bluuebunny/crossref_metadata_2025 huggingface dataset:
Recycling of Waste MDF by Steam Refining: Evaluation of Fiber and Paper Strength Properties
Authors: Hagel Sebastian , Joy Jesan , Cicala Gianluca , Saake Bodo
Published: February 2021

Currently, most of the collected waste medium-density fiberboards (MDF) is incinerated or landfilled, as economically viable recycling methods are yet to be developed. By steam refining waste medium-density fiberboards (MDF), it is possible to hydrolyze the incorporated resins and isolate a high yield fiber fraction. Further refining of the steam treated fibers might enable the fibers to be utilized in applications such as paper packaging, facilitating a cascading use of the waste material stream. To this end, intimate knowledge of the material is needed. In this study, the steam refined fibers of two waste MDF samples containing differing amounts of softwood and hardwood underwent refining and beating. The resulting fibers were characterized regarding their morphology and paper test sheets were produced to evaluate their strength (compression-, tensile- and tear-strength). Distinct differences in response to refining between the MDF samples were apparent. For the sample with the higher hardwood share an increase in strength properties with increasing steam treatment severities could be observed and it was possible to produce test sheets with comparable compression strength to recycled pulp for industrial corrugated paperboard. For the sample with a higher share of softwood, the steam treatment severity did not show any influence on fiber morphology or paper properties, and the resulting paper strength was low in comparison to the other steam refined waste MDF sample.

Graphic Abstract
On the Koebe Quarter Theorem for certain polynomials
Authors: Ignaciuk Szymon , Parol Maciej
Published: February 2021

We study problems similar to the Koebe Quarter Theorem for close-to-convex polynomials with all zeros of derivative in $${\mathbb {T}}:=\{z\in {\mathbb {C}}:|z|=1\}$$

T
:
=
{
z
∈
C
:
|
z
|
=
1
}

. We found minimal disc containing all images of $${\mathbb {D}}:=\{z\in {\mathbb {C}}: |z|<1\}$$

D
:
=
{
z
∈
C
:
|
z
|
<
1
}

and maximal disc contained in all images of $${\mathbb {D}}$$
D
through polynomials of degree 3 and 4. Moreover we determine the extremal functions for both problems.
Growth and Differentiation of Circulating Stem Cells After Extensive Ex Vivo Expansion
Authors: Barbon Silvia , Rajendran Senthilkumar , Bertalot Thomas , Piccione Monica , Gasparella Marco , Parnigotto Pier Paolo , Di Liddo Rosa , Conconi Maria Teresa
Published: February 2021

Background:

Stem cell therapy is gaining momentum as an effective treatment strategy for degenerative diseases. Adult stem cells isolated from various sources (i.e., cord blood, bone marrow, adipose tissue) are being considered as a realistic option due to their well-documented therapeutic potentials. Our previous studies standardized a method to isolate circulating multipotent cells (CMCs) that are able to sustain long term in vitro culture and differentiate towards mesodermal lineages.

Methods:

In this work, long-term cultures of CMCs were stimulated to study in vitro neuronal and myogenic differentiation. After induction, cells were analysed at different time points. Morphological studies were performed by scanning electron microscopy and specific neuronal and myogenic marker expression were evaluated using RT-PCR, flow cytometry and western blot. For myogenic plasticity study, CMCs were transplanted into in vivo model of chemically-induced muscle damage.

Results:

After neurogenic induction, CMCs showed characteristic dendrite-like morphology and expressed specific neuronal markers both at mRNA and protein level. The calcium flux activity of CMCs under stimulation with potassium chloride and the secretion of noradrenalin confirmed their ability to acquire a functional phenotype. In parallel, the myogenic potential of CMCs was confirmed by their ability to form syncytium-like structures in vitro and express myogenic markers both at early and late phases of differentiation. Interestingly, in a rat model of bupivacaine-induced muscle damage, CMCs integrated within the host tissue taking part in tissue repair.

Conclusion:

Overall, collected data demonstrated long-term cultured CMCs retain proliferative and differentiative potentials suggesting to be a good candidate for cell therapy.
Perioperative Management of Severe Acquired Coagulopathy in Patients with Left Ventricular Assist Device—a Literature Review and Expert Recommendations
Authors: Koster Andreas , Hulde Nikolai , von Dossow Vera , Erdoes Gabor
Published: February 2021

Purpose of This Review

The implantation of a left ventricular assist device (LVAD) is associated with high hemorrhage-related re-exploration rates. Improved management of coagulopathy may improve patient outcome. The optimal management of acquired coagulopathy in LVAD patients needing urgent non-cardiac surgery needs to be defined. We aim to review risk factors for perioperative bleeding and diagnosis and management of LVAD-associated coagulopathy and to provide expert recommendations for clinical practice.

