bluuebunny/crossref_metadata_2025 huggingface dataset:
Ensemble-based optimization of hydraulically fractured horizontal well placement in shale gas reservoir through Hough transform parameterization
Authors: Xue Liang , Gu Shao-Hua , Jiang Xie-Er , Liu Yue-Tian , Yang Chen
Published: February 2021

Shale gas reservoirs have been successfully developed due to the advancement of the horizontal well drilling and multistage hydraulic fracturing techniques. However, the optimization design of the horizontal well drilling, hydraulic fracturing, and operational schedule is a challenging problem. An ensemble-based optimization method (EnOpt) is proposed here to optimize the design of the hydraulically fractured horizontal well in the shale gas reservoir. The objective is to maximize the net present value (NPV) which requires a simulation model to predict the cumulative shale gas production. To accurately describe the geometry of the hydraulic fractures, the embedded discrete fracture modeling method (EDFM) is used to construct the shale gas simulation model. The effects of gas absorption, Knudsen diffusion, natural and hydraulic fractures, and gas–water two phase flow are considered in the shale gas production system. To improve the parameter continuity and Gaussianity required by the EnOpt method, the Hough transformation parameterization is used to characterize the horizontal well. The results show that the proposed method can effectively optimize the design parameters of the hydraulically fractured horizontal well, and the NPV can be improved greatly after optimization so that the design parameters can approach to their optimal values.
Estimation of Soil Carbon Stocks of Urban Freshwater Wetlands in the Colombo Ramsar Wetland City and their Potential Role in Climate Change Mitigation
Authors: Dayathilake D.D.T.L. , Lokupitiya E. , Wijeratne V.P.I.S.
Published: February 2021

Wetlands hold significant potential for climate change mitigation due to their high capacity to sequester atmospheric carbon dioxide (CO2). Colombo, Sri Lanka was recently declared as one of the eighteen global Ramsar wetland cities. The current study represents the first attempt to quantify soil organic carbon (SOC) stocks held by the urban freshwater wetlands in Colombo. The study focused on the extensive urban wetland ecosystems of Kolonnawa wetland and Thalawathugoda wetland park. SOC stocks were determined using three parameters: depth of soil, bulk density, and SOC concentration. Loss on ignition method was used in quantifying SOC concentrations. Average SOC stocks, up to a depth of 60 cm at Kolonnawa wetland and Thalawathugoda wetland park were estimated at 504 ± 14 t C/ha and 550 ± 23 t C/ha, respectively. Furthermore, the total SOC stock at Kolonnawa wetland and Thalawathugoda wetland park were estimated at 198,408 ± 5564 t CO2eq and 66,313 ± 2764 t CO2eq, respectively. When considering global estimates, it was found that freshwater wetlands in Colombo hold a higher SOC stock than tropical wet forests and tropical dry forests. The current study highlights the importance of urban ecosystems in mitigating the ever increasing concentrations of atmospheric CO2 .
Computation of Optimal Spacing and Density of Bus Rapid Transit Stations Using Evolutionary Algorithms
Authors: Umair Muhammad , ur Rehman Sabih , Sohail Aimal , Khattak Afaq
Published: February 2021

In this research, a feasible mechanism is developed to determine the optimum number of bus rapid transit (BRT) stations as well as their respective locations along the service corridor. To accomplish this, a mathematical model is developed and optimized by using three different evolutionary algorithms, namely particle swarm optimization (PSO), genetic algorithm (GA), and differential evolution (DE), and the results are compared. The total cost function is composed of two main costs namely the operator’s cost, i.e., related to costs on service provider’s end, and the user’s cost, i.e., related to costs on commuters’ end. A functional numerical example with the commuters’ demand is worked out by minimizing the cost function, which demonstrates the applicability of the framework. In our case study, PSO outclassed GA and DE on the basis of convergence rate. Since our work has proved the robustness of PSO as compared to GA and DE, we conducted our sensitivity analysis keeping PSO as our benchmark algorithm to study the influence of various parameters on the optimal cost. The computational experiments reveal that the optimal cost is substantially affected by the variations in the commuters’ demand, commuters’ walking speed, and value of the users’ access and in-vehicle time. On the contrary, the acceleration/deceleration delays at a bus station, bus operating cost, and headway have an inconsiderable impact on the optimal cost.
From the “top-down” and the “bottom-up”: Centering Foucault’s notion of biopower and individual accountability within systemic racism
Authors: Zaidi Zareen , Bush Antonio A. , Partman Ian M. , Wyatt Tasha R.
Published: February 2021

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Autism Spectrum Disorder and Social Story Research: a Scoping Study of Published, Peer-Reviewed Literature Reviews
Authors: Camilleri Louis John , Maras Katie , Brosnan Mark
Published: February 2021

