Medical error:a discussion of the medical construction of error and suggestions for reforms of medical education to decrease error

Introduction: There is a growing public perception that serious medical error is commonplace and largely tolerated by the medical profession. The Government and medical establishment's response to this perceived epidemic of error has included tighter controls over practising doctors and individual stick-and-carrot reforms of medical practice. Discussion: This paper critically reviews the literature on medical error, professional socialization and medical student education, and suggests that common themes such as uncertainty, necessary fallibility, exclusivity of professional judgement and extensive use of medical networks find their genesis, in part, in aspects of medical education and socialization into medicine. The nature and comparative failure of recent reforms of medical practice and the tension between the individualistic nature of the reforms and the collegiate nature of the medical profession are discussed. Conclusion: A more theoretically informed and longitudinal approach to decreasing medical error might be to address the genesis of medical thinking about error through reforms to the aspects of medical education and professional socialization that help to create and perpetuate the existence of avoidable error, and reinforce medical collusion concerning error. Further changes in the curriculum to emphasize team working, communication skills, evidence-based practice and strategies for managing uncertainty are therefore potentially key components in helping tomorrow's doctors to discuss, cope with and commit fewer medical errors.

Exclusive contracts in bilaterally duopolistic industries

The purpose of this article is to analyze the incentives of manufacturers to deal exclusively with retailers in bilaterally duopolistic industries with brand differentiation by manufacturers. With highly differentiated products exclusive contracts are shown to generate higher profits for manufacturers and retailers, who thus have an incentive to insist on exclusive contracting. However, if the products are close substitutes no exclusivity will emerge in equilibrium.

Exclusive contracts with private information in successive differentiated oligopolies

The purpose of this article is to analyze the incentives of manufacturers to deal exclusively with retailers in bilaterally duopolistic industries with brand differentiation by manufacturers. In contrast with the previous literature, exclusive contracts are shown to generate higher profits for manufacturers and retailers selling highly differentiated products, who thus have an incentive to insist on exclusive contracting. However, if the products are close substitutes no exclusivity will emerge in equilibrium. Furthermore, we show that exclusive contracts decrease both consumer and social welfare.

Coherent rho meson electroproduction off deuteron

QCD predicts Color Transparency (CT), which refers to nuclear medium becoming transparent to a small color neutral object produced in high momentum transfer reactions, due to reduced strong interaction. Despite several studies at BNL, SLAC, FNAL, DESY and Jefferson Lab, a definitive signal for CT still remains elusive. In this dissertation, we present the results of a new study at Jefferson Lab motivated by theoretical calculations that suggest fully exclusive measurement of coherent rho meson electroproduction off the deuteron is a favorable channel for studying CT. Vector meson production has a large cross section at high energies, and the deuteron is the best understood and simplest nuclear system. Exclusivity allows the production and propagation to be controlled separately by controlling Q 2, lf (formation length), lc (coherence length) and t. This control is important as the rapid expansion of small objects increases their interaction probability and masks CT. The CT signal is investigated in a ratio of cross sections at high t (where re-scattering is significant) to low t (where single nucleon reactions dominate). The results are presented over a Q2 range of 1 to 3 GeV2 based on the data taken with beam energy of 6 GeV.

Essays on Competition in the Pharmaceutical Industry

Chapter 1: Patents and Entry Competition in the Pharmaceutical Industry: The Role of Marketing Exclusivity Effective patent length for innovation drugs is severely curtailed because of extensive efficacy and safety tests required for FDA approval, raising concern over adequacy of incentives for new drug development. The Hatch-Waxman Act extends patent length for new drugs by five years, but also promotes generic entry by simplifying approval procedures and granting 180-day marketing exclusivity to a first generic entrant before the patent expires. In this paper we present a dynamic model to examine the effect of marketing exclusivity. We find that marketing exclusivity may be redundant and its removal may increase generic firms' profits and social welfare. Chapter 2: Why Authorized Generics?: Theoretical and Empirical Investigations Facing generic competition, the brand-name companies some-times launch generic versions themselves called authorized generics. This practice is puzzling. If it is cannibalization, it cannot be profitable. If it is divisionalization, it should be practiced always instead of sometimes. I explain this phenomenon in terms of switching costs in a model in which the incumbent first develops a customer base to ready itself against generic competition later. I show that only sufficiently low switching costs or large market size justifies launch of AGs. I then use prescription drug data to test those results and find support. Chapter 3: The Merger Paradox and R&D Oligopoly theory says that merger is unprofitable, unless a majority of firms in industry merge. Here, we introduce R&D opportunities to resolve this so-called merger paradox. We have three results. First, when there is one R&D firm, that firm can profitably merge with any number of non-R&D firms. Second, with multiple R&D firms and multiple non-R&D firms, all R&D firms can profitably merge. Third, with two R&D firms and two non-R&D firms, each R&D firms prefer to merge with a non-R&D firm. With three or more than non-R&D firms, however, the R&D firms prefer to merge with each other.

