Geographic Variation in Informed Consent Law: Two Standards for Disclosure of Treatment Risks

We analyzed 714 jury verdicts in informed consent cases tried in 25 states in 1985–2002 to determine whether the applicable standard of care (“patient” vs. “professional” standard) affected the outcome. Verdicts for plaintiffs were significantly more frequent in states with a patient standard than in states with a professional standard (27 percent vs. 17 percent, P = 0.02). This difference in outcomes did not hold for other types of medical malpractice litigation (36 percent vs. 37 percent, P = 0.8). The multivariate odds of a plaintiff’s verdict were more than twice as high in states with a patient standard than in states with a professional standard (odds ratio = 2.15, 95% confidence interval = 1.32–3.50). The law’s expectations of clinicians with respect to risk disclosure appear to vary geographically

Can the United States Afford a “No-Fault” System of Compensation for Medical Injury?

One of the key issues separating US critics of a no-fault alternative to the tort system for compensating victims of medical injury from supporters is its anticipated cost. Results from a study are presented that estimate the costs of a no-fault system, one that is similar to the system now in operation in Sweden, within the context of the US health care system

Crop residue grazing and tillage systems effects on soil physical properties and corn (Zea Mays L.) performance

Crop-livestock systems under no till (NT) could negatively affect soil physical properties and crop performance, due to the additive effects of reduced soil cover and cattle trampling due to livestock grazing, and the absence of tillage. We evaluated the effects of four grazing strategies and of a shallow tillage (ST) on soil physical properties and corn (Zea mays L.) performance for a mollisol after 15 years under crop-livestock systems under NT in Argentina. Grazing strategies evaluated were: closure (C), one grazing (OG), high stocking rate (HR) and farmer's management (FM), and the tillage systems were: NT and ST. Bulk density (BD), penetration resistance (PR), hydraulic conductivity (ks), plant population, surface root distribution, aboveground dry matter accumulation, aboveground total N (TN) accumulation and corn yield were evaluated. High stocking rate and FM increased RP. On the other hand, ST decreased PR and BD and increased ks. Corn yield was higher under ST than under NT, and under HR than under the other grazing strategies. Total N accumulation was higher under HR than under the rest of grazing strategies. Rational grazing management and use of tillage systems on resilient soils could have prevented soil physical properties be affected beyond critical thresholds.Facultad de Ciencias Agrarias y Forestale

Soil quality assessment based on soil organic matter pools under long‐term tillage systems and following tillage conversion in a semi‐humid region

A field study was conducted to assess the long-term effects of no-tillage (NT) and conventional tillage (CT), and the short-term effects following tillage conversion -from CT to NT (NTn) and from NT to CT (CTn) on soil quality (SQ) indicators in a semi-humid climate. First, plots of a long-term tillage experiment on a Luvic Phaeozem initiated in 1986, were split into two subplots in 2012, yielding four treatments: NT, CT, NTn and CTn. In 2015, composite soil samples were collected from each treatment and from a natural site (Ref) at depths 0-5, 5-10, 10-20 and 0-20 cm. Several indicators were determined: soil organic carbon (SOC) and nitrogen (SON); particulate organic C (POM-C) and N (POM-N); potential N mineralization (PMN) and soil respiration (Rs). Moreover, bulk density was determined in long-term tillage systems. Different ratios between indicators were calculated, with emphasis on its function in the agroecosystem, i.e. functional indicators. Significant differences in SOC, SON and PMN were found between CT and NT at most depths. In contrast, three years after tillage conversion, only a part of the SQ indicators studied were modified mainly at the 0-10 cm depth. The functional indicators showed differences between tillage systems in the long-term and after short-term tillage conversion depending on the depth; however, the PMN/SON ratio demonstrated differences at all depths. Under these conditions, this ratio -related to easily mineralizable N fraction- proved to be a promising indicator for assessing SQ under contrasting tillage systems regardless of the sampling depth.Fil: Martinez, Juan Manuel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Centro de Recursos Naturales Renovables de la Zona Semiárida. Universidad Nacional del Sur. Centro de Recursos Naturales Renovables de la Zona Semiárida; ArgentinaFil: Galantini, Juan Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Centro de Recursos Naturales Renovables de la Zona Semiárida. Universidad Nacional del Sur. Centro de Recursos Naturales Renovables de la Zona Semiárida; Argentina. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas; ArgentinaFil: Duval, Matias Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Centro de Recursos Naturales Renovables de la Zona Semiárida. Universidad Nacional del Sur. Centro de Recursos Naturales Renovables de la Zona Semiárida; Argentina. Universidad Nacional del Sur. Departamento de Agronomía; ArgentinaFil: López, Fernando Manuel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Centro de Recursos Naturales Renovables de la Zona Semiárida. Universidad Nacional del Sur. Centro de Recursos Naturales Renovables de la Zona Semiárida; Argentin

