bluuebunny/crossref_metadata_2025 huggingface dataset:
Riedel's Thyroiditis Complicated by Hypoparathyroidism and Hypothyroidism
Authors: McRorie E.R. , Chalmers J. , Campbell J.W.
Published: January 2017

Riedel's thyroiditis is a rare condition in which the thyroid gland is replaced by fibrous tissue. The case reported is one of Riedel's thyroiditis complicated by hypoparathyroidism and hypothyroidism. There would appear to have been only five earlier reports in the literature of hypoparathyroidism complicating Riedel's thyroiditis.
Should Hyposplenic Patients Receive Prophylaxis against Bacterial Infection?
Authors: Mckay P.J. , Kennedy D.B. , Lucie N.P.
Published: January 2017

The risk of overwhelming septicaemia, most commonly due to encapsulated organisms, is well recognised post-splenectomy. Although a similar risk is documented in hyposplenic patients, many physicians do not routinely give prophylaxis here. We report the case of a 41 year old woman with adult onset coeliac disease who developed pneumococcal meningitis resulting in severe residual disability and suggest that prophylaxis should be given to such individuals who have evidence of reduced splenic function.
The Health Status and Health Needs of Chinese Population in Glasgow
Authors: Liao Xiao-Hui , McIlwaine G.
Published: January 2017

This cross sectional study explored the health problems and health needs in the local Chinese community in Glasgow. Several data collection methods have been used in this study, including face-to-face and telephone structured interviews, postal and hand delivered questionnaires. A total of 800 questionnaires were processed, and 493 were completed, giving an overall response rate 61.6%. The results from the present survey indicated that the health status of Chinese residents in Glasgow is poorer than that of the local population. The most important findings of the study is that the Chinese community in Glasgow underuse health services, and unmet health needs exist in the community. The main barrier to effective use of present health services and benefit from the health promotion and health education programmes is language difficulties.

Following discussion with the local community, options for improving the health services for the Chinese community in Glasgow were obtained. The findings of the study have implications for health service purchaser/providers of health care to the Chinese population generally in Scotland.
Assessment and Referral Patterns of Patients Admitted after Deliberate Self-Poisoning
Authors: Brown D.H. , Reynolds N. , Pullar T.
Published: January 2017

The assessment and referral patterns of adult patients after deliberate self-poisoning in Dundee were examined. Questionnaires were completed by the admitting physicians and assessing psychiatrists over a 3 month period. Demographic data concerning the patients and the nature of self-harm were similar to previous studies. Initial referral rate was 95% but dropped to between 70% and 81% after the post receiving round. Up to 2 hours/ day could be required for assessment and 75% of the cases required some form of psychiatric follow-up. Although both groups of doctors considered that the majority of patients required or would benefit from psychiatric referral, there was poor agreement when patients were independently categorised into high or low suicide risk (kappa = 0.04). Agreement was also low regarding whether referral was essential or not (kappa = 0.06). Although junior medical staff can play an important role in screening of patients, the psychiatric service, including trained nurses, may be best placed to provide a full assessment, where required.
The Use of Aspirin and Opiates by Dumfries and Galloway General Practitioners in the Management of Acute Myocardial Infarction
Authors: Strachan D.A. , Robertson S.
Published: January 2017

In March 1994 a study in the British Medical Journal indicated a low rate of administration of aspirin and opiates by general practitioners in cases of suspected myocardial infarction.1 A retrospective analysis was made of 120 consecutive admissions to the medical intensive care unit of Dumfries and Galloway Royal Infirmary, by general practitioners, with a primary diagnosis of acute myocardial infarction. Of these 120 cases, 24% were given aspirin by their G.P. prior to admission and 64% were given opiate (IV or IM). Thirty-three percent were already on regular aspirin and of these 18% received further aspirin prior to admission. These figures were considerably better than those previously quoted1 and they showed that prior regular aspirin therapy did influence the GPs' decision on further administration of aspirin in the acute event. A questionnaire sent to all GPs in Dumfries and Galloway revealed that 100% carried aspirin in their medical bags, 62% claimed to give aspirin to patients with suspected MI, 95% used a British Heart Foundation approved dose of aspirin2 and 83.3% administered the aspirin using one of the approved methods.3
Peritoneal Mesothelioma with Gastric Outlet Obstruction
Authors: Meek R.M.D. , Ferguson J.C.
Published: January 2017

Peritoneal mesothelioma has been increasing in frequency since the 1960s. Although still a rare malignant neoplasm, early diagnosis influences prognosis. More common presenting features include abdominal pain, abdominal distension or a palpable mass; more uncommon presentations have included dysphagia secondary to achalasia, chronic pancreatitis and regional lymphadenopathy.1–3 We report two recent cases at the Southern General Hospital in Glasgow.
Glasgow Resurrectionists
Authors: McDonald S.W.
Published: January 2017

