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BackgroundRefugees are prone to injury due to often austere living conditions, social and economic disadvantages, and limited access to health care services in host countries. This study systematically quantified the prevalence of physical injuries and burns among the refugee community in Western Lebanon and examined injury characteristics, risk factors and outcomes.MethodWe conducted a cluster-based population survey across 21 camps in the Bekaa region of Lebanon from February to April 2019. A modified version of the ‘Surgeons Overseas Assessment of Surgical Need (SOSAS)’ tool v 3.0 was administered to the head of the refugee household and documented all injuries sustained by family members over the last 12 months. Descriptive and univariate regression analyses were performed to understand the association between variables.Results750 heads of household were surveyed. 112 (14.9%) household sustained injuries in the past 12 months, 39 of which (34.9%) reported disabling injuries that affected their work and daily living. Most injuries occurred inside the tent (29.9%). A burn was sustained by at least one household member in 136 (18.1%) households. The majority (63.7%) of burns affected children under 5 years and were mainly due to boiling liquid (50%). Significantly more burns were reported in households where caregivers have the inability to lockout children while cooking (25.6% vs 14.9%, p-value=0.001). Similarly, households with unemployed head significantly had more reported burns (19.7% vs 13.3%, p-value=0.05). Nearly 16.1% of injured refugees were unable to seek health care due to lack of health insurance coverage and financial liability.ConclusionRefugees suffer injuries and burns with substantial human and economic repercussions on individuals, their families and the host healthcare system. Resources should be allocated to designing safe camps and implementing educational and awareness programs with special focus on heating and cooking methods.

The increasing prevalence of diabetes, combined with a growing global shortage of health care professionals (HCP), necessitates the need to develop new approaches to diabetes care delivery to expand access to care, lessen the burden on people with diabetes, improve efficiencies, and reduce the unsustainable financial liability on health systems and payers. Use of digital diabetes technologies and telehealth protocols within a digital/virtual diabetes clinic has the potential to address these challenges. However, several issues must be resolved to move forward. In February 2020, organizers of the Advanced Technologies & Treatments for Diabetes Annual Conference convened an international panel of HCP, researchers, patient advocates, and industry representatives to review the status of digital diabetes technologies, characterize deficits in current technologies, and identify issues for consideration. Since that meeting, the importance of using telehealth and digital diabetes technologies has been demonstrated amid the global coronavirus disease (COVID-19) pandemic. This article summarizes the panel's discussion of the opportunities, obstacles, and requisites for advancing the use of these technologies as a standard of care for the management of diabetes.

The global demand in energy resources is moving the petroleum industry to the Arctic with its huge resource potential. The lack of infrastructure onshore increases the role of the Arctic marine shi...

This article is devoted to the analysis of the current legislation of Ukraine, as well as judicial practice in the context of the need to enter information in the declaration of a person authorized to perform the functions of the state or local government, namely the column "Financial Liabilities", in the form of surety, and the problem of providing a criminal legal assessment in the context of the possibility of the acts qualification under Article 366-1 of the Criminal Code of Ukraine (hereinafter - the Criminal Code of Ukraine). These issues nowadays acquire the status of an exceptional legal problem due to the lack of a single law enforcement practice, and therefore require theoretical and practical consideration. In this regard, the article focuses on the analysis of certain provisions of the Law of Ukraine "On Prevention of Corruption", consideration of the crime under Article 366-1 of the Criminal Code of Ukraine, as well as consideration of the judicial practice of the European Court of Human Rights, the Supreme Court, the Constitutional Court Ukraine, courts of appeal and local courts. Much of the author's attention is focused on the concept of legal nature and the institution of bail in general. In doing so, the author explored the above issues through the lens of human rights protection, based on the understanding of the essence of the principle of legal certainty, which is part of the concept of the rule of law. The conclusions suggested proposals as for improving the question that author discussed by amending national anti-corruption legislation in order to enable it to qualify the act provided for in Article 366-1 of the Criminal Code of Ukraine in the form of failure to enter information in the declaration column "Financial liabilities" of the persons authorized to perform the functions of state or local government in the presence of surety. In particular, the author emphasized that formulation of the norm, which defines the concept of "financial liabilities", makes it impossible to apply it in the context of qualifying a crime under Article 366-1 of the Criminal Code of Ukraine due to lack of legal certainty, which makes it impossible to maintain the principle the rule of law, and therefore a priori, human rights and freedoms will be violated.

