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Background Tumor necrosis factor-alpha inhibitors (anti-TNFs) are a primary treatment for inflammatory bowel disease. Pharmaceutical expenditures and usage of specialty drugs are increasing. In the United States, biosimilars continue to be underutilized, despite opportunities for health care cost savings. Through quality improvement (QI) methodology, we aimed to increase biosimilar utilization among eligible patients initiating intravenous (IV) anti-TNF therapy and describe patient outcomes and associated cost savings. Methods Beginning in July 2019, all patients initiating IV anti-TNF therapy were identified and tracked. Using the Institute of Healthcare Improvement Plan-Do-Study-Act cycle, a four-stage problem-solving model used for carrying out change, we trialed interventions to increase biosimilar utilization, including provider, staff, and family education, and utilization of a clinical pharmacist and insurance specialist. Statistical process control charts were used to show improvement over time. Patients’ clinical outcome and cost savings were reviewed. Results Using QI methodology, we increased biosimilar utilization from a baseline of 1% in June 2019 to 96% by February 2021, with sustained improvement. The originator (infliximab) was the insurance company’s preferred product for 20 patients (20%). Patient outcomes (IV anti-TNF levels, absence of antidrug antibodies, and physician global assessment) between biosimilars and originators were similar. Estimated cost savings over the project duration were nearly $381,000 (average sales price) and $651,000 (wholesale acquisition cost). Conclusions Through QI methodology, we increased biosimilar utilization from 1% to 96% with sustained improvement, without compromising patient outcomes or safety. Estimated cost savings were substantial. Similar methodology could be implemented at other institutions to increase biosimilar utilization and potentially decrease health care costs.

This report outlines the findings of a research project that was co-funded by the Government Centre for Dispute Resolution as part of Victoria University of Wellington's 2020/2021 Summer Scholarship Programme. It forms part of the New Zealand Commercial Mediation Study. This report aims to provide insight into the practice of commercial mediation in New Zealand and its relationship to the judiciary. It builds on the four previous reports within this study: the first and fourth which examined the nature of private commercial mediation in New Zealand by surveying mediators; the second which examined the perspectives of commercial lawyers (the 'gatekeepers'); and the third which examined the 'users' of commercial mediation, more specifically the insurance sector. Investigation into the private mediation market is necessary for the growth and development of mediation as a form of alternative dispute resolution.

Mediation is one form of dispute resolution used in resolving commercial disputes in New Zealand. Lawyers play a key role as gatekeepers to commercial mediation. This article explores the role that these gatekeepers are playing in the New Zealand private commercial mediation market. The findings are based on a survey and interviews carried out in late 2015 and early 2016. Prior to this study there was no comprehensive information on the attitude of New Zealand commercial lawyers to mediation. The evidence reported in this article suggests that lawyers are very aware of commercial mediation, and support it, but largely on their own terms. They are not undermining it. In fact, lawyers believe they are contributing positively to the mediation process. Clients have a more limited knowledge of mediation but usually follow their lawyer’s recommendations. Thus lawyers play a key role as gatekeepers to commercial mediation. The main reason lawyers recommend mediation is cost (i.e. it is cheaper than litigation). Lawyers prefer legally trained mediators with experience and a good reputation. Lawyers report high mediation settlement rates and high overall quality of mediations. Overall, the ‘gatekeepers’ are generally happy with the standard of commercial mediation in New Zealand. However, mediation exists to serve the clients, not the gatekeepers. The views of actual users are necessary to complete the picture of the New Zealand commercial mediation market.

This report outlines the findings of a research project that was co-funded by the Resolution Institute as part of Victoria University’s 2018/19 Summer Scholarship programme. It forms part of the New Zealand Commercial Mediation Study (NZCMS). This report aims to provide insight into the practice of commercial mediation in New Zealand and builds on the previous studies: the first examining the nature of private commercial mediation in New Zealand (as this does also), the second examining the perspectives of commercial lawyers, the ‘gatekeepers’ of mediation, and the third examining the perspectives of ‘users’ of commercial mediation, (more specifically in the insurance sector). The longitudinal nature of this research allows readers to see the differences in the private mediation market from early 2015 to early 2019. Investigation into the private mediation market is necessary for its growth and development as a form of alternative dispute resolution.

