Negligible Harm Research Articles

Pressing Issues of Forensic and Expert Support for the Investigation of Iatrogenic Crimes

There has been an increase in the relevance of forensic and expert support for investigating the negligent harm caused by health workers to patients' health, often resulting in death. Such actions (inaction) of medical workers are identified as a specific category of “iatrogenic crimes”. The forensic characteristic of iatrogenic crimes has some distinct features, including their subject, distinctiveness of the circumstances that occur during diagnostic, treatment, and rehabilitation procedures, as well as the ways of hiding the traces of a crime. To improve the quality of the investigation of iatrogenic crimes, the author proposes to create a forensic information network, substantiates the need to ensure the possibility of remote consultations for investigators with highly qualified medical specialists using telemedicine technologies, and to conduct thorough preparation for the appointment of forensic examinations. It is recommended that the concluding documents of every investigation and trial of iatrogenic crimes include a more detailed presentation of the progress and results of expert opinions' assessment.

An overview of degradation in solid oxide fuel cells-potential clean power sources

Solid oxide fuel cells (SOFCs) have emerged as the potential power generating devices, being profoundly effective, biofuel-based, and causing negligible harm to the environment. The commercialization of this device would introduce a new revolution in the field of electronic devices and power age. The performance of SOFCs is subject to the efficient working of its significant segments like anode, cathode, electrolyte, interconnect, and sealant. The mechanism of working of a SOFC, the kinetics and thermodynamics involved, as well as the composition of the fuel utilized are other vital variables in-charge of the performance of SOFCs. The serious issue with these devices has been the degradation of the components at high temperatures because of both intrinsic and extrinsic factors. Plenty of researchers have attempted to address this issue of degradation. Despite the fact that there are a large number of articles and reviews on corrosion, very few comprehensive reports have been published. In this review, various aspects of degradation have been covered including the mechanism, remedies, and alternatives as proposed by various researchers. It is a comprehensive review of degradation in SOFCs covering the most recent advances in the study of degradation and its mitigation measures.

Prepared Disappearing Ink and Deciphering of Documents.

Disappearing inks can be used for forgeries in many fields. In this study, thymolphthalein indicator solution was prepared as a disappearing ink. A total of 54 different solutions containing thymolphthalein were prepared at six different concentrations and nine different pH values. Among the prepared solutions, 0.16g/50mL and 0.32g/65mL thymolphthalein at pH 14 were the optimum solutions that were not distinguishable from regular ink when applied to promissory note. Fountain pens were filled with the abovementioned ink solutions and applied to promissory notes for experimental purposes. After 40h, ink residues were not visible on promissory notes written with the ink with the optimum pH (pH=14) value. To decipher the entries that disappeared, an instrumental method (Video Spectral Comparator-8000) and a chemical method (using NH3 vapor) were used, succeeded at 0.32g/65mL, but failed at 0.16g/50mL thymolphthalein. Therefore, NH3 had to be sprayed for 0.16g/50mL with negligible harm.

Direct conversion of lipids from marine microalga C. salina to biodiesel with immobilised enzymes using magnetic nanoparticle

The present study aimed at directly producing biodiesel using oil extracted from wet cells of marine microalga, Chlorella salina. The protocol involved cellulase for oil extraction and lipase for oil conversion to FAME during interesterification immobilised on magnetic nanoparticles. Anaerobically synthesized magnetic nanoparticles were characterized using TEM and XRD Spectroscopy. Studies were also carried out to learn the effect of immobilised enzymes on their respective operations and water content for FAME synthesis. The investigation showed that 2g of each immobilised enzyme- cellulase and lipase was found to be optimum for oil extraction and FAME conversion respectively and 60% water was required for biodiesel production. A maximum yield was observed as 93.56% under optimised conditions along with standard parameters. Experiment on stability and re-utilization of immobilised materials revealed that they remained intact without any loss in their functions even after 10 cycles of repeated usage. The overall study represented that it is a rapid and economical prospect for producing biodiesel commercially in a greener way causing negligible harm to ecosystem.

