The racially disparate impact of restrictions on the public funding of abortion: an analysis of current equal protection doctrine.
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Abortion, Illegal↗
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Quality-of-life ethics and constitutional jurisprudence: the demise of natural rights and equal protection for the disabled and incompetent.
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Aged↗
Health insurance system in the Republic of Macedonia.
The current health insurance system of the Republic of Macedonia was introduced by the Health Protection Law, which was adopted in 1991 and modified and supplemented by the amendments in 1993 and 1995. According to this Law, health insurance was established as an obligatory, supplementary obligatory, and voluntary insurance for certain kinds of health care. This report gives an insight into the specificities and practice of all three types of insurance in the Republic of Macedonia. A person can become an insured to the Health Insurance Fund on the basis of 23 modalities. More than 80% of the citizens are eligible to the obligatory health insurance, which provides a broad scope of basic health care rights. Payroll contributions are equal to 8.6% of gross earned wages and more than 70% of health sector revenues are derived from them. Besides some other basic resources and contributions for health financing, co-payments for health care expenses by users were introduced in 1993. Health financing and reform of the health insurance system are of high importance within the ongoing health care reform in the Republic of Macedonia. It is expected that the new Law on health insurance will strengthen the mechanisms for collecting revenues and introduce new methods of co-payment and risk-adjusted reallocation of the funds related to age structure and health status of the population.
Cost Sharing↗
Radiology residents' on-call interpretation of chest radiographs for pneumonia.
RATIONALE AND OBJECTIVES: This study is designed to assess the performance of radiology residents in interpreting emergency department chest radiographs for pneumonia and to characterize chest radiographic findings in patients for which interpretation was amended by an attending radiologist. MATERIALS AND METHODS: We retrospectively reviewed all amended reports for chest radiographs performed on emergency department patients July 2002-June 2003. Reports preliminarily interpreted by residents and amended by a board-certified staff radiologist for the presence or absence of pneumonia were identified. A panel of three experienced radiologists, blinded to reports, jointly reviewed each chest radiograph. If the panel diagnosed pneumonia, the chest radiograph was evaluated for the projection that best showed the pneumonia, its size and location, and the presence or absence of the following features: increased opacity, air bronchograms, loss of vascular markings, silhouette sign, and linear opacities. The resident's post-graduate year (PGY) training level was noted. RESULTS: One percent (134/12,600 reports) of chest radiographic reports were amended for the presence or absence of pneumonia. One hundred chest radiographs were available and comprised the series. There were 56 females and 44 males with a mean age of 45 years (range, 1-99 years). The staff radiologist diagnosed pneumonia in 79% (79/100 radiographs). The panel agreed with the staff in 77% (kappa = 0.76) and the resident in 23% (kappa = 0.43). The panel diagnosed pneumonia in 60% (60/100 radiographs) with the following chest radiographic findings: 100% (60/60), increased opacity; 37% (22/60), air bronchograms; 72% (43/60), loss of vascular markings; 40% (24/60), silhouette sign; and 20% (12/60), linear opacities. The pneumonia was right sided in 52% (31/60), left sided in 37% (22/60), and bilateral in 11% (7/60). Right-sided pneumonias were equally distributed among the three lobes, and left-sided pneumonias had a lower-lobe predominance of 77% (17/22). Seventy-five percent (45/60) of pneumonias were segmental or smaller, and 82% (49/60) of chest radiographs showing pneumonia had both posteroanterior and lateral projections. The pneumonia was conspicuous on only one projection in 43% (21/49); the posteroanterior view in 22% (11/49), and the lateral view in 20% (10/49). Eighty-one percent (81/100) of interpreting residents were PGY-3. CONCLUSION: Interpretation of chest radiographs for pneumonia by PGY-3 residents has a low error rate. Missed pneumonias often were segmental or smaller and conspicuous on only one projection.
Adolescent↗
LeuTech.
