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PubMedDate not supplied

Of sales, services, and warranties: is the prosthodontist a purveyor of goods under the Uniform Commercial Code?

The Uniform Commercial Code (UCC) governs various commercial transactions. Article Two of the Code deals with sales of goods and, historically, has not applied to the provision of goods incident to rendering professional services. Recently, some courts have held professionals liable for economic or personal injuries caused by faulty medical devices and prostheses. Liability, when found, has been based on one or more of the UCC Article Two warranties. This article discusses these warranties and those cases in which hospitals and doctors have been held liable under them. While the number of such cases is small, there are arguments that suggest that liability under these circumstances could increase in the future. An understanding of the Article Two warranties and how they have been used in lawsuits against health professionals should help minimize the chances of successful litigation against dentists.

Dental Health Services↗
PubMed1991

Materials managers question how Uniform Commercial Code treats faxed purchase orders.

A hospital materials manager is considering eliminating routine purchase orders for most items of medical supply. This is due to the increased use of the telephone and of electronic devices such as fax, transceivers and computer hookups. Written purchase orders would continue to be mailed to suppliers for capital equipment and other major expenditures. The materials manager is wondering how this time-saving practice might be affected by purchase law under the Uniform Commercial Code (UCC). In this dialogue, Dr. Decker responds to this reader's inquiry.

Capital Expenditures↗
PubMed1986

Warranty liability of the hospital for goods used during surgery.

A recent decision of the Supreme Court of Alabama goes a long way toward applying the Uniform Commercial Code (UCC) rules on warranty liability to a hospital for materials and goods used during surgical operations. Because of its potential impact upon hospitals, materials managers must understand this decision so that steps can be taken in buying and handling items to reduce the hospital's potential liability.

Alabama↗
PubMed1986

Hospital materials managers as merchants.

The Uniform Commercial Code (UCC) provides a number of special rules which apply to merchants. Some apply "between merchants" and others use the terminology "as against a merchant". It is important that hospital materials managers understand these rules as they apply to their operations. In the dialogue below, Doctor Decker discusses these rules and their application to hospitals. The applicable section of the Code is given so each can be checked for further details.

Commerce↗
PubMed2003

Structuring a sound securitization of healthcare receivables.

Securitization of receivables allows healthcare providers to obtain an additional funding source by selling their accounts receivables to investors. A double-lock-box structure allows providers to securitize Medicare and Medicaid receivables without violating federal laws. A 2001 revision to the Uniform Commercial Code facilitates providers' securitization of private healthcare insurance receivables by underscoring rights of a purchaser of those receivables. HIPAA privacy standards appear to permit the use and disclosure of protected health information in crafting a securitization program. The securitization should be structured to shield the value of the receivables to be transferred from the potential backruptcies of the originator and the purchaser.

Accounting↗
PubMed2006

Fluid structure interaction of patient specific abdominal aortic aneurysms: a comparison with solid stress models.

BACKGROUND: Abdominal aortic aneurysm (AAA) is a dilatation of the aortic wall, which can rupture, if left untreated. Previous work has shown that, maximum diameter is not a reliable determinant of AAA rupture. However, it is currently the most widely accepted indicator. Wall stress may be a better indicator and promising patient specific results from structural models using static pressure, have been published. Since flow and pressure inside AAA are non-uniform, the dynamic interaction between the pulsatile flow and wall may influence the predicted wall stress. The purpose of the present study was to compare static and dynamic wall stress analysis of patient specific AAAs. METHOD: Patient-specific AAA models were created from CT scans of three patients. Two simulations were performed on each lumen model, fluid structure interaction (FSI) model and static structural (SS) model. The AAA wall was created by dilating the lumen with a uniform 1.5 mm thickness, and was modeled as a non-linear hyperelastic material. Commercial finite element code Adina 8.2 was used for all simulations. The results were compared between the FSI and SS simulations. RESULTS: Results are presented for the wall stress patterns, wall shear stress patterns, pressure, and velocity fields within the lumen. It is demonstrated that including fluid flow can change local wall stresses slightly. However, as far as the peak wall stress is concerned, this effect is negligible as the difference between SS and FSI models is less than 1%. CONCLUSION: The results suggest that fully coupled FSI simulation, which requires considerable computational power to run, adds little to rupture risk prediction. This justifies the use of SS models in previous studies.

Aged↗
PubMed2002

Modelling of flow and wall behaviour in a mildly stenosed tube.

In the present computational analysis, pulsatile flow and vessel wall behaviour in a simplified model of a stenosed vessel were investigated. Geometry of a 45% axisymmetrically stenosed (by area) cylindrical tube and a sinusoidal inflow waveform were simulated, with the fluid being assumed to be incompressible and Newtonian. The vessel wall was treated as a thick-walled, incompressible and isotropic material with uniform mechanical properties across the normal as well as the constricted segment. The study of fluid flow and wall motion was initially carried out separately using two commercial codes CFX4.2 and ABAQUS7 respectively. Their combined effects and interactions were later investigated through an iteratively coupled algorithm. Model validations on the rigid-wall fluid and static no-flow solid models were satisfactory, with Root Mean Square deviations of around 7% in centreline axial velocity between the prediction and measurement values for the rigid wall stenosis model, and 5% in circumferential stress for a cylindrical tube model under static loading when compared with the analytical solution. Results on velocity profiles, wall shear stress, intramural strain and stress for the rigid and compliant cases were all presented. Comparison between the rigid and compliant models revealed that, the flow separation layer distal to the stenosis was thicker and longer, and wall shear stress was slightly lower in the compliant model by less than 7.2%. Results obtained from the static wall model (with uniform pressure loading) and coupled fluid/wall interaction modelling of pulsatile flow showed qualitatively similar wall strain and stress patterns but considerable differences in magnitude. The radial and axial stresses were reduced by 31 and 8%, while the circumferential stress was increased by 13% due to the presence of pulsatile flow. Under the flow and structural conditions investigated, the effects of wall compliance were small, and did not change the flow and solid behaviours qualitatively in this case.