The Napoleonic Wars and the colonial campaigns of the early 1800s created a great need for surgical training. Many of the cadavers used in Glasgow s schools of Anatomy were resurrected from local churchyards or imported from Ireland. In the 1820s, the activities of some resurrectionists showed gross insensitivity, with bodies being stolen before the funeral. In the early 1830s, cholera riots and the fear of “burking ” led to the Anatomy Bill of 1832 receiving the Royal Assent.
Cannabis Use in a General Psychiatric Population
Authors: Beesley S. , Russell A.
Published: January 2017

It is known that there is an association between cannabis use and psychosis. Clinically we had thought that there were increasing numbers of patients admitted to hospital who were using cannabis and that this was affecting their illness. A study was therefore undertaken to determine the extent of cannabis use and its relationships over a one month period. The findings and their implications for junior doctors on-call are also discussed.
Sir James Young Simpson Bart 150 Years on
Authors: McGowan S. W.
Published: January 2017

An outline is given of the discovery of chloroform in 1847 by Professor James Young Simpson. Simpson's career and his wide range of interests and achievements are described.
The Value of Cervical Screening in Women over 50 Years of Age —Time for a Multicentre Audit
Authors: McKenzie C.A. , Duncan I.D.
Published: January 2017

This study reviews the cervical smear history of women developing CIN aged over 50 years to consider if they might be discharged sooner from the cervical screening programme in Tayside Region. From the OCCURS database all women over 50 years who developed CIN between 1 Jan 1993 and 30 June 1996 were identified and their smear history obtained. Results show that had women been discharged from the screening programme at age 50 following three consecutive negative smears and a negative exit smear then only two women with CIN3 and one with microinvasive disease would have been missed in the subsequent three and a half years.

A wider geographical survey of the incidence of CIN in this older age group is needed to determine whether it is cost beneficial and cost effective to continue cervical screening beyond the age of 50 years.
Emergency Sub Total Colectomy for Chronic Constipation
Authors: Brombacher G.D. , Murray W.R.
Published: January 2017

Severe chronic constipation presents a significant management problem which may, occasionally; necessitate surgical intervention. Rarely emergency-surgery is required and we report a case in which emergency subtotal colectomy was indicated to treat faecal peritonitis secondary to stercoral ulceration.
Early Diagnosis of Hepatocellular Carcinoma in Haemochromatosis Influences Surgical Management
Authors: Pleass H. , Garden O.J.
Published: January 2017

Using case note review, a retrospective analysis was carried out of all patients referred with haemochromatosis and suspected hepatocelluclar carcinoma between 1988 and 1997 to define the mode of presentation, management and outcome of such patients. All 12 patients were male with a mean age of 67 years. Four patients presented whilst asymptomatic by alpha-fetoprotein screening. Mean time interval between diagnosis of haemochromatosis and heptocellular carcinoma was 6.7 years. One patient underwent right hepatectomy, seven patients were treated by chemoembolisation and the remaining four patients were treated symptomatically. The median survival of the chemoembolised patients was 13 months. Of those patients treated symptomatically, the median survival was four months.

Screening for hepatocellular carcinoma is often not undertaken inpatients with haemochromatosis. Survival prospects are poor in patients whose tumour presents symptomatically.
An Islander with Seizures
Authors: Stephen L.J. , Brodie M.J.
Published: January 2017

This case describes a man with progressive refractory epilepsy whose death was witnessed during a seizure. Initial brain imaging was normal, but following prolonged episodes of non-convulsive status epilepticus, progressive right-sided temporal atrophy developed over a period of two years. The clinical picture and postmortem examination were consistent with the diagnosis of Rasmussen's encephalitis, a rare condition with a bleak prognosis.
A Mobile Screening Unit, Practicalities and Problems
Authors: McEwan S.R. , Arthur P. , Scott A. , Petrie W. , Forbes C.D.
Published: January 2017

The need for a mobile screening unit to travel throughout Scotland to measure and modify cardiovascular risk factors in the apparently healthy working population was fulfilled by the conversion of a double-decker bus. The aim of the project was to assess the incidence of risk factors in healthy individuals and to modify their risk factors by individual counselling. Many unforeseen practical problems were encountered and overcome during the planning stage and during the project. The team of specially trained staff spent three and a half years screening more than 20,000 people throughout Scotland. This project provides a model for other screening projects involving a multicentre/scattered cohort
Fingertip Trauma in Children from Doors
Authors: Macgregor D.M. , Hiscox J. A.
Published: January 2017

Fingertip and nailbed trauma caused by doors is common in children, occurring when fingers are either shut in the door itself or are trapped in the hinge as the door is closed. An audit was carried out over five months of all fingertip and nailbed injuries due to trauma from a door. One hundred and eighty eight children, 2% of all attendances in this period, had sustained such trauma, 39% of these occurring in children under four years of age. One hundred and forty seven children (75%) had sustained relatively minor soft-tissue injury to the finger, However the remaining forty seven (25%) of the injuries sustained were more serious e.g. Avulsion of the nail from the nailbed or amputation of part of the fingertip and 29 (15%) of all the cases required a general anaesthetic for exploration, cleaning and repair. The Plastic Surgery department followed up these 29 children and 71 Accident & Emergency follow-up appointments were generated by the remaining injuries. The incidence of significant injury was higher than expected and caused considerable distress to both the children and their parents, It is suggested that home safety protocols should feature advice on how to avoid these injuries.
The Structure and Properties of Some Urons and Thiourons
Authors: Egginton C. D. , Vale C. P.
Published: January 2017