The Legal Duties of Long-Term Care Providers in Long-Term Care Institutions Using the Example of Fall Accidents Among Elderly Patients

Two reasons may explain a majority of neglect-related falls that are experienced by the elderly living in senior welfare institutions. Firstly, the supervisors may not manage these institutions in accordance with the law or with the Senior Citizens Welfare Act and the Establishment Standards of Senior Citizens' Welfare Institutions. This situation may compromise the facilities and nursing manpower of these institutions. Secondly, nurses may be negligent in their care of the elderly. Healthcare professionals are responsible to implement their care duties. Failure to implement these duties that result in care-recipient injury or death will expose these professionals to charges of negligent homicide or negligent assault. In order to help supervisors and nurses who work in senior welfare institutions better understand their care duties, the present article introduces relevant laws and regulations, including the Senior Citizens Welfare Act and the Establishment Standards of Senior Citizens' Welfare Institutions. In addition, we introduce three judicial decisions that highlight the domestic judicial practice related to the care duties of long-term care providers. As a result, we hope that long-term care providers may better implement their duties properly and thus avoid negligent harm to those in their care and help better protect and promote the rights and welfare of the elderly.

Reversal of Fortune: When Does Increased Distance from an Initial Negligent Act Make One More Blameworthy?

Early investigations into the effect of distance between negligent acts and subsequent harm demonstrated a causal proximity bias in judgments of blame. Specifically, fewer mediating steps between a negligent act and subsequent harm resulted in more blameworthy defendants. However, we reasoned that sometimes extra steps in a causal chain could be viewed as additional opportunities for the defendant to intervene and prevent a harmful outcome. Therefore, extra steps, or increased causal distance, without intervention by the defendant would make the defendant seem more blameworthy. Across three studies (N = 338), we demonstrated that although reversing the causal proximity bias is relatively easy, obtaining the original causal proximity bias is surprisingly difficult. We argue that increasing the number of causal steps to an outcome can be perceived as missed opportunities for the perpetrator to take corrective action. Therefore, the more steps to an outcome, the more blameworthy a defendant is judged.

Fizinio skausmo sukėlimo nustatymo ir BK 140 straipsnyje numatyto nusikaltimo pripažinimo mažareikšmiu probleminiai aspektai

Article 140 of the Criminal Code of the Republic of Lithuania establishes liability for beating or other violent actions, which cause to a person physical pain or a negligible bodily harm or a short-term illness. The article does not provide a boundary when physical abuse shall not be considered a crime, as allegedly there shall be a punishment only for causing of physical pain. Article 140 of the CC criminalizes one of the lightest consequences of physical abuse – causing of physical pain. Does this mean that any abuse or using of physical force towards another person’s body shall always carry criminal liability? The answer to this question is directly related to the range of problems of physical pain definition in criminal law, so the article includes the analysis of problem related to the assessment of causing of physical pain in criminal law. The objective of the article is to assess the problems of physical pain feature definition and distinguish criteria for its proof in criminal cases applying system-based, logical, court practice assessment and other research methods. Simultaneously, the author of the article will try to answer whether physical pain and negligible bodily harm could be recognized as a minor crime.It should be mentioned that physical abuse does not always cause physical pain, and not every caused physical pain is dangerous, illegal and harmful. While applying criminal liability for causing of physical pain, one has to define the boundaries of criminality of such actions reasonably. Adjudging of person’s actions, a crime shall not be made just formally without assessment of the fact whether the illegality of such actions has criminal nature, and whether their hazard is sufficient for considering them a crime. A formal statement that physical pain is caused is not enough. Criminal liability can be applied only in the case when the illegality of person’s behavior reaches criminal liability application hazard level. The intensity and degree of caused physical pain, as well as harm of caused pain to life and health of a certain person, shall be criteria for the application of criminal liability. The article also includes the conclusion that special medical knowledge is not required for the statement of physical pain. The fact of causing of physical pain can be stated by the court basing on the case material data, confirming the fact of previous beating or other violent actions. While stating that causing of physical pain is a harmful act, one shall base on the perception of a certain injured person (subjective criteria) and physical ability to make harm to a person (objective criteria), considering physical ability of a certain injured person.Harm of short-term illness or causing of physical pain can be of completely different nature, so there are cases when a person will be released from criminal liability due to the minority of crime. Components of crime related to causing of physical pain to a young child are established in Part 3 of Article 140 of the CC, so that the harm, depending of case circumstances, can be completely different. Even considering physical ability of an injured person (minority), the crime harmfulness degree is low due to insignificant consequences, and it does not reach the degree which closes out application of release from criminal liability due to the minority of crime. Causing of physical pain to a young child can be recognized as a minor crime according to certain case circumstances.