Most employment mediation in New Zealand is carried out by Resolution Services under the Employment Relations Act 2000. This article focuses on mediation styles. According to policy and statute, what styles are claimed to be used? According to mediators, what styles are actually used? What are the repercussions of these findings? Resolution Services’ eclectic approach to mediation styles is both consciously practiced and effective. However, this approach means that parties have little idea which style to expect and that mediators are mixing and matching styles which, according to the style creators, are not supposed to be mixed and matched.

The results of this survey provide an understanding of users’ perspectives on mediation. The respondents reported a good knowledge of mediation. They also indicated that the insurance industry as a whole is aware of mediation and supports the use of it. Users report they are using mediation often and believe that it is well utilised in the insurance sector. However, most estimate that the organisations they work for use mediation less than 25 times in any given year. Respondents’ main reason for using mediation is its cost-effectiveness. Respondents’ main reason for not using mediation is the other party’s unwillingness. This indicates the party on the other side of a dispute may be a barrier to using mediation. Respondents also noted that the other party having a weak case or unrealistic expectations were reasons not to use mediation.

Sophisticated fictional portrayals of lawyers facing ethical dilemmas can provide important insights into the nature of legal ethics and morality in the New Zealand legal profession. These insights can assist the legal community in addressing complex issues surrounding professional regulation. This article reveals legal characters who act contrary to legal ethics but with moral justifications and characters who act ethically but in a way that laypeople may view as amoral or immoral. While the depictions of lawyers are generally negative, a close analysis reveals that this is partly a result of confusion over what Dare has termed the standard conception of a lawyer's role. Fewer insights can be gained from superficial characterisations. While much has been written on this topic in other jurisdictions, more light can be shed on New Zealand's ethical landscape through the study of New Zealand's fictional texts. This article exposes a rich resource for the legal community because as Economides and O'Leary have argued in relation to legal ethics, stories matter. This dictum should apply to works of non-fiction and fiction.

This report contains follow on research from the 2015 study examining the nature of private commercial mediation in New Zealand. The aim of this research project is to examine gatekeepers’ perspectives on commercial mediation. There is a lack of empirical information on the nature and use of commercial mediation in New Zealand. This project aimed at gathering empirical data from lawyers working within this field to gain a picture of the current market. Overall conclusions include:• Lawyers know about commercial mediation and support it, but largely on their own terms. They are not undermining it. Lawyers believe they are contributing positively to the mediation process.• Clients have a more limited knowledge of mediation but usually follow their lawyer’s recommendations. Thus lawyers play a key role as gatekeepers to commercial mediation.• The main reason lawyers recommend mediation is cost ie it is cheaper than litigation.• Lawyers prefer legal trained mediators with experience and a good reputation. • Lawyers report high mediation settlement rates and high overall quality of mediation. Lawyers are generally happy with the standard of commercial mediation in New Zealand.• It appears that while mediators believe it would be advantageous to expand commercial mediation in NZ, lawyers are generally satisfied with the level and quality of commercial mediation. The group that has not yet been surveyed is clients and potential clients of commercial mediation.

Gillon v MacDonald (1878) was the climax of a feud that caused division in, and undermined the reputation of, the early New Zealand legal profession. Gillon features one of the most controversial episodes of contempt of court by a barrister in colonial legal history. The nature of the New Zealand legal profession, and in particular the relationship between bench and bar, is exposed through the case, its prologue and its aftermath. The complex saga occurred over several years and involved all three branches of government. Its causes are open to debate, but this article argues that personal and professional rivalry lies at the heart of the saga, and in particular, an obsessive vendetta on the part of George Elliot Barton. The events described in this article had far reaching consequences including possibly influencing New Zealand’s most infamous legal decision, Wi Parata v Bishop of Wellington (1877).

John Salmond dominated the New Zealand legal environment during the early twentieth century. Salmond performed many roles in the New Zealand legal system. This article focuses on his final legal role, as a Supreme Court judge, and looks at the nature of the Supreme Court Bench from 1920 to 1924. Some of New Zealand's greatest legal names sat with Salmond during this time. Twentieth century New Zealand legal history is a relatively unexplored area and requires more attention from historians. This article provides the basis for possible future work on the Supreme Court Bench during the early 1920s. In discussing the nature of "Salmond's Bench" the backgrounds of the different Supreme Court justices are explored. Following this, selected cases are analysed revealing distinctive factors relating to how this group of judges worked together and the nature of their judgments. Particular attention is paid to the divisions on the Bench regarding the crucial social issue of divorce. Viewing the decisions made by Salmond's Bench in the context of the political and social backgrounds of the judges and the historical background of this period provides a vital third dimension to the judgments. Salmond's distinctive approach to judicial decision-making becomes clearer when directly compared with the approaches of his judicial peers.