A number of compounds containing the uron ring have been synthesized and their structures confirmed using nmr spectroscopy. Analogous compounds containing a thiouron ring derived from thiourea have also been prepared and similarly examined. The physical and chemical properties of these compounds have been studied. A number of them have been examined as bases for crease-resistant textile treatment.
A Tirecord Tension Transducer
Authors: Walter J. D.
Published: January 2017

A transducer is described which can directly measure the cord tension at any point in an arbitrarily loaded tire. Cord force data obtained at the crown and in the sidewall for a typical two-ply automobile tire are presented for: (1) the inflation problem, (2) the static deflection problem, and (3) the rolling tire. Agreement between theory and experiment is good for the inflation problem, which is the only case where a cord load formula exists to allow comparison.
A Theoretical Analysis of the Effect of External Polymers on the Wrinkle Recovery of Fabrics
Authors: Chapman B. M.
Published: January 2017

The improvement observed in the wrinkle recovery of wool fabrics treated with certain external elastomeric polymers has previously been attributed to the presence of interfiber bonds, which considerably reduce the frictional component of wrinkling and provide an additional elastic restoring moment, aiding the return of the fabric to its undeformed state. These mechanisms are shown to be quantitatively consistent with the additional experimental evidence now available, including the effects of polymer treatment on a series of wool/polyester blend fabrics and the observation that washing of a polymer-treated fabric can sometimes improve its wrinkle recovery. The theory is used to separate the effects due to energy stored in the elastomer and those due to increased fiber strains.
Physical and Structural Properties of Pad-Dry-Cure, Core-, and Skin-Crosslinked Fabrics
Authors: Venkatesh G. M. , Berni R. J. , McSherry W. F. , Markezich A. R.
Published: January 2017

Core crosslinking has been shown to enhance abrasion resistance; the extent of improvement depends on the method employed to remove the surface resin. To better understand the relationship between types of crosslinking and abrasion resistance and other physical properties, resin-treated fabrics were produced by pad-dry-cure, core crosslinking, and skin crosslinking techniques. At comparable bound-resin levels the core-crosslinked fabrics, especially those produced by treatment with ammonia gas, exhibit higher abrasion resistance and tear and tensile strength, with little sacrifice in crease recovery or tensile recovery, than do the pad-dry-cure and skin-crosslinked fabrics.
The Formation of Carbonyl Groups during Irradiation of Wool and Its Relevance to Photoyellowing
Authors: Holt L. A. , Milligan B.
Published: January 2017

The carbonyl contents of wool fabrics have been determined by colorimetric analysis after partial acid hydrolysis. Irradiation of dry wool fabrics with simulated sunlight causes an increase in carbonyl content. The rate of production is approximately the same for unbleached, bleached, and fluorescently whitened fabrics, even though these fabrics yellow at markedly different rates. In contrast, irradiation of the same fabrics in water results in few additional carbonyl groups, although extensive yellowing occurs. Thus it seems unlikely that carbonyl groups are directly responsible for yellowing. However, the observation that hydrothermal yellowing of dry-irradiated wool is accompanied by a loss in carbonyl content leads us to suggest that carbonyl groups could be involved indirectly in yellowing.

The keto acids present in partial acid hydrolysates of irradiated wool have been identified by reductive amination with sodium 3H-borohydride in ammonia solution, a reaction which converts keto acids to the corresponding 3H-amino acids. The formation of radiolabeled alanine, glycine, proline, serine, threonine, glutamic acid, and tyrosine provides evidence for the photo-oxidation of a number of amino acid residues during irradiation of wool.
Penetration of Nylon Ballistic Panels by Fragment-Simulating Projectiles
Authors: Prosser Robert A.
Published: January 2017

The main purpose of this report is to present an analysis of the ballistic behavior of the fragment-simulating projectile (FSP)-nylon cloth system. For a set of Vc determinations, plots of Vr versus Vs can be adequately represented by hyperbolas. The energy lost by an FSP after complete passage through a nylon ballistic panel of L layers is virtually constant, independent of the striking velocity. The hyperbolas lie on a portion of the surface of a hyperbolic paraboloid with Vr, Vs, and L as axes. The minimum penetration velocity of a missile that has reached the plane of the Lth layer is practically equal to the Vc (or V50) for L layers. The work of penetration per interior layer is essentially constant. For the interior layers, the average force and average deceleration per layer are approximately 1.03 times 104 N and 9.34 times 106 m/s2, respectively. This behavior holds for bonded (laminated) nylon ballistic panels, for the FSP-Kevlar system, and for the right-circular-cylinder missile/nylon system so far. Response surfaces are given for the FSP-nylon and FSP-bonded nylon systems relating ballistic performance to the diameter of the FSP, the firing obliquity, and the number of layers of cloth in the panel. The associated three-dimensional plots are also provided.
Dyeing Nylon Films with Acid Dyes Modified with Various Normal Alkylamines
Authors: Kuwabara Shigeru
Published: January 2017

