Arbitration Whack-A-Mole: The Federal Policy Favoring Arbitration Hammers the Rights of Individual Employees

In a country that protects the plaintiff\u27s right to a day in court, it only seems natural that Sally should have the opportunity to take her cause to the courthouse. But the strong fedral presumption that supports the enforcement of arbitration provisions is like a hammber that pushes plaintiffs like Sally and those if Huffman into the arbitration arena. In Huffman, the Sixth Circuit rescued an employwer from an ambiguous arbitration provision contained in the employer-drafted employment agreement and enforced the arbitration provision as one of the provisions to survive expiration of the contract, even though it was not listed in the survival clause

A natural carbohydrate fraction Actigen™ from Saccharomyces cerevisiae cell wall: effects on goblet cells, gut morphology and performance of broiler chickens

A study was conducted to evaluate a natural carbohydrate fraction Actigen™ (NCF), derived from mannanoligosaccharide, in feed on growth performance, intestinal morphology and goblet cell number and area of male broilers'. Dietary treatments included: 1) control diet (antibiotic and NCF free), 2) NCF at 200g/t, 3) NCF at 400g/t, and 4) NCF 800g/t. Two hundred and forty birds were placed into 12 replicate pens per treatment (5 birds/pen), sixty birds per treatment. Body weight and feed intake were recorded weekly up to day 42. At this time a 2.5cm section of jejunum and duodenum were excised post mortem for morphological analysis. Birds fed 200g/t and 800g/t NCF were significantly (P<0.01) heavier from day 14 onwards than the control birds. Feed intake was significantly higher in birds fed 200g/t NCF compared to those fed the control at 21 and 35 days (P<0.05). Diets containing 200g/t and 800g/t of NCF significantly decreased broiler feed conversion ratio (FCR) compared to the control in the first phase (1-14 days) (P<0.01) and levels of NCF decreased FCR (P<0.05) in the second phase (15-28 days). NCF had no significant effect on villus height, villus width, crypt depth or villus to crypt ratio in either duodenum or jejunum. NCF did not significantly affect goblet cell area or goblet cell number in the duodenum, however, in the jejunum, 800g/t NCF significantly (P<0.05) increased goblet cell area over the control. In conclusion, NCF showed a positive effect on broiler performance in the starter and grower phases, and increased goblet cell area in the jejunum, suggesting higher levels of mucin production. This indicated that the performance benefit of NCF could be age-dependent, with younger birds responding more than the older ones. There were no additional benefits to performance when feeding NCF for a longer period (after 28 d of age), however it is postulated that birds fed NCF would have greater defence to pathogenic challenge through increased storage capacity of muci

State Legislative Update

Effective July 1, 1995, as part of the nursing facility enforcement regulations, the Centers for Medicare & Medicaid Services required states to provide nursing facilities with the opportunity for informal dispute reolution reviews. This dispute resolution system was set up in order to avoid the potentially prolonged resolution process associated with more formal appeals. These regulations do not prevent a nursing facility from pursuing a former appeal of the disputed deficiency, but the regulations do give an expedited alternative to the formal process

State Legislative Update

Effective July 1, 1995, as part of the nursing facility enforcement regulations, the Centers for Medicare & Medicaid Services required states to provide nursing facilities with the opportunity for informal dispute reolution reviews. This dispute resolution system was set up in order to avoid the potentially prolonged resolution process associated with more formal appeals. These regulations do not prevent a nursing facility from pursuing a former appeal of the disputed deficiency, but the regulations do give an expedited alternative to the formal process

Using the making Visible the ImpaCT Of Research (VICTOR) questionnaire to evaluate the benefits of a fellowship programme for nurses, midwives and allied health professionals

