Bruce D. Spiess, MD, FAHA

• Professor of Anesthesiology and Emergency Medicine
• Director of VCURES
• VCU?edical College of Virginia
• Richmond, Virginia

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Berger Andrew Santella Elizabeth Fitzgerald Howard Tony Johnston Kin Platt Betty Burford Cindy Neuschwander Vincent Adriani Robert Kimmel Smith Kay Allenbaugh Samuel G. Woods Joseph Welch Bob Wright Fred Gwynne Gertrude Chandler Warner Patrick Skene Catling Robert Cormier Robert Burleigh Stephen Manes Erik Kraft Jeffery Kindley Gloria Skurzynski Manuel Jordan Melvin Berger Carol Wallace Virginia Lee Burton Byron Tetrick Carolyn Simpson Amy Sterling Casil Chris Weigant Anne Ricki Hurwitz Nancy Rue Claudine G. Christmas In the Big Woods Christmas In the Country Christmas In the Philippines Christmas In the Trenches Christmas Is. Christmas Killer Christmas Kitten Christmas Knight, the Christmas Lights Christmas Long Ago From A To Z Christmas Magic Christmas Memory, A Christmas Miracle-Jonathan. 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Claudia And the New Girl Claudia And the Perfect Boy Claudia And the Phantom Phone. Brian Karas Johanna Hurwitz Meish Goldish Mel Glenn Mel Glenn Mike Thaler Mike Thaler Mike Thaler Andrea Buckless Fred Ehrlich Johanna Hurwitz Kira Dunn K. McMullan Marcia Thornton Jones Grace Maccarone Mike Thaler the Real Mother Goose Tina Posner David Armentrout Douglas Evans Grace Maccarone Susie Hodge Sean Connolly Ann M. Clever Ali Clever Beatrice Clever Beatrice And the Best Clever Cat Clever Jackal, the Clever Katya Clever Lollipop Clever Manka Clever Raccoons Clever Tom And the Leprechaun Cleversticks Clic, Clac, Muu Click Here Click! 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Clue Of the Black Keys, the Clue Of the Broken Blade, the Clue Of the Broken Locket, the Clue Of the Dancing Puppet Clue Of the Hissing Serpent Clue Of the Leaning Chimney Clue Of the Linoleum. Clue of the Screeching Owl Clue Of the Tapping Heels, the Clue Of the Velvet Mask, the Clue Of the Whistling Bagpipes Clue On the Silver Screen, the Clues From Boots Clues In the Woods Clues To Madrid, the Clumsy Crab Clyde Tombaugh And the Search Clydesdales Coach Coach Amos Coach John And His Soccer Team Coach That Never Came, the Coaching Ms. Burke Judi Barrett Dori Sanders David Randall Irene Franck Tomie dePaola Walter Sorrells Gail Gauthier George E. Stanley Patricia Reilly Giff Gertrude Chandler Warner Carolyn Keene Carolyn Keene Carolyn Keene Franklin W. Dixon Carolyn Keene Carolyn Keene Carolyn Keene Carolyn Keene Kathy Burkett Carolyn Keene Franklin W. 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Collected Poems Collected Poems, the Collected Short Plays - Wilder Collecting Collections Collector Of Moments, the Collidescope Colliding With Chris Collie, the Colombia Colombia (Visit To) Colombia In Pictures (c. Nellie Color Of Absence, the Color Of Distance Color of Fire, the Color Of His Own, A Color Of Home, the Color Of Magic, the Color Of My Words, the Color Of Water, the Color Purple, the Colorado Colorado (America-Beautiful-2) Colorado (Hello U. Colorful Characters In America Ann Cameron Mary Hill Wil Mara Reggie Finlayson Jim Haskins Rose Blue W. Auden Sylvia Plath Thornton Wilder Bonnie Dobkin Margaret Ballinger Quint Buchholz Grace Chetwin Dan Harder Charlotte Wilcox Marion Morrison Mary Virginia Fox