The fundamental data required to establish the technique of dyeing nylon and wool fibers in a water/perchloroethylene dye bath were gathered. A sodium atom of CI acid blue 62 was substituted by a series of normal alkylamine and hydrogen atoms in order to obtain complex dyes that are soluble in perchloroethylene. These dyes, which have 6, 9, and 12 carbon chain lengths, have good solubility in both water and perchloroethylene. This can be attributed to the fact that these dyes are dissolved in a dissociated state in water and in an undissociated state in perchloroethylene. The saturated amounts of these complex dyes on nylon 6 films dyed in each bath were greater than those of the original dye. There were differences between shades of nylon 6 films dyed in water and in perchloroethylene, and these seem to be attributable to the different degrees of aggregation of the complex dyes.
Rotor Yarn Structure by Cross-Sectional Microtomy
Authors: Neckář B. , Ishtiaque S. M. , Švehlová L.
Published: January 2017

A mathematical model is suggested for studying the radial packing density of yarn, and the proposed model is used for a comparative study of ring and rotor spun yarns. The results show that rotor spun yarn consists of a smaller number of fibers in the cross section compared to ring spun yarn, which explains the lower strength of rotor yarn. Although the radial packing density of both yarns is non-uniform, that of rotor yarn is nearer the yarn axis and less towards the yarn surface compared to ring spun yarn.
The Student Protest Movement
Authors: Herbert T. Walter
Published: January 2017

“As one seeks to explain what moves these young people today, one is often perplexed by apparently contradictory tendencies. The movement is strongly characterized by the desire not to be understood. Another source of perplexity is the fact that the political activity, which receives so much attention, is at its heart non-political. Except for a very few, those who engage in political activity do so on the basis of an orientation to personal life, not political life. It is a personal moral quest, not a political vision, which is really characteristic of those who are politically involved.”
The Microcomputer Revolution?
Authors: Calhoun Craig J.
Published: January 2017

The technology on which microcomputers and allied developments are based is rapidly progressing, but the extent and directions in which development continues will be determined largely by social, not autonomously technical, factors. This technology can, within the next decade or two, advance to the point where an enormous range of new applications will be economically practicable. A wide variety of microcomputer applications are already underway in computation, automation, data management, and communication. This article surveys some of the more important of these, and suggests the vast social implications which they have. The applications themselves and their effects are, it is argued, at least partially subject to social control. The article suggests some of the blocks on further innovation, and some of the social choices to be faced.
Social Science Research and the Microcomputer
Authors: Collins T. W.
Published: January 2017

During the era of the mainframe computer, 1946-1976, sociologists wholeheartedly embraced computer technology as an adjunct to quantitative research methods. The nature of the technology and the resultant structure by which most sociologists gained access to computers lent itself to several undesirable side effects. However, the undeniable calculational power of the technology was enough to outweigh those disadvantages, at least for the mainstream of the discipline. The introduction of microcomputers has significantly changed the calculational power/cost ratio inherent in computer technology and permits new structures of access, not only for sociologists, but for individuals in all walks of life. Although this does not in and of itself offer a panacea for every criticism that has ever been raised concerning the usage of computers within sociology, several of the previous disadvantages of computer technology have now been technically eliminated, if not yet eliminated in practice.
Smoking Habits Amongst House Physicians Working at Jinnah Postgraduate Medical Center, Karachi, Pakistan
Authors: Piryani Rano Mai , Rizvi Nadeem
Published: January 2017

The objective of this study was to estimate the prevalence of smoking among house physicians working at Jinnah Postgraduate Medical Center, Karachi, Pakistan.

Sixty-four (32%) of the 200 house physicians were smokers; 50% (36) had started smoking in their twenties and 44% (28) in their teens. Seventy-five per cent (48) of the smokers were influenced by friends, 20% (13) by cigarette commercials and the remainder by their parents. Ninety-five per cent (61) smoked during duty hours. The frequency of smoking among young doctors was higher than the overall prevalence of smoking in Pakistan.
Environment and Health: Vital Intersection or Contested Territory?
Authors: Clapp Richard W. , Ozonoff David
Published: January 2017

The effects of environmental exposure, broadly defined as any exposure from outside the body, on human health are unquestionably the most important determinants of public health. While important genetic determinants of disease exert their effects irrespective of exposure from outside the body, these do not contribute as much to the overall public health burden of disease as factors such as tobacco smoke, poor quality water, inadequate or contaminated food, occupational exposures to dusts and chemicals, motor vehicle accidents, interpersonal violence, air pollution, and other factors external to the body. In many cases, genetic predisposition and environmental exposures combined cause disease in an individual, so it may be impossible to separate out individual biological contributions from various external factors. Nevertheless, it is widely understood that public health concerns populations and communities, and that environmental determinants of health have been paramount throughout human history.
Environment and Public Health in a Time of Plague
Authors: Sutton Victoria
Published: January 2017