Background: There is increasing emphasis in the UK on developing a nurse, midwife and allied health professional (NMAHP) workforce that conducts research. Training for clinical academic careers is provided by the National Institute for Health and Care Research (NIHR). However, the low number of successful applicants suggested there were barriers to achieving this. The Centre for Nursing and Midwifery Led Research (CNMR) launched a fellowship programme in 2016 to backfill two days a week of NMAHPs’ time for up to a year, to give them time to make competitive applications to the NIHR. Aim: To report a study evaluating the CNMR fellowship programme. Discussion: The making Visible the ImpaCT Of Research (VICTOR) tool (Cooke et al 2019) was developed to describe the organisational impact of research. The 2016-17 CNMR fellows completed VICTOR and their responses were analysed using a framework approach. The analysis found the main benefits of participating in the programme were protected time for research, opportunities to develop collaborations, increasing intra- and inter-professional awareness of NMAHPs’ research, peer-reviewed publications, and conference presentations. Challenges included a lack of support from line managers, limited value placed on NMAHPs’ research and failure to backfill posts. Conclusion: There were some challenges with the fellowship programme, but all recipients found it to be a positive experience and undertook significant scholarly activity. Implications for practice: A contractual agreement must be established to foster committed partnerships between higher education institutions (HEIs) and the NHS. HEIs and the NHS should conduct frank discussions of the challenges encountered in fellowship programmes. Positive initiatives and outcomes in tertiary education and clinical settings should be shared to improve fellows’ experiences and enhance partnerships between HEIs and the NHS. Job descriptions should include time allocation to review fellowship candidates’ applications regardless of outcome. The showcasing of research successes and the benefits of NMAHP research must evolve to secure organisational ‘buy in’, which is the precursor to widening access to clinical academic pathways

A utility approach to individualized optimal dose selection using biomarkers

In many settings, including oncology, increasing the dose of treatment results in both increased efficacy and toxicity. With the increasing availability of validated biomarkers and prediction models, there is the potential for individualized dosing based on patient specific factors. We consider the setting where there is an existing dataset of patients treated with heterogenous doses and including binary efficacy and toxicity outcomes and patient factors such as clinical features and biomarkers. The goal is to analyze the data to estimate an optimal dose for each (future) patient based on their clinical features and biomarkers. We propose an optimal individualized dose finding rule by maximizing utility functions for individual patients while limiting the rate of toxicity. The utility is defined as a weighted combination of efficacy and toxicity probabilities. This approach maximizes overall efficacy at a prespecified constraint on overall toxicity. We model the binary efficacy and toxicity outcomes using logistic regression with dose, biomarkers and dose–biomarker interactions. To incorporate the large number of potential parameters, we use the LASSO method. We additionally constrain the dose effect to be non‐negative for both efficacy and toxicity for all patients. Simulation studies show that the utility approach combined with any of the modeling methods can improve efficacy without increasing toxicity relative to fixed dosing. The proposed methods are illustrated using a dataset of patients with lung cancer treated with radiation therapy.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154301/1/bimj2068.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154301/2/bimj2068_am.pd

An evaluation of staff experiences of the Royal Literary Fund writer-in-residence service to support improvements in written communication in healthcare

Written communication is essential to staff and patient experience in healthcare. The Royal Literary Fund has hosted a writing fellow in an NHS Trust since 2018 providing professional writing training. The aim of this evaluation was to explore the experiences of staff using the service. Semi-structured interviews were conducted with 21 staff members from a range of professions who had accessed the service. Data were analysed using thematic analysis. Findings: The writing service was highly valued. Three themes emerged: feelings about writing at work, reported benefits of attending sessions, and perceived barriers to accessing them. Staff felt underskilled in professional writing and described the wish to write more succinctly and reflectively. Self-reported confidence increased after sessions. Stigma around writing skills prevented some staff from recommending the service. Wider adoption of professional writing skills training through the NHS could have benefits in terms of increasing self-perceived skills and confidence

On Multifractal Structure in Non-Representational Art

Multifractal analysis techniques are applied to patterns in several abstract expressionist artworks, paintined by various artists. The analysis is carried out on two distinct types of structures: the physical patterns formed by a specific color (``blobs''), as well as patterns formed by the luminance gradient between adjacent colors (``edges''). It is found that the analysis method applied to ``blobs'' cannot distinguish between artists of the same movement, yielding a multifractal spectrum of dimensions between about 1.5-1.8. The method can distinguish between different types of images, however, as demonstrated by studying a radically different type of art. The data suggests that the ``edge'' method can distinguish between artists in the same movement, and is proposed to represent a toy model of visual discrimination. A ``fractal reconstruction'' analysis technique is also applied to the images, in order to determine whether or not a specific signature can be extracted which might serve as a type of fingerprint for the movement. However, these results are vague and no direct conclusions may be drawn.Comment: 53 pp LaTeX, 10 figures (ps/eps