Variation in the growth and incidence of medical malpractice claims

This study analyzes the incidence of medical malpractice claims since 1976, using data drawn from the 1982 core survey of the American Medical Association's Socioeconomic Monitoring System. The data show that, on average, physicians incurred twice as many claims per year in the years 1976 to 1981 as they did during their careers prior to that period. Using Tobit analysis, we find the annual frequency of claims to be greater among surgeons, obstetricians and gynecologists (OBGs), physicians in group practice, and physicians in states which apply the legal doctrine of informed consent. In addition, we find that the number of years since medical residency is positively related to physicians' claims incidence during the first 27 years of practice, and that OBGs and medical specialists who spend more time with their patients per office visit incur fewer claims.     

Neck injuries: I. Occipitoatlantal dislocation--a pathologic study of twelve traffic fatalities.

Twelve of 155 persons killed in traffic crashes had occipitoatlantal dislocations. Nine were vehicular occupants, 2 were cyclists, and one was a pedestrian. The dislocations involved various combinations of lacerations of the alar ligaments, the occipitoatlantal joint capsules, the dura mater, the tectorial membrane, the rectus capitis muscles, and the suboccipital muscles. In 2 instances, an occipital condyle failed instead of the corresponding alar ligament, producing condyle fractures. Atlas ring fractures occurred in 3 instances. Axial and subaxial cervical trauma were uncommon. Facial or mandibular fractures occurred in a majority of cases, vault skull fractures were uncommon, and basilar fractures were absent. Pontomedullary brainstem lacerations occurred in 9 of the 12, and 4 had midbrain lacerations. The majority of the victims succumbed to acute neurogenic shock as the sole or the major mechanism of death. The biomechanical basis for occipitoatlantal dislocation is discussed, and the author suggests that distraction, in concert with variable combinations of extension, rotation, and posterior translation is responsible for occipitoatlantal dislocations.     

Dysphoria and Hopelessness Following Battering: The Role of Perceived Control, Coping, and Self-Esteem

Coping, perceived control, dysphoria, hopelessness, and self-esteem in a sample of 100 battered women were assessed. Participants reported dysphoria and low self-esteem, but not hopelessness. High perceived control over current abuse and greater use of drugs, behavioral disengagement, denial, and self-blame as coping mechanisms were associated with increased dysphoria and low self-esteem. High expectations for control over future abuse were associated with decreased dysphoria and hopelessness and increased self-esteem. After controlling for the effects of abuse severity and low self-esteem, self-blame was a unique contributor to dysphoria and high expectations for control of future abuse were unique contributors to hopelessness. Results are discussed in terms of their implications for clinical intervention with battered women.     

Portrait of the North American runaway: A critical review

Runaway behavior has been viewed as a psychopathological problem by many. However, a review of the available research literature questions this perspective. An examination of the reported psychological profile of runaways suggests no clear relationship between personality and runaway behavior. Further, a multiplicity of factors can be noted which are potential causal agents for running away. These factors range from sociocultural values to school problems. Runaway research is shown to be methodologically limited by several factors, but the data are suggestive. Also, the authors conclude that future research on this growing social problem might utilize an “alternative values” or “deindivuation model” in generating testable hypotheses about runaway behavior.     

On the applicability of secondary dentin formation to radiological age estimation in young adults

The literature provides linear regression formulas for dental age estimation that is based on radiological two-dimensional measurements of the pulp size. The aim of the present study was to explore whether the previously presented regression formulas could lead to statistically sound results and to appropriate repeatability when applied to young individuals. Orthopantomograms (OPGs) of 44 Austrian individuals, aged between 13 and 24 years, were selected at random. In accordance with the reported method, six teeth on each OPG were chosen to carry out the measurements. Statistical analysis was performed in order to assess the difference between the estimated and the true chronological age. The regression formulas reported by Kvaal et al. (1995) led to a consistent underestimation; the regression formulas reported by Paewinsky et al. (2005) resulted in a constant overestimation of age. The statistical analysis of intraobserver and interobserver variation revealed a variation width below 2%, respectively.     

The use of geographic information systems as a forensic tool to investigate sources of marine mammal entanglement in fisheries

Commercial fisheries represent a significant anthropogenic threat to marine mammal survival. Causes of marine mammal mortality are commonly determined by detailed necropsies of stranded carcasses. Gross evidence of entanglement in a fishery might include gear attached to the body, internal indications of asphyxiation and trauma, or gear markings on the epidermis. As gear is often fishery-specific, wound patterns on the epidermis that are created by entanglements in fishing gear may serve to identify possible sources of mortality. For this study, tools within the Environmental Systems Research Institute, Inc. (ESRI) ArcMap GIS software were used to create maps that outline impressions that fishing gear can leave on the epidermis of entangled marine mammals. These maps can subsequently be used to identify possible sources of fishery entanglement for the many marine mammals that wash ashore without gear attached to their carcass. Entanglement wound patterns can be visually compared with fishing gear characteristics; however, differences in scale and image quality can introduce subjectivity that might hinder source identification. The technique described herein provides an objective way to outline the unique characteristics of fishing gear and their associated wounds on entangled marine mammals. Additionally, spatial relationships are preserved as the maps are adjusted to varying scales. Whereas the initial protocol required time-consuming digitization of the outline and visual determination of the pattern interface, this new, semiautomated technique saves analyst effort and minimizes error.     

State employment protection statutes for victims of domestic violence: public policy's response to domestic violence as an employment matter

Evidence indicates that domestic violence has negative consequences on victims' employment; yet employers lag in recognizing this as a workplace issue. To address the problem, some states have established several policy solutions. To understand the scope of the public sector's response to domestic violence as a workplace issue, a content analysis of state-level employment protection policies for domestic violence victims (N = 369) was conducted. Results indicate three broad policy categories: (a) policies that offer work leave for victims; (b) policies that aim to reduce employment discrimination of domestic violence victims; and (c) policies that aim to increase awareness and safety in the workplace. Subcategories emerged within each of these three categories. Implementation of employment protection policies varies significantly across states. Implications for workplaces, practitioners, and policy leaders are discussed.     

Accessing donor conception information in Australia: a call for retrospective access

Donor conception practices in Australia have left thousands of donor-conceived people, their families and gamete donors bereft of information. The lack of a nationally timeline-consistent approach to information access has driven these people to seek support and information from self-help groups, online communities and even their own DNA. This article examines the historical perspective of information access and how progress is being made through lobbying and public awareness. To determine the current status of information availability, fertility clinics around Australia were surveyed. It is argued that current practices continue to fail donor-conceived people, their families and gamete donors, and that until all donor offspring are afforded the right to know their genetic family history, they will continue to suffer discrimination, and potentially risk psychological and physical trauma.     

The Relational Conception of Practical Authority

I argue for a new conception of practical authority based on an analysis of the relationship between authority and subject. Commands entail a demand for practical deference, which establishes a relationship of hierarchy, vulnerability, and responsibility that involves a variety of signals and commitments. In order for this relationship to be justified, the subject must be under a preexisting duty, the authority’s commands must take precedence over the subject’s judgment regarding fulfillment of that duty, the authority must accept the position and responsibilities of command, and the authority must be sufficiently trustworthy relative to how vulnerable the subject makes herself by deferring. This results in an instrumentalist conception of practical authority that can be favorably compared to Joseph Raz’s influential service conception. The relational conception’s main advantage is that it focuses on the authority as much as the subject, requiring that the authority accept responsibility for the relationship and be sufficiently trustworthy. This allows the relational conception to avoid problems that the service conception faces and illuminates institutional authority.