LexisNexis Questions and Answers : Medical Law

LexisNexis Questions and Answers: Medical Law is designed to facilitate both continuous review and preparation for assignments and examinations. This book provides a clear and concise revision guide for each of the major topics covered in the typical health law course. It provides an understanding of medical law in each Australian jurisdiction and gives a clear and systematic approach to analysing and answering problem and essay questions. Each chapter commences with an identification of the key issues, including a summary of the relevant cases and legislation. Each question is followed by a suggested answer plan, a sample answer and comments on how the answer might be assessed by an examiner. The author also offers advice on common errors to avoid and practical hints and tips on how to achieve higher marks.

Non-Therapeutic Medication Omissions: Incidence and Predictors at an Australian Hospital

Background: The inconsistent definition of non-therapeutic medication omissions, under-reporting, and a poor understanding of their associated factors hamper efforts to improve medication administration practices. Aim: To examine the incidence of non-therapeutic medication omissions among acutely ill medical and surgical adult patients; and to identify the patient-, drug- and system-related predictors of these omissions. Method: A medication chart audit of 288 acutely ill adult medical and surgical patients admitted to 4 target wards (2 surgical and 2 medical) at an Australian hospital. Patients admitted to these wards from December 2008 to November 2009, with at least one regularly prescribed medication, were eligible. The sample was stratified according to gender, season and ward. A medication chart audit identified medication omissions, and data were collected on gender, age, length of stay, comorbidities, medication history and clinical pharmacy review. Results: Of the 288 medication charts audited, 220 (75%) had one or more medication omissions. Of the 15 020 medication administration episodes, there were 1687 omissions, resulting in an omission rate per medication administration episode of 11%. Analgesics and aperients were the most frequently omitted medications, with failure to sign the medication record and patient refusal, the main reasons for omission. Female gender (p < 0.001) and the number of medication administration episodes (p < 0.001) were statistically significant predictors of non-therapeutic medication omissions. Conclusion: The high incidence of medication omissions suggests there is need for an agreed definition of medication omission and its inclusion as a reportable incident. Increasing medication reconciliation via implementation of the Medication Management Plan may also reduce the opportunity for error. J Pharm Pract Res 2011; 41: 188-91.

Extrapolation and series acceleration procedures: Hard spheres and discs as illustrations

Three new procedures - in the context of estimation of virial coefficients and summation of the partial virial series for hard discs and hard spheres - are proposed. They are based on the parametrised Euler transformation, a novel resummation, identity and the ε-convergence methods respectively. A comparison with other estimates (molecular dynamics, graph theory and empirical methods) reveals satisfactory agreement.

Predicting invasiveness in exotic species: do subtropical native and invasive exotic aquatic plants differ in their growth responses to macronutrients?

We investigated whether plasticity in growth responses to nutrients could predict invasive potential in aquatic plants by measuring the effects of nutrients on growth of eight non-invasive native and six invasive exotic aquatic plant species. Nutrients were applied at two levels, approximating those found in urbanized and relatively undisturbed catchments, respectively. To identify systematic differences between invasive and non-invasive species, we compared the growth responses (total biomass, root:shoot allocation, and photosynthetic surface area) of native species with those of related invasive species after 13 weeks growth. The results were used to seek evidence of invasive potential among four recently naturalized species. There was evidence that invasive species tend to accumulate more biomass than native species (P = 0.0788). Root:shoot allocation did not differ between native and invasive plant species, nor was allocation affected by nutrient addition. However, the photosynthetic surface area of invasive species tended to increase with nutrients, whereas it did not among native species (P = 0.0658). Of the four recently naturalized species, Hydrocleys nymphoides showed the same nutrient-related plasticity in photosynthetic area displayed by known invasive species. Cyperus papyrus showed a strong reduction in photosynthetic area with increased nutrients. H. nymphoides and C. papyrus also accumulated more biomass than their native relatives. H. nymphoides possesses both of the traits we found to be associated with invasiveness, and should thus be regarded as likely to be invasive.

Assessing the effects of line capture and barotrauma relief procedures on post-release survival of key tropical reef fish species in Australia using recreational tagging clubs.

