The Clinton-Obama Approach to Medical Malpractice Reform: Reviving the Most Meaningful Features of Alternative Dispute Resolution

An introduction to medical malpractice reform would be incomplete without mentioning the Institute of Medicine\u27s (IOM) 1999 report, To Err is Human: Building a Safer Health System, which lists medical errors as the eighth leading cause of death in the United States. While much attention premiums, the media\u27s recent interest in the application of alternative dispute resolution (ADR) tactics in medical malpractice cases has increased. The quest for a one-size-fits-all fix to rising health care costs has turned to ADR for guidance in the past, with hopes that binding arbitration and voluntary mediation would resolve the crisis. Recently, the search has unearthed a new and somewhat counterintuitive champion: the early settlement of potential malpractice claims through the combination of medical error disclosure and apology. The IOM\u27s report recommends a strategy for improvement based on health care organizations\u27 ability to learn from errors by developing a nationwide... reporting system and encouraging healthcare providers to develop and participate in voluntary reporting systems. Introduced six years after the publication of IOM\u27s recommendations, Senate Bill 1784, The National Medical Error and Compensation (MEDiC) Act of 2005 stood the best chance of realizing the report\u27s normative advice. The MEDiC Act, introduced by Senators Hillary Rodham Clinton and Barack Obama, is modeled after several successful state programs that have effectively reduced the occurrence of medical errors while simultaneously reducing legal costs. The bill contains incentives for physicians to disclose medical errors to patients and participate in a national medical error reporting system. The remainder of this article will analyze the recurring problems inherent in the medical malpractice environment, explore a portion of ADR\u27s impact on the reformation of this environment, and offer the MEDiC Act as ADR\u27s contemporary solution for a more equitable and sustainable medical malpractice environment

Social Construction of Appropriate Use of Enterprise Social Media

Increasingly companies and governments are turning to enterprise versions of social software to accomplish organizational goals. Unlike public social media, access to Enterprise Social Media (ESM) is normally restricted to the organization or key strategic partners. We know from research on Information Technology (IT) value, that not only is system use necessary to achieve value, but also that this use must be appropriate. System use and specifically appropriate use has received very little attention in the literature. The nature of ESM tools and the absence of specific and detailed use guidelines creates an environment where employees are encouraged to explore means to achieve value. Thus, employees invoke a dynamic and interactive process to socially construct appropriate use. This paper draws on previous research on IT value, and legitimacy to propose a conceptual model to guide future research on how appropriate use of enterprise social media is socially constructed

Linking first occurrence polynomials over F_p by Steenrod operations

This paper provides analogues of the results of [G.Walker and R.M.W. Wood, Linking first occurrence polynomials over F_2 by Steenrod operations, J. Algebra 246 (2001), 739--760] for odd primes p. It is proved that for certain irreducible representations L(lambda) of the full matrix semigroup M_n(F_p), the first occurrence of L(lambda) as a composition factor in the polynomial algebra P=F_p[x_1,...,x_n] is linked by a Steenrod operation to the first occurrence of L(lambda) as a submodule in P. This operation is given explicitly as the image of an admissible monomial in the Steenrod algebra A_p under the canonical anti-automorphism chi . The first occurrences of both kinds are also linked to higher degree occurrences of L(lambda) by elements of the Milnor basis of A_p.Comment: Published by Algebraic and Geometric Topology at http://www.maths.warwick.ac.uk/agt/AGTVol2/agt-2-27.abs.htm

The Principles and Biomechanics of the Rigo Chêneau Type Brace

All scoliosis braces bearing the name “Chêneau” as part or all of their designation share a common history, originating in 1979 with the Chêneau Toulouse Munster (CTM) brace, developed by Dr. Jacques Chêneau and Professor Matthias of Munster. Since then, several variations of this brace have evolved to enhance support/correction of scoliosis in three dimensions. Design features based on the Rigo classification of scoliosis and further modifications by the co-author led to the Rigo Chêneau type brace. This is a dynamic brace, with expansion rooms to accommodate tissue migration, growth and breathing movements. The brace by the authors is hand-made and customized to the curve pattern, skeletal maturity, flexibility and structural component of each individual. It applies both de-torsional forces and three-point pressure systems to improve spinal alignment in all three planes. It is also designed to work synergistically with Schroth physiotherapeutic scoliosis specific exercises to optimize effectiveness of a conservative approach

The Chelsea Critical Care Physical Assessment Tool (CPAx): validation of an innovative new tool to measure physical morbidity in the general adult critical care population; an observational proof-of-concept pilot study.

Objective To develop a scoring system to measure physical morbidity in critical care – the Chelsea Critical Care Physical Assessment Tool (CPAx). Method The development process was iterative involving content validity indices (CVI), a focus group and an observational study of 33 patients to test construct validity against the Medical Research Council score for muscle strength, peak cough flow, Australian Therapy Outcome Measures score, Glasgow Coma Scale score, Bloomsbury sedation score, Sequential Organ Failure Assessment score, Short Form 36 (SF-36) score, days of mechanical ventilation and inter-rater reliability. Participants Trauma and general critical care patients from two London teaching hospitals. Results Users of the CPAx felt that it possessed content validity, giving a final CVI of 1.00 (P < 0.05). Construct validation data showed moderate to strong significant correlations between the CPAx score and all secondary measures, apart from the mental component of the SF-36 which demonstrated weak correlation with the CPAx score (r = 0.024, P = 0.720). Reliability testing showed internal consistency of α = 0.798 and inter-rater reliability of κ = 0.988 (95% confidence interval 0.791 to 1.000) between five raters. Conclusion This pilot work supports proof of concept of the CPAx as a measure of physical morbidity in the critical care population, and is a cogent argument for further investigation of the scoring system

The Right Approach to Right of Way Engineering

Many steps are necessary to prepare the proper documents for right of way engineering. In this session we will discuss the steps and procedures required to be in compliance with INDOT statutes, including LRS electronic submittals

Learning Deep Similarity Metric for 3D MR-TRUS Registration

Purpose: The fusion of transrectal ultrasound (TRUS) and magnetic resonance (MR) images for guiding targeted prostate biopsy has significantly improved the biopsy yield of aggressive cancers. A key component of MR-TRUS fusion is image registration. However, it is very challenging to obtain a robust automatic MR-TRUS registration due to the large appearance difference between the two imaging modalities. The work presented in this paper aims to tackle this problem by addressing two challenges: (i) the definition of a suitable similarity metric and (ii) the determination of a suitable optimization strategy. Methods: This work proposes the use of a deep convolutional neural network to learn a similarity metric for MR-TRUS registration. We also use a composite optimization strategy that explores the solution space in order to search for a suitable initialization for the second-order optimization of the learned metric. Further, a multi-pass approach is used in order to smooth the metric for optimization. Results: The learned similarity metric outperforms the classical mutual information and also the state-of-the-art MIND feature based methods. The results indicate that the overall registration framework has a large capture range. The proposed deep similarity metric based approach obtained a mean TRE of 3.86mm (with an initial TRE of 16mm) for this challenging problem. Conclusion: A similarity metric that is learned using a deep neural network can be used to assess the quality of any given image registration and can be used in conjunction with the aforementioned optimization framework to perform automatic registration that is robust to poor initialization.Comment: To appear on IJCAR