Geography Department Lerner Tom Streissguth Bobbie Kalman David C. King Bobbie Kalman Brendan January Bobbie Kalman Joy Masoff Bobbie Kalman Phyllis Raybin Emert Christina Rossetti Ann Jonas Gail Herman N. McKissack James Howe Amy Thomson Ann Rinaldi Leo Lionni Mary Hoffman Terry Pratchett Lynn Joseph James McBride Alice Walker Dennis Brindell Fradin Jean F. Blashfield Sara Bledsoe Amy Miller Geography Department Capstone Pr Cynthia Walker Emily McAuliffe Carol B. Columbus Day Comanche Indians, the Comanche Moon Comanche Peace Pipe Comanche Song Combat Helicopters Come A Stranger Come A Tide Come All You Brave Soldiers Come Along, Daisy! Come Back, Amelia Bedelia Come Back, Buddy Come Back, Salmon Come Down Now, Flying Cow! Come Out & Play, Little Mouse Come Out Muskrats Come Play With Me Come Sing, Jimmy Jo Come Sunday Come the Morning Come To A Powwow Come To School, Dear Dragon Come To the Fair Come Together: John Lennon Come What May Come With Me Come! Baglio Colin Hynson Milton Meltzer Christina Mia Gardeski Bill Lund Larry McMurtry Patrick Dearen Janice Shefelman Jay Schleifer Cynthia Voigt George Ella Lyon Clinton Cox Jane Simmons Judy Nayer Mike Thaler Alison Smith Laurie Lawlor Judy Nayer Peggy Parish Ben M. Josh Gibson Coming Home-Langston Hughes Coming Into the Country Coming Of Age Coming Of Age In Mississippi Coming Of Hoole, the Coming On Home Soon Coming To America: A Muslim Fa Coming To America: A New Life Coming To America: the Story. Commander the Gander Commander Toad & the Big Black Commander Toad & the Dis-Aster Commander Toad & the Intergala Commander Toad & the Planet Of Commander Toad & the Space Pir Commander Toad & the Voyage Ho Commander Toad In Space Commodore Perry In the Land Of Common Colds Common Ground Common Life Common Sense Commotion In the Ocean Communicating With Others Communicating With the Deaf Communication (Into-Millenn. Fradin Seymour Simon Carolee Dean Joyce McDonald Adam Osterweil Gertrude Chandler Warner Katherine Gleason Peter Foster Tim Merrison Vivian Vande Velde Lauren Brooke Nanette Mellage Floyd Cooper John McPhee Lisa Sita Anne Moody Kathryn Lasky Jacqueline Woodson Bernard Wolf Katharine N. Emsden Betsy Maestro John DiConsiglio Albert Marrin David McKelvey Jane Yolen Jane Yolen Jane Yolen Jane Yolen Jane Yolen Jane Yolen Jane Yolen Rhoda Blumberg Alvin Silverstein Molly Bang Jan Karon Thomas Paine Giles Andreae Stuart Schwartz Oliver Bosman Deborah Cannarella Grolier Educational Gail Saunders-Smith Bobbie Kalman Vivian Vande Velde Deborah Ellis Arthur Yorinks Shelagh Canning 3. Dickinson Complete Star Wars-Scrapbook Complete Super Bowl Story, the Comportamiento animal Composition, the Compost Critters Compost! Computer Caper, the Computer From A To Z, the Computer Nut, the Computer Programmer Computers Comstock Lode Conch Bearer, the Concord (Rozakis) Concorde Concrete (Material World) Concrete Mixers (Blastoff! Confessions Of- Drama Queen Confessions Of Nat Turner, the Confess-O-Rama Confetti: Poems For Children Con-Fidence Conformation Faults Confucius: the Golden Rule Confucius:Philospher & Teacher Confused Hanukkah, A Congo Congo Congress Congress Of the United States Conifers Conjurer Princess Connecticut Connecticut Connecticut (America-Beau. Murdico Claire Llewellyn Ray McClellan Ruth Pennebaker Christin Ditchfield Christin Ditchfield Elaine Pageler Kana Riley David S.

