and has ephemeris of T_c(BJD_TDB)=2456347.79679 \pm 0.00036 and P=7.845631 \pm 0.000046 d. Equally plausible fits that employ empirical constraints on the host star parameters rather than isochrones yield a larger planet mass and radius by ~4-7%. KELT-6b has surface gravity and incident flux similar to HD209458b, but orbits a host that is more metal poor than HD209458 by ~0.3 dex. Thus, the KELT-6 system offers an opportunity to perform a comparative measurement of two similar planets in similar environments around stars of very different metallicities. The precise radial velocity data also reveal an acceleration indicative of a longer-period third body in the system, although the companion is not detected in Keck adaptive optics images.Comment: Published in AJ, 17 pages, 15 figures, 6 table

Evaluation of an inter-professional workshop to develop a psychosocial assessment and child-centred communication training programme for paediatricians in training

BACKGROUND: The quality of psychosocial assessment of children in consultations varies widely. One reason for this difference is the variability in effective mental health and communication training at undergraduate and post-qualification levels. In recognition of this problem, the Royal College of Paediatrics and Child Health in the United Kingdom have developed the Child in Mind Project that aims to meet this deficit in medical training. This paper describes the evaluation of a workshop that explored the experiences and expectations of health care professionals in the development of a training programme for doctors. METHODS: The one-day inter-professional workshop was attended by 63 participants who were invited to complete evaluation forms before and immediately after the workshop. RESULTS: The results showed that the workshop was partially successful in providing an opportunity for an inter-professional group to exchange ideas and influence the development of a significant project. Exploring the content and process of the proposed training programme and the opportunity for participants to share experiences of effective practice were valued. Participants identified that the current culture within many health care settings would be an obstacle to successful implementation of a training programme. Working within existing training structures will be essential. Areas for improvement in the workshop included clearer statement of goals at the outset and a more suitable environment for the numbers of participants. CONCLUSIONS: The participants made a valuable contribution to the development of the training programme identifying specific challenges. Inter-professional collaborations are likely to result in more deliverable and relevant training programmes. Continued consultation with potential users of the programme – both trainers and trainees will be essential

KELT-6b: A P ~ 7.9 Day Hot Saturn Transiting a Metal-poor Star with a Long-period Companion

We report the discovery of KELT-6b, a mildly inflated Saturn-mass planet transiting a metal-poor host. The initial transit signal was identified in KELT-North survey data, and the planetary nature of the occulter was established using a combination of follow-up photometry, high-resolution imaging, high-resolution spectroscopy, and precise radial velocity measurements. The fiducial model from a global analysis including constraints from isochrones indicates that the V = 10.38 host star (BD+31 2447) is a mildly evolved, late-F star with T eff = 6102 ± 43 K, , and [Fe/H] = –0.28 ± 0.04, with an inferred mass M = 1.09 ± 0.04 M ☉ and radius . The planetary companion has mass MP = 0.43 ± 0.05 M Jup, radius , surface gravity , and density . The planet is on an orbit with semimajor axis a = 0.079 ± 0.001 AU and eccentricity , which is roughly consistent with circular, and has ephemeris of T c(BJDTDB) = 2456347.79679 ± 0.00036 and P = 7.845631 ± 0.000046 days. Equally plausible fits that employ empirical constraints on the host-star parameters rather than isochrones yield a larger planet mass and radius by ~4}-7}. KELT-6b has surface gravity and incident flux similar to HD 209458b, but orbits a host that is more metal poor than HD 209458 by ~0.3 dex. Thus, the KELT-6 system offers an opportunity to perform a comparative measurement of two similar planets in similar environments around stars of very different metallicities. The precise radial velocity data also reveal an acceleration indicative of a longer-period third body in the system, although the companion is not detected in Keck adaptive optics images

The Mass of KOI-94d and a Relation for Planet Radius, Mass, and Incident Flux

We measure the mass of a modestly irradiated giant planet, KOI-94d. We wish to determine whether this planet, which is in a 22 day orbit and receives 2700 times as much incident flux as Jupiter, is as dense as Jupiter or rarefied like inflated hot Jupiters. KOI-94 also hosts at least three smaller transiting planets, all of which were detected by the Kepler mission. With 26 radial velocities of KOI-94 from the W. M. Keck Observatory and a simultaneous fit to the Kepler light curve, we measure the mass of the giant planet and determine that it is not inflated. Support for the planetary interpretation of the other three candidates comes from gravitational interactions through transit timing variations, the statistical robustness of multi-planet systems against false positives, and several lines of evidence that no other star resides within the photometric aperture. We report the properties of KOI-94b (M_P = 10.5 ± 4.6 M_⊕, R_P = 1.71 ± 0.16 R_⊕, P = 3.74 days), KOI-94c (M_P = 15.6^(+5.7)_(-15.6) M_⊕, R_P = 4.32 ± 0.41 R_⊕, P = 10.4 days), KOI-94d (M_P = 106 ± 11 M_⊕, R_P = 11.27 ± 1.06 R_⊕, P = 22.3 days), and KOI-94e (M_P = 35^(+18)_(-28) M_⊕, R_P = 6.56 ± 0.62 R_⊕, P = 54.3 days). The radial velocity analyses of KOI-94b and KOI-94e offer marginal (>2σ) mass detections, whereas the observations of KOI-94c offer only an upper limit to its mass. Using the KOI-94 system and other planets with published values for both mass and radius (138 exoplanets total, including 35 with M_P 150 M_⊕. These equations can be used to predict the radius or mass of a planet