Einige Erwägungen zur juristischen Untersuchung in Mexiko

Die neuen Paradigmen der Rechtswissenschaft nötigen uns beim Erwerb juristischen Wissens dazu, uns in eine kreativere und problemorientiertere Dynamik des Lehrens-Lernens einzugliedern. Die neuen Generationen der Rechtsgelehrten sollten darum bemüht sein, die verschiedenen theoretisch-methodologischen Strömungen des Rechts, z.B. des juristischen Realismus, den juristischen Strukturalismus sowie die angewandte juristische Soziologie zu studieren und zu analysieren. Andererseits sollten sie nicht dogmatisch und ausschliesslich den juristischen Positivismus des 19. Jahrhunderts vertreten. Die juristischen Fakultäten und Schulen der Republik Mexiko zeichnen sich dadurch aus, dass sie die traditionelle juristische Lehre bewahren. Darin liegt der Grund, dass es nur wenige Juristen gibt, die sich der juristischen Forschung und der wissenschaftlichen Praxis widmen.

Gender stereotypes: sexuality and contraception in Mexican university students of middle class

Since feminist studies and gender perspective, sexuality and reproduction continue to be a topic of interest in Mexico. The objective of this study was to identify gender stereotypes in sexuality and contraception practices in Mexican university students of middle class. We used a qualitative methodology with in-depth interviews, using as analysis axes the sexual and contraception practices. The results showed gender stereotypes in university students as active, seductive and conquerors, characterized by a double standard of morality in the type of relationship: Formal where love, affection, trust and commitment are present, and Informal, where a love relationship or sexual exclusivity is not incorporated.

Sensitive and specific detection of viable Mycobacterium avium subsp. paratuberculosis in raw milk by the Peptide-mediated magnetic separation (PMS)-phage assay

This study describes further validation of a previously described Peptide-mediated magnetic separation (PMS)-Phage assay, and its application to test raw cows’ milk for presence of viable Mycobacterium avium subsp. paratuberculosis (MAP). The inclusivity and exclusivity of the PMS-phage assay were initially assessed, before the 50% limit of detection (LOD50) was determined and compared with those of PMS-qPCR (targeting both IS900 and f57) and PMS-culture. These methods were then applied in parallel to test 146 individual milk samples and 22 bulk tank milk samples from Johne’s affected herds. Viable MAP were detected by the PMS-phage assay in 31 (21.2%) of 146 individual milk samples (mean plaque count of 228.1 PFU/50 ml, range 6-948 PFU/50 ml), and 13 (59.1%) of 22 bulk tank milks (mean plaque count of 136.83 PFU/50 ml, range 18-695 PFU/50 ml). In contrast, only 7 (9.1%) of 77 individual milks and 10 (45.4%) of 22 bulk tank milks tested PMS-qPCR positive, and 17 (11.6%) of 146 individual milks and 11 (50%) of 22 bulk tank milks tested PMS-culture positive. The mean 50% limits of detection (LOD50) of the PMS-phage, PMS-IS900 qPCR and PMS-f57 qPCR assays, determined by testing MAP-spiked milk, were 0.93, 135.63 and 297.35 MAP CFU/50 ml milk, respectively. Collectively, these results demonstrate that, in our laboratory, the PMS-phage assay is a sensitive and specific method to quickly detect the presence of viable MAP cells in milk. However, due to its complicated, multi-step nature, the method would not be a suitable MAP screening method for the dairy industry.

Testicular volume and reproductive status of Wild Callithrix jacchus

ARAÚJO, Arrilton ; SOUSA, Maria Bernardete Cordeiro . Testicular volume and reproductive status of Wild Callithrix jacchus. International Journal of Primatology, v.29, p.1355–1364, 2008. DOI 10.1007/s10764-008-9291-4

Sneakerheads and Custom Kicks: Insights into Symbolic Mass Customization

This chapter presents an exploratory study involving a group of athletic shoe enthusiasts and their feelings towards customized footwear. These "sneakerheads" demonstrate their infatuation with sneakers via activities ranging from creating catalogs of custom shoes to buying and selling rare athletic footwear online. The key characteristic these individuals share is that, for them, athletic shoes are a fundamental fashion accessory stepped in symbolism and meaning. A series of in-depth interviews utilizing the Zaltman Metaphor Elicitation Technique (ZMET) provide a better understanding of how issues such as art, self-expression, exclusivity, peer recognition, and counterfeit goods interact with the mass customization of symbolic products by category experts.