In virtually all of our c ontracts treatment episode data set generic ritonavir 250 mg without prescription, with perhaps one or two exceptions symptoms kidney buy ritonavir 250 mg cheap, we have a 90-day termination p rovisio n medications given before surgery buy 250mg ritonavir amex. We looked at product utilization in over 8 medications and pregnancy quality 250 mg ritonavir,500 surgical cases in 60 of our facilities with over 2 medicine woman buy 250 mg ritonavir otc,100 surgeons participating treatment example ritonavir 250 mg discount. At the end of that evaluation process, our owners said this was too much work to award just a three-year contract. Schneller, the Value of Group P urchasing in the Health Care Supply Chain 6 (2000), at wpcarey. Some have proposed altering Statement 7, citing to concerns about alleged anticompetitive contracting practices. For example, it is silent on alleged exclusive dealing, tying, and bundling concerns that many panelists discussed in the Hearings. It is also silent on other potential competitive concerns, such as price-fixing, market allocation, mergers, etc. This statement provides in part: "The Agencies will not challenge, absent extraordinary circumstances, any joint purchasing arrangement among health care providers where two conditions are present: (1) the purchases account for less than 35 percent of the total sales of the purchased product or service in the relevant market; and (2) the cost of the products and services purchased jointly accounts for less than 20 percent of the total revenues from all products or services sold by each competing participant in the joint purchasing arrangement. The Agencies believe amending the statement to address some, but not all potential issues, is likely to be counterproductive. For example, some might argue that because certain issues were discussed, Statement 7 implicitly endorses as legal whatever conduct is not specifically addressed. The Agencies will examine, on a case-by-case basis, the facts of any alleged anticompetitive contracting practices to determine whether the practice violates the antitrust laws. It is hardly atypical for Agency guid elines to add ress on ly a certain class of competitive issu es. The Com petitor Collaboration G uidelines also address only a limited set of anticompetitive concerns; they were not de signed to address all possible anticompetitive conduct asso ciated with com petitor collab oratio ns. As appropriate, the Agencies will bring cases against providers who collusively refuse to enter into such arrangements or provide such information. The Agencies also will challenge unilateral conduct or bundled contracting practices, where appropriate. Many obtain coverage through a government program or purchase an individual insurance policy. Many individuals also purchase additional insurance to cover Medicare co-payments and those health care goods and services for which Medicare does not pay. Health insurance and other third party payment programs pay for a substantial majority of health care services. Chapter 6 summarizes competition law as it applies to the health insurance industry and then analyzes current controversies, including most favored nation clauses, mandated benefits, and consumer directed health plans. Representatives from insurance groups and organizations, as well as legal, economic, and academic experts, spoke at the Hearings on insurance-related panels, including: Health Insurance: Payor/Provider Issues (September 9, 2002); Health Insurance Monopoly Issues: Market Definition (April 23); Health Insurance Monopoly Issues: Competitive Effects (April 23); Health Insurance Monopoly Issues: Entry and Efficiencies (April 24); Health Insurance Monopsony: Market Definition (April 24); Health Insurance Monopsony: Competitive Effects (April 25); Health Insurance/Providers: Countervailing Market Power (May 7); Most Favored Nation Clauses (May 7); Financing Design/Consumer Information Issues (June 12); Mandated Benefits (June 25); and Medicare and Medicaid (September 30). Health insurance generally covers hospitalization, emergency care, and a range of clinical services. As noted previously, Americans obtain insurance coverage from various sources, including employmentbased insurance, individual insurance, and Federal and State public sources, such as Medicare and Medicaid. This chapter first summarizes the state and federal laws and regulations that affect the health insurance industry. Next, this chapter describes employment-based, individually-purchased, and governmentfunded health care coverage, and considers the impact of public purchasing on the overall health care system. This chapter also discusses some issues 5 concerning the approximately 15 percent of the American population that is without health insurance at some point during the year. Finally, this chapter discusses consumer-driven health care initiatives and proposals. The applicable regulatory framework for employment-based health insurance also may vary depending on whether the employer purchases coverage from a commercial insurer, self-insures the health plan, or uses a combination of approaches. McCarran-Ferguson Act the McCarran-Ferguson Act was adopted in 1945 to resolve a dispute over the authority of state and federal governments to regulate the business of insurance. State Laws and Regulations Each state has its own laws and regulations