Lawyers should not be discouraged that they seem to make so little progress in their so-called "3 body problem": the function of and relationship among the 3 principal institutions of the national ...government. Separation of powers is deceptively simple: 3 entities with 3 distinct powers and the relationship among those entities. This paper argues that so little progress has been made because the wrong questions are being argued. The article takes a look at the conventional debate about how to resolve separation of powers questions. The basic ideas at the root of separation-of-powers thinking must be revisited in favor of a new set of ideas.
Summary Assessment of bone marrow involvement by malignant plasma cells is an important element in the diagnosis and follow-up of patients with multiple myeloma and other plasma cell dyscrasias. ...Microscope-based differential counts of bone marrow aspirates are used as the primary method to evaluate bone marrow plasma cell percentages. However, multiple myeloma is often a focal process, a fact that impacts the accuracy and reliability of the results of bone marrow plasma cell percentages obtained by differential counts of bone marrow aspirate smears. Moreover, the interobserver and intraobserver reproducibility of counting bone marrow plasma cells microscopically has not been adequately tested. CD138 allows excellent assessment of plasma cell numbers and distribution in bone marrow biopsies. We compared estimates of plasma cell percentages in bone marrow aspirates and in hematoxylin-eosin– and CD138-stained bone marrow biopsy sections (CD138 sections) in 79 bone marrows from patients with multiple myeloma. There was a notable discrepancy in bone marrow plasma cell percentages using the different methods of observation. In particular, there was a relatively poor concordance of plasma cell percentage estimation between aspirate smears and CD138 sections. Estimates of plasma cell percentage using CD138 sections demonstrated the highest interobserver concordance. This observation was supported by computer-assisted image analysis. In addition, CD138 expression highlighted patterns of plasma cell infiltration indicative of neoplasia even in the absence of plasmacytosis. We conclude that examination of CD138 sections should be considered for routine use in the estimation of plasma cell load in the bone marrow.
Palladium complexes of functionalised heterocyclic carbene complexes have been synthesised. Treatment of imidazolium salts with Ag
2O yields Ag
I(carbene)
2 complexes, which act as carbene transfer ...agents when reacted with palladium salts. In this manner, Pd(Me)(1-(2-ethylpyridyl)-3-methylimidazolin-2-ylidene)Cl
2 (
4a) and Pd(Me)(1-benzyl-3-methylimidazolin-2-ylidene)
2Cl (
4c) have been prepared from PdMeCl(cod) (cod=1,5-cyclooctadiene) and the appropriate silver complex. Similarly, the reaction of a Ag(carbene)
2 complex with PdCl
2(MeCN)
2 gives Pd(1-benzyl-3-methylimidazolin-2-ylidene)
2Cl
2 (
4b). The tridentate carbene complex Pd(Me)(1,3-di(2-picolyl)imidazolin-2-ylidene)BF
4 (
6a) is synthesised via the in situ reaction of the imidazolium salt with Ag
2O, followed by PdMeCl(cod) and AgBF
4, whilst PdCl{1,3-bis(diisopropyl-2-ethylamino)imidazolin-2-ylidene}BF
4 (
6c) is synthesised in an identical manner from PdCl
2(MeCN)
2. The chelated complexes 1,1′-dimethyl-3,3′-(1,2-xylylene)diimidazolin-2,2′-diylidenePd(II) dibromide (
5a), 1,1′-dimethyl-3,3′-(1,3-xylylene)diimidazolin-2,2′-diylidenePd(II) dibromide (
5b) and Pd(imidazoliophane)Br
2 (
5c) have been synthesised via the reaction of the appropriate imidazolium salt with Pd(OAc)
2. X-ray crystal structures of the imidazolium salt, 1,3-di(2-picolyl)imidazolium chloride (
1f) and the complex Pd(Me)(tetramethylimidazolin-2-ylidene)
2Cl (2) are reported. Complex
2 shows square planar coordination with the two carbene ligands
trans to each other. The carbene ligands are inclined at 65.3° to the coordination plane. Several complexes proved to be highly stable and efficient catalysts for intermolecular Heck and Suzuki coupling reactions, giving turnover numbers of up to 980 000 (Heck) and 177 500 (Suzuki).
IN MEMORY OF J. Paul Lomio Magill, M. Elizabeth; Kramer, Larry; Babcock, Barbara ...
Stanford law review,
01/2016, Letnik:
68, Številka:
1
Journal Article
Recenzirano
In memory of the services provided to Stanford Law School and the Stanford Law Review, we
dedicate the first issue of Volume 68 to the memory of J. Paul Lomio, an extraordinary director of
the ...Stanford Law School library and an irreplaceable member of the Stanford community. The following tributes were given during Paul Lomio’s memorial on May 12, 2015., In memory of the services provided to Stanford Law School and the Stanford Law Review, we
dedicate the first issue of Volume 68 to the memory of J. Paul Lomio, an extraordinary director of
the Stanford Law School library and an irreplaceable member of the Stanford community. The following tributes were given during Paul Lomio's memorial on May 12, 2015.