Social Stories (SS) is a widely used intervention for children on the autism spectrum. A search of databases (CINAH EBSCO, A+Eductaion, ERIC, Education Source, PsyINFO, PubMed, Science Direct, Scopus, Web of Science, and ABI Inform Global) identified that, since its development over 25 years ago, the research exploring SS has been reviewed 17 times. These reviews include synthesis of literature; systematic reviews, meta-analyses; comparative reviews; and descriptive reviews. A scoping review of these 17 literature reviews identified 5 major themes: (1) research design of SS studies, (2) effectiveness of SS, (3) factors influencing outcomes of SSs, (4) social validity of SS interventions, and (5) maintenance and generalisation of SS outcomes. Future recommendations related to SS research were also identified.
Investigation of Chemomechanical Effects on Sapphire Surfaces Modified by Ion-Implantation-Induced Carbon Impurities
Authors: Yadav Arti , Moharrami Noushin , Bull Steve
Published: February 2021

Modification of the chemomechanical behaviour of the surface of sapphire by ion implantation to improve its near-surface mechanical properties has been investigated. 300 keV Ti+ ions at various doses were implanted and the concentration and damage profiles characterised using Rutherford Backscattering (RBS). At high doses (≥ 3 × 1016 Ti+ cm−2), a surface amorphous layer is formed due to implantation-induced damage. Nanoindentation was used to determine the hardness behaviour of the ion-implanted layer. Hardness increases at low implantation doses, associated with implantation-induced damage, but it is also observed that chemomechanical softening of the surface is reduced due to the removal of adsorbed water. In situ Raman scattering measurements demonstrate this removal at low doses and the re-establishment of the adsorbed water layer at high doses. The adsorption process is changed due to the introduction of carbon into the sapphire surface during implantation. For the optimum-implanted dose, the water readsorption does not recur even several years after the implantation treatment was first carried out. The loss of water adsorption is related to the formation of a non-polar carbonaceous layer on the sapphire surface by cracking of back-streamed diffusion pump oil deposited on the sample surface by inelastic collisions with the ion beam. Based on this study, it is concluded that ion implantation with an appropriate ion species and dose can control the chemomechanical effect and improve the hardness of ceramics, such as sapphire.
Swarm-based counter UAV defense system
Authors: Brust Matthias R. , Danoy Grégoire , Stolfi Daniel H. , Bouvry Pascal
Published: February 2021

Unmanned Aerial Vehicles (UAVs) have quickly become one of the promising Internet-of-Things (IoT) devices for smart cities. Thanks to their mobility, agility, and onboard sensors’ customizability, UAVs have already demonstrated immense potential for numerous commercial applications. The UAVs expansion will come at the price of a dense, high-speed and dynamic traffic prone to UAVs going rogue or deployed with malicious intent. Counter UAV systems (C-UAS) are thus required to ensure their operations are safe. Existing C-UAS, which for the majority come from the military domain, lack scalability or induce collateral damages. This paper proposes a C-UAS able to intercept and escort intruders. It relies on an autonomous defense UAV swarm, capable of self-organizing their defense formation and to intercept the malicious UAV. This fully localized and GPS-free approach follows a modular design regarding the defense phases and it uses a newly developed balanced clustering to realize the intercept- and capture-formation. The resulting networked defense UAV swarm is resilient to communication losses. Finally, a prototype UAV simulator has been implemented. Through extensive simulations, we demonstrate the feasibility and performance of our approach.
Global Landscape of Native Protein Complexes in Synechocystis sp. PCC 6803
Authors: Xu Chen , Wang Bing , Yang Lin , Zhongming Hu Lucas , Yi Lanxing , Wang Yaxuan , Chen Shenglan , Emili Andrew , Wan Cuihong
Published: February 2021

Synechocystis sp. PCC 6803 (hereafter: Synechocystis) is a model organism for studying photosynthesis, energy metabolism, and environmental stress. Although known as the first fully sequenced phototrophic organism, Synechocystis still has almost half of its proteome without functional annotations. In this study, by using co-fractionation coupled with liquid chromatography-tandem mass spectrometry (LC-MS/MS), we define 291 multi-protein complexes, encompassing 24,092 protein–protein interactions (PPIs) among 2062 distinct gene products. This information not only reveals the roles of photosynthesis in metabolism, cell motility, DNA repair, cell division, and other physiological processes, but also shows how protein functions vary from bacteria to higher plants due to changes in interaction partners. It also allows us to uncover the functions of hypothetical proteins, such as Sll0445, Sll0446, and Sll0447 involved in photosynthesis and cell motility, and Sll1334 involved in regulation of fatty acid biogenesis. Here we present the most extensive PPI data for Synechocystis so far, which provide critical insights into fundamental molecular mechanisms in cyanobacteria.
From Thin to Thick Representation: How a Female President Shapes Female Parliamentary Behavior
Authors: WAHMAN MICHAEL , FRANTZESKAKIS NIKOLAOS , YILDIRIM TEVFIK MURAT
Published: February 2021

