Merit Rating for Physicians’ Malpractice Premiums: Only a Modest Deterrent

Results of a study showed that the targeting of malpractice-prone physicians from past paid-claims histories is only moderately accurate. It is possible, however, to gather more detailed information about physicians in addition to claims history and premium class that might lead to a more accurate prospective identification of those who will incur future paid claims

Arbitration Agreements In Health Care: Myths and Reality

It is asserted that alternative dispute resolution methods, particularly mandatory binding arbitration agreements, have become the rule in health care delivery. A study was conducted to ascertain how widespread mandatory arbitration agreements between health plans and providers and their enrollees and patients really are, to assess how decisions regarding their use are made and to evaluate the prospects of their future use

SOME FORENSIC ASPECTS OF BALLISTIC IMAGING

Analysis of ballistics evidence (spent cartridge casings and bullets) has been a staple of forensic criminal investigation for almost a century. Computer-assisted databases of images of ballistics evidence have been used since the mid-1980s to help search for potential matches between pieces of evidence. In this article, we draw on the 2008 National Research Council Report Ballistic Imaging to assess the state of ballistic imaging technology. In particular, we discuss the feasibility of creating a national reference ballistic imaging database (RBID) from test-fires of all newly manufactured or imported firearms. A national RBID might aid in using crime scene ballistic evidence to generate investigative leads to a crime gun’s point of sale. We conclude that a national RBID is not feasible at this time, primarily because existing imaging methodologies have insufficient discriminatory power. We also examine the emerging technology of micro- stamping for forensic identification purposes: etching a known identifier on firearm or ammunition parts so that they can be directly read and recovered from crime scene evidence. Microstamping could provide a stronger basis for identification based on ballistic evidence than the status quo, but substantial further research is needed to thoroughly assess its practical viability

The ‘Volatile’ World of Vapor Intrusion: Understanding Vapor Intrusion Regulation and the Potential for Litigation

This article provides a conceptual overview of vapor intrusion, identifies available guidance for assessment of the vapor intrusion pathway, and examines the potential for government enforcement actions, citizen suits, and tort suits involving vapor intrusion

Assessment of arterial stiffness, oxidative stress and inflammation in acute kidney injury

Background: It is well know that arterial stiffness, oxidative stress and inflammation are features of chronic kidney disease. The arterial changes have a multitude of potential interconnected causes including endothelial dysfunction, oxidative stress, inflammation, atherosclerosis and vascular calcification. There is evidence that arterial stiffness becomes progressively worse as CKD progresses. The contribution of the biochemical changes of uremic toxicity to arterial stiffness is less clear. The aim of this study is to elucidate the vascular changes in acute kidney injury. We hypothesise that arterial stiffness will be increased during acute kidney injury and this will return to normal after kidney function recovers

Indispensable Ocean: Aligning Ocean Health and Human Well-Being

The ocean is a critical part of Earth's life-support system and vital for the well-being of humanity. Once thought to be limitless, the ocean's resources are showing serious signs of deterioration and depletion on a global scale. Adverse changes are accelerating at an unprecedented rate relative to the changes seen over millions of years.This report is the result of a conversation by the Blue Ribbon Panel, a group of diverse leaders in industry, government, conservation, and academia who aim to serve as a collective voice to build sustainable solutions for the ocean

Relationships between synoptic-scale transport and interannual variability of inorganic cations in surface snow at Summit, Greenland: 1992-1996

Version of RecordTo fully utilize the long-term chemical records retrieved from central Greenland ice cores, specific relationships between atmospheric circulation and the variability of chemical species in the records need to be better understood. This research examines associations between the variability of surface snow inorganic cation chemistry at Summit, Greenland (collected during 1992-1996 summer field seasons) and changes in air mass transport pathways and source regions, as well as variations in aerosol source strength. Transport patterns and source regions are determined through 10-day isentropic backward air mass trajectories during a 1 month (late May to late June) common season over the 5 years. Changes in the extent of exposed continental surfaces in source regions are evaluated to estimate aerosol-associated calcium and magnesium ion source strength, while forest fire activity in the circumpolar north is investigated to estimate aerosol ammonium ion source strength. During the 1995 common season, 3 times more calcium and magnesium accumulated in the snowpack than the other study years. Also, an increasing trend of ammonium concentration was noted throughout the 5 years. Anomalous transport pathways and velocities were observed during 1995, which likely contributed to the high levels of calcium and magnesium. Increased forest fire activity in North America was concurrent with increased levels of ammonium and potassium, except for 1996, when ion levels were above average and forest fire activity was below average. Because of the ubiquitous nature of soluble ions, we conclude that it is very difficult to establish a quantitative link between the ion content of snow and firn at Summit and changes in aerosol source regions and source strength.Slater, J. F., Dibb, J. E., Keim, B. D., & Kahl, J. D. w. (2001). Relationships between synoptic-scale transport and interannual variability of inorganic cations in surface snow at Summit, Greenland: 1992-1996. Journal of Geophysical Research 106(D18), 20,897-20,91