The environment and public health goals hold a common value of healthy populations. The threat of bioterrorism requires a partnership of both, building upon the long history of the link between public health and the environment. This existing relationship is key to an effective system of biodefense for the nation, because the use of biological weapons through every environmental pathway poses a potential threat. Contaminations of water, growing crops, grazing cattle, air through inhalation, dermal absorption, or consumption of food or water in the human environment are potential delivery methods. For these risks of bioterrorism in the environment, there is an existing federal regulatory and statutory framework upon which the relationship between the environment and public health can be strengthened and shaped.
Who Will Protect the “Disruptive” Dialysis Patient?
Authors: Smetanka Stella L.
Published: January 2017

“There is an art to being a patient. Sometimes you must ask the hard questions and at other times, you must put your faith in the hands of another human being. In some way, doctors and their patients are partners. Some patients are good at it. Other patients get in their own way. It’s like a dance.”
The Perils of Singleton v. Norris: Ethics and beyond
Authors: Gabos Kelly A.
Published: January 2017

Nearly 20 years ago, in Ford v. Wainright, the Supreme Court held that it is unconstitutional to execute a legally incompetent inmate. Due to advancements in pharmacological therapy and the ability to make inmates legally competent through medication, various courts since Ford have determined the mechanisms by which competency through medication can be accomplished. Those decisions led to cases involving the legality of forcibly medicating inmates to make them competent to stand trial and to be executed. One recent case involving execution competency is the Eighth Circuit’s decision in Singleton v. Norris.

In Singleton, the Eighth Circuit held that execution as an ultimate consequence of administering psychotropic medication to legally incompetent inmates cannot be considered in the determination of whether it was proper to forcibly medicate that inmate. The Eighth Circuit’s decision permitted the execution of Charles Singleton, a schizophrenic who fought against involuntary administration of the medications that rendered him competent to be executed.
Demanding Individually Safe Drugs Today: Overcoming the Cross-Labeling Legal Hurdle to Pharmacogenomics
Authors: Sasjack Scott
Published: January 2017

If new refrigerators hurt 7% of customers and failed to work for another one-third of them, customers would expect refunds … manufacturers would be strictly liable for the injuries, and there would be implied warranties even if the manufacturer made no guarantees.

What if physicians could use genetic tests to tailor prescriptions to their patients’ individual genotypes? Physicians and pharmaceutical companies can use pharmacogenomics to decrease the number of adverse drug reactions, increase drug efficacy, and lower health care costs. Unfortunately, crosslabeling rules serve as both legal and policy hurdles for these advances, hurdles the FDA has the power to remove. Part I explains pharmacogenomics and why it currently has a narrow application. Part II discusses the FDA's regulatory approach to pharmacogenomics. Part III explains the legal and policy hurdles of cross-labeling and how they impede the more widespread use of pharmacogenomics. Part IV examines ways to clear the legal crosslabeling hurdles while Part V examines ways to clear the policy cross-labeling hurdles. Finally, Part VI discusses some of the many other complex legal and policy issues that lawmakers, regulators, and the industry will need to resolve in order to realize the full potential of pharmacogenomics.
“Monitoring” Corporate Corruption: DOJ's Use of Deferred Prosecution Agreements in Health Care
Authors: Boozang Kathleen M. , Handler-Hutchinson Simone
Published: January 2017

It has become a truism to cite Enron as the new millennium’s watershed impetus for government assertion of power to improve corporate governance. While indictment of corrupt corporations and their executive leadership seems an obvious corrective to corporate norms that have gone astray, the unsuccessful prosecution and demise of Arthur Andersen proved a stunning backfire of such a blunt weapon. The public accounting industry shrunk even further, to the detriment of clients, and thousands lost their jobs. Arthur Andersen taught that an indictment itself may be sufficiently damaging to close the doors of a public corporation.
… And Health Care for All: Immigrants in the Shadow of the Promise of Universal Health Care
Authors: Ortega Adrianne
Published: January 2017

President Obama’s ambitious universal health care plan aims to provide affordable and accessible health care for all. The plan to cover the estimated 46.5 million uninsured, however, ignores the over thirty million non-citizens living in the United States. If the United States passes universal health care coverage, Congress should repeal the prohibitions of the Welfare Reform Act, extend Medicaid coverage to non-citizens, and allow non-citizens to purchase employer-based insurance coverage.