How does the symbolic power of a female president affect female parliamentary behavior? Whereas female descriptive representation has increased around the world, women parliamentarians still face significant discrimination and stereotyping, inhibiting their ability to have a real voice and offer “thick” representation to women voters. We leverage the case of Malawi, a case where the presidency changed hands from a man to a woman through a truly exogenous shock, to study the effect of a female president on female parliamentary behavior. Drawing on unique parliamentary transcripts data, we argue and show that women MPs under a female president become empowered and less confined to stereotypical gendered issue-ownership patterns, leading to a significant increase in female MP speech making. Our results directly address theories of symbolic representation by focusing particularly on intraelite role-model effects.
Immigration, médias et sécuritisation au Canada : une étude deLa Presseet duNational Post, 1998–2015
Authors: Vigneau Elsa
Published: February 2021

Cet article propose une documentation empirique du processus social de construction de l'immigration comme un problème de sécurité pour l’État canadien et sa population, et ce, au travers d'une analyse de contenu thématique d'articles de journaux publiés parLa Presseet leNational Postentre 1998 et 2015. Il quantifie et compare la place occupée par quatre discours-types au sein du discours médiatique canadien sur l'immigration. Ultimement, il révèle un discours de sécurité publique élevé fluctuant de façon importante sur la période et réfute l'hypothèse d'une intensification linéaire de la sécuritisation.
Range-wide decline of Chinese giant salamanders Andrias spp. from suitable habitat
Authors: Tapley Benjamin , Turvey Samuel T. , Chen Shu , Wei Gang , Xie Feng , Yang Jian , Liang Zhiqiang , Tian Haifeng , Wu Minyao , Okada Sumio , Wang Jie , Lü Jingcai , Zhou Feng , Xu Jingcheng , Zhao Haipeng , Redbond Jay , Brown Thomas , Cunningham Andrew A.
Published: February 2021

Over recent decades, Chinese giant salamanders Andrias spp. have declined dramatically across much of their range. Overexploitation and habitat degradation have been widely cited as the cause of these declines. To investigate the relative contribution of each of these factors in driving the declines, we carried out standardized ecological and questionnaire surveys at 98 sites across the range of giant salamanders in China. We did not find any statistically significant differences between water parameters (temperature, dissolved oxygen, ammonia, nitrite, nitrate, salinity, alkalinity, hardness and flow rate) recorded at sites where giant salamanders were detected by survey teams and/or had been recently seen by local respondents, and sites where they were not detected and/or from which they had recently been extirpated. Additionally, we found direct and indirect evidence that the extraction of giant salamanders from the wild is ongoing, including within protected areas. Our results support the hypothesis that the decline of giant salamanders across China has been primarily driven by overexploitation. Data on water parameters may be informative for the establishment of conservation breeding programmes, an initiative recommended for the conservation of these species.
Medical Paternalism or Legal Imperialism: Not the Only Alternatives for HandlingSaikewicz-type Cases
Authors: Buchanan Allen
Published: February 2021

In 1977, the Supreme Judicial Court of Massachusetts held in theSaikewiczcase that the probate court is the proper tribunal for making decisions whether to give or to withhold “life-prolonging treatment” for terminally ill incompetent patients. This ruling provoked debate in the medical and legal communities. Dr. Arnold Relman, Editor ofThe New England Journal of Medicine,argues thatSaikewiczencroaches on existing sound medical practice and requires decision-making machinery that is impractical and inhumane. Relman contends that treatment decisions for terminally ill incompetents inSaikewicz-type cases should be made by the physician in consultation with the patient's family. Law professor Charles Baron, in contrast, defendsSaikewicz'sjudicialization approach, arguing that such decisions must be made in an adversary framework that approximates the ideal of the rule of law.

In the present Article, Professor Buchanan argues that Relman's criticism ofSaikewiczrests on a defective, medical paternalist view of the physician-patient relationship, and that Baron's support ofSaikewiczis based on an unjustifiable, legal imperialist view of decision making for incompetents. In Buchanan's view, Relman's approach fails to distinguish appropriately between the making of medical judgments and the making of moral judgments and wrongly assumes that the patient's family typically cannot understand the elements of the decision, while Baron's approach unjustifiably extends the sphere of the legal process by ignoring the special moral relationship that usually exists between the family and its incompetent member.

Buchanan proposes an alternative decision-making approach that he believes incorporates the merits, while remedying the defects, of both Baron's and Relman's approaches. The alternative is based on three propositions. (1) The properpresumptioninSaikewicz-typecases is that the family of an incompetent is to make decisions concerning treatment. (2) Thispresumptionof the family's dominant role in decision making isdefeasible:protection of the patient's rights requires that decisions be made within a framework that allows vigorous discussion and accountability through impartial review and that provides for legal intervention when necessary. (3) The institutional framework for implementing the features listed in the preceding proposition will rely heavily upon anethicscommittee that is neither an all-medical prognosis committee nor an administrative agency of the hospital.