Recent Findings

In patients undergoing LVAD implantation, the severity of coagulopathy is directly related to the severity of the cardiac failure. The evidence from current literature for optimal management of acquired coagulopathy during and after LVAD implantation is sparse. The traditional transfusion strategy of replacing coagulation factors with fresh frozen plasma involves the risk of transfusion-associated circulatory overload. Current recommendations for targeted replacement of coagulation factors with 4-factor prothrombin concentrate and fibrinogen concentrate in cardiac surgery may be translated in this special setting.

The targeted, point-of-care use of concentrated coagulation factors may improve treatment of severe acquired coagulopathy during LVAD implantation and in LVAD patients needing urgent non-cardiac surgery.
Severe allergic reactions after COVID-19 vaccination with the Pfizer/BioNTech vaccine in Great Britain and USA
Authors: Klimek Ludger , Novak Natalija , Hamelmann Eckard , Werfel Thomas , Wagenmann Martin , Taube Christian , Bauer Andrea , Merk Hans , Rabe Uta , Jung Kirsten , Schlenter Wolfgang , Ring Johannes , Chaker Adam , Wehrmann Wolfgang , Becker Sven , Mülleneisen Norbert , Nemat Katja , Czech Wolfgang , Wrede Holger , Brehler Randolf , Fuchs Thomas , Jakob Thilo , Ankermann Tobias , Schmidt Sebastian M. , Gerstlauer Michael , Vogelberg Christian , Zuberbier Thomas , Hartmann Karin , Worm Margitta
Published: February 2021

Two employees of the National Health Service (NHS) in England developed severe allergic reactions following administration of BNT162b2 vaccine against COVID-19 (coronavirus disease 2019). The British SmPC for the BNT162b2 vaccine already includes reference to a contraindication for use in individuals who have had an allergic reaction to the vaccine or any of its components. As a precautionary measure, the Medicines and Healthcare products Regulatory Agency (MHRA) has issued interim guidance to the NHS not to vaccinate in principle in “patients with severe allergies”. Allergic reactions to vaccines are very rare, but vaccine components are known to cause allergic reactions. BNT162b2 is a vaccine based on an mRNA embedded in lipid nanoparticles and blended with other substances to enable its transport into the cells. In the pivotal phase III clinical trial, the BNT162b2 vaccine was generally well tolerated, but this large clinical trial, used to support vaccine approval by the MHRA and US Food and Drug Administration, excluded individuals with a “history of a severe adverse reaction related to the vaccine and/or a severe allergic reaction (e.g., anaphylaxis) to a component of the study medication”. Vaccines are recognized as one of the most effective public health interventions. This repeated administration of a foreign protein (antigen) necessitates a careful allergological history before each application and diagnostic clarification and a risk–benefit assessment before each injection. Severe allergic reactions to vaccines are rare but can be life-threatening, and it is prudent to raise awareness of this hazard among vaccination teams and to take adequate precautions while more experience is gained with this new vaccine.
Intelligent IoT systems for civil infrastructure health monitoring: a research roadmap
Authors: Bertino E. , Jahanshahi M. R. , Singla A. , Wu R.-T.
Published: February 2021

This paper addresses the problem of efficient and effective data collection and analytics for applications such as civil infrastructure monitoring and emergency management. Such problem requires the development of techniques by which data acquisition devices, such as IoT devices, can: (a) perform local analysis of collected data; and (b) based on the results of such analysis, autonomously decide further data acquisition. The ability to perform local analysis is critical in order to reduce the transmission costs and latency as the results of an analysis are usually smaller in size than the original data. As an example, in case of strict real-time requirements, the analysis results can be transmitted in real-time, whereas the actual collected data can be uploaded later on. The ability to autonomously decide about further data acquisition enhances scalability and reduces the need of real-time human involvement in data acquisition processes, especially in contexts with critical real-time requirements. The paper focuses on deep neural networks and discusses techniques for supporting transfer learning and pruning, so to reduce the times for training the networks and the size of the networks for deployment at IoT devices. We also discuss approaches based on machine learning reinforcement techniques enhancing the autonomy of IoT devices.
A Systematic Review on Sexual Boredom
Authors: de Oliveira Leonor , Carvalho Joana , Nobre Pedro
Published: February 2021

Background

Empirical data on sexual boredom are scarce and unsystematized, contrasting with the literature on general boredom.

Aim

The aim of this review of literature is to verify how sexual boredom is defined in previous research and which relationships were found with sexual functioning, relationship dynamics, or gender.

Methods

A systematic search was conducted in EBSCO, Scopus, Web of Science, and PubMed databases for papers published until August 2020. Search terms used were “sexual boredom” or “sexual tedium” or “sexual indifference” or “sexual monotony” or a combination of “boredom” and “sexual activity” or “intercourse”. This systematic review followed PRISMA guidelines.

Outcomes

Articles were grouped in general boredom and sexuality research and in sexual boredom research.