LeuTech is a sterile, lyophilised kit-packaged diagnostic system containing murine anti-CD15 IgM monoclonal antibody proprietary radiolabelled with technetium 99m ((99m) Tc) for infection imaging. After intravenous injection of LeuTech, diagnostic imaging can be obtained within 1h with conventional planar gamma camera techniques. LeuTech binds to neutrophils in vivo at the infection site. LeuTech is a fast (1h to obtain image), convenient (one-step injection), safe, effective (bright, clear images) and cost-effective diagnostic for existing and new nuclear imaging markets including chronic and acute indications such as appendicitis, ischaemic bowel, post-surgical infection and nosocomial infection. Palatin Technologies has successfully completed a Phase III trial with LeuTech in 203 patients at 10 sites in the USA for the detection of equivocal appendicitis. A BLA with the US FDA for LeuTech has been filed for the diagnosis of equivocal appendicitis. The US FDA has recommended LeuTech for approval for the diagnosis of appendicitis in patients with equivocal signs and symptoms. On 28 September 2000 Palatin received a 'complete review' letter from the FDA regarding the BLA for LeuTech. While, there were no further data requested on the safety and clinical efficacy of LeuTech, FDA requested some manufacturing, quality control and validation steps and data to be completed prior the approval of LeuTech. Palatin plans to finalise the amendments to BLA in the H2 of 2002. LeuTech is also being investigated in Phase II clinical trials for the diagnosis of osteomyelitis in 45 patients at four sites. Positive interim results from a Phase II clinical study conducted in 19 patients with diabetic foot ulcers and suspected osteomyelitis were announced at the Society of Nuclear Medicine Annual Meeting, Toronto, Canada, in June 2001. Imaging with LeuTech provided a diagnostic image within 1 hour compared with the 24 hours required to obtain an image using standard-of-care diagnostic, Indium oxide-labelled white blood cells. Walter Reed Army Medical Center is evaluating LeuTech for early detection of inhalation anthrax. LeuTech is planned to be evaluated for the detection of osteomyelitis secondary to joint replacements (such as hip replacement), postoperative abscesses, ulcerative colitis and other intra-abdominal infections (colitis, spleen or urinary tract). Palatin Technologies has exclusive rights to murine anti-CD15 IgM monoclonal antibody from The Wistar Institute of Biology and Anatomy. LeuTech has been licensed to Mallinckrodt worldwide, except for Europe. In October 2000, Mallinckrodt was acquired by Tyco International. On 15 May 2002, Palatin Technologies announced that its agreement with Tyco/Healthcare/Mallinckrodt regarding LeuTech marketing was amended to require Mallinckrodt to pay an additional $3.2 million to cover half of Palatin's expenses for the completion of the FDA's review. The additional funding is conditional upon reaching of certain milestones with Palatin receiving $800,000 within ten days of the signing of the amendment. Under the terms of the original agreement (1999), Palatin received a licensing fee of $500,000 and $13 million for the stock. All expenses prior to FDA approval were equally shared. Palatin will manufacture LeuTech and will receive a transfer price per unit and also royalties on net sales.
Acute Disease↗
The Parsi Marriage and Divorce (Amendment) Act, 1988 (No. 5 of 1988), 25 March 1988.
This Act amends the Parsi Marriage and Divorce Act, 1936, of India in the following ways, among others: 1) marriage age is set at 21 for males and 18 for females (even if they have changed religion); 2) children of invalid marriages are legitimate if they would have been legitimate if the marriage had been valid; 3) divorce can be obtained on the grounds of incurable unsoundness of mind for a period of two years; cruelty; desertion for two years (instead of three, as previously); nonresumption of cohabitation after a decree for separate maintenance for one year (instead of two years); conversion to some other religion (not merely ceasing to be a Parsi); nonresumption of cohabitation for one year after a decree of judicial separation or restitution of conjugal rights, regardless of guilt; and mutual consent; 4) both husband and wife have equal rights to obtain provisional alimony and permanent alimony and maintenance from each other; 5) the age for custody and maintenance of children is increased from 16 to 18; and 6) all suits brought under the law are to tried in camera.
Asia↗
Genetic testing in the workplace: the employer's coin toss.
A toss of the coin by the modern-day employer reveals two options regarding genetic testing in the workplace. The employer may choose to take advantage of increasingly precise, available, and affordable genetic testing in order to ascertain the genetic characteristics--and deficiencies--of its employees. This outcome exposes the employer to a vast array of potential litigation and liability relating to the Americans with Disabilities Act, the Fourth Amendment, Title VII of the Civil Rights Act, and state legislation designed to protect genetic privacy. Alternatively, the employer may neglect to indulge in this trend of genetic testing and may face liability for employer negligence, violations of federal legislation such as OSHA regulations, and increased costs associated with insuring the health of genetically endangered employees. In the rapidly developing universe of genetic intelligence, the employer is faced with a staggering dilemma.
Carpal Tunnel Syndrome↗
Physician-assisted suicide and the Supreme Court: the Washington and Vacco verdicts.
In June 1997, the Supreme Court decided that statutes proscribing physicians from providing lethal medication for use by competent, terminally ill patients do not violate the Due Process or Equal Protection Clauses of the Constitution. The Court returned the question of physician-assisted suicide to the states, but did not foreclose future review of state laws that may be too restrictive of care at the end of life. The conceptual distinctions between assisted suicide, refusal of life-sustaining treatment, and administration of pain medication to terminally ill patients were endorsed as important guideposts for future analyses.
Advisory Committees↗