The medical malpractice insurance "crises" and federal medical malpractice tort reform: Collection and analysis of bills passed by the United States House of Representatives from 1995--2005

There have been three medical malpractice insurance "crises" in the United States over a time spanning roughly the past three decades (Poisson, 2004, p. 759-760). Each crisis is characterized by a number of common features, including rapidly increasing medical malpractice insurance premiums, cancellation of existing insurance policies, and a decreased willingness of insurers to offer or renew medical malpractice insurance policies (Poisson, 2004, p. 759-760). Given the recurrent "crises," many sources argue that medical malpractice insurance coverage has become too expensive a commodity—one that many physicians simply cannot afford (U.S. Department of Health and Human Services [HHS], 2002, p. 1-2; Physician Insurers Association of America [PIAA], 2003, p. 1; Jackiw, 2004, p. 506; Glassman, 2004, p. 417; Padget, 2003, p. 216). ^ The prohibitively high cost of medical liability insurance is said to limit the geographical areas and medical specializations in which physicians are willing to practice. As a result, the high costs of medical liability insurance are ultimately said to affect whether or not people have access to health care services. ^ In an effort to control the medical liability insurance crises—and to preserve or restore peoples' access to health care—every state in the United States has passed "at least some laws designed to reduce medical malpractice premium rates" (GAO, 2003, p.5-6). More recently, however, the United States has witnessed a push to implement federal reform of the medical malpractice tort system. Accordingly, this project focuses on federal medical malpractice tort reform. This project was designed to investigate the following specific question: Do the federal medical malpractice tort reform bills which passed in the House of Representatives between 1995 and 2005 differ in respect to their principle features? To answer this question, the text of the bills, law review articles, and reports from government and private agencies were analyzed. Further, a matrix was compiled to concisely summarize the principle features of the proposed federal medical malpractice tort reform bills. Insight gleaned from this investigation and matrix compilation informs discussion about the potential ramifications of enacting federal medical malpractice tort reform legislation. ^

AN ESTIMATION OF IN UTERO DRUG EXPOSURE BY DETERMINANTS OF FREQUENCY AND DISTRIBUTION OF MATERNAL DRUG CONSUMPTION

Data derived from 1,194 gravidas presenting at the observation unit of a city/county hospital between October 11, 1979 through December 7, 1979 were evaluated with respect to the proportion ingesting drugs during pregnancy. The mean age of the mother at the time of the interview was 22.0 years; 43.0 percent were Black; 34.0 percent Latin-American, 21.0 percent White and 2.0 percent other; mean gravida was 2.5 pregnancies; mean parity was 1.0; and mean number of previous abortions was 0.34. Completed interview data was available for 1,119 gravida, corresponding urinalyses for 997 subjects. Ninety and one-tenth percent (90.1 percent) of the subjects reported ingestion of one or more drug preparation(s) (prescription, OTC, or substances used for recreational purposes) during pregnancy with a range of 0 to 11 substances and a mean of 2.7. Dietary supplements (vitamins and minerals) were most frequently reported followed by non-narcotic analgesics. Seventy-six and one tenth percent (76.1 percent) of the population reported consumption of prescription medication, 42.5 percent reported consumption of over-the-counter medications, 45.7 percent reported consumption of a substance for recreational purposes and 4.3 percent reported illicit consumption of a substance. For selected substances, no measurable difference was found between obtaining the information from the interview method or from a urinalysis assay. ^

Late Cenozoic silicoflagellate biostratigraphy, relative paleotemperature, and distribution of various genera and morphologic subgroups with remarks on noteworthy occurrences at DSDP Leg 86 Holes

A quantitative study of late Cenozoic silicoflagellates from the northwestern Pacific sites of Deep Sea Drilling Project Leg 86 shows a relative paleotemperature (Ts) gradient with lowest values (Ts = 30) in the north. Some new ecostratigraphic relations for the region are indicated, such as the last common occurrence of Dictyocha brevispina at 2.6 - 3.0 m.y. ago during a cool interval. Elements of North Pacific and low-latitude biostratigraphic zonations can be identified, but the mixing of cool- and warm-indicator taxa prompted the definition of the new Miocene Mesocena hexalitha Subzone and Pliocene Distephanus jimlingii Subzone. Scanning-electron microscope study of Leg 86 silicoflagellates was done to determine whether various types of skeletal surface texture are temperature dependent. To conduct the study we organized a new surface-texture descriptive code, which characterizes the apical structure/basal ring/spine sequence using new definitions of the terms crenulate (C), linear (L), nodular (N), reticulate (R), and smooth (S). One new silicoflagellate genus, Caryocha Bukry et Monechi, n. gen., is described and several new combinations are made.