RESULTS

This review consists of 43 articles, of which 31 are quantitative studies, 8 are qualitative studies, and 4 are mixed-method studies. Studies concerning general boredom and sexuality include research on diverse aspects of sexual behavior, namely solitary sexual behavior, extra-dyadic sex, compulsive sexual behavior, and risky sexual behavior. Sexual boredom research included papers regarding personality, sexual response, and varied aspects of sexual behavior.

Clinical Implications

Findings suggest sexual boredom is related with sexual response, sexual satisfaction, and hypersexuality, which renders clinical relevance. Sexual boredom impacts well-being, and further research should focus on exploring potential mechanisms underpinning this sexual problem.

Strengths and limitations

To the authors’ knowledge, this is the only existing systematic review of sexual boredom and allowed identifying key features of sexual boredom and related aspects. However, because most studies are correlational, and several do not use comprehensive measures of sexual boredom, no causal relationships were identified.

CONCLUSION

This review indicates the construct of sexual boredom includes individual, relationship, and societal aspects. However, no definition of sexual boredom includes these, and current knowledge does not allow formulating a model or a theory of sexual boredom.
Design at hackathons: new opportunities for design research
Authors: Flus Meagan , Hurst Ada
Published: February 2021

Hackathons are short-term events at which participants work in small groups to ideate, develop and present a solution to a problem. Despite their popularity, and significant relevance to design research, they have only recently come into research focus. This study presents a review of the existing literature on the characteristics of designing at hackathons. Hackathon participants are found to follow typical divergence–convergence patterns in their design process throughout the hackathon. Unique features include the initial effort to form teams and the significant emphasis on preparing and delivering a solution demo at the final pitch. Therefore, hackathons present themselves as a unique setting in which design is conducted and learned, and by extension, can be studied. Overall, the review provides a foundation to inform future research on design at hackathons. Methodological limitations of current studies on hackathons are discussed and the feasibility of more systematic studies of design in these types of settings is assessed. Further, we explore how the unique nature of the hackathon format and the diverse profiles of hackathon participants with regards to subject matter knowledge, design expertise and prior hackathon experience may affect design cognition and behaviour at each stage of the design process in distinctive ways.
Fragmentation and Old Evidence
Authors: Fleisher Will
Published: February 2021

Bayesian confirmation theory is our best formal framework for describing inductive reasoning. The problem of old evidence is a particularly difficult one for confirmation theory, because it suggests that this framework fails to account for central and important cases of inductive reasoning and scientific inference. I show that we can appeal to the fragmentation of doxastic states to solve this problem for confirmation theory. This fragmentation solution is independently well-motivated because of the success of fragmentation in solving other problems. I also argue that the fragmentation solution is preferable to other solutions to the problem of old evidence. These other solutions are already committed to something like fragmentation, but suffer from difficulties due to their additional commitments. If these arguments are successful, Bayesian confirmation theory is saved from the problem of old evidence, and the argument for fragmentation is bolstered by its ability to solve yet another problem.
Antisaccade error rates and gap effects in psychosis syndromes from bipolar-schizophrenia network for intermediate phenotypes 2 (B-SNIP2)
Authors: Huang Ling-Yu , Jackson Brooke S. , Rodrigue Amanda L. , Tamminga Carol A. , Gershon Elliot S. , Pearlson Godfrey D. , Keshavan Matcheri S. , Keedy Sarah S. , Hill S. Kristian , Sweeney John A. , Clementz Brett A. , McDowell Jennifer E.
Published: February 2021

Background

Antisaccade tasks can be used to index cognitive control processes, e.g. attention, behavioral inhibition, working memory, and goal maintenance in people with brain disorders. Though diagnoses of schizophrenia (SZ), schizoaffective (SAD), and bipolar I with psychosis (BDP) are typically considered to be distinct entities, previous work shows patterns of cognitive deficits differing in degree, rather than in kind, across these syndromes.

Methods

Large samples of individuals with psychotic disorders were recruited through the Bipolar-Schizophrenia Network on Intermediate Phenotypes 2 (B-SNIP2) study. Anti- and pro-saccade task performances were evaluated in 189 people with SZ, 185 people with SAD, 96 people with BDP, and 279 healthy comparison participants. Logistic functions were fitted to each group's antisaccade speed-performance tradeoff patterns.

Results

Psychosis groups had higher antisaccade error rates than the healthy group, with SZ and SAD participants committing 2 times as many errors, and BDP participants committing 1.5 times as many errors. Latencies on correctly performed antisaccade trials in SZ and SAD were longer than in healthy participants, although error trial latencies were preserved. Parameters of speed-performance tradeoff functions indicated that compared to the healthy group, SZ and SAD groups had optimal performance characterized by more errors, as well as less benefit from prolonged response latencies. Prosaccade metrics did not differ between groups.