governing health insurance. In a trilogy of cases decided between 1978 and 1982, the Supreme Court clarified that the McCarran-Ferguson Act exempted the business of insurance, not the business of insurance companies. The "savings clause" allows for state regulation of insurance, and the "deemer" clause prevents employee benefit plans from being deemed to be insurers. It applies to plans in the private sector and those sponsored by state and local governments. Mandated benefits fall into three general categories: (1) provider mandates, which require health insurers to cover services provided by certain providers or categories of providers. Gitterman 6/25 at 8-9 (noting that Idaho has only ten mandated benefits, but Maryland has 52). The Mental Health Parity Act generally requires gro up health plan s and insurers to provide fo r parity in lifetime and annua l dollar limits on mental health benefits with dollar limits on med ical and surgical benefits. Employers who offer health insurance through commercial insurers usually negotiate on behalf of their employees for specific benefits at a specified monthly premium per person or family. According to one report, employee contributions in 1996 accounted for approximately 30 percent of total health insurance premiums. Allen 4/25 at 105-06 (in Arkansas, commercial insurance products are provided by three national plans, two large local plans, and 6 4 in-state and out-of state third party administrators, as well as self-insured plans providing health coverage to 45 to 50 percent of the covered population). Commercial insurance companies include both for-pro fit and no t-for-pro fit entities. Although Blue Cross and B lue Shield Plans traditionally have bee n nonprofit com panies, som e have converted, or attem pted to convert, to for-profit status in rece nt years. See also Gre g Ke lly, Financing Design / Consumer Information Issues 2 (6/12) [hereinafter G. The specific attachment point is the amount above which the insurer must reimburse the emplo yer for eligible claims made by an individual plan participant. The aggregate attachment point is the amount above which the insurer must reimburse the employer for eligible claims made by all plan p articipa nts. Issues and Priorities One speaker provided an overview of the priorities of employees and employers in dealing with health insurance coverage. Young 6/12 at 91-96; Michael Yo ung, Financing Design/Consumer Information Issues 2-3, 7 (6/12) (slides) [hereinafter M. The same panelist noted that although some administrative hassles have been eliminated as electronic claims processing beco mes m ore p revalent, electro nic datab ases are not universal and m any em ployees still face administrative difficulties as they navigate the 52 51 50 health care system. Many insurance companies, on which employers rely to set the standards concerning what treatments are covered, also are slow to adopt coverage for alternative treatments. Finally, he noted that the percentage of large employers providing health benefits for retirees app ears to be dwindling quickly. Young Presentation, supra note 51, at 3 (citing a "Robert W ood Johnson Foundation survey of 800 registered voters, January 2002"). Young 6/12 at 92 ("[A] lot of our clients will have em ployees who se payroll ded uction for health care will be greater than their increase in their salary. Darling 6/12 at 101 ("[A]ll [health] benefits are foregone wages or other benefits paid for by the worker"). See also Hym an & Hall, supra note 2 8, at 26 -27 ("[D]ifficulties with employm entbased insurance stem from the fact that someone other than the ultimate consumer o f health ca re is making mo st of the decision s abo ut what coverage to purchase and how much to pay"); M. Employers generally have greater negotiating power with insurance companies than individuals. In fact, the tax preference s for em ploym ent-based coverage like ly confers the m ost significant advantage. But see Gingrich 6/12 at 15 ("[W]e artificially constrain and raise the cost of insurance for the self-employed, the unem ployed, sma ll businesses, and family farm s. See also infra notes 200209, and accom panying text (discussing consumerdriven health care), and supra Chapter 1 (discussing quality). This panelist emphasized the importance emp loyees place o n health benefits, 69 11 employment-based health insurance. In 2003, the company provided a fixed subsidy of $220 per month to employees for health care coverage, regardless of the health care plan they chose. His company also increased copayments for office and emergency room visits, introduced hospital deductibles, and carved out the pharmacy benefit and introduced a three-tier formulary. Their response has been to move to lower cost plans, even if it means more hassles to access specialists. See infra notes 200-209, and acco mpanying text, for a discussion o f consumer-d riven he alth care. This panelist suggested that with guaranteed issue, a small employer may choose to remain uninsured until one of its employees needs extensive medical care, knowing that regulations require the insurance companies to issue coverage and some state laws restrict the price and type of coverage. Kelly 6/12 at 115-18 ("Under [state] guaranteed issue, an individual who becomes ill may apply for private insurance coverage and must be accepted. This is comp arable to allowing a p erson to