The contractual type of Build-Operate-Transfer (BOT) is becoming a more common delivery method of Public-Private Partnerships (PPP) for infrastructure projects. However, their implementation is not seamless due to a number of factors including uncertainty in future demand, which discourages participation of private investors. In response, governments often provide Minimum Revenue Guarantee (MRG) which is a contractual clause that can be invoked if project revenue falls below the guarantee threshold. While MRG does not provide an upfront subsidy such as a grant, it exposes the governments to significant financial liability. In 2001, the South Korean government partnered with a consortium of private investors to deliver the Incheon Airport Highway using the BOT framework. The MRG clause was also an integral part of the BOT contract with the total net additional liability to the government exceeding $1.5 billion. This case study paper presents a renegotiation framework that is based on the equivalent NPV constraint condition. The implementation results show that the partners can find a set of alternative solutions that reduce government financial exposure while maintaining the private sector’s NPV.

This paper develops a three-layer supply chain for defective and non-defective types of produced items by supplier and manufacturer. The condition of the chain that without any financial liability on the manufacturer, defective items will be sent back to the supplier after screening. In the subsequent stage, the retailer accepts the non-defective items produced by the manufacturer after the screening and sends back the defective items to the manufacturer. Hence the retailer receives the perfect quality items for selling to the customers, but the retailer considers the effect of the deterioration of items. This model also considers the impact of several business strategies such as; optimal order size of raw materials, production rate, unit production cost, idle time costs of the supplier, and manufacturer in a collaborative marketing system, etc. to determine the optimum average profit of the integrated model. This study discusses the selling price of the retailer, demand rate of the customer, purchase cost of supplier and holding cost, which can be a significant breakthrough in expanding the profit of the business in real terms. Numerical example and sensitivity analysis are presented to illustrate the phenomenon of theoretical study and demonstrate the managerial implication of the model.

Aim: The current study explores the benefits in children with cochlear implants (CI) from the parentalperspective. The objective is to understand the concerns of parents in order to plan appropriaterecommendations for habilitation and educational programs.Method: Fifty-three parents of children with CI completed the questionnaire titled, “Parental Perspectiveson CI”. The questionnaire consisted of 106 statements with 10 subsections that analyse the different aspectsrelated to the pre and post –implantation process.Results: The study reported that parents are satisfied with the overall development of the child. However,they expressed significant concerns regarding recurring cost of the implant, distance, travel and also thefuture of the child with CI.Conclusion: Parents recognize that CI has made an overall positive impact on their children. They alsorecognize CI as a heavy financial liability post implantation that may not allow children to obtain theoptimal benefit. The study also indicated that the government should initiate financial policies to provide thenecessary support for habilitation and equipment maintenance

Bowel injury is a known inherent complication of minimally invasive gynecologic surgery; however, it does not automatically signify medical malpractice. Plaintiff attorneys representing patients seeking legal recourse from a bowel injury typically allege claims of intraoperative negligence, delay in diagnosis, or lack of informed consent in an effort to circumvent the assertion that it is a known inherent complication. In addition, damage awards in bowel injury lawsuits can easily exceed the amount covered by the policy limits of a medical malpractice insurance plan, leaving the gynecologist financially responsible for the difference. Therefore, it is crucial to understand when it may be appropriate to consent to a settlement offer, which can relieve the gynecologist from financial liability for amounts awarded above the medical malpractice policy limits. The purpose of this medical-legal review is to make minimally invasive gynecologic surgeons more aware of the legal strategies used by plaintiff attorneys representing patients who have incurred bowel injuries, and how to limit liability in lawsuits.

En aras al principio de adhesión voluntaria y abierta, las cooperativas presentan singularidades en torno a la figura del capital social, que las diferencia de otras entidades mercantiles. Dichas peculiaridades comportan un tratamiento contable especial del capital cooperativo. Las normas internacionales de contabilidad prevén la calificación contable del capital cooperativo como pasivo financiero o como fondo propio, según la regulación legal y/o estatutaria del derecho de baja del socio. Este planteamiento se ha traspuesto al derecho contable de la Unión Europea y de España, afectando a un buen número de cooperativas europeas, incidiendo en su imagen financiera. En este trabajo tratamos las peculiaridades contables que emanan de la posibilidad de la baja del socio en el marco de la normativa contable internacional, nacional y los últimos posicionamientos de organismos reguladores.Recibido: 12 junio 2017Aceptado: 14 octubre 2017Publicación en línea: 22 diciembre 2017

With increased poaching pressures, rhinoceroses have become a financial liability due to expensive anti-poaching security costs required to protect this species. Nonetheless, approximately one-thir...

Drawing on evidence from three case studies, we show how the State's Financial Liability has worked in assigning risk in large PPP contracts in Spain. Project failure and the concessionaires' bankruptcy have resulted in the government having to assume heavy financial obligations, which have ultimately been absorbed by taxpayers and users. In contrast, Spain's leading construction companies, which were also major investors in the concessionaires, have been able to minimize their risk. Myopic PPPs have been entered into based on the transference of liabilities to taxpayers and users, and the, consequent, minimization of risks for the main private investors.