Rapid assessment of boat-generated waves within sheltered waterways

It is well known that waves generated by passing ships and boats can cause problems for other users of a waterway and the surrounding environment. In recent decades there has been a growing need to quantify these waves so that fair and realistic regulations can be implemented to ensure vessel operations cause minimal or negligible harm. The majority of regulatory criteria adopted both locally and internationally have relied upon the identification and quantification of just a single characteristic wave from the entire train of waves generated by a vessel, usually the highest. However, it has been shown that this is generally inadequate when considering the more complex wave patterns that are generated when craft operate in shallow water environments. This paper reports on a recent study that defined three key waves that should be quantified when assessing vessel wave wake in shallow water conditions to account for all potentially dangerous or damaging waves, particularly those of low height and high energy. Also outlined is the development of a tool that can rapidly and accurately predict the characteristics of the three key waves. This tool was developed using data acquired from a comprehensive set of model scale experiments and has been validated against measured data from independent full scale trials. The tool can be used to account for the effect that water depth, hull form and vessel speed has on the waves generated. The Wave Wake Predictor is now freely available online to assist those tasked with designing new vessels, or those who wish to identify any potentially serious wave wake issues very early in the planning and design stages of any vessel for a particular route.

Tourniquet device for hemorrhage control during cesarean section of complete placenta previa pregnancies

To reduce massive and potentially fatal hemorrhage during cesarean section (CS) delivery because of the transverse incision through the lower uterine segment and placenta in central placenta previa (CPP), especially the type in which the placenta attaches to the anterior wall of the uterus. Thirty-four patients with CPP were enrolled in the study and 14 of them accepted the tourniquet method. The main outcome evaluations were blood loss, the proportion of red blood cell-transfused patients, the need for other hemostatic procedures and complications in either the mother or infant after the completion of the tourniquet procedure. A statistically significant benefit was noted between the two groups of the frequency of post-partum hemorrhage (PPH), the median estimated blood loss and the proportion of transfused patients. The effectiveness of the tourniquet method could be further proved by the relative risk with confidence intervals for PPH data and additional procedures. The clinical data of 34 patients show that this is an effective surgical treatment to reduce blood loss and suggest that there is negligible harm to patients and fetuses.

Does profession or experience affect a practitioner's perception when assigning potential harm avoided by pharmacists interventions

AimThe aims of the study were to assess the differences in rating of potential harm avoided by a pharmacist's intervention using a multidisciplinary team and whether the experience of a...

Effects of heat recovery for district heating on waste incineration health impact: A simulation study in Northern Italy

The construction of waste incinerators in populated areas always causes substantial public concern. Since the heat from waste combustion can be recovered to power district heating networks and allows for the switch-off of domestic boilers in urbanized areas, predictive models for health assessment should also take into account the potential benefits of abating an important source of diffuse emission.In this work, we simulated the dispersion of atmospheric pollutants from a waste incinerator under construction in Parma (Italy) into different environmental compartments and estimated the potential health effect of both criteria- (PM10) and micro-pollutants (PCDD/F, PAH, Cd, Hg). We analyzed two emission scenarios, one considering only the new incinerator, and the other accounting for the potential decrease in pollutant concentrations due to the activation of a district heating network. We estimated the effect of uncertainty in parameter estimation on health risk through Monte Carlo simulations. In addition, we analyzed the robustness of health risk to alternative assumptions on: a) the geographical origins of the potentially contaminated food, and b) the dietary habits of the exposed population.Our analysis showed that under the specific set of assumptions and emission scenarios explored in the present work: (i) the proposed waste incinerator plant appears to cause negligible harm to the resident population; (ii) despite the net increase in PM10 mass balance, ground-level concentration of fine particulate matter may be curbed by the activation of an extensive district heating system powered through waste combustion heat recovery and the concurrent switch-off of domestic/industrial heating boilers. In addition, our study showed that the health risk caused by waste incineration emissions is sensitive to assumptions about the typical diet of the resident population, and the geographical origins of food production.