purchase auto insurance for a car wreck after its happened. This speaker indicated that guaranteed issue resu lted in a m inimum monthly premium for family coverage of $1,176 in Portland, Maine, $3,57 6 in T renton, Ne w Jersey, and $1,1 13 in Ithaca, New York. Conversely, in three states without such laws, the monthly premium for comparab le family coverage was $355 in M adison, W isconsin, $410 in Arlingto n, Virg inia, and $46 1 in Pittsburgh, Pennsylvania. K elly (stmt), supra note 40, at 5; Gingrich 6/1 2 at 15; Harringto n & M iller, supra note 74, at 359. Medicare provides coverage for approximately 40 million elderly and disabled Americans, and Medicaid provides coverage for approximately 50 million low-income Americans. They influence the areas in which competition can exist, and the rules under which it has to exist, and the risks and rewards, and the institutional framework within which all of those things take place. K elly (stmt), supra note 4 0, at 7 (noting that "the sm all group market is, on average, much more expensive than the individual ma rket" and sm all business members paid approximately 25 percent more than individuals for insurance policies available on the Interne t); M. Individual policies, however, often do not provide coverage as com prehensive as that available in the gro up market, and such pricing comparisons may not be based on similar co verage. There are approxim ately 40 0,00 0 people in 93 92 14 individuals who are eligible for either Social Security Old-Age Benefits or Railroad Retirement Benefits also are eligible for Medicare. Most people are eligible for Medicare Part A because they or a spouse paid into the program through payroll tax deductions while they were employed. Cashia 9/30 at 164; Joseph Cashia, Nationa l Ren al Allia nce: Suc cess Starts with Choosing the Right Partner 9 (9/3 0) (slides), at. Other co vered services include: ambulatory surgery center facility fees for approved procedures, part-time or intermittent home health care service s, certain outpatient medica l and m ental health therapies, and blood provided as an outpatient or as part o f a Part B covered service. B ecause M edicare is financed on a "pay-asyou-go" basis, the expenses of current beneficiaries are paid with contributions from payroll taxes imposed on those currently working. Individuals who did not pay into Medicare through payroll taxes can participate in P art A b y paying a premium. Some of these standardized Medigap policies also pay for some routine services and prescription drugs. Part D will provide some coverage for prescription drugs for certain eligible enrollees. Some M edicare beneficiaries receive additional health insurance through employer provided retiremen t program s. Pizer 4/23at 146-47; Steven Pizer, Competition in the Medicare+Choice Program 5 (4/23) (slides) [hereinafter Pizer Presentation], at. According to this speaker, to the extent plans compete, it typically has been on the benefits they provide. This rule has an important anti-fraud rationale, but it creates difficulties when services are more efficiently delivered without this requirement. For example, a consultation between a rural general practitioner and an urban specialist might be beneficial to the patient, but it is less likely to occur if the urban specialist cannot bill for his services unless the patient travels to his office. Costs are shared between the federal and state governments, with federal contributions varying based on the wealth of the state and the amounts the state contributes toward the program. The scope of services provided to Medicaid recipients includes: inpatient and outpatient hospital services, prenatal care, childhood vaccines, physician services, and nursing facilities services for persons aged 21 or older. Other Medicaid services may include family planning services and supplies, rural health clinic services, home health care for persons eligible for skilled-nursing service, laboratory and xray services, pediatric and family nurse practitioner services and nurse-midwife services, and early and periodic screening, diagnostic, and treatment services for child ren under age 21. Other Public Programs uninsured children in families with income up to 200 percent of the federal poverty level. There are a number of additional public programs that provide care to specific categories of individuals. The Department of Veterans Affairs provides medical assistance to eligible veterans. Physicians also may ag ree to contra cts with discounted fees to avoid losing p atients. See Buxton 5/8 at 99 (stating that Blue Cross and other payors are working on the use of tiered fees for p hysicians to encourage higher quality outcomes and also stating that such incentives are "the wave of the future. Some individuals can afford to purchase health insurance, but voluntarily elect to bear the risk of not doing so. This estimated figure varies significantly, however, depending on the time period employed and the survey d ata that is use d. See Myths about the Uninsured: Hearing on the Uninsured Before the Health Subcomm. Nichols, V ice President, Center for Studying Health System Change) [h ereinafter Nichols Stateme nt], at waysandmeans. Surveys differ in their size and sam pling m ethod s, the ways in which questions are asked about insurance coverage, and the period over which insurance coverage or uninsurance is measured.