IMPORTANCE: Although surprise medical bills are receiving considerable attention from lawmakers and the news media, to date there has been little systematic study of the incidence and financial consequences of out-of-network billing. OBJECTIVE: To examine out-of-network billing among privately insured patients with an inpatient admission or emergency department (ED) visit at in-network hospitals. DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis using data from the Clinformatics Data Mart database (Optum), which includes health insurance claims for individuals from all 50 US states receiving private health insurance from a large commercial insurer was conducted of all inpatient admissions (n = 5 457 981) and ED visits (n = 13 579 006) at in-network hospitals between January 1, 2010, and December 31, 2016. Data were collected and analyzed in March 2019. EXPOSURES: Receipt of a bill for care from at least 1 out-of-network physician or medical transport service associated with patient admission or ED visit. MAIN OUTCOMES AND MEASURES: The incidence of out-of-network billing and the potential amount of patients' financial liability associated with out-of-network bills from the admission or visit. RESULTS: Of 5 457 981 inpatient admissions and 13 579 006 ED admissions between 2010 and 2016, the percentage of ED visits with an out-of-network bill increased from 32.3% to 42.8% (P

This article is concerned with the study of legal uncertainties arising in practice when implementing provisions of article 325 of the Customs Code of Ukraine. It is stated that the issue of economic operators compensating for their expenses incurred in connection with the customs control forms unreasonably introduced by officials of income and fees bodies (including the same in response to the requirements of law enforcement agencies) has not been resolved yet. After all, the above provision of the Customs Code of Ukraine is not applied in practice, in connection with which business operators incurred and continue to incur unreasonable losses and significant, unforeseen expenditures. Among them are the costs of container equipment excess use; the costs of goods storage in ports (both using the storage capacity of ports, and by converting commercial road vehicles into “warehouses on wheels”); the costs of loading and unloading (this does not take into account even the fact that it is physically impossible to inspect some categories of cargo as such inspection requires opening and unloading of 100 percent packages while maintaining the cargo integrity and marketable condition, but the packaging of the goods is caused damage to say nothing of the cases where signs of damage to the goods are obvious, etc.). Attention is focused on the fact that the issue of introducing the mechanism of compulsory state insurance of financial liability for damage that may be caused to individuals and their property by unlawful decisions and action or failure to act by revenue and fees bodies or their officials in their duties performance remains open to date.

The island of Malta has a rich heritage, which is evident in the rustic appeal of this island. Ġbejna forms an integral part of the Maltese food heritage. This artisan product is made from sheep or goat milk curds and aged for several months to develop its distinctive taste. During the ageing process, the cheese can become spoiled by fungi and unsafe for human consumption. This is a significant public health risk and a financial liability for producers. Conventional microbiology techniques do not detect these slow-growing pigment-less fungi early, allowing occasional distribution of contaminated products. We propose the use of hyperspectral imaging to detect these fungi during the early stages of cheese production. In contrast with a typical digital camera, which compiles the light signal into three broad wavelength bands; red, green and blue, a hyperspectral camera records numerous narrow and contiguous wavelength bands reflected from an object. This produces a series of images, each corresponding to the reflected electromagnetic energy in the respective narrow band of wavelengths. This image series may, in turn, be used for early fungal detection and identification. To test this hypothesis, a model cheeselet was produced to conduct compatibility and stability studies, through measurements of colony forming units, water activity, moisture levels, pH, protein and sugar content. The ġbejna model was then challenged with fungal strains isolated from commercial ġbejna and imaged using a hyperspectral camera. An algorithm is under development to differentiate contaminated samples from uncontaminated samples using image analysis and multivariate statistics.

KDD made history in 2020. It was planned to be held in the San Diego Convention Center in an environment that would attract a large number of participants, companies to an attractive location. The program planners also made a concerted effort to broaden the intellectual scope of the forum as well as participation by diverse communities. In particular, the conference planned for offering complimentary full-time daycare to enable participation by women and parents with young children. The emergence of COVID-19 disease in March, however, caused considerable uncertainty leading to a final determination for a first-ever entirely virtual conference. This shift was dramatic at multiple levels since KDD is more than a meeting of presenters and their audience. It is also a place for demonstrations, chance encounters and a very engaging floor exhibition with its own ongoing events. Without exhibitors, their sponsors, and missing attendees, KDD won't be KDD. And it will also have a significant financial liability to the conference for the event contracts already in place. With significant cooperation from ACM and support from SIGKDD Executive Committee the team not only avoided financial impact but emerged with a net positive financial outcome even after reducing the registration fees by over 80%.

