Frequent and major amendments to the Criminal Code have resulted in many negative effects in Serbian criminal law. One of the consequences of these changes and additions is the adoption of such a ...crime, which was then "expressly" replaced by the same in just a few months. It is difficult to say whether the original solution was so bad that it had to be replaced immediately, or whether the legislator came up with a new (better) solution that would stop violent behavior at sports events and public gatherings. However, this new legal solution will certainly not achieve what the legislator wanted, which, among other things, in many ways devalues expectations in the already shaky authority of the criminal legislation of Serbia. Without doubting the sincere intentions of the legislator, this crime had to be in the legislative-technical sense, but also in the essential, much better done, as the authors point out, as well as the "pains" of the current legal solution.
Members of the House of Commons Public Accounts Committee said that a mixture of increasing efficiency targets, rising financial pressures, and patients waiting longer for treatment raised the risk ...of clinical negligence claims "spiralling out of control" without effective action. 1 In a report on managing the costs of clinical negligence in hospital trusts, the committee said that the annual cost of claims had quadrupled over the past decade, from £0.4bn (€0.45bn; $0.54bn) in 2006-07 to £1.6bn in 2016-17, diverting resources away from frontline services. After the publication of the committee's report Action against Medical Accidents (AvMA), the Law Society, and the Association of Personal Injury Lawyers jointly agreed terms of reference for a working party to reduce legal costs in clinical negligence cases below £25000. A government spokesperson said, "Clinical negligence costs are too high, so we are working on proposals to fix the amount that legal firms can recover from clinical negligence cases and provide families affected by severe avoidable birth injuries-a leading cause of clinical negligence costs-with an alternative to lengthy court disputes."
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BFBNIB, CMK, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
Domino effects are low‐probability high‐consequence accidents causing severe damage to humans, process plants, and the environment. Because domino effects affect large areas and are difficult to ...control, preventive safety measures have been given priority over mitigative measures. As a result, safety distances and safety inventories have been used as preventive safety measures to reduce the escalation probability of domino effects. However, these safety measures are usually designed considering static accident scenarios. In this study, we show that compared to a static worst‐case accident analysis, a dynamic consequence analysis provides a more rational approach for risk assessment and management of domino effects. This study also presents the application of Bayesian networks and conflict analysis to risk‐based allocation of chemical inventories to minimize the consequences and thus to reduce the escalation probability. It emphasizes the risk management of chemical inventories as an inherent safety measure, particularly in existing process plants where the applicability of other safety measures such as safety distances is limited.
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BFBNIB, FSPLJ, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
A coherent, cross government strategy is needed to tackle the rising cost of clinical negligence claims, and the Department of Health should work with the Ministry of Justice to develop this by ...September 2018, the National Audit Office (NAO) has said. 1 Many of the factors contributing to rising clinical negligence costs have been identified by the Department of Health and NHS Resolution (formerly the NHS Litigation Authority), said the NAO's report-but the factors likely to be most effective fall within the remit of more than one government department or are largely outside the health system's control. The report said that NHS Resolution should work with other bodies-such as NHS Improvement, NHS Protect (part of the NHS Business Services Authority), and the Solicitors Regulation Authority-to improve sharing and collection of data about complaints, incidents, and negligence claims throughout the system, to help inform and improve claims management. Meg Hillier, chair of the House of Commons Committee of Public Accounts, commented, "The Department of Health and Ministry of Justice have been too slow to work together to turn the tide . . . actions to save £90m a year by 2020-21 are a drop in the ocean in the face of forecast costs of £3.2bn a year by 2021.