The evolving profile, role and relevance of the medical director in a pharmaceutical company

Over the last years, operations in Pharmaceutical Companies have become more complex, trying to adapt to new demands of the market environment. Overall, the observed change of paradigm requires adapting, mainly by the setting of new priorities, diversification of investments, cost containment strategies, exploring new markets and developping new sets of skills. In this context, new functions have been created, the relevance of some has diminished, and the importance of others has arisen. Amongst these, the medical structure within a Pharmaceutical Company, increased to meet demands, with companies adopting different models to respond to these needs, and becoming a pillar to the business. Assuming the leading role within a medical department, the medical director function often lies in the shadow. It is a key function within Pharma Industry, either on a country or on a Global basis. It has evolved and changed in the past years to meet the constant demands of a changing environment. The Medical Director is a highly skilled and differeniated professional who provides medical and scientific governance within a Pharmaceutical company, since early stages of drug development and up to loss of exclusivity, not only but also by leading a team of other physicians, pharmacists or life scientists whose functions comprise specificities that the medical director needs to understand, provide input to, oversee and lead. As the organization of Pharmaceutical Companies tends to be different, in accordance to values, culture, markets and strategies, the scope of activities of a Medical Director can be broader or may be limited, depending on size of the organization and governance model, but they must fulfil a large set of requirements in order to leverage impact on internal and internal customers. Key technical competencies for medical directors such as an MD degree, a strong clinical foundation, knowledge of drug development, project and team management experience and written and verbal skills are relatively easy to define, but underlying behavioural competencies are more difficult to ascertain, and these are more often the true predictors of success in the role. Beyond seamless proficiency in technical skills, at this level interpersonal skills become far more important, as they are the driver and the distinctive factor between a good and an excelent medical director. And this has impact in the business and in the people doing it.

Testicular volume and reproductive status of Wild Callithrix jacchus

ARAÚJO, Arrilton ; SOUSA, Maria Bernardete Cordeiro . Testicular volume and reproductive status of Wild Callithrix jacchus. International Journal of Primatology, v.29, p.1355–1364, 2008. DOI 10.1007/s10764-008-9291-4

Conhecimentos e dificuldades das mães face à amamentação

Enquadramento: Devido à elevada prevalência de abandono precoce da amamentação, diversas instituições (e.g., OMS, UNICEF) têm-se preocupado em proteger, promover e apoiar o aleitamento materno um pouco por todo o mundo, defendendo a sua exclusividade durante os primeiros seis meses de vida do bebé, complementado a partir dessa idade pela introdução de alimentos e mantido até aos 2 anos de idade ou mais, se esse for o desejo da mãe. Objetivos: Avaliar os conhecimentos das mães sobre a amamentação; identificar as dificuldades vivenciadas pelas mães em relação à amamentação; analisar a relação entre as variáveis sociodemográficas e obstétricas das mães e os seus conhecimentos e dificuldades sobre a amamentação. Metodologia: Estudo quantitativo, descritivo, analítico, correlacional e de corte transversal, conduzido numa amostra não probabilística de 100 mães de recém-nascidos e/ou lactentes até 1 ano de vida, internadas no serviço de obstetrícia, neonatologia, pediatria e urgência de uma Unidade Local de Saúde do Norte do País. As inquiridas tinham idade mínima de 16 e máxima de 43 anos (M=30,77; Dp=6,356). Foi utilizado um questionário de caraterização sociodemográfica e um questionário de autorrelato da vivência das mães sobre a amamentação, desenvolvido por Sousa (2014). Resultados: Os principais resultados mostraram que 50% das mães consideram possuir bons conhecimentos relativos à amamentação, porém, apenas 39% foram classificadas com bons conhecimentos, enquanto 52% revelaram dificuldades elevadas. Os conhecimentos foram avaliados tendo por base a sinalização correta da importância da amamentação na primeira hora de vida do bebé por 93% das mães, exclusiva até aos 6 meses (28%), a composição do leite materno e composição imunológica 93%, a maioria das mães considerou saber identificar os sinais da pega correta. Relativamente ao horário da amamentação, 62% ainda considera correto amamentar de três em três horas e 14% defende que o bebé deve mamar 10 minutos em cada mama. Os conhecimentos relacionaram-se significativamente com as mães com ensino superior (x2=17,828; p=0,00) e nas que se encontram a amamentar atualmente (UMW=278,000; p=0,01). As dificuldades mais prevalentes associaram-se às fissuras (56,4%), ingurgitamento mamário (38,5%), mastite (3,8%), dor (40%) e dificuldade na pega (60%), tendo-se constatado diferenças estatisticamente significativas associadas ao ingurgitamento mamário, à mastite e abcesso mamário. Exerce influência nas dificuldades das mães, ter sido informada pelo obstetra (UMW=324,000; p=0,02) e não ter expectativas na primeira amamentação (UMW=521,500; p=0,01). Conclusão: O estudo revela bons conhecimentos globais mas dificuldades elevadas, sendo estas as comumente referenciadas noutros estudos. Face a isto, mantem-se necessário apoiar nas dificuldades vividas durante a amamentação, adequando as estratégias de promoção, proteção e apoio ao AM, para que os resultados possam ser bem-sucedidos. Palavras-chave: aleitamento materno, conhecimentos, dificuldades.