Common coral trout, Plectropomus leopardus Lacepede, crimson snapper, Lutjanus erythropterus Bloch, saddletail snapper, Lutjanus malabaricus (Bloch & Schneider), red emperor, Lutjanus sebae (Cuvier), redthroat emperor, Lethrinus miniatus (Schneider) and grass emperor, Lethrinus laticaudis Alleyne & Macleay, were tagged to determine the effects of barotrauma relief procedures (weighted shot-line release and venting using a hollow needle) and other factors on survival. Release condition was the most significant factor affecting the subsequent recapture rate of all species. Capture depth was significant in all species apart from L. malabaricus and L. miniatus, the general trend being reduced recapture probability with increasing capture depth. Recapture rates of fish hooked in either the lip or mouth were generally significantly higher than for those hooked in the throat or gut. Statistically significant benefit from treating fish for barotrauma was found in only L. malabaricus, but the lack of any negative effects of treating fish indicated that the practices of venting and shot-lining should not be discouraged by fisheries managers for these species.

Perturbation expansions and series acceleration procedures: Part-II. Extrapolation techniques

Three new procedures for the extrapolation of series coefficients from a given power series expansion are proposed. They are based on (i) a novel resummation identity, (ii) parametrised Euler transformation (pet) and (iii) a modifiedpet. Several examples taken from the Ising model series expansions, ferrimagnetic systems, etc., are illustrated. Apart from these applications, the higher order virial coefficients for hard spheres and hard discs have also been evaluated using the new techniques and these are compared with the estimates obtained by other methods. A satisfactory agreement is revealed between the two.

A compliant mechanism kit with flexible beams and connectors along with analysis and optimal synthesis procedures

We present a compliant mechanism kit as a parallel to the kits available for rigid-body mechanisms. The kit consists of flexible beams and connectors that can be easily hand-assembled using snap fits. The mechanisms assembled using the kit accurately capture the aspects of the topology, shape, and size of joint-free compliant mechanisms. Thus, the kit enables designers to conceive and design new, practicable, single-piece compliant mechanisms that do not require assembly. The concept of the kit also resolves a discrepancy in the finite element (FE) modeling of beam-based compliant mechanisms. The discrepancy arises when two or more beams are joined at one point and thus leading to increased stiffness. After resolving this discrepancy, this work extends the topology optimization to automatically generate designs that can be assembled with the kit for quick and easy validation instead of time-consuming prototyping. Thus, the kit and the accompanying analysis and optimal synthesis procedures comprise a self-contained educational as well as a research and practice toolset for compliant mechanisms. The paper also illustrates how human creativity finds new ways of using the kit beyond the original intended use and how it enables even a novice to design compliant mechanisms. (C) 2011 Elsevier Ltd. All rights reserved.

Comparison of North American universities with and without medical schools and their technology transfer initiatives

Empirical research available on technology transfer initiatives is either North American or European. Literature over the last two decades shows various research objectives such as identifying the variables to be measured and statistical methods to be used in the context of studying university based technology transfer initiatives. AUTM survey data from years 1996 to 2008 provides insightful patterns about the North American technology transfer initiatives, we use this data in our paper. This paper has three sections namely, a comparison of North American Universities with (n=1129) and without Medical Schools (n=786), an analysis of the top 75th percentile of these samples and a DEA analysis of these samples. We use 20 variables. Researchers have attempted to classify university based technology transfer initiative variables into multi-stages, namely, disclosures, patents and license agreements. Using the same approach, however with minor variations, three stages are defined in this paper. The first stage is to do with inputs from R&D expenditure and outputs namely, invention disclosures. The second stage is to do with invention disclosures being the input and patents issued being the output. The third stage is to do with patents issued as an input and technology transfers as outcomes.

Economics of co-managing water quality and invasive species for California and Baja California coastal boats

Regulatory action to protect California’s coastal water quality from degradation by copper from recreational boats’ antifouling paints interacts with efforts to prevent transport of invasive, hull-fouling species. A copper regulatory program is in place for a major yacht basin in northern San Diego Bay and in process for other major, California boat basins. “Companion” fouling control strategies are used with copper-based antifouling paints, as some invasive species have developed resistance to the copper biocide. Such strategies are critical for boats with less toxic or nontoxic hull coatings. Boat traffic along over 3,000 miles of coastline in California and Baja California increases invasive species transport risks. For example, 80% of boats in Baja California marinas are from the United States, especially California. Policy makers, boating businesses and boat owners need information on costs and supply-side capacity for effective fouling control measures to co-manage water quality and invasive species concerns. (PDF contains 3 pages)

Everybody Farts: Celebrating the Body and Refuting Medical Paternalism in Joyce's Ulysses