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This paper is concerned with introducing a family of multivariate mixed Negative Binomial regression models in the context of a posteriori ratemaking. The multivariate mixed Negative Binomial ...regression model can be considered as a candidate model for capturing overdispersion and positive dependencies in multi-dimensional claim count data settings, which all recent studies suggest are the norm when the ratemaking consists of pricing different types of claim counts arising from the same policy. For expository purposes, we consider the bivariate Negative Binomial-Gamma and Negative Binomial-Inverse Gaussian regression models. An Expectation-Maximization type algorithm is developed for maximum likelihood estimation of the parameters of the models for which the definition of a joint probability mass function in closed form is not feasible when the marginal means are modelled in terms of covariates. In order to illustrate the versatility of the proposed estimation procedure a numerical illustration is performed on motor insurance data on the number of claims from third party liability bodily injury and property damage. Finally, the a posteriori, or Bonus-Malus, premium rates resulting from the bivariate Negative Binomial-Gamma and Negative Binomial-Inverse Gaussian regression model are compared to those determined by the bivariate Negative Binomial and Poisson-Inverse Gaussian regression models.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
ABSTRACTSchlingermann, BE, Lodge, CA, Gissane, C, and Rankin, PM. Effects of the Gaelic Athletic Association 15 on lower extremity injury incidence and neuromuscular functional outcomes in collegiate ...Gaelic games. J Strength Cond Res 32(7)1993–2001, 2018—The purpose of this observational analytical cohort study was to assess the effectiveness of an injury prevention program (IPP)—Gaelic Athletic Association 15 (GAA15)—on the incidence of injury in collegiate Gaelic games. One hundred and thirty-one Gaelic games players (mean age 20.5 years ± SD 3.0) were used for analysis in this study. Participants completed preseason and postseason testing which involved performance of the Y-Balance Test. The GAA15 was used for the intervention group; coaches were instructed to implement the program before every training session and match throughout the collegiate Gaelic Athletic Association (GAA) season. The control group adopted their normal warm-up procedures for the season. The playersʼ injuries were documented on a weekly basis by allied health care professionals working with the teams using an online database system. Results showed significant improvements in composite Y-Balance scores in favor of the intervention group (adjusted mean difference Right1.8 % normalized mean reach distance (%NMRD) p = 0.007/Left2.3 %NMRD p = 0.001). Injury rates in the intervention group (2.62 injuries per 1,000 hours) were reduced by 66% (p = 0.001) in comparison with an age-matched control group (7.62 per 1,000 hour). Training injuries, hamstring injuries, noncontact injuries, and severe injuries were also reduced as a result of the implementation of the GAA15 (injury rate ratio0.20, 0.59, 0.39, and 0.45, respectively). Implementation of an IPP such as the GAA15 can reduce the risk of injury in Gaelic games and influence playersʼ neuromuscular performance assessed through the Y-Balance Test.
Purpose
The purpose of this study was to analyze the relationship between the occupation ratio and partial-thickness rotator cuff tears.
Methods
The study included and retrospectively investigated ...683 patients with partial-thickness rotator cuff tears between 2013 and 2017. Fifty patients with impingement syndrome were also enrolled as the control group for normal-population comparison. The participants were divided into five groups: Group A, control group; Group B, < 50% articular-side tears; Group C, ≥ 50% articular-side tears; Group D, < 50% bursal-side tears; and Group E, ≥ 50% bursal-side tears. Muscle volume was evaluated by measurement of each occupation ratio of the supraspinatus and infraspinatus tendons on the most lateral view of the T1-weighted oblique-sagittal images in which the scapular spine remained in contact with the scapular body.
Results
Fifty patients were enrolled in Group A. A total of 683 patients with Partial thickness rotator cuff tear were divided and classified into the following groups: 272 into Group B, 153 into Group C, 161 into Group D, and 97 into Group E. The supraspinatus occupation ratios of all partial-thickness rotator cuff tear groups were significantly lower than those of the control group. Furthermore, the supraspinatus occupation ratios of Groups C and E (≥ 50% partial-thickness rotator cuff tears) were significantly lower than those of Groups B and D (< 50% partial-thickness rotator cuff tears). However, the infraspinatus occupation ratio of only Group E was significantly lower than that of the other groups.
Conclusion
The supraspinatus occupation ratios of both the ≥ 50% articular- and bursal-side partial-thickness rotator cuff tears were lower than those of the other partial-thickness rotator cuff tears. Conversely, the infraspinatus occupation ratio of only the ≥ 50% bursal-side partial-thickness rotator cuff tears was low.
Level of evidence
IV.
Background
Studies suggest that the collagen degeneration and disordered arrangement of collagen fibers in rotator cuff tears are associated with an increase in activity of matrix metalloproteases 1 ...and 3 (MMP-1 and MMP-3), and that MMP activity may be in part genetically mediated. The degree to which this might be clinically relevant in patients with rotator cuff tears has not been well characterized.
Questions/purposes
(1) Is genetic polymorphism of MMP-1 and MMP-3 associated with rotator cuff tears? (2) Are there haplotypes of MMP-1 and MMP-3 correlated with rotator cuff tears? (3) Compared with control subjects, do patients with rotator cuff tears have a higher proportion of relatives with the same disease?