Análisis de la exclusividad del objeto social de las compañías de transporte en el Ecuador

El presente trabajo trata sobre la exclusividad del objeto social con el que deben contar las compañías de transporte terrestre en el Ecuador al momento de prestar un servicio, cuyo estudio se realiza desde el Derecho Administrativo estableciendo conceptos de los distintos actos jurídicos en los que se ven involucrados el Estado, los particulares y la ciudadanía. Al hablar del transporte como servicio público, es necesario reconocer que existen organismos de control, planificación y regulación como es el caso de la Agencia Nacional de Tránsito, reconociendo también las competencias que actualmente tienen los Gobiernos Autónomos Descentralizados Regionales, Municipales o Metropolitanos. Además, las operadoras de tránsito para su funcionamiento en cualquiera de sus clases y tipos deben cumplir con requisitos exigidos por la Ley Orgánica de Tránsito y Transporte Terrestre y Seguridad Vial, reglamentos, resoluciones y ordenanzas; en este sentido se analiza el proceso que las operadoras deben realizar para su constitución, operación y contratación. Finalmente se realiza el análisis del caso de la operadora TRANSUPERAM S.A., compañía de transporte mixto que contando con un objeto social exclusivo, realizó el procedimiento correspondiente para su constitución y operación, sin embargo debido a la exclusividad del servicio que la empresa pretende brindar siendo este al sector público, hasta el momento no se otorga el permiso de operación ya que su objeto social debe mantener iguales condiciones que otras operadoras de transporte comercial mixto, entre otras consideraciones basadas en informes técnicos jurídicos, económicos e incluso de la intervención de la Agencia Nacional de Tránsito.

Essays on competition in the pharmaceutical industry

Chapter 1: Patents and Entry Competition in the Pharmaceutical Industry: The Role of Marketing Exclusivity. Effective patent length for innovation drugs is severely curtailed because of extensive efficacy and safety tests required for FDA approval, raising concern over adequacy of incentives for new drug development. The Hatch-Waxman Act extends patent length for new drugs by five years, but also promotes generic entry by simplifying approval procedures and granting 180-day marketing exclusivity to a first generic entrant before the patent expires. In this paper we present a dynamic model to examine the effect of marketing exclusivity. We find that marketing exclusivity may be redundant and its removal may increase generic firms' profits and social welfare. ^ Chapter 2: Why Authorized Generics?: Theoretical and Empirical Investigations Facing generic competition, the brand-name companies some-times launch generic versions themselves called authorized generics. This practice is puzzling. If it is cannibalization, it cannot be profitable. If it is divisionalization, it should be practiced always instead of sometimes. I explain this phenomenon in terms of switching costs in a model in which the incumbent first develops a customer base to ready itself against generic competition later. I show that only sufficiently low switching costs or large market size justifies launch of AGs. I then use prescription drug data to test those results and find support. ^ Chapter 3: The Merger Paradox and R&D Oligopoly theory says that merger is unprofitable, unless a majority of firms in industry merge. Here, we introduce R&D opportunities to resolve this so-called merger paradox. We have three results. First, when there is one R&D firm, that firm can profitably merge with any number of non-R&D firms. Second, with multiple R&D firms and multiple non-R&D firms, all R&D firms can profitably merge. Third, with two R&D firms and two non-R&D firms, each R&D firms prefer to merge with a non-R&D firm. With three or more than non-R&D firms, however, the R&D firms prefer to merge with each other.^