This report delivers the results from the first project to systematically explore commercial mediation in NZ. A key aim of this project is to move the study of commercial mediation in NZ from anecdote to evidence. There has been a lot of talk about the growing importance of commercial mediation in NZ but no empirical evidence to support the claims. This information vacuum weakens the mediation profession’s efforts to effectively promote mediation for commercial disputes. It also leaves the profession vulnerable to criticism from those suspicious of mediation i.e. it is difficult to rebut criticism without convincing evidence.Specific research questions covered in the project include:How much commercial mediation is taking place?What styles of mediation are being used in commercial disputes?How effective is this mediation?Who is carrying out commercial mediation? Where is it happening?How can the use of commercial mediation be increased and encouraged?What are the key challenges facing commercial mediation?Relevant written sources have been analysed and individual mediators surveyed and interviewed regarding the nature of their work. Along with providing an overview of NZ’s commercial mediation landscape the project will hopefully stimulate further research into this area of mediation practice. This report assesses the current state of commercial mediation in NZ and offer predictions for the future.

Chief Justice James Prendergast has largely been demonised over the last two decades as a result of his famous decision in the Wi Parata v The Bishop of Wellington case in 1877. In that decision, he notably stated that the apparent cession of sovereignty in the Treaty of Waitangi was "a simple nullity". This statement has effectively taken on a life of its own, and is still cited – with polarising effect – in the current debate on the place of the Treaty in modern New Zealand society. The author argues, however, that the debate and commentary on the case has largely omitted to consider Prendergast as a man of his times and background and as an important part of a small legal community. The part that others had to play in the Wi Parata case is often not mentioned, for example. This article seeks to redress the balance somewhat. In doing so, it does not underestimate the devastating effect which the decision had in supporting the alienation of Maori land. However it emphasises that Prendergast's view represented the orthodoxy of the time, and for some considerable time thereafter, and that his main fault was that he failed to rise above the prejudices of the settler society in which he lived.

The P300 is an easily elicited psychophysiological phenomenon that may reflect phases of information processing inherent in many complex cognitive endeavors. In this study, cortical event-related potentials were collected from 49 subjects during an inspection time task. P300 amplitude at the temporal and occipital sites correlated with inspection time and with performance on Raven's Standard Matrices. This study supports some of the previous work on P300 correlates and suggests that future integration of the IT and ERP paradigms will be fruitful.

The Continuous Visual Memory Test (CVMT; Trahan & Larrabee, 1988) is a recognition format assessment of figural memory. It includes 112 ambiguous designs presented sequentially, with a number of designs that recur through the 112 presentations. The patient's task is to identify the recurring figures by responding with the word “old” for recurring stimuli and “new” for non-recurring stimuli. This study examined cortical event-related potentials during discrimination of old vs. new stimuli. While no latency differences between stimuli were found, P300 amplitude was greater during recognition of old stimuli and increasingly prominent at anterior sites. A stimulus by electrode site interaction suggests greater functional involvement in the discrimination by the frontal areas. This points to a degree of psychophysiological validation of the CVMT and cortical specificity of the task. © 1996 John Wiley & Sons, Inc.

The N1P2 complex is a component of cortical event related-potentials. It has been linked to intelligence as well as early processing and attention. This study examined a new measure—the slope of the N1P2 complex—during an inspection time task. The 49 participants also completed the Raven's Standard Progressive Matrices as an intelligence index. P200 slope at the frontal and temporo-occipital, but not at temporal or occipital, recording sites was significantly correlated with both inspection time and Raven's performance. This study supports earlier N1P2 links with intelligence, and refines the ERP measure and eliciting task.

E-learning’ can be defined as a method of learning that is supported by the use of information technology (‘IT’). It is believed that e-learning has the power to transform the way we teach and that it may improve learning. However, when designing an online environment, lecturers do not always take into consideration certain crucial elements of teaching — including the motivation of their students. Similarly, the research has largely ignored the role of motivation in the online learning environment due to the assumption that e-learners are self-motivated and active learners. This article looks at certain elements that can be used to foster the motivation of students in the online environment.