Working later in the USA and Ireland: implications for precariously and securely employed women

Policies to extend working life (EWL) assume homogeneous workers face similar choices about working longer: this may be difficult for women, workers in physically onerous jobs or in low-paid precarious employment. Work-life trajectories are gendered; women interrupt employment and pension-building to provide care. There is occupational variation in capacities to prolong working lives: physically demanding jobs cause work-related health deficits. The precariously employed cannot contribute regularly to pensions and may face age discrimination. This research provides an inter-occupational and cross-national dimension to EWL research, comparing women teachers and health-care workers in the United States of America (USA) and Republic of Ireland. It documents intra-cohort distinctions that emerge among women when considering educational opportunities and occupational tracks expressed in lifecourse trajectories and accumulated capacities for extended work. Analysis draws on interview data from ten teachers and ten healthcare workers in each country, comparing the implications of EWL policies for women workers: in precarious versus secure occupations and occupations with different physical demands. It reveals work-life trajectories leading to poorer financial and health outcomes for older health-care workers, especially in the USA. Most women (regardless of occupation or country) opposed extending working life, with concerns ranging from health status and ability to work to the desire to have healthy years in retirement. The most important distinctions are between the occupational categories considered, rather than cross-national differences. Implications for national and work-place policy and research are considered.The research on which this paper is based was supported by a Marie Curie International Outgoing Fellowship within the 7th European Community Framework Programme. This article is also based on work from COST Action IS1409, supported by COST (European Cooperation in Science and Technology). Funding from the State University of New York College of Arts and Sciences enabled the authors to collaborate on the paper. Funders played no role in the design, execution, analysis or interpretation of data or the writing of the study.peer-reviewe

Working later in the USA and Ireland: implications for precariously and securely employed women

Policies to extend working life (EWL) assume homogeneous workers face similar choices about working longer: this may be difficult for women, workers in physically onerous jobs or in low-paid precarious employment. Work-life trajectories are gendered; women interrupt employment and pension-building to provide care. There is occupational variation in capacities to prolong working lives: physically demanding jobs cause work-related health deficits. The precariously employed cannot contribute regularly to pensions and may face age discrimination. This research provides an inter-occupational and cross-national dimension to EWL research, comparing women teachers and health-care workers in the United States of America (USA) and Republic of Ireland. It documents intra-cohort distinctions that emerge among women when considering educational opportunities and occupational tracks expressed in lifecourse trajectories and accumulated capacities for extended work. Analysis draws on interview data from ten teachers and ten healthcare workers in each country, comparing the implications of EWL policies for women workers: in precarious versus secure occupations and occupations with different physical demands. It reveals work-life trajectories leading to poorer financial and health outcomes for older health-care workers, especially in the USA. Most women (regardless of occupation or country) opposed extending working life, with concerns ranging from health status and ability to work to the desire to have healthy years in retirement. The most important distinctions are between the occupational categories considered, rather than cross-national differences. Implications for national and work-place policy and research are considered.The research on which this paper is based was supported by a Marie Curie International Outgoing Fellowship within the 7th European Community Framework Programme. This article is also based on work from COST Action IS1409, supported by COST (European Cooperation in Science and Technology). Funding from the State University of New York College of Arts and Sciences enabled the authors to collaborate on the paper. Funders played no role in the design, execution, analysis or interpretation of data or the writing of the study

Working later in the USA and Ireland: implications for precariously and securely employed women

Policies to extend working life (EWL) assume homogeneous workers face similar choices about working longer: this may be difficult for women, workers in physically onerous jobs or in low-paid precarious employment. Work-life trajectories are gendered; women interrupt employment and pension-building to provide care. There is occupational variation in capacities to prolong working lives: physically demanding jobs cause work-related health deficits. The precariously employed cannot contribute regularly to pensions and may face age discrimination. This research provides an inter-occupational and cross-national dimension to EWL research, comparing women teachers and health-care workers in the United States of America (USA) and Republic of Ireland. It documents intra-cohort distinctions that emerge among women when considering educational opportunities and occupational tracks expressed in lifecourse trajectories and accumulated capacities for extended work. Analysis draws on interview data from ten teachers and ten healthcare workers in each country, comparing the implications of EWL policies for women workers: in precarious versus secure occupations and occupations with different physical demands. It reveals work-life trajectories leading to poorer financial and health outcomes for older health-care workers, especially in the USA. Most women (regardless of occupation or country) opposed extending working life, with concerns ranging from health status and ability to work to the desire to have healthy years in retirement. The most important distinctions are between the occupational categories considered, rather than cross-national differences. Implications for national and work-place policy and research are considered.The research on which this paper is based was supported by a Marie Curie International Outgoing Fellowship within the 7th European Community Framework Programme. This article is also based on work from COST Action IS1409, supported by COST (European Cooperation in Science and Technology). Funding from the State University of New York College of Arts and Sciences enabled the authors to collaborate on the paper. Funders played no role in the design, execution, analysis or interpretation of data or the writing of the study.peer-reviewe