Conclusions

With basic prosaccade mechanisms intact, the higher speed-performance tradeoff cost for antisaccade performance in psychosis cases indicates a deficit that is specific to the higher-order cognitive aspects of saccade generation.
Judicial Review of Internal Policy Decisions of Private Nonprofit Hospitals: A Common Law Approach
Authors: McMahon John J.
Published: February 2021

Internal policy decisions of private nonprofit hospitals can have a powerful impact. For example, the denial of medical staff privileges to a physician can limit his income and perhaps damage his reputation. The rejection of a prospective father’s request to assist his wife in the hospital’s delivery room during childbirth deprives the couple of the opportunity to share one of life’s most profound experiences.

Plaintiffs aggrieved by, and seeking to challenge, a policy decision of a private nonprofit hospital often turn instinctively to the fourteenth amendment to the U.S. Constitution for a remedy, hoping to prove (1) “state action” by the hospital and (2) violation of the constitutional rights of the plaintiff. Currently, suggests the author, such an approach is likely to be of limited usefulness. As an alternative, the plaintiff may be able to marshall a common law challenge based on the argument that the hospital, although privately owned, is “affected with a public interest”—that is, it is sufficiently “public” in nature and function that it has a common law duty to serve the public fairly and reasonably, a duty enforceable in a state court. Courts that characterize private nonprofit hospitals as enterprises affected with a public interest (as many courts currently do) will review the challenged hospital policy decision and will decide whether or not, on balance, it was “procedurally fair” and “substantively rational.” This common law approach to judicial review, whose roots are deep in medieval English law, will have a bright future if state courts are willing to heed their common law heritage.
Letting Defective Babies Die: Who Decides?
Authors: Ellis T. S.
Published: February 2021

This Article explores who, in the first instance, should decide whether to withhold or withdraw treatment from a defective newborn. The Article begins by defining the term “severely defective newborn” and discussing potential sources of liability for persons who decide to withhold or withdraw treatment. It next analyzes the ability of parents, physicians, and courts to make these treatment decisions. The Article concludes that, although parents and physicians may eventually make the specific determination, the legislature should at least set guidelines so that the decisions will be, in some measure, consistent, predictable, adequately informed, and in accord with community values.
O’Bannon v. Town Court Nursing Center: Patients’ Right to Participate in Nursing Home Decertification
Authors: Rosenfeld Susan
Published: February 2021

A decertification action by the Department of Health and Human Services (formerly the Department of Health, Education and Welfare) substantially impacts on the lives of Medicaid patients who reside in the affected nursing home. Decertification means that the federal government, the state government, or both will no longer pay for the care of Medicaid patients in the decertified home. Thus, a decision to decertify necessitates the transfer of elderly and infirm Medicaid patients out of the decertified home. Since this transfer may threaten the lives and health of these patients, they should be granted the right to participate in pre-decertification proceedings.

However, in O'Bannon v. Town Court Nursing Center, the Supreme Court decided that patients do not have the right to participate in predecertification proceedings. The Court rejected the patients’ due process arguments, finding: 1) that decertification does not deprive the patients of any constitutionally protected interest in life, liberty, or property; and 2) that any adverse consequences of decertification are only an “indirect and incidental” result of government action.

This Comment analyzes the Supreme Court opinion and concludes that the patients have protectable property and life interests that entitle them to participate in some form of hearing prior to the decertification of the nursing home where they reside. In addition, this Comment suggests alternative methods for asserting nursing home patients’ legal rights.
State Legislation on Abortion after Roe v. Wade: Selected Constitutional Issues
Authors: Bryant M. David
Published: February 2021

Over the past three years, a great volume of legislation on abortion has been produced by state legislatures in an attempt to fill the vacuum created by the United States Supreme Court’s 1973 decision in Roe v. Wade. This Article examines several of the most common types of statutory provisions and assesses their constitutionality in light of Roe v. Wade and other applicable federal and state legal standards.
Clinical Approaches to Teaching Legal Medicine to Physicians: Medicolegal Emergencies and Consultations
Authors: Dietz Park Elliott
Published: February 2021

Physicians-in-training generally have insufficient exposure to legal medicine to prepare them for the medicolegal problems they will encounter in practice. This Article outlines the current structure of the field of legal medicine in America, and sets forth two strategies with clinical orientations for teaching legal medicine to physicians-in-training: (1) providing a didactic course offering accurate and practical information on medicolegal emergency situations; and (2) establishing a consultation service in legal medicine capable of providing clinical information or training in such settings as the emergency room, the outpatient departments, and the inpatient wards.
Controlling Physician Oversupply Through Certificate of Need
Authors: Tierney John T. , Waters William J. , Williams Donald C.
Published: February 2021

By 1990 the aggregate supply of physicians in the United States is likely to exceed the population's requirements by 10 percent or more. State and regional aggregate and specialty-specific surpluses may be more extreme. Since the demand for physician services appears to be determined to a significant degree by the supply of physicians, the number of physicians who can maintain financially viable practices in a region is not likely to be limited effectively by the normal market interaction of supply and demand. Excessive physician supplies may, however, have a number of deleterious effects, including rapid escalation of health care costs, fragmentation of patient care, and a decrease in the quality of patient care.