James Joyce’s Ulysses celebrates all facets of daily life in its refusal to censor raw human emotions and emissions. He adopts a critically medical perspective to portray this honest, unfiltered narrative. In doing so, he reveals the ineffectiveness of the physician-patient relationship due to doctors’ paternalistic attitudes that hinder nonjudgmental, open listening of this unfiltered narrative. His exploration of the doctor’s moral scrutiny, cultural prejudices, and authoritative estrangement from the patient underscore the importance in remembering that physicians and patients alike are ultimately just fellow human beings. Wryly, he drives this point to literal nausea, as his narrative proudly asserts the revulsive details of public health, digestion, and death. In his gritty ruminations on the human body’s material reality, Joyce mocks the physician’s highbrow paternalism by forcing him to identify with the farting, vomiting, decaying bodies around him. In celebrating the uncensored human narrative, Joyce challenges physician and patient alike to openly listen to the stories of others.

Physiological Determinants of Invasive Success Linking Distribution Patterns to Metabolic Physiology in Native and Invasive Blue Mussels (genus Mytilus)

In the early 20th century, a blue mussel species from the Mediterranean invaded the California coast and subsequently out-competed the native species south of Monterey Bay. Like other invasive species, Mytilus galloprovincialis has physiological traits that make it successful in habitats formerly occupied by the native M. trossulus, namely its adaptation to warm sea surface temperatures. This study looks at the current genotype distributions and enzymatic activities of field-acclimatized mussels within the hybrid zone where the species co-occur as well as mussels that have been acclimated for four weeks to different temperature and salinity conditions. In the field-acclimatized and laboratory-acclimated mussels, the native species exhibited significantly higher enzyme rates, which may reflect an evolutionary adaptation to compensate to low habitat temperatures. Indeed, the results of the laboratory acclimation indicate that these differences are genetically based. Whether an acclimation capacity exists may require even longer-term acclimation to different temperatures. Current findings suggest that the further spread of the invasive species is likely to be governed in large measure by the potentially counteracting effects of rising temperatures, which would favor the northerly spread of M. galloprovincialis, and increased winter precipitation, which would favor the persistence of M. trossulus. However, the success of M. galloprovincialis during acclimation to ‘dilute’ salinity (25 ppt) suggests that the invasive species can tolerate a greater salinity range than previously thought. Thus, further investigation is needed to build a comprehensive predictive model of the movement of M. galloprovincialis and the hybrid zone along the California coast.

Ocorrência e caracterização de Estafilococos coagulase negativos isolados de recémnascidos com bacteremias em unidade de terapia intensiva neonatal no HUPE-UERJ

Staphylococcus coagulase-negativo (SCN) estão frequentemente envolvidos em infecções nosocomiais associadas com o uso de cateteres e outros procedimentos médicos invasivos. A habilidade de aderir às superfícies abióticas e de produzir biofilme tem sido reconhecida entre os principais fatores de virulência dos SCN, especialmente de S. epidermidis, a principal espécie responsável por infecções relacionadas à assistência a saúde - IRASs. Dentre as demais espécies de SCN capazes de produzir biofilme, S. haemolyticus tem sido relacionado com quadros de infecções em recém-nascidos (RNs). O presente estudo teve como objetivo principal investigar aspectos microbiológicos e epidemiológicos dos processos infecciosos invasivos relacionados com SCN em neonatos internados em unidade de terapia intensiva neonatal (UTIN) de um hospital universitário do município do Rio de Janeiro (2008-2010). A técnica de PCR multiplex-mPCR foi empregada na determinação das espécies de 40 amostras de SCN isoladas de hemoculturas de RNs fazendo uso de cateteres intravenosos e submetidos à terapia antimicrobiana empírica com vancomicina e/ou gentamicina. A fenotipagem foi realizada por três métodos distintos: Simplificado em microplaca, Vitek 2 e API-Staph. Os perfis de resistência aos antimicrobianos foram verificados através do teste de disco-difusão, determinação de CIM (Oxacilina) e presença do gene mecA. A capacidade de produção de biofilme foi investigada pelos testes do Ágar Vermelho do Congo e ensaios de aderência em superfícies abióticas (poliestireno e vidro) além da PCR para os genes icaAB, atlE e aap. O perfil genômico dos micro-organismos foi determinado pela técnica de PFGE. Os resultados demonstraram o isolamento de S. haemolyticus (77%), S. epidermidis (15%), S. captis (5%) e S. warneri (3%). A análise comparativa dos resultados obtidos pelo m-PCR com métodos fenotípicos demonstrou uma concordância de 97,5% com o esquema simplificado e de ~40% Vitek 2 e o API Staph. A maioria (82,5%) das amostras apresentou perfis variados de multiresistência aos 16 antimicrobianos testados e resistência a oxacilina, apesar de 25% destas não apresentarem o gene mecA. Apesar da maioria das amostras de SCN ter apresentado capacidade de produzir slime e/ou biofilme não foi observada total correlação com a presença dos genes mecA, icaAB, aap, atlE, enfatizando a natureza multifatorial da produção de biofilme de SCN. Diferente do observado para as demais espécies, algumas amostras de S. haemolyticus foram incapazes de aderir ao vidro e ao poliestireno e/ou apresentaram os genes aap (38,7%), atlE (42%) além de icaAB (71%). Na UTIN foi detectada a presença de seis diferentes tipos clonais da espécie prevalente, indicando a disseminação de S. haemolyticusnesta unidade hospitalar e a endemicidade em nossa comunidade.