Through the case method and Socratic dialogue, first year law students are taught to develop critical legal analytic skills-to “think like a lawyer.” Those skills, however, are primarily, if not entirely, intellectual. This article discusses the need to address emotional issues in educating law students. Unlike other articles, my article does not merely urge professors to raise such issues in their classes and discuss them analytically. Rather, I want students to actually experience emotion in the classroom setting as they discuss various fact situations and the legal principles involved in the resolution of disputes involving those facts. Law students need to understand and appreciate the emotions of people, including their own emotions, if they are to become the best lawyers they are capable of becoming. Educating law students about emotions should not be deferred until upper class clinical courses or professional responsibility courses. The place to begin that education is in the first year. To encourage such education, I present specific examples from my first-year Torts class in which I raise issues in a manner that results in an emotional response by students. I demonstrate how such methodology stimulates class discussion and enriches the law student’s educational experience.

Clinical issues related to informed consent and competency are present in all areas of medicine and are, quite possibly, the most relevant in the disciplines of psychiatry and neurology. The very nature of the specialty (involving disease of mind or brain) often calls into question the ability of the patient to understand the medical procedures or treatment that are being proposed.

This article reports on a survey of forensic psychiatrists and psychologists who read two case study vignettes and assessed whether each criminal defendant was competent to stand trial, using three differently worded standards of competency: one that focused on whether the defendant's thinking was rational, a second that focused on whether the defendant's behavior was rational, and a third that did not use the word "rational." The objective was to discover whether forensic examiners would distinguish among the standards (i.e., find the defendant competent under one standard but not under another) or whether they would find the defendant competent under all standards or incompetent under all standards. In responding to both vignettes, more than three-fourths of all respondents either found the defendant competent under all three standards or incompetent under all three standards. In addition, in answering one vignette, the respondents were divided almost equally in deciding whether the defendant was competent to stand trial. These results are analyzed and respondents' comments are discussed. The article concludes with specific proposals to improve competency-to-stand-trial assessments.

In Kansas v. Hendricks, 521 U.S. 346 (1997), by the narrowest of margins, the Supreme Court upheld the Kansas Sexually Violent Predator (SVP) statute against several constitutional attacks. With this Supreme Court imprimatur, SVP legislation has become the wave of the present-a politically popular solution to the problem of repeated sexual violence against women and children. Typically, after an individual identifiable as an SVP serves a criminal sentence, he is subjected to civil commitment and detained indefinitely. Many scholars assert that Hendricks was wrongly decided and that SVP legislation should be held unconstitutional. I review their arguments and conclude that after Hendricks, they are not likely to succeed. However, the Supreme Court did not consider an equal protection attack on SVP legislation. In my article, I explain why an equal protection challenge claiming that SVPs are similarly situated with other civilly committed patients is likely to fail. Nevertheless, I believe that a properly framed equal protection claim could, and should succeed. I explain why, based on other Supreme Court decisions, SVP legislation impermissibly discriminates against sentence-expiring convicts, incompetent criminal defendants, and nondangerous insanity acquittees by exempting from SVP commitment other individuals who are equally mentally disordered and dangerous.

The P300 is a component of cortical event related-potentials that has been linked to memory and recognition. This study examined P300 amplitude and latency during recognition of pairs of words from the WMS-R Verbal Paired Associate Learning subscale. After 24 subjects learned the pairs of words, they were shown pairs of words taken directly from the subscale that were combined to form matching or nonmatching pairs. This parallels the Delayed Recall subtest of the WMS-R. P300 amplitude was greater during recognition of matching word pairs and most prominent at central and parietal recording sites. P300 latency was shorter for matching than for nonmatching pairs. This points to a degree of psychophysiological validity of the WMS-R paired associate learning delayed recall task.

This study examined both electroencephalography (EEG) and brain stem evoked responses (BSERs) as indices of cortical dysfunction in children who experience learning disabilities (LD). Fifteen 9‐ to 12‐year‐olds from self‐contained LD classrooms were compared with 15 control children of the same age‐range for eyes‐open and eyes‐closed spontaneous EEG and for lateral symmetry of click‐elicited BSERs. Spontaneous EEG with eyes closed showed the largest between‐group differences over the bilateral temporal sites, where the LD group demonstrated a relative depression of delta and theta frequency bands and a relative increase in alpha. Control children, however, exhibited a more orderly progression or rate of maturation in EEG development compared to LD children. Neither differences in latencies of BSER peaks, I, III, and V, nor lateral asymmetry in BSERs were found between the diagnostic groups. Similar to the findings for EEGs, control children exhibited a more systematic increase in BSER peak latencies as a ...