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Dinosaur Dances Dinosaur Days Dinosaur Deals Dinosaur Detectives Dinosaur Detectives Dinosaur Dig Dinosaur Dinner With A Slice treatment tinea versicolor purchase 250mg ritonavir overnight delivery. Dinosaur Dinners Dinosaur Disaster Dinosaur Discoveries Dinosaur Dream Dinosaur Eggs Dinosaur Encore Dinosaur Footprints and Roland Dinosaur For Middleville, A Dinosaur Garden Dinosaur Ghosts-Coelophysis Dinosaur Habitat Dinosaur Heresies, the Dinosaur Hunters Dinosaur Mummies Dinosaur Mystery, the Dinosaur Named After Me, A Dinosaur Named Sue: Colossal. Dinosaur Story Dinosaur Time Dinosaur Times Dinosaur Train Dinosaur Valentine Dinosaur Who Lived-Backyard Claudia Mills Margie Palatini Mary Pope Osborne May Nelson M. Kerr Faith Ringgold Stephanie Calmenson Riki Levinson Mark London Williams Pamela Duncan Edwards Sue Hendrickson Jerry Pallotta Ray, Jr. Nelson Lucille Recht Penner Kathleen Weidner Zoehfeld William Joyce Brooke Hartzog Aliki Bob Barner F. Murphy Judith Bauer Stamper Peter Chrisp Kathryn Lasky Dennis Lee Lee Davis Franklin W. Dixon Gail Gibbons Dennis Nolan Jennifer Dussling Patricia Mullins Brooke Hartzog Ed Alba Liza Donnelly J. Bakker Kate McMullan Kelly Milner Halls Gertrude Chandler Warner Bernard Most Pat Relf Fay Robinson Kathleen Weidner Zoehfeld Paul Stickland Joanna Cole Peggy Parish Vita Jimenez John Steven Gurney Liza Donnelly B. Strange & Wonderful Dinosaurs, Dinosaurs Dinosaurs: A Closer Look Dinosaurs: A Nonfiction. Dirt Bike Adventure Dirt Bike Racer Dirt Bike Runaway Dirt Bikes Dirt Boy Dirt Movers Dirt On Their Skirts Dirty Cowboy, the Anna Milbourne B. Hennessy Aliki Tracy Christopher Brian Floca Gallimard Jeunesse Gail Gibbons Lee Bennett Hopkins Grace Maccarone Paul Willis John Cooper Stephanie Turnbull Scott Steedman Laurie Krasny Brown Dennis R. Shealy Jean Rogers Aliki Mary Pope Osborne Larry Dane Brimner Ruth Thomson Laurene Krasny Brown Carol Harrison William Wise Giles Andreae William Mannetti Rona Putterman Martha Weston Diane Goode Barbara Kerley Laurie Krasny Brown Laurie Krasny Brown Patricia Lauber Laurence Pringle Byron Barton Dougal Dixon Will Osborne Dougal Dixon Eulalia Garcia Dougal Dixon Dougal Dixon Tony Mitton Jean Craighead George Andrew Davenport Lewann Sotnak Douglas Adams Vicki Cobb W. Wesley Miller Matt Christopher Matt Christopher Jesse Young Erik Jon Slangerup Bobbie Kalman Doreen Rappaport Amy Timberlake 2. Disasters Disasters At Sea Disasters In Space Exploration Disclosure Disconnected Discover Mars Discover the Destroyer Discoveries&Inventions (Egypt) Discoveries, Inventions & Idea Discovering - Inca Ice Maiden Discovering Dinosaurs Discovering El Nino Discovering Graph Secrets Discovering History. Janeczko Lisa Rowe Fraustino Brian James Margaret Wise Brown Mel Cebulash Marjorie Weinman Sharmat Deborah Kent Jude Watson Rosa Guy Elizabeth Lenhard Carol A. Fuchs Sid Fleischman Betsy Byars Terry McMillan Richard Wilbur Elvira Woodruff Franklin W. Miller Gertrude Chandler Warner Lois Walfrid Johnson Lois Walfrid Johnson Greg Roza Phoebe Marsh George Sullivan Ellen Leroe Ned Halley Andrew Donkin Gregory