In this Article, the authors review the potential effectiveness of a number of policy interventions that might be employed to optimize physician supplies in areas of excess. They evaluate the following alternatives: (1) a limit on the number of medical school graduates; (2) control of physician residencies by number and by specialty; (3) creation or implementation of incentive policies; (4) control by hospitals—indirectly by limiting the number of beds, or directly by denying staff privileges; (5) widespread development of HMOs; (6) direct employment by the federal government of the majority of practicing physicians; and (7) creation of certificate of need for physician licensure. The authors conclude that, at least in the short term, certificate of need'for physician licensure is the alternative that shows the greatest promise of enabling the number and specialties of physicians providing patient care in areas facing a physician surplus to be managed in such a way that the populations of such areas can obtain adequate medical care at a reasonable cost.
HMO Development: Threat or Opportunity for Hospitals?
Authors: Mackie Dustin L. , Biblo Robert L.
Published: February 2021

Many hospitals presently find themselves at a vulnerable stage in their development. The increased efficacy of antibiotics, together with the population's increased life span and decreasing birth rate, have reduced the need for the kind of acute inpatient care that hospitals traditionally have provided. Moreover, hospitals now are feeling pressure from federal and state regulatory agencies to eliminate approximately 20 percent of the nation's acute-care beds. Concurrent with the population's changing health needs and with the increasing regulatory pressure from government, the acute-care hospital also must contend with the advent of a rival medical care delivery organization—the health maintenance organization (HMO)—whose primary goal is to provide quality medical services in a costefficient manner. One of the most important ways in which HMOs contain costs is by attempting to reduce significantly the rate of hospitalization of their members, an approach that threatens the very livelihood of some hospitals.

The authors describe five alternative strategies that hospitals can adopt to meet the potential threat of HMOs—filibustering, passive acceptance, direct sponsorship, accommodation, or strong support. They maintain that the latter of these strategies, strong support, places hospitals in the most favorable position to convert the threat of HMO development into an opportunity to build a mutually beneficial relationship.
In re Grady: The Mentally Retarded Individual's Right to Choose Sterilization
Authors: Lachance Denise
Published: February 2021

In the case of In re Grady, the New Jersey Superior Court addressed important issues concerning the propriety of a court's exercise of parens patriae jurisdiction to ratify parents’ substituted consent to the sterilization of their mentally retarded child. This Note discusses the genesis of the fundamental right to choose sterilization, its application to mentally retarded individuals, and the adequacy of the procedural framework enunciated in Grady to assure that substituted consent by the parents is exercised solely in the mentally retarded individual's “best interests.” This Note concludes that, while the Grady court properly exercised its parens patriae jurisdiction, the procedural framework enunciated is inadequate. The Note proposes a model that would implement the procedural elements the Note determines are essential to a “best interests” inquiry. The proposal requires: (1) that the individual be adjudicated incompetent; (2) that a guardian ad litem be appointed and required to argue that sterilization is not in the incompetent's “best interests”; and (3) that the court determine, as a question of fact, whether the parents’ exercise of substituted consent is in the incompetent's “best interests.” The Note also suggests criteria which can be used in making the “best interests” determination, and recommends that “clear and convincing” evidence be required to support the “best interests” standard.
The Antitrust Implications of Boycotts by Health Care Professionals: Professional Standards, Professional Ethics and The First Amendment
Authors: Gilmore Debra A.
Published: February 2021

One rapidly evolving area of the law is the application of antitrust law to health care professionals. After the United States Supreme Court decided in 1975 that the “learned professions” were subject to the constraints imposed by the Sherman Antitrust Act, a significant number of antitrust actions have been filed against health care professionals and their professional organizations under Section 1 of the Sherman Act. These suits have found anticompetitive behavior in a variety of forms, ranging from tying arrangements and price-fixing agreements to certain forms of exclusive contracts and group boycotts.
Adversarial Medical and Scientific Testimony and Lay Jurors: A Proposal for Medical Malpractice Reform
Authors: Menon Jody Weisberg
Published: February 2021

Pleas for reform of the legal system are common. One area of the legal system which has drawn considerable scholarly attention is the jury system. Courts often employ juries as fact-finders in civil cases according to the Seventh Amendment of the Constitution: “In Suits at common law, where the value in controversy shall exceed twenty dollars, the right of trial by jury shall be preserved … .” The general theory behind the use of juries is that they are the most capable fact-finders and the bestsuited tribunal for arriving at the most accurate and just outcomes. This idea, however, has been under attack, particularly by those who claim that cases involving certain difficult issues or types of evidence are an inappropriate province for lay jurors who typically have no special background or experience from which to make informed, fair decisions.