President Obama’s plan follows the lead of state universal health care legislation by retaining private, employer-sponsored insurance coverage and expanding the eligibility requirements of the Medicaid program. This strategy will not aid uninsured immigrants or overburdened states and hospitals, though, because current law excludes most non-citizens from nonemergency health care services.
Retail Health Clinics: How the Next Innovation in Market-Driven Health Care is Testing State and Federal Law
Authors: Rozga Kaj
Published: January 2017

The emergence of in-store retail health clinics (RHCs) has sparked a debate that pits quality of care concerns against the advantages of consumer choice in the marketplace for health care. RHCs appear in pharmacies, grocery stores, and big-box retailers like Wal-Mart, offering basic health care services on a walk-in basis that are administered primarily by nurse practitioners (NPs). Proponents of these clinics hail their pro-market effects: convenience and cost-savings associated with consumer-driven health care; lower prices from increased competition between providers; and increased access to basic health care. Critics of RHCs raise concerns that quality of care is hindered by the lack of physician oversight, disruption of the “medical home,” and the conflicts of interest arising from prescribing drugs at pharmacy-housed clinics.
Legal Impediments to Implementing Value-Based Purchasing in Healthcare
Authors: Claiborne Anne B. , Hesse Julia R. , Roble Daniel T. ,   Ropes & Gray LLP
Published: January 2017

The U.S. healthcare system continually confronts the challenge of controlling costs, improving quality and patient safety, and increasing or maintaining patient access to care. Payors and purchasers of healthcare (both public and private) strive to develop mechanisms to guarantee that they are purchasing the highest-value care – seeking to ensure that amounts paid take into account and provide incentives encouraging the delivery of high-quality, cost-efficient care. Through “value-based purchasing” (“VBP”) strategies, healthcare payors and purchasers are transforming from passive payors of claims (as in a traditional fee for service system) to active purchasers of quality care. To date, employers, health plans, and the Centers for Medicare and Medicaid Services (“CMS”) have implemented well over 100 VBP programs. However, progress is slower than anticipated. As the Institute of Medicine (“IOM”) and others have noted, adoption of VBP reforms may be hampered by legal barriers arising from a number of state and federal laws. The goal of this paper is to identify potential state and federal legal impediments to implementing VBP in healthcare.
The Commercial Speech Doctrine in Health Regulation: The Clash between the Public Interest in a Robust First Amendment and the Public Interest in Effective Protection from Harm
Authors: Orentlicher David
Published: January 2017

Historically, government has been given more leeway when invoking its interests in safeguarding the public health than when asserting other state interests. Thus, for example, when considering a constitutional challenge to mandatory smallpox immunization in Jacobson v. Massachusetts, the Supreme Court employed its highly deferential, rational basis review rather than the stricter level of scrutiny that it normally employs when individuals assert interests in bodily integrity. Similarly, Congress and the Food and Drug Administration (FDA) have imposed greater restrictions on the speech of pharmaceutical companies than have been considered acceptable for speech in other commercial settings.

In recent years, however, it appears that a trend is developing toward applying the same level of constitutional scrutiny to health regulation. In Abigail Alliance, a three-judge panel in the U.S. Court of Appeals for the D.C. Circuit overrode FDA regulations to recognize a constitutional right of access for patients to experimental chemotherapy.
Flexibilities in WTO Law to Support Tobacco Control Regulation
Authors: Voon Tania
Published: January 2017

Cases concerning the regulation of tobacco have long existed within the World Trade Organization (WTO) and its predecessor, the General Agreement on Tariffs and Trade 1947 (GATT 1947), although often these cases have not centered on the detrimental health impact of tobacco products. With the 2012 circulation of the Report of the WTO Appellate Body in U.S.—Clove Cigarettes, the potential friction between international trade law and tobacco regulation in the context of public health has come to the fore. In that Report, the Appellate Body found in part against the United States’ flavored cigarette ban. Combined with the ongoing WTO challenges to mandatory plain tobacco packaging in Australia—Tobacco Plain Packaging, governments might begin to fear that the WTO agreements represent an insurmountable barrier to ambitious tobacco control measures. However, careful examination of the Clove Cigarettes case alongside the two other recent Appellate Body Reports (U.S.—Tuna II (Mexico)5 and U.S.—COOL6) on the WTO's Agreement on Technical Barriers to Trade (TBT Agreement)7 demonstrates that the TBT Agreement has ample flexibility to accommodate health objectives underlying tobacco regulation.
Commercial Speech Law and Tobacco Marketing: A Comparative Discussion of the United States and Canada
Authors: Berman Micah L.
Published: January 2017

In November 2011, U.S. District Court Judge Richard Leon ruled that the U.S. Food and Drug Administration's (FDA’s) proposed graphic health warnings for cigarette packages violated tobacco companies’ First Amendment rights. In doing so, he pointedly refused to consider the experiences of Canada, the United Kingdom, and the more than thirty other countries that had adopted similar graphic warnings in the past decade. Rather, he swatted away all references to those other countries’ experiences by stating (first at oral argument and then in his decision) that “none of [those countries] afford First Amendment protections like those found in our Constitution.”

While it is true that no other country uses the First Amendment per se, many other countries do offer constitutional protection to freedom of speech and/or freedom of expression. Indeed, several other countries apply “strikingly similar” legal tests when reviewing restrictions on speech (and on commercial speech in particular). Thus, the statement that other countries do not “afford First Amendment protections like those found in our Constitution” is an oversimplification.
The Trans-Pacific Partnership Agreement: A Gold-Plated Gift to the Global Tobacco Industry?
Authors: Kelsey Jane
Published: January 2017

Proponents of the Trans-Pacific Partnership agreement (TPPA) describe it as a twenty-first century agreement that will reach further behind the border than any previous free trade or investment agreement. As the chief executive of Business New Zealand said during the round of TPPA negotiations in Auckland in December 2012:

It is true that TPP is more than just a trade negotiation.