With Germany's nuclear phase-out, 23 reactors need to be dismantled in the near future. Initiated by the difficult financial situation of affected utilities in 2014, a major discourse on ensuring financial liability led to a redistribution of liabilities and finances, with the utilities remaining in charge of dismantling, while liability for interim and final storage now transferred to the public. This paper assesses whether the new regulation is ultimately likely to be to the benefit of the public. It introduces a two-stage stochastic optimization framework encompassing the different dismantling phases, resulting waste flows and storage levels of low- and intermediate-level waste (LLW and ILW) as well as the associated costs. Results show that storage risk – proclaimed as a major barrier to efficient decommissioning – is not a major driver for the optimal decommissioning schedule. However, a delay of ten years might increase interim storage costs now borne by the public by over 20%. Lacking experience and handling capacity of the industry could significantly shrink the buffer currently included in utility funds in order to deal with dismantling uncertainties. Our analysis reveals the storage gate as the new crucial interface between utilities and the public storage provider.

Financial liability of the employee is a variety of contractual liability arising from specific features of legal work. This study aims to analyze the concrete situations in which the patrimony can be held liable to the employee, given the diversity of employment situations in which an employee may be engaged.

Background Medicare beneficiaries hospitalized under observation status are subject to cost-sharing with no spending limit under Medicare Part B. Because low-income status is associated with increased hospital use, there is concern that such beneficiaries may be at increased risk for high use and out-of-pocket costs related to observation care. Our objective was to determine whether low-income Medicare beneficiaries are at risk for high use and high financial liability for observation care compared with higher-income beneficiaries. Methods We performed a retrospective, observational analysis of Medicare Part B claims and US Census Bureau data from 2013. Medicare beneficiaries with Part A and B coverage for the full calendar year, with 1 or more observation stay(s), were included in the study. Beneficiaries were divided into quartiles representing poverty level. The associations between poverty quartile and high use of observation care and between poverty quartile and high financial liability for observation care were evaluated. Results After multivariate adjustment, the risk of high use was higher for beneficiaries in the poor (Quartile 3) and poorest (Quartile 4) quartiles compared with those in the wealthiest quartile (Quartile 1) (adjusted odds ratio [AOR], 1.21; 95% confidence interval [CI], 1.13-1.31; AOR, 1.24; 95% CI, 1.16-1.33). The risk of high financial liability was higher in every poverty quartile compared with the wealthiest and peaked in Quartile 3, which represented the poor but not the poorest beneficiaries (AOR, 1.17; 95% CI, 1.10-1.24). Conclusions Poverty predicts high use of observation care. The poor or near poor may be at highest risk for high liability.

In a precedent-setting action, New Jersey is directing Chemours, DowDuPont, Solvay, and 3M to pay millions of dollars to investigate and clean up poly- and perfluoroalkyl substances (PFAS) pollution in the state. New Jersey’s Department of Environmental Protection says its move marks the first time a state has assigned financial liability for pollution to chemical manufacturers that formerly made, formerly released, or still emit PFAS. “Now is the time for action at the state level” on PFAS pollution, New Jersey environmental protection commissioner Catherine R. McCabe says. The US Environmental Protection Agency’s recently announced action plan to address PFAS contamination will take years to implement, she notes. The New Jersey agency says it believes the four companies are responsible for significant PFAS contamination in the state. Surface water, groundwater, sediments, soils, air, fish, plants, and other natural resources in New Jersey are tainted with PFAS from operations of Chemours, DowDuPont

The convergence process of Brazilian Accounting Standards Applied to the Public Sector (NBCAPS) to the International Public Sector Accounting Standards (IPSAS) brought into focus the discussions on the use of a mixed method in the public sector. The aim of this paper is to analyze the accrual accounting method applied in the public sector and the recognition of out standing remains that were not processed and expenses from previous fiscal years in Brazilianmunicipalities. The hypotheses tested the reflection of the partial implementation of accrual financial results of the Brazilian municipalities. Distortions caused in the financial liabilities and in the financial surplus of 4,246 Brazilian municipalities were observed in the light of the accounting theory, by reason of the adjustments made in recognition of out standing remains that were not processed and expenses from previous fiscal years, which represented 97.59% of the total sample comprised by 4,351 municipalities analyzed. To perform the analysis we used the asset values , financial liability, due unprocessed remains and expenses from previous fiscal years, collected from the Brazil Finance (FINBRA) base in the period 2002 to 2009. It is concluded that the smaller cities are less regular in sending their accounting data to the National Treasury Secretariat (STN). In 57.51% of the sample there was a variation of less than 5% in the balance after making adjustments. The occurrence of reversals in the financial surplus of 1,310 municipalities/year analyzed as well as investments in financial losses to 1,143 municipalities/year analyzed due to partial implementation of the accrual basis were found.Key words: accrual basis, public sector, due unprocessed remains, expenses from previous years.

This paper compares three internationally representative regulatory frameworks for pesticides. We look first at the USA, which shifted regulatory powers from the US Department of Agriculture to the Environmental Protection Agency in the early 1970s, during a historical transition from a predominantly economic to a predominantly social regulatory model. The second country is Brazil, currently the world's largest consumer of pesticides, followed by the USA in second place. In the early 1990s, Brazil's new regulatory model adopted a troika of decision-making ministries (agriculture, health and environment), with the prevalence of economic over social-environmental interests. The third case is the regulatory framework adopted in 2011 by the EU, where shifts in risk-assessment criteria and corporate financial liability reveal a prevalence of concerns involving social-environmental regulation. Copyright The Author 2013. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com, Oxford University Press.