The legal system uses expert witnesses to assist triers of fact in understanding issues which are beyond their common knowledge or difficult to comprehend.
Enterprise Medical Liability and the Choice of the Responsible Enterprise
Authors: Abraham Kenneth S. , Weiler Paul C.
Published: February 2021

During the last year, the proposal of “enterprise” liability for medical malpractice became a major issue in debates about health care and malpractice reform. The idea, however, was not new. In scholarly work over an extended period, we have been developing the systematic case for the concept of enterprise — or, as we originally termed it, “organizational” — liability for medical malpractice. After several years of debating the critics of our proposal to shift the focus of liability for medical injury from individual physicians to the organizations that deliver health care, we were naturally gratified that the idea was now on the national agenda.

In particular, we recommended adoption of enterprise liability to President Clinton's Health Care Task Force. The Task Force did embrace a version of the idea as its own, but then encountered stiff resistance from a number of special interests.
Bad “Bad Baby” Bills
Authors: Mehlman Maxwell J.
Published: February 2021

In the twenty-year-long debate over medical malpractice reform, obstetrics is unique. No other area of specialty medical practice has managed to argue successfully that its malpractice victims should be singled out and barred from obtaining relief through the tort system. Yet, following a well-organized lobbying effort by OB/GYNs, the state legislatures in Virginia and Florida have enacted so-called “bad baby bills” that create workers-compensation-type programs for victims of birth-related injuries. Such statutes provide the exclusive remedy for this and only this class of plaintiffs. Other states are considering following suit: bills have been introduced in North Carolina, Illinois and New York.

What justifies this extraordinary legislative action? Proponents of the reforms admit that the effect of these statutes is to reduce the malpractice burden on OB/GYNs. But they are careful to portray patients rather than physicians as the primary beneficiaries of their efforts.
Patient Accountability and Quality of Care: Lessons From Medical Consumerism and the Patients’ Rights, Women’s Health and Disability Rights Movements
Authors: Rodwin Marc A.
Published: February 2021

This article contrasts the prevailing model for assessing and improving medical care—the quality of care paradigm—with an alternative approach—the patient accountability paradigm. The first approach is technocratic: it measures and promotes the quality of medical care through technical and objective means. It relies on outside experts, analysis of data and protocols, and impersonal judgements of professionals to guide decisions. The second approach guides physicians and providers and subjects them to patient control. It enlists the participation of patients and consumers to evaluate and change the medical care system and to promote the rights and choices of patients and consumers. The strengths and limitations of the patient accountability approach are illustrated by four movements: 1) the patients’ rights movement; 2) medical consumerism; 3) the women’s health movement; and 4) the disability rights movement.
Recent Advances in Medically Assisted Conception: Legal, Ethical and Social Issues
Authors: Knoppers Bartha M. , LeBris Sonia
Published: February 2021

A review of reports, bills and legislation from around the world, during the period from 1987 to 1991, reveals certain areas of consensus on the possible or actual, ethical and legal regulation of medically assisted conception. Other areas remain controversial, due not only to cultural and religious differences but also to the social significance of the very implementation of these new technologies. Irrespective of these differences, the reformulation of certain shared international principles of human rights permits a greater specificity both in their translation and in their application to medically assisted conception. Areas discussed include the dignity of the person, the security of human genetic material, the quality of services, the inviolability of the person and the inalienability of the person.
Community Care, Competition and Coercion: A Legal Perspective on Privatized Mental Health Care
Authors: Wisor Ronald L.
Published: February 2021

Even as the Clinton administration considers an increased federal commitment to mental health care, delivery of such care remains fixed at the state level. In Massachusetts, state officials are privatizing mental health care on an unprecedented scale, an experiment that promises to provide better care at lower cost. This Note explores whether privatization can achieve that lofty goal, given a legal system that has made individual patient autonomy its preeminent value. The author concludes that wide-scale privatization and modern notions of self-determination can only coexist with a significant investment in the support services that are critical to the community tenure of former state hospital patients.
The Empire of Death: How Culture and Economics Affect Informed Consent in the U.S., the U.K., and Japan
Authors: Annas George J. , Miller Frances H.
Published: February 2021

American culture reflects a paradox: the more openly we discuss death and its inevitability, the more money we spend to postpone and deny it. Sherwin Nuland's book How We Die, a frank description of the way our bodies deteriorate with and without medical intervention, topped the New York Times best seller list in the spring of 1994. At the same time, Jack Kevorkian, arguably the world 's best known physician, was being acquitted of violating Michigan 's law against assisted suicide, while a Michigan commission was debating legislative changes to permit physicians to help their terminally ill patients kill themselves. Despite such open discussion of death and expansion of the informed consent doctrine, U.S. medical expenditures at the end of life remain astronomically high. Most of this elevated spending is attributable to new medical technology.