Higher Prehospital Priority Level of Stroke Improves Thrombolysis Frequency and Time to Stroke Unit

Early initiated treatment of stroke increases the chances of a good recovery. This randomized controlled study evaluates how an increased priority level for patients with stroke, from level 2 to 1, from the Emergency Medical Communication Center influences thrombolysis frequency, time to stroke unit, and whether other medical emergencies reported negative consequences. Patients aged 18 to 85 years in Stockholm, Sweden, with symptoms of stroke within 6 hours were randomized from the Emergency Medical Communication Center or emergency medical services to an intervention group, priority level 1, immediate call of an ambulance, or to a control group with standard priority level, that is, priority level 2 (within 30 minutes). Before study start, an educational program on identification of stroke and importance of early initiated treatment was directed to all medical dispatchers and ambulance and emergency department personnel. During 2008, 942 patients were randomized of which 53% (n=496) had a final stroke/transient ischemic attack diagnosis. Patients in the Emergency Medical Communication Center randomized intervention group reached the stroke unit 26 minutes earlier than the control group (P<0.001) after the emergency call. Thrombolysis was given to 24% of the patients in the intervention group compared with 10% of the control subjects (P<0.001). The higher priority level showed no negative effect on other critical ill patients requiring priority level 1 prehospital attention. This randomized study shows negligible harm to other medical emergencies, a significant increase in thrombolysis frequency, and a shorter time to the stroke unit for patients with stroke upgraded to priority level 1 from the Emergency Medical Communication Center and through the acute chain of stroke care.

Imaging and Analyzing the Elasticity of Vascular Smooth Muscle Cells by Atomic Force Acoustic Microscope

Vascular smooth muscle cells (VSMCs) play an important role in the good performance of the vasculature. To study the surface, intracellular structure and elasticity of VSMCs, atomic force acoustic microscope (AFAM) was used for imaging VSMCs from A7r5 rat aorta arteries. The topography images of VSMCs were obtained in contact mode and the acoustic images were obtained by AFAM in sample vibration mode. Then, the force curve measurement derived using Young’s modulus of the interested areas was used for evaluating elasticity properties. The acoustic images were found in higher resolution with more information than the topography images. The force curves showed the difference in Young’s modulus of the different parts of VSMC. These findings demonstrate that AFAM is useful for displaying the surface, structure and elasticity property of VSMCs clearly, with short scanning time, negligible harm or damage to cell and nanometer-level resolution.

Administrative Law Adjudications Involving Healthcare Professionals: Mental Health Expert Testimony

Mental health experts are often needed to provide expert testimony about a respondent healthcare professional's retrospective mental state and prospective fitness for duty. This calls for the expert to parse the degree to which educational deficiency and mental illness were substantial contributing factors to any alleged past misconduct, and to offer recommendations for prospective mental health treatment and educational and supervisory remediation of any diagnosed disorders or deficiencies. Unlike adjudication of malpractice—in which the goal is to make an injured party whole by financial compensation for negligent harm—the goal of administrative agency investigation, adjudication, and peer review is to protect the public by serving as an overseer of the quality of the profession. Health care agency investigators and finders of fact require mental health experts who can discern applicable standards of care and procedure and who can offer opinions that may differ in nature substantially from those typically required in ordinary malpractice litigation.

Universal newborn hearing screening

The present statement reviews the evidence for universal newborn hearing screening (UNHS). A systematic review of the literature was conducted using Medline and using search dates from 1996 to the third week of August 2009. The following search terms were used: neonatal screening AND hearing loss AND hearing disorders. The key phrase "universal newborn hearing screening" was also searched. The Cochrane Central Register of Controlled Trials and systematic reviews was searched. Three systematic reviews, one controlled non-randomized trial and multiple cohort studies were found. It was determined that there was satisfactory evidence to support UNHS. The results of the available literature are consistent and indicate clear evidence that without UNHS, delayed diagnosis leads to significant harm for children and their families; with UNHS, diagnosis and intervention occur earlier; earlier intervention translates to improved language outcomes; and in well-run programs, there is negligible harm from screening.