This chapter examines the impact of the acquired immunodeficiency syndrome (AIDS) on individuals with hemophilia and their families. Disease caused by the AIDS virus (human immunodeficiency virus (HIV)) is doubly devastating because it produces a lethal physical illness and contributes to the social isolation of those infected. People with AIDS have recurrent infections requiring frequent physician visits, repeated hospitalizations, and expensive medications; they also experience rampant discrimination and often are barred from attending school and the workplace. The financial liability of hemophiliacs increased exponentially between 1982 and 1992, although government legislative actions provided some relief. Hemophiliacs initiated litigation against blood bankers, pharmaceutical firms, and government health officials in Europe and North America, who were accused of knowingly dispensing contaminated blood and blood products. This chapter details the social, medical, and financial impacts of HIV on the hemophilia community and describes the measures taken to ease their burden.

There has been considerable attention in the lay media regarding the “unfairness” and the financial burden placed on Medicare beneficiaries admitted by hospitals under an observation status. As a result, legal and public challenges1,2 to the Centers for Medicare and Medicaid’s (CMS) observation rule have been filed to reduce patients’ financial liability when driven solely by the “status” assigned to their hospitalization. Partly because of this outpouring of patient-driven criticism, the CMS amended the previous observation admission rules. On October 1, 2013, the CMS implemented the “Two Midnight Rule”3 to reduce the growing number of observation hospitalizations extending beyond 48 hours (between 2009 and 2011, the number of patients in observation beyond 72 hours increased by 88%)4 and to lessen Medicare patients’ financial burden due to hospitals’ uncertainty surrounding level of care designations. For hospitals treating a majority of Medicaid patients, it would appear harder to quantify the financial impact to enrollees or to the health care system of the current observation system. Medicaid enrollees (especially children) are frequently not required to pay deductibles or copayments for emergency or hospital-based services. The designation of an enrollee’s stay as observation or inpatient would appear to be cost-neutral to patients and to the health care system, but that is an incorrect assumption. Large quantifiable administrative and compliance costs exist from the current federal and state observation regulations that impact our health care system. The risk of not assigning the correct admission status to a patient’s hospitalization is significant and has resulted in legal and financial penalties for hospitals and doctors. In the case of Medicaid and managed Medicaid patients, regulatory …

The notions of systemic importance and systemic risk of financial institutions are closely related to the topology of financial liability networks. In this work, we reconstruct and analyze the financial liability network of an entire economy using data of 50,159 firms and banks. Our analysis contains 80.2% of the total liabilities of firms towards banks and all interbank liabilities in the Austrian banking system. The combination of firm-bank networks and interbank networks allows us to extend the concept of systemic risk to the real economy. In particular, the systemic importance of individual companies can be assessed, and for the first time, the financial ties between the financial and the real economy become explicitly visible. We find that firms contribute to systemic risk in similar ways as banks do. We identify a set of mid-sized companies that carry substantial systemic risk. Their default would affect up to 40% of the Austrian financial market. We find that all firms together create more systemic risk than the entire financial sector. In 2008, the total systemic risk of the Austrian interbank network amounted to only 29% of the total systemic risk of the entire financial network consisting of firms and banks. The work demonstrates that the notions of systemically important financial institutions (SIFIs) can be directly extended to firms.

The objectives of tis research is to find out implication of BPK (Auditor Board of Republic of Indonesia) in the implementation of auditing and responsibility of state finance which is manage by state own company as regulated by national regulations. This study used normative juridical and analytic descriptive approach. The study indicated that BPK has authorities to conduct finance audit and control and ask responsibility to BUMN management board because assets of BUMN is belonged to state assest although the assests is separated, it cannot be converted to be BUMN assest. Its juridical implication, there is not transformation from state finance to private finance in managing separated state assests, consequently BPK as independent external auditor has authority to audit professionally.

Electronic commerce (EC) transactions are subject to multiple information security threats. Proposes that consumer trust in EC transactions is influenced by perceived information security and distinguishes it from the objective assessment of security threats. Proposes mechanisms of encryption, protection, authentication, and verification as antecedents of perceived information security. These mechanisms are derived from technological solutions to security threats that are visible to consumers and hence contribute to actual consumer perceptions. Tests propositions in a study of 179 consumers and shows a significant relationship between consumers’ perceived information security and trust in EC transactions. Explores the role of limited financial liability as a surrogate for perceived security. However, the findings show that there is a minimal effect of financial liability on consumers’ trust in EC. Engenders several new insights regarding the role of perceived security in EC transactions.