Abstract Purpose As medical practices transform to patient-centered medical homes (PCMHs), it is important to identify the ongoing costs of maintaining these “advanced primary care” functions. A key ...required input is personnel effort. This study's objective was to assess direct personnel costs to practices associated with the staffing necessary to deliver PCMH functions as outlined in the National Committee for Quality Assurance Standards. Methods We developed a PCMH cost dimensions tool to assess costs associated with activities uniquely required to maintain PCMH functions. We interviewed practice managers, nurse supervisors, and medical directors in 20 varied primary care practices in 2 states, guided by the tool. Outcome measures included categories of staff used to perform various PCMH functions, time and personnel costs, and whether practices were delivering PCMH functions. Results Costs per full-time equivalent primary care clinician associated with PCMH functions varied across practices with an average of $7,691 per month in Utah practices and $9,658 in Colorado practices. PCMH incremental costs per encounter were $32.71 in Utah and $36.68 in Colorado. The average estimated cost per member per month for an assumed panel of 2,000 patients was $3.85 in Utah and $4.83 in Colorado. Conclusions Identifying costs of maintaining PCMH functions will contribute to effective payment reform and to sustainability of transformation. Maintenance and ongoing support of PCMH functions require additional time and new skills, which may be provided by existing staff, additional staff, or both. Adequate compensation for ongoing and substantial incremental costs is critical for practices to sustain PCMH functions.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Abstract Purpose We examined quality, satisfaction, financial, and productivity outcomes associated with implementation of Care by Design (CBD), the University of Utah's version of the ...patient-centered medical home. Methods We measured the implementation of individual elements of CBD using a combination of observation, chart audit, and collection of data from operational reports. We assessed correlations between level of implementation of each element and measures of quality, patient and clinician satisfaction, financial performance, and efficiency. Results Team function elements had positive correlations ( P ≤.05) with 6 quality measures, 4 patient satisfaction measure, and 3 clinician satisfaction measures. Continuity elements had positive correlations with 2 satisfaction measures and 1 quality measure. Clinician continuity was the key driver in the composite element of appropriate access. Unexpected findings included the negative correlation of use of templated questionnaires with 3 patient satisfaction measures. Trade-offs were observed for performance of blood draws in the examination room and the efficiency of visits, with some positive and some negative correlations depending on the outcome. Conclusions Elements related to care teams and continuity appear to be key elements of CBD as they influence all 3 CBD organizing principles: appropriate access, care teams, and planned care. These relationships, as well as unexpected, unfavorable ones, require further study and refined analyses to identify causal associations.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Symmetrical Bis(acetylido)ruthenium(II) Complexes Field, Leslie D.; Magill, Alison M.; Shearer, Timothy K. ...
European Journal of Inorganic Chemistry,
August 2011, Letnik:
2011, Številka:
23
Book Review, Journal Article
Recenzirano
Symmetrical, mononuclear bis(acetylido)ruthenium(II) complexes were prepared by the reaction of trans‐RuMe2(dmpe)2 dmpe = 1,2‐bis(dimethylphosphanyl)ethane with terminal alkynes. The complexes were ...characterised by multinuclear NMR spectroscopy and X‐ray crystallography. In some cases, the complexes catalyse the head‐to‐head dimerisation of terminal alkynes to yield organic butenynes. The regiochemistry of this dimerisation depends on the solvent used; methanol results in the isolation of (Z)‐butenynes, whereas toluene gives predominantly (E) isomers.
Symmetrical, mononuclear bis(acetylido)ruthenium(II) complexes were prepared by the reaction of a dialkylruthenium complex with terminal alkynes. In some cases, head‐to‐head dimerisation of the terminal alkynes was observed yielding organic butenynes. The regiochemistry of this dimerisation was found to depend on the solvent used.
Background
The current review revisits the article entitled: “Active Ingredients: How and Why Evidence‐Based Alcohol Behavioral Treatment Interventions Work” published in Alcoholism: Clinical and ...Experimental Research. This work summarized proceedings from a 2004 Symposium of the same name that was held at the Annual Meeting of the Research Society on Alcoholism (RSA). A decade has passed, which provides occasion for an evaluation of progress. In 2014, an RSA symposium titled Active Treatment Ingredients and Client Mechanisms of Change in Behavioral Treatments for Alcohol Use Disorders: Progress 10 Years Later did just that.
Methods
The current review revisits state‐of‐the‐art research on the 3 treatments examined 10 years ago: cognitive behavioral therapy, alcohol behavior couples therapy, and 12‐step facilitation. Because of its empirically validated effectiveness and robust research agenda on the study of process outcome, motivational interviewing has been selected as the fourth treatment modality to be discussed. For each of these 4 treatments, the reviewers provide a critical assessment of current theory and research with a special emphasis on key recommendations for the future.
Results
Noteworthy progress has been made in identifying active ingredients of treatments and mechanisms of behavior change in these 4 behavioral interventions for alcohol and other drug use disorders. Not only have we established some of the mechanisms through which these evidence‐based treatments work, but we have also uncovered some of the limitations in our existing frameworks and methods.
Conclusions
Further progress in this area will require a broader view with respect to conceptual frameworks, analytic methods, and measurement instrumentation.
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