The Road from Medical Injury to Claims Resolution: How No-Fault and Tort Differ

In the area of medical malpractice, no-fault has been offered as a response to the criticisms leveled against tort litigation for medical injuries. Five issues of no-fault are examined within the context of obstetrical malpractice

Chirality in Bare and Passivated Gold Nanoclusters

Chiral structures have been found as the lowest-energy isomers of bare (Au$_{28}$ and Au$_{55}) and thiol-passivated (Au$_{28}(SCH$_{3})$_{16}$and Au$_{38}(SCH_{3})_{24}) gold nanoclusters. The degree of chirality existing in the chiral clusters was calculated using the Hausdorff chirality measure. We found that the index of chirality is higher in the passivated clusters and decreases with the cluster size. These results are consistent with the observed chiroptical activity recently reported for glutahione-passivated gold nanoclusters, and provide theoretical support for the existence of chirality in these novel compounds.Comment: 5 pages, 1 figure. Submitted to PR

Developing theory and practice: Creation of a Community of Practice through Action Research produced excellence in stroke care

The study was funded by a grant from the Special Trustees of the Trust. Copyright @ 2010 Informa UK, Ltd.This article has been made available through the Brunel Open Access Publishing Fund.This article has been made available through the Brunel Open Access Publishing Fund.Much emphasis is placed on expert knowledge like evidence-based stroke guidelines, with insufficient attention paid to processes required to translate this into delivery of everyday good care. This paper highlights the worth of creating a Community of Practice (CoP) as a means to achieve this. Drawing on findings from a study conducted in 2000/2002 of processes involved in establishing a nationally lauded high quality Stroke Unit, it demonstrates how successful development of a new service was linked to creation of a CoP. Recent literature suggests CoPs have a key in implementing evidence-based practice; this study supports this claim whilst revealing for the first time the practical knowledge and skills required to develop this style of working. Findings indicate that participatory and democratic characteristics of Action Research are congruent with the collaborative approach required for developing a CoP. The study is an exemplar of how practitioner researchers can capture learning from changing practice, thus contributing to evidence-based healthcare with theoretical and practical knowledge. Findings are relevant to those developing stroke services globally but also to those interested in evidencebased practice.This article is available through the Brunel Open Access Publishing Fund

Beyond belief: Strategic taboos and organizational identity in strategic agenda setting

A comprehensive strategic agenda matters for fundamental strategic change. Our study seeks to explore and theorize how organizational identity beliefs influence the judgment of strategic actors when setting an organization’s strategic agenda. We offer the notion of “strategic taboo” as those strategic options initially disqualified and deemed inconsistent with the organizational identity beliefs of strategic actors. Our study is concerned with how strategic actors confront strategic taboos in the process of setting an organization’s strategic agenda. Based on a revelatory inductive case study, we find that strategic actors engage in assessing the concordance of the strategic taboos with organizational identity beliefs and, more specifically, that they focus on key identity elements (philosophy; priorities; practices) when doing so. We develop a typology of three reinterpretation practices that are each concerned with a key identity element. While contextualizing assesses the potential concordance of a strategic taboo with an organization’s overall philosophy and purpose, instrumentalizing assesses such concordance with respect to what actors deem an organization’s priorities to be. Finally, normalizing explores concordance with respect to compatibility and fit with the organization’s practices. We suggest that assessing concordance of a strategic taboo with identity elements consists in reinterpreting collective identity beliefs in ways that make them consistent with what organizational actors deem the right course of action. This article discusses the implications for theory and research on strategic agenda setting, strategic change, a practice-based perspective on strategy, and on organizational identity. © The Author(s) 2014

Ab initio calculations for bromine adlayers on the Ag(100) and Au(100) surfaces: the c(2x2) structure

Ab initio total-energy density-functional methods with supercell models have been employed to calculate the c(2x2) structure of the Br-adsorbed Ag(100) and Au(100) surfaces. The atomic geometries of the surfaces and the preferred bonding sites of the bromine have been determined. The bonding character of bromine with the substrates has also been studied by analyzing the electronic density of states and the charge transfer. The calculations show that while the four-fold hollow-site configuration is more stable than the two-fold bridge-site topology on the Ag(100) surface, bromine prefers the bridge site on the Au(100) surface. The one-fold on-top configuration is the least stable configuration on both surfaces. It is also observed that the second layer of the Ag substrate undergoes a small buckling as a consequence of the adsorption of Br. Our results provide a theoretical explanation for the experimental observations that the adsorption of bromine on the Ag(100) and Au(100) surfaces results in different bonding configurations.Comment: 10 pages, 4 figure, 5 tables, Phys. Rev. B, in pres