Patients and their families were involved in just 40% of investigations into whether negligent NHS care resulted in children being born with cerebral palsy between 2012 and 2016, a new analysis has found. The report from NHS Resolution, formerly the NHS Litigation Authority, examined 50 cases of cerebral palsy or brain injury between 2012 and 2016 where a legal liability had been established.1 It estimated that the potential financial liability of these cases could surpass £390m (€440m; $530m), excluding defence costs and the wider healthcare costs to the NHS. Obstetric claims accounted for 10% of the 10 686 claims received under NHS Resolution’s indemnity schemes …

Residents are graduating from training programs and they may not be aware that there are different types of malpractice insurance; thus, they may simply not be in positions to comprehend the personal financial liability they could incur if their contracts are not structured appropriately. This chapter will discuss the two types of malpractice insurance and provide you with the advantages and disadvantages of both forms of malpractice coverage. The second part of the chapter will cover the insurance benefits that should be included in your contract with your employer or with the practice that you join.

Context.—Tests that are performed outside of the ordering institution, send-out tests, represent an area of risk to patients because of complexity associated with sending tests out. Risks related to send-out tests include increased number of handoffs, ordering the wrong or unnecessary test, specimen delays, data entry errors, preventable delays in reporting and acknowledging results, and excess financial liability. Many of the most expensive and most misunderstood tests are send-out genetic tests.Objective.—To design and develop an active utilization management program to reduce the risk to patients and improve value of genetic send-out tests.Design.—Send-out test requests that met defined criteria were reviewed by a rotating team of doctoral-level consultants and a genetic counselor in a pediatric tertiary care center.Results.—Two hundred fifty-one cases were reviewed during an 8-month period. After review, nearly one-quarter of genetic test requests were modified in the downward direction, saving a total of 2% of the entire send-out bill and 19% of the test requests under management. Ultimately, these savings were passed on to patients.Conclusions.—Implementing an active utilization strategy for expensive send-out tests can be achieved with minimal technical resources and results in improved value of testing to patients.

The authors present data and information about appointment, tenure, and compensation policies to describe how medical schools are redefining the terms under which they relate to their full-time clinical faculties. First, the authors note the increasing differentiation of clinical faculty members into two groups, researchers and clinicians. The present-day competitive realities of both research and clinical enterprises have prompted this change and the principles of mission-based management are reinforcing it. Second, they document the long-term tendency of schools to appoint new clinical faculty members to contract-term (as opposed to tenure) appointments, as special non-tenure-eligible tracks for clinically oriented faculty proliferate. Third, they report on the policies of schools to limit the financial guarantees provided to clinical faculty members who are awarded tenure. For schools that have yet to address this issue, they discuss the various employment and pay arrangements that inform or confuse the question. Fourth, they describe historic problems with clinical faculty compensation arrangements and illustrate, with examples from ten schools, the characteristics of recently implemented performance- and risk-based compensation plans. While these trends in institutional policies and practices may initially concern faculty advocate groups, the authors argue that they may serve the long-term interests of those groups. The terms of relationships between medical schools and their clinical faculties are tied closely to the specifics of organizational structure, which are currently undergoing review and change. The challenge all schools face is to define these terms in ways that allow them to continue to attract high-quality clinical faculty while avoiding an insupportable financial liability.

Under the international convention system for oil spill liability and compensation, shipowners and oil cargo owners are sharing the costs of oil pollution (cleanup and damages). While the industries find the burden of financial liability too heavy, the compensation provided through the Conventions (Civil Liability Conventions and Fund Conventions [CLCs/FCs]) has become increasingly insufficient to satisfy the total admissible claims. What has to be done? Increase the financial liability of the responsible parties? Let the victims of pollution shoulder part of their uncompensated claims alone? Neither can be fairly accepted. This paper will discuss a solution based on the theory of risk-profit, upon which the current Conventions (CLCs/FCs) are founded. In this regard, the paper also will compare the Conventions with a domestic regime—the U.S. Oil Pollution Act of 1990.

As the payer environment is carved into many segments, each with its own accountability relative to its financial liability, family members, providers, and even other case managers often find it difficult to comprehend the perspectives of the various parties represented. Indeed, one brain injury case I recently evaluated had four payer case managers: one from the patient's health plan, one from a disease management program for his premorbid diabetes, and two from Medicaid-sponsored programs for the disabled. For payer-based case managers, the ubiquitous case manager role confusion compounds product unfamiliarity.