In J.G. Ballard 's Empire of the Sun, the United States, British and Japanese cultures are contrasted through the eyes of a young British boy incarcerated by the Japanese army in China during World War II.
Access to Medical Care for HIV - Infected Individuals Under the Americans with Disabilities Act: A Duty to Treat
Authors: Cohen Jill
Published: February 2021

In 1990, Congress enacted the Americans with Disabilities Act (ADA). This Note examines the legislative history of the ADA and uncovers Congress's intent to impose a duty on health care providers to treat people with disabilities unless an individual poses a “direct threat” to the health or safety of others. This Note posits that, with the passage of the ADA, Congress imposed a statutory duty on health care providers to give care to people infected with HIV who qualify under the statute. This Note concludes that while the “direct threat” exception may lessen the impact of the ADA, those infected with HIV should enjoy greater access to health care than ever before.
The Under-Enrollment of HIV-infected Foster Children in Clinical Trials and Protocols and the Need for Corrective State Action
Authors: McNutt Briar
Published: February 2021

The incidence of HIV infection and AIDS in children has grown at an alarming rate. Approximately one million children worldwide have HIV infection. By the year 2000, an estimated ten million children will suffer from the disease. Currently, the United States has a population of an estimated 10,000 to 20,000 HIV-infected children. As of June 30, 1993, the Centers for Disease Control and Prevention (CDC) reported 4,710 known AIDS cases in children twelve years-old and younger. At that point, New York City reported 1,124 pediatric AIDS cases which represented twenty-four percent of all cases in the United States.

With the rising number of HIV-infected children, the medical community in the United States has begun to search for HIV-and AIDS-related treatments particularized for children. In addition to establishing guidelines for HIV-infected children's frequent check-ups and timely immunizations, the medical community has initiated research studies involving HIV-infected children.
Globalization and Biotechnology: UNESCO and an International Strategy to Advance Human Rights and Public Health
Authors: Taylor Allyn L.
Published: February 2021

The global Human Genome Project (HGP) promises dramatic advances in biomedical science and in identifying and treating diseases and illnesses that exact an enormous toll on people throughout the world. The HGP portends a conceptual revolution in health care: many foresee a new “predictive medicine” based on the development of genetic screening, testing and gene therapy.

Although advances in genetic science create the potential for dramatic progress against disease in rich and poor states, they also pose profound national and global policy concerns, including the potential impact of the scientific developments on human rights and public health. The development of more precise genetic information raises the specter of genetic discrimination by public and private sectors in all nations with access to the new technologies. In addition, nations will grapple increasingly with the appropriate balance between screening for and treatment of genetic diseases in order to promote public health and protect individual rights to privacy and confidentiality. Genetic screening and services also raise human rights questions relating to equitable resource allocation and the protection of public health.
The FDA’s Accelerated Approval Process: Does the Pharmaceutical Industry Have Adequate Incentives for Self-Regulation?
Authors: Orlando Vivian I.
Published: February 2021

Prompted by criticisms of long delays in its drug approval processes, the Food and Drug Administration (FDA or the Administration) took a number of measures in recent years to expedite access and increase availability of new drugs for terminally ill patients. These reforms began in the late 1980s, as acquired immune deficiency syndrome (AIDS) advocacy organizations openly criticized the FDA, noting that its policies were insufficient to address the prevalence of AIDS and the lag time for FDA approval of new AIDS treatments. The FDA's primary responsibility is to promote efficacy and ensure safety of new drugs. Consequently, the FDA must balance patients' desires to obtain new medications to treat serious and lifethreatening illnesses against government's desires to protect patients from abuses of the new drug approval process. The structure of the FDA's regulatory procedures is, therefore, essential to providing safe, effective medical treatments to patients. FDA regulations and guidelines set forth standards and practices that pharmaceutical companies must follow to gain approval of newly developed drugs.
Constitutional Protection of Confessions Made by Mentally Retarded Defendants
Authors: Praiss Donna M.
Published: February 2021

Criminal confessions made in response to custodial questioning are excluded from evidence unless a defendant voluntarily, knowingly and intelligently waived his Miranda rights. In Connelly, the Supreme Court erred by holding that, absent explicit police coercion, a mentally ill individual's waiver is valid. The Court failed to consider the defendant's subjective impairments that might invalidate his waiver. By contrast, the Patterson Court suggested that a defendant's right to counsel may attach at an early stage in a criminal proceeding if the defendant has a significant need for counsel.

