What you don't know can hurt you: why managed care organizations have a legal duty to disclose the use of financial incentives to limit medical care

This article, winner of the 2000-2001 American Health Lawyers' Student Writing Competition, examines the conflicting policy goals at the heart of managed care--particularly in the use of financial incentives for physicians who limit their use of referrals and expensive diagnostic tests. While conceding the legality of such incentives, the author contends that Managed Care Organizations (MCOs) have a legal duty to disclose their existence to beneficiaries. After analyzing the basis for imposing a duty to disclose, the author proceeds to examine such issues as the proper timing, level, and extent of disclosure.     

Fatal postpartum spontaneous liver rupture: case report and literature review

Maternal hepatic rupture is a rare complication of pregnancy that can be fatal to both mother and child. This phenomenon is most often associated with preeclampsia/eclampsia and/or HELLP syndrome, which is defined by a collection of clinical features including hemolysis (H), elevated liver enzymes (EL), and a low platelet count (LP). These disease processes are typically identified and treated during pregnancy, often in the last trimester. The described case is unusual in that the decedent had no known history of preeclampsia/eclampsia or HELLP syndrome during this pregnancy, and she died suddenly several days postpartum of liver rupture with massive intraperitoneal hemorrhage following a routine cesarean section delivery and an uneventful hospital course. Similar cases are infrequent in the literature, which is reviewed in this report.     

CHINA’S STYLE

正Chinese president's visit to the Middle East is not just an economic,butdiplomatic investmentChina's friendly diplomatic links with Middle Eastern countries are not a new phenomenon.Some would argue that they go back centuries to the era of previous imperial trade links,and the Silk Road routes that carried spices,resources and precious metals between the two regions.In modern times,however.     

Examining the Consequences of the “Prevalent Life Events” of Arrest and Incarceration among an Urban African-American Cohort

The life course perspective has traditionally examined prevalent adult life events, such as marriage and employment, and their potential to redirect offending trajectories. However, for African-Americans, the life events of arrest and incarceration are becoming equally prevalent in young adulthood. Therefore, it is critical to understand how these “standard” criminal justice practices, which are designed to deter as well as punish, affect deviance among this population. This study evaluates the long-term consequences of criminal justice intervention on substance use and offending into midlife among an African-American community cohort using propensity score matching and multivariate regression analyses. The results largely point to a criminogenic effect of criminal justice intervention on midlife deviance with a particularly strong effect of young adult arrest on rates of violent and property arrest counts into midlife. The theoretical and policy implications of the findings are discussed.     

Exploratory trial of schema-focussed therapy in a forensic personality disordered population

The management of needs and risks in personality disordered offender populations has become a focus for health and criminal justice services in the UK. Recent studies demonstrate the effectiveness of schema focussed therapy (SFT) for patients with borderline personality disorder. This study was an exploratory trial of the feasibility of implementing SFT in a population of patients with personality disorder in a high secure hospital in England. Preliminary evaluations of the effects of SFT were conducted to investigate whether those receiving SFT demonstrated significant improvements on measures of anger, impulsiveness, schemata and interpersonal style. No significant effects were evident although there was a significant increase in defectiveness/shame schema in the SFT group. Lack of effectiveness of SFT is likely due to the preliminary nature of this study. Future trials of SFT need to ensure comprehensive therapist preparation, control of TAU, bigger samples, address attrition and provide more intensive therapy.     

Using FastID to analyze complex SNP mixtures from indoor dust

Forensically relevant single nucleotide polymorphisms (SNPs) can provide valuable supplemental information to short tandem repeats (STRs) for investigative leads, and genotyping can now be streamlined using massively parallel sequencing (MPS). Dust is an attractive evidence source, as it accumulates on undisturbed surfaces, often is overlooked by perpetrators, and contains sufficient human DNA for analysis. To assess whether SNPs genotyped from indoor dust using MPS could be used to detect known household occupants, 13 households were recruited and provided buccal samples from each occupant and dust from five predefined indoor locations. Thermo Fisher Scientific Precision ID Identity and Ancestry Panels were utilized for SNP genotyping, and sequencing was completed using Illumina^® chemistry. FastID, a software developed to permit mixture analysis and identity searching, was used to assess whether known occupants could be detected from associated household dust samples. A modified “subtraction” method was also used in FastID to estimate the percentage of alleles in each dust sample contributed by known and unknown occupants. On average, 72% of autosomal SNPs were recovered from dust samples. When using FastID, (a) 93% of known occupants were detected in at least one indoor dust sample and could not be excluded as contributors to the mixture, and (b) non-contributor alleles were detected in 54% of dust samples (29 ± 11 alleles per dust sample). Overall, this study highlights the potential of analyzing human DNA present in indoor dust to detect known household occupants, which could be valuable for investigative leads.