Crop residue grazing and tillage systems effects on soil physical properties and corn (Zea Mays L.) performance

Crop-livestock systems under no till (NT) could negatively affect soil physical properties and crop performance, due to the additive effects of reduced soil cover and cattle trampling due to livestock grazing, and the absence of tillage. We evaluated the effects of four grazing strategies and of a shallow tillage (ST) on soil physical properties and corn (Zea mays L.) performance for a mollisol after 15 years under crop-livestock systems under NT in Argentina. Grazing strategies evaluated were: closure (C), one grazing (OG), high stocking rate (HR) and farmer's management (FM), and the tillage systems were: NT and ST. Bulk density (BD), penetration resistance (PR), hydraulic conductivity (ks), plant population, surface root distribution, aboveground dry matter accumulation, aboveground total N (TN) accumulation and corn yield were evaluated. High stocking rate and FM increased RP. On the other hand, ST decreased PR and BD and increased ks. Corn yield was higher under ST than under NT, and under HR than under the other grazing strategies. Total N accumulation was higher under HR than under the rest of grazing strategies. Rational grazing management and use of tillage systems on resilient soils could have prevented soil physical properties be affected beyond critical thresholds.Facultad de Ciencias Agrarias y Forestale

Universal architecture of bacterial chemoreceptor arrays

Chemoreceptors are key components of the high-performance signal transduction system that controls bacterial chemotaxis. Chemoreceptors are typically localized in a cluster at the cell pole, where interactions among the receptors in the cluster are thought to contribute to the high sensitivity, wide dynamic range, and precise adaptation of the signaling system. Previous structural and genomic studies have produced conflicting models, however, for the arrangement of the chemoreceptors in the clusters. Using whole-cell electron cryo-tomography, here we show that chemoreceptors of different classes and in many different species representing several major bacterial phyla are all arranged into a highly conserved, 12-nm hexagonal array consistent with the proposed “trimer of dimers” organization. The various observed lengths of the receptors confirm current models for the methylation, flexible bundle, signaling, and linker sub-domains in vivo. Our results suggest that the basic mechanism and function of receptor clustering is universal among bacterial species and was thus conserved during evolution

Sources, perceived usefulness and understanding of information disseminated to families who entered home quarantine during the H1N1 pandemic in Victoria, Australia: a cross-sectional study