Reconstruction of the provenance and distribution of terrigenous sediments off NE South America over the last 30ka

We investigate the redistribution of terrigenous materials in the northeastern (NE) South American continental margin during slowdown events of the Atlantic Meridional Overturning Circulation (AMOC). The compilation of stratigraphic data from 108 marine sediment cores collected across the western tropical Atlantic shows an extreme rise in sedimentation rates off the Parnaíba River mouth (about 2°S) during Heinrich Stadial 1 (HS1, 18-15 ka). Sediment core GeoB16206-1, raised offshore the Parnaíba River mouth, documents relatively constant 143Nd/144Nd values (expressed as epsilonNd(0)) throughout the last 30 ka. Whereas the homogeneous epsilonNd(0) data support the input of fluvial sediments by the Parnaíba River from the same source area directly onshore, the increases in Fe/Ca, Al/Si and Rb/Sr during HS1 indicate a marked intensification of fluvial erosion in the Parnaíba River drainage basin. In contrast, the epsilonNd(0) values from sediment core GeoB16224-1 collected off French Guiana (about 7°N) suggest Amazon-sourced materials within the last 30 ka. We attribute the extremely high volume of terrigenous sediments deposited offshore the Parnaíba River mouth during HS1 to (i) an enhanced precipitation in the catchment region and (ii) a reduced North Brazil Current, which are both associated with a weakened AMOC.

(Table 2) Concentrations of dissolved Zn, Cd, Pb, and Cu in waters of the Baltic Sea

A method of determination of low concentrations of zinc, cadmium, lead, and copper dissolved in seawater and interstitial water with use of inversion voltammetry with AC solution conditions is described. The optimum conditions for measurements with accumulation on a mercury-film electrode with a silver substrate are presented. Detection limit is 0.2 ?g/l for zinc and 0.05 ?g/l for cadmium, lead, and copper. Large number of determinations can be carried out during expeditions at natural pH of seawater containing these four metals.

Median grain size and distribution of sand in ODP Hole 108-660A (Fig. 5)

50 m of Middle Eocene pure radiolarian ooze were drilled at ODP Site 660 in the equatorial East Atlantic, 80 km northeast of the Kane Gap. The oozes comprise a 10 m high and 2 km broad mound of seismic reverberations, covered by manganese-rich sediment, and contain trace amounts of sponge spicules and diatoms, negligible organic carbon (0.15%), clay, and variable amounts of pyrite. The yellow to pale brown silty sediments are relatively coarse-grained (30-45% coarser than 6 µm), little bioturbated, and commonly massive or laminated on a cm-scale. The unlithified radiolarian ooze may indicate an interval of high oceanic productivity, probably linked to a palaeoposition of Site 660 close to the equatorial upwelling belt during Middle Eocene time. The absence of organic matter, however, and both the laminated bedding and the mound-like structure of the deposit on the lower slope of a continental rise indicate deposition by relatively intense contour currents of oxygen-rich deep water, which passed through the Kane Gap, winnowed the fine clay fraction, and prevented the preservation of organic carbon. The ooze may be either a contourite-lag deposit, or a contourite accumulation of displaced radiolarians, originating south of the Kane Gap and being deposited in its northern lee, thus documenting the passage of a strong cross-equatorial bottom-water current formed near Antarctica. These Eocene contourites may be an analogue for ancient radiolarites in the Tethyan Ocean.