Clustered mutations in the <i>GRIK2</i> kainate receptor subunit gene underlie diverse neurodevelopmental disorders

Kainate receptors (KARs) are glutamate-gated cation channels with diverse roles in the central nervous system. Bi-allelic loss of function of the KAR-encoding gene GRIK2 causes a nonsyndromic neurodevelopmental disorder (NDD) with intellectual disability and developmental delay as core features. The extent to which mono-allelic variants in GRIK2 also underlie NDDs is less understood because only a single individual has been reported previously. Here, we describe an additional eleven individuals with heterozygous de novo variants in GRIK2 causative for neurodevelopmental deficits that include intellectual disability. Five children harbored recurrent de novo variants (three encoding p.Thr660Lys and two p.Thr660Arg), and four children and one adult were homozygous for a previously reported variant (c.1969G>A [p.Ala657Thr]). Individuals with shared variants had some overlapping behavioral and neurological dysfunction, suggesting that the GRIK2 variants are likely pathogenic. Analogous mutations introduced into recombinant GluK2 KAR subunits at sites within the M3 transmembrane domain (encoding p.Ala657Thr, p.Thr660Lys, and p.Thr660Arg) and the M3-S2 linker domain (encoding p.Ile668Thr) had complex effects on functional properties and membrane localization of homomeric and heteromeric KARs. Both p.Thr660Lys and p.Thr660Arg mutant KARs exhibited markedly slowed gating kinetics, similar to p.Ala657Thr-containing receptors. Moreover, we observed emerging genotype-phenotype correlations, including the presence of severe epilepsy in individuals with the p.Thr660Lys variant and hypomyelination in individuals with either the p.Thr660Lys or p.Thr660Arg variant. Collectively, these results demonstrate that human GRIK2 variants predicted to alter channel function are causative for early childhood development disorders and further emphasize the importance of clarifying the role of KARs in early nervous system development

Heterozygous ANKRD17 loss-of-function variants cause a syndrome with intellectual disability, speech delay, and dysmorphism

ANKRD17 is an ankyrin repeat-containing protein thought to play a role in cell cycle progression, whose ortholog in Drosophila functions in the Hippo pathway as a co-factor of Yorkie. Here, we delineate a neurodevelopmental disorder caused by de novo heterozygous ANKRD17 variants. The mutational spectrum of this cohort of 34 individuals from 32 families is highly suggestive of haploinsufficiency as the underlying mechanism of disease, with 21 truncating or essential splice site variants, 9 missense variants, 1 in-frame insertion-deletion, and 1 microdeletion (1.16 Mb). Consequently, our data indicate that loss of ANKRD17 is likely the main cause of phenotypes previously associated with large multi-gene chromosomal aberrations of the 4q13.3 region. Protein modeling suggests that most of the missense variants disrupt the stability of the ankyrin repeats through alteration of core structural residues. The major phenotypic characteristic of our cohort is a variable degree of developmental delay/intellectual disability, particularly affecting speech, while additional features include growth failure, feeding difficulties, non-specific MRI abnormalities, epilepsy and/or abnormal EEG, predisposition to recurrent infections (mostly bacterial), ophthalmological abnormalities, gait/balance disturbance, and joint hypermobility. Moreover, many individuals shared similar dysmorphic facial features. Analysis of single-cell RNA-seq data from the developing human telencephalon indicated ANKRD17 expression at multiple stages of neurogenesis, adding further evidence to the assertion that damaging ANKRD17 variants cause a neurodevelopmental disorder