Background Voluntary home quarantine of cases and close contacts was the main non-pharmaceutical intervention used to limit transmission of pandemic (H1N1) 2009 influenza (pH1N1) in the initial response to the outbreak of the disease in Australia. The effectiveness of voluntary quarantine logically depends on affected families having a clear understanding of what they are being asked to do. Information may come from many sources, including the media, health officials, family and friends, schools, and health professionals. We report the extent to which families who entered home quarantine received and used information on what they were supposed to do. Specifically, we outline their sources of information; the perceived usefulness of each source; and associations between understanding of recommendations and compliance. Methods Cross-sectional survey administered via the internet and computer assisted telephone interview to families whose school children were recommended to go into home quarantine because they were diagnosed with H1N1 or were a close contact of a case. The sample included 314 of 1157 potentially eligible households (27% response rate) from 33 schools in metropolitan Melbourne. Adjusting for clustering within schools, we describe self-reported \u27understanding of what they were meant to do during the quarantine period\u27; source of information (e.g. health department) and usefulness of information. Using logistic regression we examine whether compliance with quarantine recommendations was associated with understanding and the type of information source used. Results Ninety per cent understood what they were meant to do during the quarantine period with levels of understanding higher in households with cases (98%, 95% CI 93%-99% vs 88%, 95% CI 84%-91%, P = 0.006). Over 87% of parents received information about quarantine from the school, 63% from the health department and 44% from the media. 53% of households were fully compliant and there was increased compliance in households that reported that they understood what they were meant to do (Odds Ratio 2.27, 95% CI 1.35-3.80). Conclusions It is critical that public health officials work closely with other government departments and media to provide clear, consistent and simple information about what to do during quarantine as high levels of understanding will maximise compliance in the quarantined population

Physicians and Drug Representatives: Exploring the Dynamics of the Relationship

BACKGROUND: Interactions between physicians and drug representatives are common, even though research shows that physicians understand the conflict of interest between marketing and patient care. Little is known about how physicians resolve this contradiction. OBJECTIVE: To determine physicians’ techniques for managing cognitive inconsistencies within their relationships with drug representatives. DESIGN, SETTING, AND PARTICIPANTS: Six focus groups were conducted with 32 academic and community physicians in San Diego, Atlanta, and Chicago. MEASUREMENTS: Qualitative analysis of focus group transcripts to determine physicians’ attitudes towards conflict of interest and detailing, their beliefs about the quality of information conveyed and the impact on prescribing, and their resolution of the conflict between detailers’ desire to sell product and patient care. RESULTS: Physicians understood the concept of conflict of interest and applied it to relationships with detailers. However, they maintained favorable views of physician–detailer exchanges. Holding these mutually contradictory attitudes, physicians were in a position of cognitive dissonance. To resolve the dissonance, they used a variety of denials and rationalizations: They avoided thinking about the conflict of interest, they disagreed that industry relationships affected physician behavior, they denied responsibility for the problem, they enumerated techniques for remaining impartial, and they reasoned that meetings with detailers were educational and benefited patients. CONCLUSIONS: Although physicians understood the concept of conflict of interest, relationships with detailers set up psychological dynamics that influenced their reasoning. Our findings suggest that voluntary guidelines, like those proposed by most major medical societies, are inadequate. It may be that only the prohibition of physician–detailer interactions will be effective

Crop residue grazing and tillage systems effects on soil physical properties and corn (Zea Mays L.) performance

Crop-livestock systems under no till (NT) could negatively affect soil physical properties and crop performance, due to the additive effects of reduced soil cover and cattle trampling due to livestock grazing, and the absence of tillage. We evaluated the effects of four grazing strategies and of a shallow tillage (ST) on soil physical properties and corn (Zea mays L.) performance for a mollisol after 15 years under crop-livestock systems under NT in Argentina. Grazing strategies evaluated were: closure (C), one grazing (OG), high stocking rate (HR) and farmer's management (FM), and the tillage systems were: NT and ST. Bulk density (BD), penetration resistance (PR), hydraulic conductivity (ks), plant population, surface root distribution, aboveground dry matter accumulation, aboveground total N (TN) accumulation and corn yield were evaluated. High stocking rate and FM increased RP. On the other hand, ST decreased PR and BD and increased ks. Corn yield was higher under ST than under NT, and under HR than under the other grazing strategies. Total N accumulation was higher under HR than under the rest of grazing strategies. Rational grazing management and use of tillage systems on resilient soils could have prevented soil physical properties be affected beyond critical thresholds.Facultad de Ciencias Agrarias y Forestale