Besides evaluating and responding to the Relman and Baron approaches, Buchanan examines the contribution to theSaikewiczdebate made by law-and-medicine professor George Annas. In essence, Buchanan rejects Annas's argument that, taken together, theSaikewiczopinion and theQuinlanopinion of the Supreme Court of New Jersey delineate a proper division of medical and legal decision-making responsibility concerning terminally ill incompetents. Buchanan concludes that, contrary to Annas's view, those two cases are not reconcilable.
Report on the Center for Law and Health Sciences
Authors: Weiner Stephen M.
Published: February 2021

The Center for Law and Health Sciences (the “Center”), a component of the Boston University School of Law (the “Law School”), organizes and conducts research and educational programs that examine selected relationships between the legal and health care systems. The Center provides the Law School with a vehicle not only for focusing research on interactions of law and health care, but also for incorporating legal analytical techniques into the projects of other health affairs units of Boston University. The Center's key goal is to create programs that contribute to an understanding (1) of the application of traditional legal analyses to issues that relate to the delivery of health services, as well as (2) of the implications arising from features of the health care system for the development of legal doctrines.
Wiser Than the Laws?: The Legal Accountability of The Medical Profession
Authors: Gold Jay Alexander
Published: February 2021

This Article argues that many seemingly disparate questions in health law are related to the issue of how experts are to be held accountable to nonexperts—show the principle that decisions should be made by those most affected is to be reconciled with the principle that decisions should be made by those with experience and training in the area. The basic subject matter of health law comprises a number of relationships between medical professionals, on the one hand, and laymen, on the other. In dealing with the proper allocation of decision-making authority within these relationships, the Article considers the social role of medical profession, the theoretical issues in the accountability of expertise, and the nature of medical expertise. On the basis of this discussion, the Article develops principles that can be applied throughout health law.

Whenever anyone appears to be investigating … medicine contrary to the written regulations, … any one of the citizens who wishes may indict him in court, on the ground that he … persuades young men to practice medicine in an illegal way, to practice on their own authority …. For no one ought to be wiser than the laws.

Plato, The Statesman
Guilty But Mentally Ill: A Retreat from the Insanity Defense
Authors: Sherman Scott Leigh
Published: February 2021

“Guilty but mentally ill” legislation responds to the increasing outbreak of violent crimes and to public skepticism concerning the ability of psychiatrists to determine the advisability of a criminal's return to society. Under this alternative to the traditional insanity defense, once the defendant chooses to plead not guilty by reason of insanity, the trier of fact may elect to find him guilty, but mentally ill. This may occur when it is determined that the defendant's mental illness is not severe enough to negate culpability. The court must then sentence the defendant to a term in prison instead of committing him to a psychiatric institution.

This Note discusses the origins of the guilty but mentally ill verdict and outlines the development of commitment standards for civil patients and insanity acquittees. While these standards appeared to be merging for a period of time the more recent trend has been to treat civil patients and insanity acquitees differently. This Note maintains that the guilty but mentally ill verdict involves an unnecessarily severe curtailment of the mentally ill offender's constitutional rights.

The Note delineates a proposal critiquing the misconceptions on which the statute is based and the excessive restraints on liberty it causes. The proposal examines the reasons for the public's misgivings with the insanity defense and suggests that the threat to the public's safety may not be as serious as it appears. Furthermore, it indicates that while problems remain with the existing insanity defense, the solution to those problems provided by the guilty but mentally ill statute outweighs the risk that insanity acquittees pose to the public.
The Risk of Birth Defects: Jacobs v. Theimer and Parents’ Right to Know
Authors: Kass Miriam , Shaw Margery W.
Published: February 2021

This Article discusses the Texas Supreme Court's holding in Jacobs v. Theimer that the parents of a defective child had a cause of action for damages against a physician for alleged negligent failure to inform the mother during pregnancy that she had contracted rubella and therefore might have a defective child, thereby causing her to lose the opportunity to have an abortion. The Article raises a number of questions that posi-Jacobs courts probably will confront concerning the duty of physicians and genetic counselors to keep their clients informed; describes some social and medical developments—including recent progress in medical genetics and prenatal diagnosis—which are likely to make Jacobs a significant precedent; evaluates the court's decision to allow a damage suit only for the costs of treating and caring for the child's defects; and briefly addresses the question of whether the Jacobs case comes within the sphere of suits for what has come to be known as “wrongful birth” and “wrongful life.”
Control of Fraud and Abuse in Medicare and Medicaid
Authors: Pies Harvey E.
Published: February 2021

