Torts-Joint Tort-Feasors--Release of One Not Release of All

Plaintiff, a woman who had been struck by a taxicab, underwent treatment by defendant-physician. After eight months under defendant\u27s care, she accepted his assurances that she would fully recover, and executed a general release in favor of the taxi driver. Plaintiff subsequently discovered, however, that the defendant had been negligent in his treatment of her both before and after the execution of the release. In a malpractice action before the Supreme Court of New York judgment was entered in favor of the plaintiff, and defendant appealed. The Appellate Division dismissed the original complaint, holding that the general release discharging the original wrongdoer also discharged the physician. On appeal, held, reversed and judgment reinstated, three judges dissenting. The release of one tort-feasor does not discharge another tort-feasor unless it is so intended or the consideration given constitutes full satisfaction. Derby v. Prewitt, 12 N.Y.2d 100, 236 N.Y.S.2d 953, 187 N.E.2d 556 (1963)

Developing participatory methods that meet the needs of rural communities: the Rural ECOH study

The international literature is replete with case studies of community participation in healthcare planning. Many have not been systematically or robustly evaluated. The Rural ECOH study, across six Australian communities, was designed to robustly evaluate the usefulness of 'Remote Service Futures', an evidence-based method of community participation. Using oral health as a focus, the theory was that services and local people would come together for evidenced-based discussions about oral health and would design costed strategies to address oral health challenges. Whilst 'Remote Service Futures' has been successfully used in the United Kingdom, in the Australian context, its translation has not been easy. Our findings reflect the dilemma of whether local organisations really want to delegate decision-making power to communities, and whether people want to participate in structured ways. We discuss the challenges that we encountered, and provide examples of the approaches that we have used to engage all stakeholders, including modifications to ethics processes, using social media, community conversations, working with existing community and social groups, and extensive work with community champions. Our findings have implications for policy and practice. Whilst internationally, policy promotes the active engagement of citizens and health service providers in health planning, service design and evaluation, there is little guidance on how this can be achieved. Our recommendations provide clear direction for enacting participation policy at a service and community level

PROPEL: implementation of an evidence based pelvic floor muscle training intervention for women with pelvic organ prolapse: a realist evaluation and outcomes study protocol

Abstract Background Pelvic Organ Prolapse (POP) is estimated to affect 41%–50% of women aged over 40. Findings from the multi-centre randomised controlled “Pelvic Organ Prolapse PhysiotherapY” (POPPY) trial showed that individualised pelvic floor muscle training (PFMT) was effective in reducing symptoms of prolapse, improved quality of life and showed clear potential to be cost-effective. However, provision of PFMT for prolapse continues to vary across the UK, with limited numbers of women’s health physiotherapists specialising in its delivery. Implementation of this robust evidence from the POPPY trial will require attention to different models of delivery (e.g. staff skill mix) to fit with differing care environments. Methods A Realist Evaluation (RE) of implementation and outcomes of PFMT delivery in contrasting NHS settings will be conducted using multiple case study sites. Involving substantial local stakeholder engagement will permit a detailed exploration of how local sites make decisions on how to deliver PFMT and how these lead to service change. The RE will track how implementation is working; identify what influences outcomes; and, guided by the RE-AIM framework, will collect robust outcomes data. This will require mixed methods data collection and analysis. Qualitative data will be collected at four time-points across each site to understand local contexts and decisions regarding options for intervention delivery and to monitor implementation, uptake, adherence and outcomes. Patient outcome data will be collected at baseline, six months and one year follow-up for 120 women. Primary outcome will be the Pelvic Organ Prolapse Symptom Score (POP-SS). An economic evaluation will assess the costs and benefits associated with different delivery models taking account of further health care resource use by the women. Cost data will be combined with the primary outcome in a cost effectiveness analysis, and the EQ-5D-5L data in a cost utility analysis for each of the different models of delivery. Discussion Study of the implementation of varying models of service delivery of PFMT across contrasting sites combined with outcomes data and a cost effectiveness analysis will provide insight into the implementation and value of different models of PFMT service delivery and the cost benefits to the NHS in the longer term