(Figure 2) Range and distribution chart of dinoflagellate cysts recovered from Campanian to Maestrichtian sediments at DSDP Hole 95-612

Fifty-nine samples from the basal 110 m of DSDP Hole 612 (United States Atlantic Margin) were analyzed for palynomorph content. In total, 84 species and subspecies of dinoflagellate cysts were recorded which, on comparison with published data and shipboard analyses, indicate a Campanian to Maestrichtian age for this part of the succession. The Campanian/Maestrichtian contact is taken to occur in the upper part of Core 612-69.

Sediment thickness and distribution of facies types in the Kara Sea

We studied the impact of the last glacial (late Weichselian) sea level cycle on sediment architecture in the inner Kara Sea using high-resolution acoustic sub-bottom profiling. The acoustic lines were ground-truthed with dated sediment cores. Furthermore we refined the location of the eastern LGM ice margin, by new sub bottom profiles. New model results of post-Last Glacial Maximum (LGM) isostatic rebound for this area allow a well-constrained interpretation of acoustic units in terms of sequence stratigraphy. The lowstand (or regressive) system tract sediments are absent but are represented by an unconformity atop of Pleistocene sediments on the shelf and by a major incised dendritic paleo-river network. The subsequent transgressive and highstand system tracts are best preserved in the incised channels and the recent estuaries while only minor sediment accumulation on the adjacent shelf areas is documented. The Kara Sea can be subdivided into three areas: estuaries (A), the shelf (B) and (C) deeper lying areas that accumulated a total of 114 * 10**10 t of Holocene sediments.

Stable isotope record and distribution of foraminifera in sediment core GeoB3004-1

Fluctuations in the abundance of selected foraminiferal indicator species and diversity allowed the reconstruction of changes in deepwater oxygenation and monsoon-driven organic matter fluxes in the deep western Arabian Sea during the last 190 kyr. Times of maximum surface production coincide with periods of intensified SW monsoon as shown by the abundance of Globigerina bulloides and enhanced carbonate corrosion. Benthic ecosystem variability in the deep Arabian Sea is not exclusively driven by variations in monsoonal upwelling and related organic matter supply to the seafloor but also by changes in deepwater ventilation. Deepening of the base of the oxygen minimum zone (OMZ) below 1800 m water depth is strongly coherent on the precessional band but lags proxies of SW monsoon strength by 4 to 6 kyr. The "out-of-phase" relationship between OMZ deepening and maximum SW monsoon strength is explained by temporal changes in the advection of oxygen-rich deepwater masses of North Atlantic and Antarctic origin. This process affected the remineralization and burial efficiency of organic matter in the deep Arabian Sea, resulting in the observed phase lag between maximum monsoon strength and organic carbon preservation.

Calibration and application of B/Ca, Cd/Ca, and d11B in Neogloboquadrina pachyderma (sinistral)

The North Atlantic and Norwegian Sea are prominent sinks of atmospheric CO2 today, but their roles in the past remain poorly constrained. In this study, we attempt to use B/Ca and d11B ratios in the planktonic foraminifera Neogloboquadrina pachyderma (sinistral variety) to reconstruct subsurface water pH and pCO2 changes in the polar North Atlantic during the last deglaciation. Comparison of core-top results with nearby hydrographic data shows that B/Ca in N. pachyderma (s) is mainly controlled by seawater [B(OH)4]?/[HCO3]? with a roughly constant partition coefficient (KD =([B/Ca]of CaCO3)/([B(OH)4]-/[HCO3]-)of seawater) of 1.48 ± 0.15 * 10**-3 (2sigma), and d11B in this species is offset below d11B of the borate in seawater by 3.38 ± 0.71 per mil (2sigma). These values represent our best estimates with the sparse available hydrographic data close to our core-tops. More culturing and sediment trap work is needed to improve our understanding of boron incorporation into N. pachyderma (s). Application of a constant KD of 1.48 * 10**-3 to high resolution N. pachyderma (s) B/Ca records from two adjacent cores off Iceland shows that subsurface pCO2 at the habitat depth of N. pachyderma (s) (~50 m) generally followed the atmospheric CO2 trend but with negative offsets of ~10-50 ppmv during 19-10 ka. These B/Ca-based reconstructions are supported by independent estimates from low-resolution d11B measurements in the same cores. We also calibrate and apply Cd/Ca in N. pachyderma (s) to reconstruct nutrient levels for the same down cores. Like today's North Atlantic, past subsurface pCO2 variability off Iceland was significantly correlated with nutrient changes that might be linked to surface nutrient utilization and mixing within the upper water column. Because surface pCO2 (at 0 m water depth) is always lower than at deeper depths and if the application of a constant KD is valid, our results suggest that the polar North Atlantic has remained a CO2 sink during the calcification seasons of N. pachyderma (s) over the last deglaciation.