This Comment explores issues concerning the control of fraud and abuse in health programs financed with public funds, specifically the Medicare and Medicaid programs. It summarizes the nature, scope, and possible causes of what some regard as a fraud and abuse “crisis,” and points out the difficulties and obstacles facing those who attempt to develop legislative and executive action aimed at controlling fraud and abuse. Recent federal initiatives in fraud and abuse control are examined, and a brief summary of key provisions of H.R. 3 (the Medicare-Medicaid Anti-fraud and Abuse Amendments, which may prove to be a landmark piece of legislation in this area) is provided. The author emphasizes that more effective control of fraud and abuse is necessary if further expansion of government financing of health programs, including national health insurance, is to occur in the near future. At the same time, caution must be taken not to neglect the appropriate use of other mechanisms necessary for reducing the costs of medical care and improving its quality. In addition, it is likely that efforts to stem fraud and abuse will raise important medicolegal and public policy issues that will require careful interdisciplinary consideration.
Diagnosis of Death in Comatose Patients under Resuscitation Treatment: A Critical Review of the Harvard Report
Authors: van Till H. A. H. , de Bourouill d’Aulnis
Published: February 2021

In this Article, which draws primarily on continental West European views on death and dying, the author contends that the Harvard criteria for irreversible coma (1968) are not reliable for diagnosing death in comatose patients under resuscitation treatment. The Article suggests that use of the Harvard Criteria to diagnose death leaves such patients legally unprotected against surgical assaults such as organ removal and biomedical experiments while they still may be living and capable of perception, possibly including the perception of pain and the spoken word. An alternative to the Harvard Criteria—angiography—is offered, and several additional issues related to the definition and diagnosis of death are discussed. Finally, the author suggests that even prior to death, termination of resuscitation treatment of irreversibly comatose patients, though followed by death, should be lawful.
Managing Public Health Risks: The Swine Flu Immunization Program Revisited
Authors: Fielding Jonathan E.
Published: February 2021

In this Comment, the Massachusetts Commissioner of Public Health views the federal government’s 1976-77 Swine Flu Immunization Program, which was sharply criticized by Dr. Cyril Wecht in a recent Article in this journal, as a classic example of a public policy decision made under conditions of stress and uncertainty. Once the responsible government officials had made a public commitment to immunize the entire populace of the United States, he contends, they found it very difficult to reformulate the program in response to changing information concerning its relative costs and benefits. Dr. Fielding offers suggestions for avoiding in the future some of the problems that surrounded the Swine Flu Program and for preventing further erosion of public confidence in essential preventive medicine programs.
Report on the Medicine and Law Committee of the American Bar Association's Section of Insurance, Negligence and Compensation Law
Authors: Dunn Lee J.
Published: February 2021

The Medicine and Law Committee of the American Bar Association's Section of Insurance, Negligence and Compensation Law was established in 1973 to meet the growing needs arising from the interface between law and the medical and health sciences. Although joint work had been conducted by the ABA and the American Medical Association prior to 1973, the organization of the Committee marked the first major project of any Section of the ABA aimed specifically at identifying and understanding the effects of medicine and the health sciences upon the everyday practice of law. As such, it provides a common ground to hundreds of attorneys whose practices involve medicolegal issues, and offers them the opportunity to learn from each other, to keep abreast of recent developments, and to approach constructively many theoretical and practical problems.
Patient Confidentiality Statutes in Medicare & Medicaid Fraud Investigations
Authors: Khajezadeh Dina
Published: February 2021

The Medicare and Medicaid programs have been burdened with health care providers’ fraudulent and abusive practices since their implementation in 1965. To help states discover and prevent Medicare and Medicaid fraud, Congress has enacted statutes permitting access to patients’ medical records in investigations of fraud. The majority of states have enacted physician-patient and psychotherapist-patient privilege statutes to protect confidential information from disclosure. Thus, the state's need for patient information conflicts with the patient's right of privacy. This Note discusses several court decisions that have wrestled with the tension between these two policies. The courts, after balancing the state interest in eliminating fraud against the patient's privacy interest, have often allowed disclosure of patient medical records. Although some courts have attempted to limit the extent of the information disclosed, few have set forth explicit standards to protect patient records from unwarranted disclosure of confidential information. This Note suggests guidelines for courts, legislatures and health care providers to uniformly limit the extent of this disclosure.
Reproductive Autonomy and Evolutionary Biology: A Regulatory Framework for Trait-Selection Technologies
Authors: Jones Owen D.
Published: February 2021