Mining companies post financial securities that are mandatory in many jurisdictions to cover reclamation and closure obligations. For a financial institution that underwrites such financial securities, financial liability constitutes a fundamental risk. Nevertheless, the nature of reclamation and closure obligations assumed by mining operations is such that appropriate understanding of underlying performance attributes is required. These non-financial attributes cover the spectrum from technical and environmental to regulations and stakeholders. Long duration of the obligations also means that the scope, methodology and cost of reclamation and closure activities are necessarily revised and refined with the passage of time, and ultimately determine the success or failure of the undertakings. The paper offers insight into how a financial institution views and assesses mine closure risks and liability, and concludes that although tangible parameters and characteristics are critical for sound assessment, it is somewhat inevitable to encounter subjective and uncertain aspects of reclamation and closure obligations that render the assessment more challenging whilst making it difficult to fully mitigate the risks.

This article defines the workers' compensation system, including injury statistics and reasons for spiraling costs and suggests to employers ways to manage this risk in an effort to achieve both employee satisfaction and decreased financial liability. As key components of the system, physicians are educated as to how the system works and encouraged to become active participants in helping promote employee well-being.

Despite modern advances in technology, civil engineering failures continue to occur. Most investigations identify the technical causes and financial liability. This paper looks at where and why the engineering process (planning, design, construction, and operation) breaks down. The data base is largely from the writer's unpublished failure investigations. Approximately 500 failures are evaluated. Of these, 58% originated in design, 38% in construction, and 4% in operation. Approximately half of the problems occurring during construction originated in design; the other half in construction. Three causes are identified: absence, ignorance, and rejection of current technology. Absence accounts for 12%, ignorance for 33%, and rejection for 55%. Of the total, 88% reflect human shortcomings that can be reduced by acknowledging professional limitations, continuing education, modifying design and construction systems, and resisting the unbalanced pressures that thwart good engineering.

With increasingly strict guidelines for insurance coverage, hospitals have adopted meticulous resource utilization review and management processes. It is important for physicians to appreciate that careful documentation of certain patient parameters may not only optimize the facility's reimbursement but have profound impact on the patient's out-of-pocket expenses. Hospital utilization teams have access to the frequently changing national payor guidelines for policy benefits, usually revolving around whether the patient meets medical necessity criteria for being classified as an "inpatient" vs. an "observation" outpatient. Those statuses are not merely time-based, and lead to marked differences in patient deductibles and coverage for medication, room, procedure, laboratory, and ancillary charges. There are nationally-recognized guidelines for classification, based on severity of illness and intensity of services provided. By participating in case management activities, physicians can have an important patient advocate role, and thereby minimize the financial burden to these individuals and their families.

Results of a 1987 national survey of 284 continuum of care retirement communities related to Christian faith groups are reported. Findings indicate a diversity of structural relationships between church-affiliated organizations and their parent religious bodies, and that most parent bodies do not assume financial liability for their affiliates. Major advantages to religious affiliation are consumer trust, opportunity to carry out the church's mission, and marketing. A major disadvantage are perceptions that these communities serve only “their own.” Implications of affiliation are discussed.

As in most countries and as included in international treaties regarding oil spills, Canadian law is based on the premise that the “polluter pays” for all costs associated with the response to cleaning up oil spills and settling of all relevant damage claims. The Canada Oil and Gas Operations Act (COGOA) and associated regulations, which are administered by the National Energy Board (NEB), specify the liability requirements which must be met by any applicant which receives approval to carry out oil and gas related activities in Canadian frontier areas. This paper gives a brief history of the development of the liability requirements, outlines the specific requirements under COGOA and describes the process followed by the NEB to administer the liability requirements. All costs referred to in this paper are quoted in Canadian dollars.

This paper presents the preliminary results of one of the key financial liability issues raised by the operating companies during the competitive procurement process for the long-term operation and maintenance of the 24-year old Pinellas County 3,000 tpd waste-to-energy facility.Copyright © 2008 by ASME

The Polish Physician's and Dentist's Profession Act and Polish Pharmaceutical Law oblige physicians to prescribing drugs strictly in line with the official indications listed in the Summaries of Product Characteristic (SPC). Prescriptions beyond SPC ('off-label') may be interpreted as 'medical experiments' with legal and financial liability resting solely with the doctor, the reimbursement is also denied. The aim of the study was to analyze discrepancies between up-to-date expert guidelines for treating atopic eczema (AE), indications listed in SPC, reimbursement policy, and scientific evidence for the efficacy of recommended drugs. Expert recommendations for the treatment of AE were confronted with SPC of recommended drugs and their reimbursement scheme. A systematic review of clinical trials was carried out, with their quality assessed using the GRADE tool. Among drugs recommended by experts for the treatment of AE, 484 medicinal products were licensed for use in Poland, including 89 with official indication for AE. Of these, clinical trials confirmed efficacy of active components of 36 topical or systemic calcineurin inhibitors and 19 topical glucocorticoid preparations. Thirty preparations for AE were reimbursed, including 19 recommended by experts and confirmed as effective. Further 75 products with active substances both recommended and effective were licensed for use in Poland, but not for AE. We conclude that regarding pharmacotherapy of atopic eczema, there are considerable discrepancies between expert recommendations, scientific evidence for the effectiveness of recommended drugs, and the acceptable uses of the drugs as determined by the Summaries of Product Characteristics (SPC) that are in force in Poland.