Methods
We evaluated 64 patients with full-thickness rotator cuff tears and 64 asymptomatic control subjects. Patients younger 65 years, with nontraumatic tears, were included. The tear or integrity of the rotator cuff tear was evaluated by MRI or ultrasonography in all individuals. The patients and control subjects were paired by age. MMP-1 and MMP-3 genotypes were determined using the PCR-restriction fragment length polymorphism assays.
Results
Genetic polymorphisms in MMP-1 and MMP-3 are associated with rotator cuff tear, in which individuals with rotator cuff tears have associated genotypes 1G/2G (patients, 32 of 64 50%, control subjects, 16 of 64 25%; odds ratio OR, 4.8; 95% CI, 2.1–11.0; p < 0.001) and 2G/2G were at great risk (patients, 15 of 64 23%, control subjects, seven of 64 11%; OR, 5.2; 95% CI,1.8–14.9; p < 0.001), and patients with rotator cuff tears were associated with a higher proportion of 2G allele distribution (62 of 128 48% versus 30 of 128 23%; p < 0.001). Patients with the 5A/5A genotype are at greater risk of rotator cuff tear (patients, 15 of 64 23%; control subjects, four of 64 6%; OR, 5.5; 95% CI, 1.4–20.9; p = 0.021), and there was higher 5A allele distribution in patients with rotator cuff tears (patients, 68 of 128 53%; control subjects, 52 of 128 41%; p = 0.045). Individuals with the haplotype 2G/5A were more likely to have rotator cuff tears develop (patients, 42 of 64 66%; control subjects, 17 of 64 27%; OR, 5.3; 95% CI, 2.5-11.3; p < 0.001). Patients with rotator cuff tears reported, in higher number, the existence of relatives who previously had treatment for rotator cuff tears (19 of 64 30% versus four of 64 6%; OR, 6.3; 95% CI, 2.0-19.9; p = 0.001).
Conclusions
The genetic polymorphism of MMP-1 and MMP-3 is associated with rotator cuff tear. Individuals with haplotype 2G/5A were more susceptible to rotator cuff tears in the population studied.
Clinical Relevance
Knowledge of the genetic markers related to rotator cuff tears can enable identification of susceptible individuals and increase understanding of the pathogenesis of tendon degeneration.
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FZAB, GEOZS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background
Minor events that occur in the workplace sometimes are evaluated with MRI, which may reveal age-related changes in the symptomatic body part. These age-related changes are often ascribed ...to the event. However, evidence of similar or worse pathophysiology in the contralateral joint would suggest that the symptoms might be new, but the pathophysiology is not.
Questions/purposes
Using a convenience sample of occupational injury claimants with bilateral MRI to evaluate unilateral knee or shoulder symptoms ascribed to a single event at work, we sought to determine whether MRI findings of the shoulder and knee are more often congruent or incongruent with new unilateral symptoms.
Methods
Two hundred ninety-four occupational injury claimants employed at companies throughout Texas that do not subscribe to workers’ compensation insurance, who were older than 40 years, and with unilateral shoulder or knee symptoms, were studied. Starting in 2012, all patients seen by OccMD Group PA who present with unilateral symptoms ascribed to work undergo bilateral MRI, based on several previous occasions where bilateral MRI proved to be a compelling demonstration that perceived injuries are more likely age-related, previously well-adapted pathophysiology. MRI findings (anything described as abnormal by the radiologist; eg, defect size or signal change) was considered congruent if the abnormality of one or more structures on the symptomatic side was greater than that of the corresponding structures in the asymptomatic joint. Bivariate analysis was used to compare the frequency of MRI findings congruent and incongruent with symptoms. Logistic regression was used to evaluate factors associated with MRI findings of the shoulder or knee.
Results
Less than half of the patients with shoulder (90 of 189; 48%; p = 0.36) or knee (45 of 105; 43%; p = 0.038) symptoms had worse pathologic features on the symptomatic side. Older age was associated with disorders in the infraspinatus tendon (59 ± 8 versus 56 ± 8 years; p = 0.012), glenoid labrum (60 ± 9 versus 57 ± 8 years; p = 0.025), and biceps tendon (60 ± 8 versus 57 ± 8 years; p = 0.0038). Eighty-seven percent of patients (91 of 105) had structural changes in the medial meniscus described by the radiologist.
Conclusions
Occupational injury claimants 40 years of age and older with unilateral knee and shoulder symptoms ascribed to a work event tend to have bilateral age-related MRI changes. Age-related disorders should be distinguished from acute injury.
Level of Evidence
Level IV, diagnostic study.
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FZAB, GEOZS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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