That's because TPP has the capacity to reach further into domestic economies and domestic policy settings than a conventional trade agreement - as it must if the essential requirements of business are to be addressed and a real difference made, for growth, jobs and community success.

More specifically, the TPPA aims to frame how governments make their domestic policy and regulatory decisions as a complement to more extensive rules that constrain the substance of those decisions. These “disciplines” aim to empower commercial players and advance their interests, and to marginalize competing priorities, advocates, and agencies; including democratic political institutions.
The First Amendment and Public Health, at Odds
Authors: Mermin Seth E. , Graff Samantha K.
Published: January 2017

At the turn of the last century, allies of industry on the Supreme Court deployed a novel constitutional doctrine to thwart government regulations aimed at improving public health and safety. During the Lochner v. New York era, the Supreme Court discovered a right to “freedom of contract” in the Due Process Clause of the Fourteenth Amendment that advanced the “economic liberty” of businesses to conduct their affairs without government oversight. The newfound freedom of contract forbade, for example, public policies aimed at improving factory conditions by setting maximum working hours, forbidding child labor, or setting a minimum wage. The Court later somewhat abashedly changed course, finding that government in fact had great leeway to implement economic regulations protecting and promoting general welfare.

Today, seventy-five years after the Supreme Court repudiated the doctrine of economic substantive due process, the Court has backtracked to the notion that the Constitution significantly impedes the government's ability to safeguard public health and safety by regulating commercial activities.
Tobacco Control Lessons from the Higgs Boson: Observing a Hidden Field behind Changing Tobacco Control Norms in Japan
Authors: Levin Mark A.
Published: January 2017

Despite the overall theme of this Issue being the future of global tobacco control, this Article is about Japan, with the conscious intention of presenting Japan as a demonstration of a different type of tobacco control environment. To be clear, I am not trying to suggest Japan is an unambiguously positive exemplar for other nations. Rather, it is with the idea that Japan's circumstances might be showing us that things are not always as bad as they might first appear. To quote Mick Jagger and Keith Richards, great philosophers of the twentieth century, “You can't always get what you want, but if you try sometimes, you just might find, you get what you need.”
Combating the Prescription Painkiller Epidemic: A National Prescription Drug Reporting Program
Authors: Shepherd Joanna
Published: January 2017

Prescription painkiller abuse is the fastest growing drug problem in the United States. In the past year, approximately one out of twenty Americans reported misuse or abuse of prescription painkillers. Several factors contribute to the prescription painkiller epidemic. Drug abusers use various methods—such as doctor shopping, paying with cash, and filling prescriptions in different states—to avoid detection and obtain prescription painkillers for illegitimate uses. A few rogue physicians and pharmacists, lured by substantial profits, enable drug abusers by illegally prescribing or supplying controlled substances. Even ethical physicians rarely have adequate training to recognize and address prescription drug abuse, and as a result, prescribe painkillers to patients who are not using them for legitimate medical purposes. Similarly, although the majority of pharmacies have taken steps to combat drug abuse and reduce prescription painkiller dispensing, under current reporting systems, pharmacists lack visibility into several important indicators of drug abuse. As a result, even the most vigilant pharmacists find it extremely difficult to identify and detect drug abuse with certainty.

While state governments have established prescription drug monitoring programs (PDMPs) to crack down on prescription drug abuse, these programs have proven to be inadequate. The programs currently suffer from inadequate data collection, ineffective utilization of data, insufficient interstate data sharing, and constraints on sharing data with law enforcement and state agencies. By contrast, third-party prescription payment systems run by pharmacy benefit managers (PBMs) or health insurers have been effective in detecting prescription drug abuse. This paper suggests that a national prescription drug reporting program building on existing PBM networks could be significantly more effective than existing state PDMPs in detecting prescription drug abuse.
Beyond Payment and Delivery Reform: The Individual Mandate's Cost-Control Potential
Authors: Moncrieff Abigail R. , Padi Manisha
Published: January 2017

In a symposium focused on healthcare cost control, most of our authors have unsurprisingly highlighted and assessed Obamacare’s payment and delivery reforms—the supply-side efforts to decrease costs of medical treatment. But there is another party in healthcare decision-making who is equally or even more important: the patient. The question we will tackle here is whether the individual mandate and its accompanying patient-centered insurance reforms might decrease costs for patients in ways that ought to matter in assessing Obamacare’s cost control provisions.