Electrical conduction by interface states in semiconductor heterojunctions

peer reviewedaudience: researcher, professionalElectrical conduction in semiconductor heterojunctions containing defect states in the interface region is studied. As the classical drift-diffusion mechanism cannot in any case explain electrical conduction in semiconductor heterojunctions, tunnelling involving interface states is often considered as a possible conduction path. A theoretical treatment is made where defect states in the interface region with a continuous energy distribution are included. Electrical conduction through this defect band then allows the transit of electrons from the conduction band of one semiconductor to the valence band of the second component. The analysis is initiated by electrical measurements on n-CdS/p-CdTe heterojunctions obtained by chemical vapour deposition of CdS on (111) oriented CdTe single crystals, for which current--voltage and capacitance--frequency results are shown. The theoretical analysis is based on the numerical resolution of Poisson's equation and the continuity equations of electrons, holes and defect states, where a current component corresponding to the defect band conduction is explicitly included. Comparison with the experimental curves shows that this formalism yields an efficient tool to model the conduction process through the interface region. It also allows us to determine critical values of the physical parameters when a particular step in the conduction mechanism becomes dominant

Women’s experiences of receiving care for pelvic organ prolapse: a qualitative study

Background Pelvic organ prolapse is a common urogenital condition affecting 41–50% of women over the age of 40. To achieve early diagnosis and appropriate treatment, it is important that care is sensitive to and meets women’s needs, throughout their patient journey. This study explored women’s experiences of seeking diagnosis and treatment for prolapse and their needs and priorities for improving person-centred care. Methods Twenty-two women receiving prolapse care through urogynaecology services across three purposefully selected NHS UK sites took part in three focus groups and four telephone interviews. A topic guide facilitated discussions about women’s experiences of prolapse, diagnosis, treatment, follow-up, interactions with healthcare professionals, overall service delivery, and ideals for future services to meet their needs. Data were analysed thematically. Results Three themes emerged relating to women’s experiences of a) Evaluating what is normal b) Hobson’s choice of treatment decisions, and c) The trial and error of treatment and technique. Women often delayed seeking help for their symptoms due to lack of awareness, embarrassment and stigma. When presented to GPs, their symptoms were often dismissed and unaddressed until they became more severe. Women reported receiving little or no choice in treatment decisions. Choices were often influenced by health professionals’ preferences which were subtly reflected through the framing of the offer. Women’s embodied knowledge of their condition and treatment was largely unheeded, resulting in decisions that were inconsistent with women’s preferences and needs. Physiotherapy based interventions were reported as helping women regain control over their symptoms and life. A need for greater awareness of prolapse and physiotherapy interventions among women, GPs and consultants was identified alongside greater focus on prevention, early diagnosis and regular follow-up. Greater choice and involvement in treatment decision making was desired. Conclusions As prolapse treatment options expand to include more conservative choices, greater awareness and education is needed among women and professionals about these as a first line treatment and preventive measure, alongside a multi-professional team approach to treatment decision making. Women presenting with prolapse symptoms need to be listened to by the health care team, offered better information about treatment choices, and supported to make a decision that is right for them

Parmodulins Inhibit Thrombus Formation Without Inducing Endothelial Injury Caused by Vorapaxar

Protease-activated receptor-1 (PAR1) couples the coagulation cascade to platelet activation during myocardial infarction and to endothelial inflammation during sepsis. This receptor demonstrates marked signaling bias. Its activation by thrombin stimulates prothrombotic and proinflammatory signaling, whereas its activation by activated protein C (APC) stimulates cytoprotective and antiinflammatory signaling. A challenge in developing PAR1-targeted therapies is to inhibit detrimental signaling while sparing beneficial pathways. We now characterize a novel class of structurally unrelated small-molecule PAR1 antagonists, termed parmodulins, and compare the activity of these compounds to previously characterized compounds that act at the PAR1 ligand–binding site. We find that parmodulins target the cytoplasmic face of PAR1 without modifying the ligand-binding site, blocking signaling through Gαq but not Gα13 in vitro and thrombus formation in vivo. In endothelium, parmodulins inhibit prothrombotic and proinflammatory signaling without blocking APC-mediated pathways or inducing endothelial injury. In contrast, orthosteric PAR1 antagonists such as vorapaxar inhibit all signaling downstream of PAR1. Furthermore, exposure of endothelial cells to nanomolar concentrations of vorapaxar induces endothelial cell barrier dysfunction and apoptosis. These studies demonstrate how functionally selective antagonism can be achieved by targeting the cytoplasmic face of a G-protein–coupled receptor to selectively block pathologic signaling while preserving cytoprotective pathways