Arterial Occlusive Diseases↗
PubMed2001

Effect of particle inlet distributions on deposition in a triple bifurcation lung airway model.

Considering a triple bifurcation as a representative lung airway model of the upper bronchial tree, the effect of different random inlet particle distributions on deposition patterns and efficiencies have been numerically analyzed. The steady laminar three-dimensional transport equations for a dilute micron-size particle suspension have been solved using a commercial finite-volume code with user-enhanced programs. Particle release positions were assigned employing a random number generator following random-parabolic, random-uniform, and random-random distribution functions. Via back tracking, starting positions of all depositing particles were determined for each particle release distribution, including a deterministic-parabolic one which served as a base case. The results indicate that: (1) The starting regions of the depositing particles in a given bifurcation are fixed for the same inlet Reynolds number and Stokes number combination, regardless of the type of distribution profile. The situation for the particle deposition patterns is somewhat similar. However, the type of distribution of inlet particles strongly influences the particle deposition efficiencies. (2) Values of particle deposition efficiencies are very close for the same (parabolically) distributed deterministic versus random inlet particles when all other conditions are fixed. (3) According to the simulation validations, a determinstic parabolic distribution of inlet particles may be sufficient for laboratory data comparison purposes, but random distributions should reflect realistic environmental or medical aerosol inhalation more accurately.

Administration, Inhalation↗
PubMed2005

Fluid-structure interaction in abdominal aortic aneurysms: effects of asymmetry and wall thickness.

BACKGROUND: Abdominal aortic aneurysm (AAA) is a prevalent disease which is of significant concern because of the morbidity associated with the continuing expansion of the abdominal aorta and its ultimate rupture. The transient interaction between blood flow and the wall contributes to wall stress which, if it exceeds the failure strength of the dilated arterial wall, will lead to aneurysm rupture. Utilizing a computational approach, the biomechanical environment of virtual AAAs can be evaluated to study the affects of asymmetry and wall thickness on this stress, two parameters that contribute to increased risk of aneurysm rupture. METHODS: Ten virtual aneurysm models were created with five different asymmetry parameters ranging from beta = 0.2 to 1.0 and either a uniform or variable wall thickness to study the flow and wall dynamics by means of fully coupled fluid-structure interaction (FSI) analyses. The AAA wall was designed to have a (i) uniform 1.5 mm thickness or (ii) variable thickness ranging from 0.5-1.5 mm extruded normally from the boundary surface of the lumen. These models were meshed with linear hexahedral elements, imported into a commercial finite element code and analyzed under transient flow conditions. The method proposed was then compared with traditional computational solid stress techniques on the basis of peak wall stress predictions and cost of computational effort. RESULTS: The results provide quantitative predictions of flow patterns and wall mechanics as well as the effects of aneurysm asymmetry and wall thickness heterogeneity on the estimation of peak wall stress. These parameters affect the magnitude and distribution of Von Mises stresses; varying wall thickness increases the maximum Von Mises stress by 4 times its uniform thickness counterpart. A pre-peak systole retrograde flow was observed in the AAA sac for all models, which is due to the elastic energy stored in the compliant arterial wall and the expansion force of the artery during systole. CONCLUSION: Both wall thickness and geometry asymmetry affect the stress exhibited by a virtual AAA. Our results suggest that an asymmetric AAA with regional variations in wall thickness would be exposed to higher mechanical stresses and an increased risk of rupture than a more fusiform AAA with uniform wall thickness. Therefore, it is important to accurately reproduce vessel geometry and wall thickness in computational predictions of AAA biomechanics.

Animals↗
PubMed2001

Effects of curved inlet tubes on air flow and particle deposition in bifurcating lung models.

In vivo bifurcating airways are complex and the airway segments leading to the bifurcations are not always straight, but curved to various degrees. How do such curved inlet tubes influence the motion as well as local deposition and hence the biological responses of inhaled particulate matter in lung airways? In this paper steady laminar dilute suspension flows of micron-particles are simulated in realistic double bifurcations with curved inlet tubes, i.e., 0 degrees < or =theta< or =90 degrees, using a commercial finite-volume code with user-enhanced programs. The resulting air-flow patterns as well as particle transport and wall depositions were analyzed for different flow inlet conditions, i.e., uniform and parabolic velocity profiles, and geometric configurations. The curved inlet segments have quite pronounced effects on air-flow, particle motion and wall deposition in the downstream bifurcating airways. In contrast to straight double bifurcations, those with bent parent tubes also exhibit irregular variations in particle deposition efficiencies as a function of Stokes number and Reynolds number. There are fewer particles deposited at mildly curved inlet segments, but the particle deposition efficiencies at the downstream sequential bifurcations vary much when compared to those with straight inlets. Under certain flow conditions in sharply curved lung airways, relatively high, localized particle depositions may take place. The findings provide necessary information for toxicologic or therapeutic impact assessments and for global lung dosimetry models of inhaled particulate matter.

Biomechanical Phenomena↗