Professors, teachers and school administrators are increasingly faced with concerns not even thought of in previous decades. For example, drugs, weapons, suicides, robberies, and assaults are now everyday occurrences in some educational facilities. Being able to cope with such situations requires care and some knowledge of the law. In addition, the danger to school employees can go even further, such as personal financial liability in the form of damage law suits by students against the school and its employees. Obviously, the thought of an educator losing personal assets and retirement pay because of only trying to protect other students or one’s own self is daunting.

Prescribing errors have historically been under-recognised, under-researched, and largely ignored by the medical establishment. Happily, this is changing. We are now starting to appreciate the damage to individual patients, and healthcare organisations as a whole, by errors in prescribing and poor training of medical staff. The next few years will hopefully see an improvement in the UK situation, potentially with General Medical Council (GMC)-led national prescribing training and assessment forming a major part in this effort. However, it is worth reflecting that there is unlikely to be a simple “quick fix” to prescribing errors. The scale of the problem of errors in medical prescribing in developed healthcare systems is staggering. The GMC reported, in 1993, that adverse events resulting from treatment errors contributed to 10% of UK hospital admissions and generated a potential financial liability of over £2 billion annually. This report seemingly had little immediate effect on the medical profession at large or our political masters.1 Small-scale studies in individual UK hospitals have generally revealed a high incidence of prescribing error and sequelae. For example, in 2002 a study from two London teaching hospitals estimated that prescribing errors led to an adverse event in around 10% of admitted patients, and one iatrogenic death per 384 patients admitted during the study.2 Similar studies, in different parts of the UK and other countries, have yielded similar results, although lack of standardized methodology makes comparison of studies difficult.3

Spreadsheet audit and review procedures are an essential part of almost all City of London financial transactions. Structured processes are used to discover errors in large financial spreadsheets underpinning major transactions of all types. Serious errors are routinely found and are fed back to model development teams generally under conditions of extreme time urgency. Corrected models form the essence of the completed transaction and firms undertaking model audit and review expose themselves to significant financial liability in the event of any remaining significant error. It is noteworthy that in the United Kingdom, the management of spreadsheet error is almost unheard of outside of the City of London despite the commercial ubiquity of the spreadsheet.

40 Background: Occupational and Physical therapies (OT/PT) are effective treatments to decrease disability and functional status. Few studies have examined the variations in the cost of outpatient OT/PT. For adults with cancer, the added financial burden of cancer rehabilitation is unknown. The study objectives were to (1) describe the variation in patient financial burden for the most commonly used OT/PT services by the provider type (either OT or PT) and State; and (2) determine the impact of therapy caps on the price of service provided among Medicare beneficiaries. Methods: This retrospective, population-based study used the Medicare Provider Utilization and Payment Data Public Use File (PUF), released in April 2014 by the Center for Medicare and Medicaid Services (CMS) to examine variations in care by level of insurance (uninsured, insured and reimbursed), between providers and across states with descriptive statistics. We also examined the impact of the therapy cap on number of visits allowed and the proposed reduction of the therapy cap dollar amount on services use and patient out-of-pocket liability. Results: 3,663 (9.2%) OT’s and 36,247 (90.8%) PT’s were included. Differences between provider’s charges were minimal. Wisconsin, Illinois, Tennessee and Texas had the most inflated charges, respectively, for OT and PT. 12-14 visits plus evaluation are covered under 2012 therapy cap, and the amount of visits would be cut to 7-9 with the MedPAC cap. Conclusions: This study suggests there is wide variation between the potential patient liability for the price of OT/PT based on service provided, state received and insurance coverage. For older adults with cancer who need OT/PT services, this will be an additional cost to their care. Patients without insurance pay a premium for OT/PT services.

Expiration dates are used by couponers to limit their financial liability temporally. Traditional wisdom assumes that coupon redemptions are greatest in the period immediately following the coupon drop and decline monotonically. Using regret theory, the authors predict that expiration dates induce a second mode in the redemption pattern just prior to the expiration date. They test this prediction by extending an existing coupon redemption model to incorporate an expiration effect and then estimating both the existing and the expiration models using weekly coupon redemption data for spaghetti sauce from A.C. Nielsen panels in two cities. Results are consistent with their prediction. Implications for practitioners and researchers are discussed.

The Nuclear Regulatory Commission (NRC) is moving toward promulgating comprehensive new regulations governing decommissioning. Increasing numbers of state legislatures and utility commissions are becoming more interested in decommissioning activities. In addition, large gatherings such as this are focusing increased attention on various aspects of decommissioning. Given this atmosphere, perhaps it is appropriate to assess how attitudes and policies toward the financial aspects of decommissioning are changing and evolving and the role of state and federal authorities in this process.