The Constitution protects, in some measure, each person's autonomy in making basic decisions about family, parenthood, and procreation. This Article examines the extent to which courts should protect from government intrusions a parent's access to technologies that influence specific characteristics of offspring. Beginning with Supreme Court opinions that articulate constitutional and social values regarding reproductive autonomy, the Article explores how important new insights from evolutionary biology may supplement an understanding of Human procreation. Specifically, the Article explains how trait selection can constitute an important part of larger “reproductive strategies” that powerfully affect an individual's “inclusive fitness” (itself a measure of reproductive success). It concludes that access to trait-selection technologies should receive the same federal protection from government intrusions as that afforded access to abortion. It proposes the first limit to that protection, however, when a parent seeks to select for a trait, or to use a technique, that would be clearly and significantly damaging to the future child. The Article subsequently divides the use of trait-selection technologies (TSTs) into eight contexts and proposes a preliminary framework by which a regulatory system could legitimately distinguish among them.
A Tale of Three Women: A Survey of the Rights and Responsibilities of Unmarried Women Who Conceive by Alternative Insemination and a Model for Legislative Reform
Authors: Henry Vickie L.
Published: February 2021

Courts in a number of jurisdictions have recently confronted questions of legal parentage concerning children conceived by alternative insemination. Typically, the biological mother is contesting the right of either the sperm donor or a non-biological co-parent to custody or visitation. This Note surveys the current state of the law and demonstrates a lack of protection for the rights of unmarried biological mothers and their co-parents. This Note then proposes a new paradigm for establishing the parties’ rights and obligations, one that reflects the parties’ pre-insemination, mutual intent regarding parenting responsibilities and encourages legal acknowledgement of and protection for the families people are creating with the help of AI.
Quality Improvement in Community-Based, Long-Term Care: Theory and Reality
Authors: Kinney Eleanor D. , Freedman Jay A. , Loveland Cook Cynthia A.
Published: February 2021

Community-based, long-term care has become an increasingly popular and needed service for the aged and disabled populations in recent years. These services witnessed a major expansion in 1981 when Congress created the Home and Community-Based Waiver authority for the Medicaid program. Currently, all states offer some complement of community-based, long-term care services to their elderly and disabled populations and nearly all states have Medicaid Home and Community-Based Services waivers which extend these services to their Medicaid eligible clients.

An ever increasing proportion of the population is in need of community-based, long-term care services. Between nine and eleven million Americans of all ages are chronically disabled and require some help with tasks of daily living. In 1990, thirty percent of the elderly with at least one impaired activity of daily living used a community-based, long-term care service. Not surprisingly, expenditures for community-based, long-term care have increased.
Future Fear: Prenatal Duties Imposed By Private Parties
Authors: Solomon Renee I.
Published: February 2021

The national abortion debate, rising drug use and homelessness, and the return to conservatism intersect in the trend which increasingly recognizes fetal rights, often at the expense of women's rights. Pregnant women, as never before, are faced with criminal charges and physical invasions in the name of protection of fetuses. This Note examines the sociological forces creating these situations and suggests better solutions. The Note cautions against the future fear that private parties will claim a legal right to interfere with a pregnant woman's behavior, and illustrates the need to prevent it.
Earth's Vanishing Medicine Cabinet: Rain Forest Destruction and Its Impact on the Pharmaceutical Industry
Authors: Newman Erin B.
Published: February 2021

Todos tem direito ao meio ambiente ecologicamente equilibrado. Everyone has the right to an ecologically balanced environment. In 1988, the Brazilian Constitutional Assembly incorporated this imperative into the Brazilian Constitution as part of a chapter on environmental protection. After hundreds of years of environmental ignorance, our planet's inhabitants have experienced a growth of environmental awareness. One global environmental tragedy garnering substantial recent attention is the depletion of the planet's tropical rain forests. In addition to eternally altering the human environment, rain forest destruction poses a serious threat to both the pharmaceutical industry and individuals in need of medical care. A substantial portion of existing pharmaceuticals are plant-based and animal-based, and the pharmaceutical industry continues to explore additional species for medicinal potential, particularly in tropical regions. As mass deforestation of these areas forces countless species into extinction, specimens yet to be analyzed for their pharmaceutical potential will be eternally lost. As one noted conservationist explained, “Even severe pollution is reversible, but species extinction is irreversible.”
TheEstelleMedical Professional Judgment Standard: The Right of Those in State Custody to Receive High-Cost Medical Treatments
Authors: Posner Marc J.
Published: February 2021

This Article discusses the rights of prisoners, pretrial detainees, and the involuntarily committed to receive high-cost medical treatments. More specifically, the Article analyzes U.S. Supreme Court and lower court case law dealing with the medical care rights of those in state custody and argues that, under a proper understanding of this case law, the financial considerations of states should play no role in determining the rights of these people to receive high-cost medical care. Finally, the Article defends the current medical care standard against various critiques.
Aid-in-Dying: Should We Decriminalize Physician-Assisted Suicide and Physician-Committed Euthanasia?
Authors: CeloCruz Maria T.
Published: February 2021

Recent news stories, medical journal articles, and two state voter referenda have publicized physicians’ providing their patients with aid-in-dying. This Note distinguishes two components of aid-in-dying: physician-assisted suicide and physiciancommitted voluntary active euthanasia. The Note traces these components’ distinct historical and legal treatments and critically examines arguments for and against both types of action. This Note concludes that aid-in-dying measures should limit legalization initiatives to physician-assisted suicide and should not embrace physician-committed voluntary active euthanasia.
The Case Against Compulsory Casefinding in Controlling AIDS—Testing, Screening and Reporting
Authors: Gostin Lawrence O. , Curran William J. , Clark Mary E.
Published: February 2021