This Note addresses the special needs of a mentally retarded person in the criminal justice system. The Note argues that mentally retarded suspects require careful explanation of Miranda rights in order to understand them. The intellectual and adaptive deficiencies which characterize mental retardation also necessitate an inquiry into a valid waiver that accounts for these disabilities. Furthermore, the special needs of the mentally retarded mandate that the right to counsel attach as early as the precustodial stage of an investigation. Early access to counsel most effectively assures that a mentally retarded person's waiver of constitutional rights is voluntary, knowing and intelligent.
Prenatal Genetic Testing and Screening: Constructing Needs and Reinforcing Inequities
Authors: Lippman Abby
Published: February 2021

This Article considers the influence and implications of the application of genetic technologies to definitions of disease and to the treatment of illness. The concept of “geneticization” is introduced to emphasize the dominant discourse in today's stories of health and disease and the social construction of biological phenomenon is described. The reassurance, choice and control supposedly provided by prenatal genetic testing and screening are critically examined, and their role in constructing the need for such technology is addressed. Using the stories told about prenatal diagnosis as a focus, the consequences of a genetic perspective for and on women and their health care needs are explored.
An eHealth Diptych: The Impact of Privacy Regulation on Medical Error and Malpractice Litigation
Authors: Terry Nicolas P.
Published: February 2021

Notwithstanding the continuing debate over the future of managed care and the appropriate protections to be included in a Patient's Bill of Rights, the safeguarding of patient privacy and the reduction of medical error have emerged as the dominant health law issues. Displacing even the implications of the advances in genomics from the front and editorial pages of our newspapers, privacy and medical error have left the cozy world of professional journals and political platitudes to demand corrective action.
Most-Favored-Nation Clauses and Monopsonistic Power: An Unhealthy Mix?
Authors: Stenger Susan E.
Published: February 2021

Most-favored-nations clauses appear in health insurance contracts allegedly to prevent price discrimination by health care providers among competing insurers. In fact, use of these provisions often works to exclude competitors from the health insurance market. This Note examines the antitrust implications of most-favored-nations clauses as used in the health insurance industry.
An Economic and Antitrust Analysis of the Distribution of Medical Products
Authors: Celnicker Arnold C.
Published: February 2021

The techniques used to distribute medical products are designed to maximize the manufacturers’ profits by charging a relatively low price to hospitals and a relatively high price to other purchasers, such as doctors and nursing homes. This pricing scheme raises complex antitrust problems, including vertical price fixing between the manufacturer and its distributors, price discrimination by the manufacturer, and agreements between the manufacturer and the hospitals restricting the hospitals’ ability to resell. This Article examines these antitrust issues.
Heckler v. Chaney: Judicial and Administrative Regulation of Capital Punishment by Lethal Injection
Authors: Stolls Michele
Published: February 2021

Capital punishment by lethal injection, which was expected to be the most safe and effective of available methods, can produce unusually cruel and inhuman death. In Heckler v. Chaney, inmates sentenced to death by lethal injection, as well as members of both the medical and legal communities, challenged the Food and Drug Administration’s (FDA) refusal to regulate certain drugs used for capital punishment by lethal injection. By declining to review the FDA’s nonenforcement decision, the Supreme Court also declined an opportunity to reevaluate its standard for determining cruel and unusual punishment, which upholds any method of execution that is no more unusually cruel than existing methods. This Comment examines the propriety of judicial and administrative regulation of capital punishment by lethal injection.
Private Credentialing of Health Care Personnel: An Antitrust Perspective—Part One
Authors: Havighurst Clark C. , King Nancy M. P.
Published: February 2021

This Article explores the antitrust and other implications of private credentialing and accrediting programs in the health care industry. Although such programs are usually sponsored by powerful competitor groups, they serve the procompetitive purpose of providing useful information and authoritative advice to independent decision makers. Part One examines the risk that credentialing will sometimes be unfair to competitors and deceive consumers. Its survey of common-law, antitrust, and regulatory interventions to correct such unfairness and deception seeks to determine the degree of oversight to which credentialing and similar activities have been and should be subjected. In recommending that judicial or regulatory scrutiny should be limited to discovering whether standards and practices have a rational relation to a procompetitive purpose, the Article argues that greater intrusion into credentialing schemes would be inconsistent with market theory and first amendment values and would discourage line-drawing efforts that stimulate competition and facilitate consumer choice. By emphasizing throughout that personnel certification and institutional accreditation embody ideology and opinion as well as factual information, Part One sets the stage for the argument in Part Two that antitrust law can and should be used to contest the dominance of a single ideology of health care and to facilitate the development of alternative sources of consumer information. The Article’s overall thesis is that, whereas the quality of advice given to the public about health care personnel and similar matters should not be closely regulated, neither should the supply of competing information and opinion be artificially curtailed.
Malpractice Issues in Heart Transplantation
Authors: Overcast Thomas D. , Merrikin Karen J. , Evans Roger W.
Published: February 2021

As organ transplantation procedures become accepted as standard medical practice, it is anticipated that the frequency of liability claims against transplant care providers will increase. This article examines current statutory and common law analyses of malpractice issues in transplantation, with particular attention given to issues of informed consent as they arise both for the organ donor and donee.