Annual Survey of Virginia Law: Damages for Medical Malpractice in Virginia

As a general rule, a plaintiff in actions for personal injury and wrongful death in Virginia, regardless ofwhether the cause derives from medical malpractice, may state a claim for any medical expenses incurred as a result of the alleged injury or death. By definition, an expense is incurred when it has been paid or one become[s] legally obligated to pay it. A tortfeasor is bound and obligated to make the plaintiff whole, which means the injured party or his estate must be reasonably compensated for the fair and reasonable value of incurred medical expenses

Gut microbiota in HIV-pneumonia patients is related to peripheral CD4 counts, lung microbiota, and in vitro macrophage dysfunction.

Pneumonia is common and frequently fatal in HIV-infected patients, due to rampant, systemic inflammation and failure to control microbial infection. While airway microbiota composition is related to local inflammatory response, gut microbiota has been shown to correlate with the degree of peripheral immune activation (IL6 and IP10 expression) in HIV-infected patients. We thus hypothesized that both airway and gut microbiota are perturbed in HIV-infected pneumonia patients, that the gut microbiota is related to peripheral CD4+ cell counts, and that its associated products differentially program immune cell populations necessary for controlling microbial infection in CD4-high and CD4-low patients. To assess these relationships, paired bronchoalveolar lavage and stool microbiota (bacterial and fungal) from a large cohort of Ugandan, HIV-infected patients with pneumonia were examined, and in vitro tests of the effect of gut microbiome products on macrophage effector phenotypes performed. While lower airway microbiota stratified into three compositionally distinct microbiota as previously described, these were not related to peripheral CD4 cell count. In contrast, variation in gut microbiota composition significantly related to CD4 cell count, lung microbiota composition, and patient mortality. Compared with patients with high CD4+ cell counts, those with low counts possessed more compositionally similar airway and gut microbiota, evidence of microbial translocation, and their associated gut microbiome products reduced macrophage activation and IL-10 expression and increased IL-1β expression in vitro. These findings suggest that the gut microbiome is related to CD4 status and plays a key role in modulating macrophage function, critical to microbial control in HIV-infected patients with pneumonia

Cost Impact of The Transitional Care Model for Hospitalized Cognitively Impaired Older Adults

Using advanced practice nurses to support high risk patients and their families to transition from hospital to home can reduce postacute care use and costs. A study comparing three evidence-based care management interventions for a population of hospitalized older adults with cognitive impairment found that the Transitional Care Model, which relies on advanced practice nurses to deliver services from hospital to home, was associated with lower postacute care costs when compared to two “hospital only” interventions

Criminal Justice in the 21st Century: Allegheny County Jail

Criminal Justice in the 21st Century: Allegheny County Jail looks into the history, purposes, and structure of the Allegheny County Jail. This report outlines national and local data trends within jails and discusses the historic and current purposes of jails. It also highlights innovative programs and challenges within the county’s jail and potential best practices to address them

Criminal Justice in the 21st Century: Allegheny County Courts and Probation

Criminal Justice in the 21st Century: Allegheny County Courts and Probation examines the structure, responsibilities, successes, and opportunities within Allegheny County's courts and probation department. The report highlights initiatives and innovations implemented by the Fifth Judicial District’s Criminal Division and key local data indicators. It also identifies current challenges within the county’s court and probation system and potential national best practices to address these challenges

Criminal Justice in the 21st Century: Allegheny County Law Enforcement

Criminal Justice in the 21st Century: Allegheny County Law Enforcement examines the role of the police both nationally and in Allegheny County. The report identifies local law enforcement agencies and their role within the county criminal justice system. This report also highlights key local data trends and discusses the impact of law enforcement on the criminal justice system. It also highlights national best practices in policing

Criminal Justice in the 21st Century: Allegheny County Pretrial Decisions

Criminal Justice in the 21st Century: Allegheny County Pretrial Decisions examines the pretrial procedures and decisions made within the county criminal justice system. The report examines how pretrial decisions are made and national standards for pretrial services. The report highlights innovative practices occurring within the county and key local data. It also outlines national best practices in pretrial decisions

Criminal Justice in the 21st Century: Allegheny County Prosecution and Defense

Criminal Justice in the 21st Century: Allegheny County Prosecution and Defense examines the roles of prosecution and defense nationally and within the county including the offices of the district attorney and public defender. The report looks at key local data and opportunities within criminal court procedures to reduce the county jail population and the number of people under correctional control. The report highlights innovation national best practices in the area of prosecution and defense

Association of citrulline concentration at birth with lower respiratory tract infection in infancy: Findings from a multi-site birth cohort study

Assessing the association of the newborn metabolic state with severity of subsequent respiratory tract infection may provide important insights on infection pathogenesis. In this multi-site birth cohort study, we identified newborn metabolites associated with lower respiratory tract infection (LRTI) in the first year of life in a discovery cohort and assessed for replication in two independent cohorts. Increased citrulline concentration was associated with decreased odds of LRTI (discovery cohort: aOR 0.83 [95% CI 0.70-0.99], p = 0.04; replication cohorts: aOR 0.58 [95% CI 0.28-1.22], p = 0.15). While our findings require further replication and investigation of mechanisms of action, they identify a novel target for LRTI prevention and treatment

Distinct lung microbiota associate with HIV-associated chronic lung disease in children.

Chronic lung disease (CLD) is a common co-morbidity for HIV-positive children and adolescents on antiretroviral therapy (ART) in sub-Saharan Africa. In this population, distinct airway microbiota may differentially confer risk of CLD. In a cross-sectional study of 202 HIV-infected children aged 6-16 years in Harare, Zimbabwe, we determined the association of sputum microbiota composition (using 16S ribosomal RNA V4 gene region sequencing) with CLD defined using clinical, spirometric, or radiographic criteria. Forty-two percent of children were determined to have CLD according to our definition. Dirichlet multinomial mixtures identified four compositionally distinct sputum microbiota structures. Patients whose sputum microbiota was dominated by Haemophilus, Moraxella or Neisseria (HMN) were at 1.5 times higher risk of CLD than those with Streptococcus or Prevotella (SP)-dominated microbiota (RR = 1.48, p = 0.035). Cell-free products of HMN sputum microbiota induced features of epithelial disruption and inflammatory gene expression in vitro, indicating enhanced pathogenic potential of these CLD-associated microbiota. Thus, HIV-positive children harbor distinct sputum microbiota, with those dominated by Haemophilus, Moraxella or Neisseria associated with enhanced pathogenesis in vitro and clinical CLD