Negative incentive steering in a policy network

In this article the process of developing a policy for the recent comprehensive retrenchment operation in the Dutch university system is analysed from a theoretical point of view on decisionmaking. The article especially addresses the question whether some empirical evidence can be found for the rationalist view of collective decision-making, which states that a process of social communication should eventually lead to a unanimous and rational consensus concerning the selection of the optimal policy.\ud \ud The actual analysis concerns the way a retrenchment policy has been developed in a process of social communication between the most important actors: the Minister of Education and Science and the thirteen Dutch universities. It is assumed that the various communicative linkages between these actors can be interpreted as a policy network in which both governmental and non-governmental actors operate.\ud \ud The article concludes that in the Dutch university policy-network a complicated balance of interdependencies exists and that several sub-networks can be distinguished. It is also concluded that the Minister, while recognizing the interdependencies in the network, was able to use a special kind of (negative) incentive, inducing the universities to act as he wished.\ud \ud This negative incentive steering, however, also persuaded the universities to go to the utmost in their consultation efforts, thus trying to reach the rationalist ideal of collective decision-making. The final conclusion therefore is that the rationalist view of collective decision-making does not appear to be unrealistic. The article ends with a warning against a common mistake made regarding the normative appearance of the rationalist perspective

Catholic Healthcare Organizations and the Articulation of Their Identity

Contains fulltext : 69947.pdf (publisher's version ) (Open Access

The influence of using digital diagnostic information on orthodontic treatment planning - a pilot study

The purpose of this pilot study was to assess whether orthodontic treatment planning is reproducible when carried out using digital records compared with clinical examinations or using standard records. The study also assessed patients' opinion of face-to-face consultations and potential use of teleorthodontics. The study was designed as a prospective observational cross-sectional pilot study and carried out in a UK dental teaching hospital involving 27 subjects. Four consultant Orthodontists carried out treatment planning, firstly following a clinical examination, then using standard records, and then using digital records. Each subject completed a questionnaire. Cohen's kappa coefficient and Fleiss' kappa coefficient were used to assess intra-observer reproducibility and inter-observer reproducibility of treatment planning decisions, respectively. A change in the diagnostic information format affected treatment planning reproducibility for half of the observers. Inter-observer reproducibility was greater when using hard copy records in comparison to digital records. No subjects were unsatisfied with their face-to-face consultation

Cost of managing an episode of relapse in multiple sclerosis in the United States

BACKGROUND: The purpose of this study was to determine the direct medical US cost of managing multiple sclerosis relapses. METHODS: Direct data analysis and cost modeling were employed to derive typical resource use profiles and costs in 2002 US dollars, from the perspective of a third-party payer responsible for comprehensive health-care. The location and scope of health care services provided over a 90-day period were used to define three levels of relapse management. Hospitalization and resulting subsequent care was defined as high intensity management. A medium level of intervention was defined as either use of the emergency room, an observational unit, or administration of acute treatments, such as intravenous methylprednisolone in an outpatient or home setting. The lowest intensity of care comprised physician office visits and symptom-related medications. Data were obtained from many sources including all payer inpatient, ambulatory and emergency room databases from several states, fee schedules, government reports, and literature. All charges were adjusted using cost-to-charge ratios. RESULTS: Average cost per person for high management level was $12,870, based on analysis of 4,634 hospital cases (mean age 48 years, 73$1,847 and mild episode $243. CONCLUSIONS: Management strategies leading to a reduction in the frequency and severity of a relapse, less reliance on inpatient care, or increased access to steroid infusions in the home, would have a substantial impact on the economic consequences of managing relapses

Fabrication of Massive Sheets of Single Layer Patterned Arrays Using Lipid Directed Reengineered Phi29 Motor Dodecamer

The bottom-up assembly of patterned arrays is an exciting and important area in current nanotechnology. Arrays can be engineered to serve as components in chips for a virtually inexhaustible list of applications ranging from disease diagnosis to ultra-high-density data storage. Phi29 motor dodecamer has been reported to form elegant multilayer tetragonal arrays. However, multilayer protein arrays are of limited use for nanotechnological applications which demand nanoreplica or coating technologies. The ability to produce a single layer array of biological structures with high replication fidelity represents a significant advance in the area of nanomimetics. In this paper, we report on the assembly of single layer sheets of reengineered phi29 motor dodecamer. A thin lipid monolayer was used to direct the assembly of massive sheets of single layer patterned arrays of the reengineered motor dodecamer. Uniform, clean and highly ordered arrays were constructed as shown by both transmission electron microscopy and atomic force microscopy imaging