Most research employing physiological stress profiling procedures has relied upon statistical analyses that are flawed in two ways: (a) These analyses typically average the physiological levels observed across a series of observations during any one phase of the profile, thereby ignoring rate of change as a relevant parameter, and (b) the problem of autocorrelation, or the natural correlation of time-series observations of the same physiologic activity, is unaddressed. We hope to introduce the biofeedback field to the technique of interrupted time-series analysis, which effectively deals with these two flaws. Interrupted time-series analysis additionally permits statistical conclusions based upon the stress profile of a single individual, thereby providing an objective basis for decisions concerning the effectiveness of training or the timing of changes in training for a single client. We describe the application of the technique to the analysis of a stress profile of a subject diagnosed as hypertensive.

In this article, the author asserts that the right of involuntarily confined mental patients to refuse psychiatric treatment is both legally sound and medically desirable. This right is viewed as one example of the broader right of any patient to deny his consent to proposed medical treatment. The author critiques two devices that are utilized to subvert the right of mental patients to refuse psychiatric treatment: (1) a competency test that equates the patient's competence with his willingness to accept the psychiatrist's proposed therapy, and (2) the appointment of guardians to act as substitute decision-makers for civil and criminal patients who have not been declared incompetent to make treatment decisions.

Evidence has accumulated rapidly to support the hypothesis that neurological anomalies underlie specific forms of learning disability (LD). This article reviews recent studies directed at the electrophysiological assessment of LD children, with emphasis on the brain stem evoked response(BSER) methodology. Child studies appear to indicate that there are significant differences in BSERs between LD and age-matched normal controls. The methodological and statistical differences among these studies, which have clouded the findings and made replication difficult, are reviewed. Improvements in sampling and empirical procedures are suggested, including the use of discriminant analysis to explore BSER asymmetries in LD children. Future inquiry into the measurement and analysis of BSER activity in LD populations is warranted on the basis of these preliminary findings. New information may bring professionals closer to an understanding of the neurological causes of specific subtypes of LD and permit earlier identification of these "at risk" populations.

Our criminal law is premised on this assumption: Because an individual has the ability to choose between socially acceptable and socially unacceptable behavior, he or she can be held responsible for conduct that violates the law. Thus, an individual who chooses to commit a crime is morally blameworthy and therefore an appropriate subject for punishment. The insanity defense developed as a device to exclude from criminal responsibility people whom society views as not blameworthy. A severely mentally disordered individual is not considered blameworthy because he or she lacks the capacity (free will) to form the intent to commit a criminal act.

Studies of color pecking preferences in newly hatched chicks (Gallus domesticus) have shown unimodal preference in the orange region of the spectrum or bimodal preferences at blue and orange. In the present study, dark-harched White Leghorn chicks were tested in darkness with targets illuminated at 1 or 3 radiant intensity levels. Results showed the least amount of pecking at green (541 nm.) and peak preferences in blue-violet and orange-red regions. Findings were similar when other dark-hatched chicks were tested in the light (Experiment 2). Overall, findings suggest unlearned pecking preferences for short and long wavelengths, with minimums at green. Possible evolutionary and photochemical bases for such a bimodal wavelength preference function were discussed. Since bimodality was unaffected by target intensity and background, these variables probably do not account for the unimodal function reported by others.

This chapter will explore some of the nonbehavioral neurodiagnostic assessment techniques that were introduced in Chapter 3 of this volume. These techniques include neuroimaging techniques, such as computerized tomography (CT) and magnetic resonance imaging (MRI), electroencephalography, and evoked potentials. To illustrate the potential of these tehcniques for assessment in child neuropsychology we have chosen to focus specifically upon learning disabilities (LD).

The published papers and accompanying essay which make up this doctoral thesis examine economic aspects of the competitive process in mature product industrial markets and draw implications for competition policy. The analysis of price competition relates patterns of price leadership and discount competition to features of market structure (using the UK petrol market as a case study) and examines the influence of large buyers on price determination. Policies towards buying power and price discrimination in several countries are compared and appraised. The analysis of long-run adjustment and competitive equilibrium focuses on the diversification process, analysing the industry structure determinants of the inter-industry pattern of diversification within a risk/return framework. The same risk/return optimisation provides the basis for an examination of the role of risk differentials in determining inter-firm and inter-industry differences in return on capital. Some implications are drawn for the interpretation by competition authorities of the returns earned by dominant firms.