The spread of acquired immune deficiency syndrome (AIDS) demands a comprehensive and effective public health response. Because no treatment or vaccine is currently available, traditional infection control measures are being considered. Proposals include compulsory testing and screening of selected high risk populations. The fairness and accuracy of compulsory screening programs depend upon the reliability of medical technology and the balancing of public health and individual confidentiality interests. This Article proposes criteria for evaluating compulsory testing and screening programs. It concludes that voluntary identification, education, and counselling of infected persons is the most effective means of encouraging the behavioral changes that are necessary to halt the spread of AIDS.
Drunk Driving and the Alcoholic Offender: A New Approach to an Old Problem
Authors: Gouvin Eric J.
Published: February 2021

Health laws in every state recognize alcoholism as a treatable disease. State drunk driving laws, however, inadequately provide for alcoholic drunk drivers. Studies show that problem drinkers make up as much as two-thirds of the DWI offender class. Alcoholic drunk drivers cannot fully conform their drinking behavior to the dictates of the law as long as their alcoholism remains untreated. This Note argues that the law should consistently treat alcoholism as a disease. This Note suggests that the most appropriate way for the legal system to deal with alcoholic DWI offenders is to suspend the offender's license until he can show that he has successfully completed an initial alcohol detoxification/rehabilitation program. In addition, because alcoholism requires lifelong treatment, alcoholic drivers should be required to present periodic documentation that their condition is under supervised treatment. Epileptic drivers are handled in a similar manner in most states.
Implications of Negligent Selection and Retention of Physicians in the Age of ERISA
Authors: Dorros Torin A. , Stone T. Howard
Published: February 2021

Enormous and fundamental changes are currently taking place in health care delivery. These changes include the consolidation of health care providers—from hospitals, physicians, and insurance companies, to medical supply businesses, managed care networks, and other health care providers—and numerous health care and insurance reform efforts by government at all levels. These changes pose significant implications for the delivery of health care in the United States, and will impact the manner, cost, and accessibility of health care delivery. These changes will almost certainly affect the quality of health care services as well. The quality of health care in the United States has for many years been a central concern of government, industry, health care providers, payors, and consumers. Quality in health care is essential to overall national health, the guarantor of a productive and healthy populace, and an important indicator of United States social and technological preeminence.
Cancer and The Adjudicative Process: The Interface of Environmental Protection and Toxic Tort Law
Authors: Schwartzbauer Edward J. , Shindell Sidney
Published: February 2021

But it does not matter to a man whether he acts at his own peril or not, unless harm comes of it, and there must always be some one within reach of the consequences of the act before any harm can be done.

—Oliver Wendell Holmes

[Scientists must be certain of their interpretation of the facts, that their priorities are correct, and that they are not bringing unnecessary and unjustified anxiety to many by over-statement or by expression of cancer risks in terms incomprehensible to the lay public.

—John Higginson, Director, International Agency for Research on Cancer
The Genetics of Secrecy in Adoption, Artificial Insemination, andIn VitroFertilization
Authors: Lamport Ann T.
Published: February 2021

In light of the significant role that heredity plays in many disease processes, statutes requiring strict secrecy with regard to medical records in cases of adoption, artificial insemination andin vitrofertilization should be reassessed. In adoption cases, attitudes concerning the adoptee’s ancestry have progressed over the century, but adoptees still are unable to access their records. The problem of inaccessibility is also apparent in medical genetics clinics where valuable genetic information, necessary for an accurate diagnosis, is unavailable to the clinic, the adoptive parents, and the birth parents.

A uniform law which responds to these interests and problems should be promulgated. This Note discusses the need for better access to and availability of medical records. The Note proposes a Uniform Act and suggests that, at a minimum, it include a scheme for regulating the donation of genetic material, strong record-keeping requirements with respect to family histories and pedigrees, and finally, an open access provision for certain information for both children and parents.
The Fraud and Abuse Statute in an Evolving Health Care Marketplace: Life in the Health Care Speakeasy
Authors: Blumstein James F.
Published: February 2021

The health care market, the organizations that deliver health care, and health care payment mechanisms have all changed significantly in recent years and continue to change. In contrast, the so-called antikickback provision of the fraud and abuse statute remains much as it was in 1977, when it was amended into its current general form. By prohibiting financial incentives to induce referrals, the antikickback law counters abuses to the Medicare and Medicaid programs that are likely to proliferate in a cost-based, fee-forservice (FFS) health care market. In a FFS system, financial incentives stimulate increased use of services and often result in overutilization. The antikickback section has significantly less relevance to a capitated health care system in which the payment system itself inhibits overutilization and other costly practices. However, the antikickback section is broad and the regulatory safe harbors promulgated under it are narrow. As a result, practices such as capitation, which encourage cost-effective care and the formation of organizations to provide care on a capitated basis, are poorly insulated from the strictures of the statute.
Genetic Discrimination: The Use of Genetically Based Diagnostic and Prognostic Tests by Employers and Insurers
Authors: Gostin Larry
Published: February 2021