Benthic foraminiferal Cd/Ca and isotope record from the South Atlantic

A depth transect of cores from 1268 to 3909 m water depth in the western South Atlantic are ideally situated to monitor the interocean exchange of deep water and variations in the relative strength of northern and southern sources of deep water production. Benthic foraminiferal Cd/Ca and d13C data suggest that Glacial North Atlantic Intermediate Water (GNAIW) extended at least as far south as 28°S in the western South Atlantic. The core of nutrient-depleted water was situated at ~1500 m, above and below water masses with higher nutrient concentrations. When examined in conjunction with published paired Cd/Ca and d13C from intermediate depth cores from other basins, it appears that the extent of GNAIW influence on the intermediate waters of the world's oceans was less than suggested previously. Differentiating among possible pathways for the glacial deep ocean (>3 km) requires a better understanding of the controls on Cd/Ca and d13C values of benthic foraminifera.

Composition and distribution of silica in sediments of the Broken Ridge

Within a dipping sequence of middle Cretaceous to Eocene sediments on Broken Ridge, opal-A, opal-CT, and quartz occur as minor constituents in carbonate and ash-rich sediments. Biogenic opal-A is mainly derived from diatoms and radiolarians. Opal-A and almost all siliceous microfossils disappear within a narrow (<20-m-thick) transition zone below which authigenic opal-CT and quartz are present. These latter silica polymorphs occur together within a 750-m-thick interval, but the ratio of quartz/opal-CT increases with increasing age and depth within the pre-rift sediment sequence. The boundary between opal-A- and opal-CT-bearing sediments is also a physical boundary at which density, P-wave velocity, and acoustic impedance change. This physical transition is probably caused by infilling of pore space by opal-CT lepispheres.

Characteristics and distribution of Neogene turbidites at ODP Site 108-657

Numerous and variable silty-sandy siliciclastic turbidites were observed in Neogene pelagic sediments (late Miocene to Holocene) at Site 657: (1) thick-bedded, coarse-grained and thin-bedded, fine-grained turbidites; and (2) turbidites composed of eolian dune sand and shallow-water bioclasts or of fluvial-sand or mixed sandy component assemblages. The stratigraphic distribution of these turbidites indicates five periods during which climatic conditions and material sources change. Turbidite occurrence prior to 6.2 Ma (late Miocene) is sparse; the deposits contain coarse and fine-grained turbidites with quartz grains of eolian or mixed origin suggesting the existence of arid conditions at about 8.5 and 6.5 Ma. A coarse-grained turbidite of fluvial origin, recording a humid climate, occurs at about 6.2 Ma. During the early Pliocene, turbidites are frequent (15/Ma); they contain only fine-grained sequences comprising material of mixed origin, which indicates a more humid climate perhaps. The late Pliocene starts with rare coarse-grained turbidites of wind-transported sand while the uppermost Pliocene deposits show a higher frequency of fine-grained sequences (10/0.7 Ma) composed mainly of fluvial material. During the early Pleistocene, similar high turbidite frequency was observed (20/1.3 Ma) but with a total lack of eolian supply. During the last 0.7 Ma, the frequency decreases and the sequences are characterized by highly variable sediment components that could be related to strong variations of climatic conditions. The sedimentary characteristics of turbidites are mainly controlled by sediment source and climate. The frequency must be influenced by sea-level variations, by cyclic processes of climatic origin, and possibly by variations in the continental slope morphology. Clay mineral assemblages suggest a south Saharan source of terrigenous material during the late Miocene and the Pliocene and a northwest Saharan source during the Pleistocene.