Predicting blame assignment in a case of negligent harm

Theories of blame posit that observers consider causality, controllability, and foreseeability when assigning blame to actors. The present study examined which of these factors, either on their own or in interaction, predicted blame assigned to actors in a case of harm caused by negligence. The findings revealed that only causal impact ratings predicted blame. The findings also revealed a novel form of asymmetric discounting: the causal impact of a negligent actor was used to discount blame assigned to an innocent actor, but the causal impact of the innocent actor was not used to discount the blame assigned to the negligent actor.

Unavoidable Accident

In negligence law, “unavoidable accident” is the risk that remains when an actor has used due care. The counterpart of unavoidable accident is “negligent harm.” Negligence law makes parties immune for unavoidable accident even when they have used less than due care. Courts have developed a number of methods by which they “sort” accidents to unavoidable accident or to negligent harm, holding parties liable only for the latter. These sorting techniques are interesting in their own right and also provide a way of conceptualizing the relationship between specific negligence and res ipsa loquitur, which are two variants of the negligence rule. One judicial sorting technique reveals a paradox of negligence law. New safety technology often reduces the amount of unavoidable accident and simultaneously increases the expected number of “compliance errors,” or routine negligent lapses, that actors will make. Paradoxically, an actor’s use of new safety technology can make it more likely that a court will sort an accident to negligent harm as opposed to unavoidable accident. The article develops these theoretical ideas through a series of graphical illustrations analogous to those of traditional price theory.

Do the Claims Hold Up? A Study of Medical Negligence Claims Against Neurologists

We performed an in‐depth review of each of the 42 closed medical malpractice claims filed in the past 20 years against neurologist defendants covered by a common insurer. For each case, we determined whether the neurologist had rendered harmful, substandard care and noted the case outcome. In 23 of 42 claims (55 percent), there had been no harmful negligence, and payment on behalf of the neurologist occurred only once. The other 19 claims had negligent harm, but in 13 of them (68 percent) no payment was made on behalf of the negligent neurologist. In our series, the medical negligence system performed poorly, yielding a majority of inappropriate claims and no payment in a majority of appropriate claims.

Technique for rapid in vitro single-cell elastography

Statistically meaningful assays require scanning a large number of cells in a short time. Here we present a technique for rapid in vitro single-cell elastography. The technique is based on atomic force acoustic microscopy but (1) requires only a few minutes of scan time, (2) can be used on live cells briefly removed from most of the nutrient fluid, (3) does negligible harm or damage to the cell, (4) provides semiquantitative information on the distribution of modulus across the cell and (5) yields data with 1- to 10-nm resolution. We describe the new technique in detail, apply it to baby hamster kidney cells, verify the results and calibrate the images with atomic force microscope force-distance measurements. The technique enables rapid assessment of physical/biochemical signals on the cell modulus and contributes to current understanding of cell mechanics.

Food for Thought: Consistent Protocol Could Strengthen Food Supply Security Measures

When Americans buy food at their hometown grocery stores or frequent favorite restaurants, it is unlikely that much thought is given to whether any of the food consumed may ultimately cause their demise. They should. Food safety laws are an integral part of the domestic food supply and have been for most of this century. The attack on America on September 11, 2001 forced government officials, producers, and consumers to seek out and bolster any potential weak spots in national security. The domestic food supply is one such area of concern. The recent passage of the Public Health Security and Bioterrorism Preparedness Act of 2002 validates the concern that the food supply is at risk for possible terrorist activity. While the terrorist aspect of food safety regulation is most prominent, another more pervasive area of concern gaining regulatory attention is biological, not necessarily terrorist, activity. This Comment explores current food safety laws and practices and suggests that more consistent safety protocol throughout every link in the "farm-to-table" chain could bolster the integrity of the domestic food supply in the post-September 11th environment against both intentional and negligent harm risks.