Regularized iterative and non-iterative procedures for object restoration from experimental data

A regularized algorithm for the recovery of band-limited signals from noisy data is described. The regularization is characterized by a single parameter. Iterative and non-iterative implementations of the algorithm are shown to have useful properties, the former offering the advantage of flexibility and the latter a potential for rapid data processing. Comparative results, using experimental data obtained in laser anemometry studies with a photon correlator, are presented both with and without regularization. © 1983 Taylor & Francis Ltd.

Predicting future thermal habitat suitability of competing native and invasive fish species: from metabolic scope to oceanographic modelling

Global increase in sea temperatures has been suggested to facilitate the incoming and spread of tropical invaders. The increasing success of these species may be related to their higher physiological performance compared with indigenous ones. Here, we determined the effect of temperature on the aerobic metabolic scope (MS) of two herbivorous fish species that occupy a similar ecological niche in the Mediterranean Sea: the native salema (Sarpa salpa) and the invasive marbled spinefoot (Siganus rivulatus). Our results demonstrate a large difference in the optimal temperature for aerobic scope between the salema (21.8°C) and the marbled spinefoot (29.1°C), highlighting the importance of temperature in determining the energy availability and, potentially, the distribution patterns of the two species. A modelling approach based on a present-day projection and a future scenario for oceanographic conditions was used to make predictions about the thermal habitat suitability (THS, an index based on the relationship between MS and temperature) of the two species, both at the basin level (the whole Mediterranean Sea) and at the regional level (the Sicilian Channel, a key area for the inflow of invasive species from the Eastern to the Western Mediterranean Sea). For the present-day projection, our basin-scale model shows higher THS of the marbled spinefoot than the salema in the Eastern compared with the Western Mediterranean Sea. However, by 2050, the THS of the marbled spinefoot is predicted to increase throughout the whole Mediterranean Sea, causing its westward expansion. Nevertheless, the regional-scale model suggests that the future thermal conditions of Western Sicily will remain relatively unsuitable for the invasive species and could act as a barrier for its spread westward. We suggest that metabolic scope can be used as a tool to evaluate the potential invasiveness of alien species and the resilience to global warming of native species.

Parasite mediated predation between native and invasive amphipods.

Parasites can structure biological communities directly through population regulation and indirectly by processes such as apparent competition. However, the role of parasites in the process of biological invasion is less well understood and mechanisms of parasite mediation of predation among hosts are unclear. Mutual predation between native and invading species is an important factor in determining the outcome of invasions in freshwater amphipod communities. Here, we show that parasites mediate mutual intraguild predation among native and invading species and may thereby facilitate the invasion process. We find that the native amphipod Gammarus duebeni celticus is host to a microsporidian parasite, Pleistophora sp. (new species), with a frequency of infection of 0-90%. However, the parasite does not infect three invading species, G. tigrinus, G. pulex and Crangonyx pseudogracilis. In field and laboratory manipulations, we show that the parasite exhibits cryptic virulence: the parasite does not affect host fitness in single-species populations, but virulence becomes apparent when the native and invading species interact. That is, infection has no direct effect on G. d. celticus survivorship, size or fecundity; however, in mixed-species experiments, parasitized natives show a reduced capacity to prey on the smaller invading species and are more likely to be preyed upon by the largest invading species. Thus, by altering dominance relationships and hierarchies of mutual predation, parasitism strongly influences, and has the potential to change, the outcome of biological invasions.