The individual mandate’s cost control potential lies in its reduction or even elimination of patients’ decision costs. The mandate, together with its minimum coverage requirements and a handful of the statute’s substantive insurance reforms, combats demand-side inefficiencies that might arise from patients’ bounded rationality. Decisions about whether to buy commercial insurance, how much insurance to buy, whether to consume preventive care, and how much to pay for that care are all difficult decisions. In order to make optimal choices, patients need a lot of information that is costly to obtain and to evaluate.
State Fiscal Considerations and Research Opportunities Emerging from the Affordable Care Act's Medicaid Expansion
Authors: Sullivan Jean C. , Gershon Rachel
Published: January 2017

As enacted, the Affordable Care Act (ACA) directed states to provide Medicaid coverage to most nonelderly adults with incomes up to 138% of the Federal Poverty Level (the “Medicaid expansion group”) beginning in 2014. The Medicaid expansion provision of the ACA is an integral component of fulfilling the ACA’s primary objective to achieve near-universal health insurance coverage rates across the United States.

Title XIX of the Social Security Act (Title XIX) is Medicaid’s enabling statute. Medicaid is a medical assistance program for certain low-income individuals, jointly funded and administered by federal and state governments. Certain features of the Medicaid program provide a framework within which the ACA and subsequent Supreme Court decision National Federation of Independent Business (NFIB) v. Sebelius can be understood.
Richard Smith Ankle Arthroplasty
Authors: Kirkup John
Published: January 2017

The indications for ankle joint replacement and the advantages of a ‘ball-and-socket’ type of prosthesis are examined. The results of 24 Richard Smith ankle replacements of which 18 were followed for an average of 7 years are analysed and the case for abandoning this prosthesis is discussed.
Undergraduate Training for Communication in Medical Practice
Authors: Crisp A H
Published: January 2017

Communication is a major aspect of medical practice in such areas as the consultation, counselling, team work, management duties, health education and teaching. Many communication skills essential to the clinical consultation are different from those used in everyday life. They require an understanding of the doctor/patient relationship and of the self as well as of others. They also require a subserving repertoire of specific behavioural skills. The present paper sets out to emphasize this pervasive importance of communication skills in medical practice and to suggest some educational goals and objectives for those skills of particular relevance to the consultation. It describes one attempt to pursue these within the author's own school despite the piecemeal nature of such teaching. In Britain great emphasis is placed on the importance of clinical skills and this is reflected in the priority given to them in the final professional examination, and yet their communication aspects are rarely well defined within the curriculum or directly assessed. The author advocates the teaching and assessment of communication skills as a continuous process throughout undergraduate and postgraduate medical education for clinical practice.
Does Dimethicone Increase the Efficacy of Antacids in the Treatment of Reflux Oesophagitis?
Authors: Ogilvie A L , Atkinson Michael
Published: January 2017

Dimethicone is a common additive to antacids, although its value in the treatment of reflux oesophagitis is unproven. Its efficacy was assessed by comparing the effect of a dimethicone-containing antacid gel (Asilone Gel) with a simple antacid gel in a double-blind trial in 45 patients with reflux oesophagitis. Thirty-eight patients completed the eight-week course of therapy.

Antacid therapy alone resulted in a significant improvement of both symptoms and oesophagitis in gastro-oesophageal reflux. The inclusion of dimethicone in the antacid gel preparation did not confer any benefit in terms of symptomatic assessment but did confer a small advantage with regard to objective markers of oesophageal inflammation, suggesting that a dimethicone-containing antacid is of value in the treatment of symptomatic gastro-oesophageal reflux.
Combination Chemotherapy of Squamous Cell Carcinoma of the Bronchus with Cisplatinum and Bleomycin Followed by Radiotherapy: Results of a Pilot Study
Authors: Karp S J , Young Teresa E , Bakowski Marie T , Spittle Margaret F
Published: January 2017

Thirteen patients were entered into an uncontrolled pilot study to investigate the response to, and toxicity of, a combination of cisplatinum (20 mg/m2) and bleomycin (6 mg/m2) infused daily for 5 days and repeated every 21 days up to a maximum of 4 cycles, in the treatment of squamous cell carcinoma of the bronchus. This regimen was subsequently followed by a split course of local irradiation. All patients have been followed to death. Six patients showed a partial response to chemotherapy while 7 showed no response or progressive disease. The median survival was 5 months. The median survival of the responders was 15 months and that of the non-responders 3 months. Two patients developed the syndrome of inappropriate antidiuretic hormone secretion from which one died. The longest survivor, who died 26 months after the commencement of chemotherapy, had severe mediastinal and pulmonary fibrosis.
The Middle Ear in Cleft Palate Children Pre and Post Palatal Closure
Authors: Dhillon R S
Published: January 2017

A multicentre prospective trial was commenced in July 1984 to establish the incidence of otitis media with effusion (OME) in children born with a cleft of the palate. Additionally, the data recorded would allow an assessment of the effect of palatal closure on middle ear function.

Prior to palatal closure, 97% of ears in a group of 50 patients had otitis media with effusion (OME). The insertion of a long-term ventilation tube provided a means of aeration of one ear with the non-ventilated ear acting as a control. Eighty percent of control ears had persistent OME during a 24-month follow-up period post palatal repair.

It would seem that OME is universally present in children with a cleft palate prior to 4 months of age and this incidence is only marginally diminished by palatal surgery. The liaison between plastic surgical and ENT units should be even closer than before in order to manage these patients satisfactorily.