Genetic discrimination is detrimental to public health programs, as well as to society generally. Advances in genetic testing and screening, accelerated and prompted by the Human Genome Initiative, increase society's ability to detect and monitor chromosomal differences. These technologies and their resulting genomic data will enhance medical science, but may also encourage discrimination. Although few employers or insurers currently utilize genetic screening, testing or data, rising employee benefit costs and market forces create powerful incentives for usage.

Current municipal, state and federal laws, including the Americans with Disabilities Act (ADA), may not sufficiently protect employees and insureds from genetic discrimination. While municipal and state protections should not be overlooked, the ADA's sweeping scope may currently provide the most comprehensive safeguard. Federal laws banning discrimination on the basis of race or sex might also successfully redress some forms of genetic discrimination. Genetic technologies’ advent necessitates efforts to rectify state and federal statutory coverage gaps, strictly regulate employers and produce comprehensive guidelines regarding its use.
Reflections on Current Proposals to Abolish or Reform the Insanity Defense
Authors: Arenella Peter
Published: February 2021

In addition to provoking public and scholarly debate, the recent acquittal of John W. Hinckley, Jr. has prompted the Ninety-Seventh Congress to consider various bills that would abolish or reform the federal insanity defense. The following is an unedited version of Professor Arenella’s testimony concerning these bills given before the House of Representatives’ Subcommittee on Criminal Justice on August 12, 1982.
Consciousness: The Most Critical Moral (Constitutional) Standard for Human Personhood
Authors: Cranford Ronald E. , Smith David Randolph
Published: February 2021

For the past two decades, the medical profession and society have debated the definition of death. Some reasonable consensus has been reached on this issue, in theory and in practice. In the last few years, however, a far more important debate has been evolving — the definition of human personhood. Human personhood has been discussed extensively in the past with respect to the abortion question and other issues concerning the beginning of life. More recently, however, the definition of personhood has been raised with respect to termination of treatment decisions at the end of life and, in particular, on the appropriate care of patients in a persistent vegetative state.

Our major premise is that consciousness is the most critical moral, legal, and constitutional standard, not for human life itself, but for human personhood. There is nothing highly original in our approach to this particular issue; others have advanced similar arguments in recent years.
The Conundrum of Charitability: Reassessing Tax Exemption For Hospitals
Authors: Hyman David A.
Published: February 2021

Tax exemption is an ancient, honorable and expensive tradition. Tax exemption for hospitals is all of these three, but it also places in sharp focus a fundamental problem with tax exemption in general. Organizations can retain their tax exemption while changing circumstances or expectations undermine the rationale that led to the exemption in the first place. Hospitals are perhaps the best example of this problem. The dramatic changes in the health care environment have eliminated most of the characteristics of a hospital that originally persuaded the citizenry to grant it an exemption. Hospitals have entered into competition with tax-paying businesses, and have increasingly behaved like competitive actors. Such conduct may well be beneficial, but it does not follow that tax exemption is appropriate. Rather than an undifferentiated subsidy, a shift to focused goals will provide charitable hospitals with the opportunity and incentive to “do the right thing.”
Deregulating Mandatory Medical Prescription
Authors: Mitchell Chester N.
Published: February 2021

This Article links the legal evolution of mandatory medical prescription since 1900 to the police-power's prohibition of alcohol and the opiates as well as to the self-interested monopolization of new drugs by physicians. The Article advances a theory of professionalization consistent with the evidence that mandatory prescription is not in the public interest. The Article suggests that the supremacy of self-medication is consistent with competition policy, the medical profession's fiduciary duty to clients, reduced medical costs and improved health. The author analyzes the consequences of regulating drug production, testing, marketing and consumtion by granting decision-making authority to the lowest-cost risk avoider, suggesting this as a plausible basis for legal reform.
Radon Gas: Contractor Liability for an Indoor Health Hazard
Authors: Shuko Carolyn Marie
Published: February 2021

Many families throughout the United States have recently detected dangerously high concentrations of radon gas inside their homes. Radon, a carcinogenic gas produced from uranium, has been discovered in structures overlying uranium-bearing rock. This discovery may result in litigation to determine contractor liability for building upon radon-releasing rock sites. This Note examines the strengths and weaknesses of the various theories of contractor liability and considers potential statutory claims under the Clean Air Act. The Note suggests, as an alternative approach to recovery, a proposed regulatory scheme and implementation plan.