L. Applegate Jane Shuter Jane Shuter John Reinhard Janine Scott Patricia Seibert Sandra Markle Judith Irving Melvin Berger Melvin Berger Laura Purdie Salas Richard Brightfield John Marks Templeton Andrew Langley Gordon Korman Ann Gabhart John R. Do It Yourself Beauty Do Like A Duck Does Do Like Kyla Do Not Disturb Do Not Open Do Not Pass Go Do Penguins Get Frostbite Le Guin Neal Shusterman Brian Knapp Deb Vanasse Scott Anderson Sid Hite Adele Griffin Ann Packer Miko Andrews Hannah Gerrard Mary Towne Sylvia A. Murphy Tonya Leslie Elizabeth Kay Garry Disher Karen Wallace Laura Hamilton Waxman Kenneth Mallory Nick Arnold Paula Danziger Christina Mia Gardeski Trudi Strain Trueit Barbara Hall Gilbert Morris Karen Cooper Theresa Greenaway Michael Allaby Jon Agee Melvin Berger Kathy Mormile David McCoy Jamie Gilson Melvin & Gilda Berger Kathy Tucker David Fischer Karen W. Bressler Judy Hindley Angela Johnson Margery Facklam Brinton Turkle Kirkpatrick Hill Melvin & Gilda Berger 10 5. Berger Melvin Berger Catherine Ripley Jerry Spinelli Alison McDonough Melvin Berger Melvin Berger Nat Gabriel Eileen Spinelli Dori Hillestad Butler Charlotte Zolotow Joanne Oppenheim Bernard Waber Judith St. Green Gerald Hausman Joanna Cole John Bierhorst William Steig William Steig William Steig Hugh Lofting Hugh Lofting Martin Booth Natalie Kinsey-Warnock Inez Snyder Boris Pasternak Dee Ready Marlene Targ Brill Amy Moses Gail Saunders-Smith Diane Duane Petra Mathers Rick Meyerowitz Eric Carle Melvin & Gilda Berger Mindy Schanback Virginia A. Stroud Juliet Clutton-Brock Laura Vaccaro Seeger Paul Fehlner Kate Spohn Kate Spohn Lucy Floyd Ben M. Feldman David Lubar Colby Rodowsky Vivian Sathre Dick Gackenbach Marilynn Reynolds Lynea Bowdish L. Baglio Harry Mazer DyAnne DiSalvo-Ryan Carla Golembe Janice Boland Mary Stolz Constance Hiser Vivian Sathre Joseph Bruchac Philippa Pearce Jennifer Rae Matt Christopher Jonathan Long Matt Christopher Matt Christopher Jeannette Sanderson Jeannette Sanderson Karen Spafford-Fitz Allan Zullo Norman Bridwell Keiko Kasza Polly M. Robertus Farley Mowat Frances Wilbur William Corbin Christopher Russell Shirley Hughes Franklin W. Martin Gerald Hausman Ellen Miles Seymour Reit Tiki Elkhart Gary Paulsen Beverley Wood Gary Paulsen Alden R. Carter Dav Pilkey Melvin Burgess Susan Sinnott Rob Thomas Jan Siebold Isabel Gallego Eve Bunting Esmeralda Santiago Mary Downing Hahn Yona Zeldis McDonough Shirley Albert Ann M. Flanagan Gibbs Davis Yona Zeldis McDonough Betty Ren Wright Martine Leavitt Harriette Arnow Kristine Hooks Henrik Ibsen Rumer Godden Stephen King Bruce Brooks Wayne Grover Wayne Grover Ben M. Reed Mary Pope Osborne Mary Pope Osborne Marica Seligson Kimberly Weinberger Kathleen W. Cerullo Steve Alten William Steig William Steig Geography Department Lerner Lura Rogers Byron Augustin Elaine Landau Deanne Durrett Jewell Reinhart Coburn M. Company Walt Flood Miguel de Cervantes Michael Burgan Pat Mora Monalisa Degross Mary E. Welvaert Roger Wachtel Brendan Halpin Mack Duffy Eileen McGaferty Janine Scott Lilian Moore Akimi Gibson Joan M. Harris Martina Selway Jeanne Whitehouse Peterson Margaret Wise Brown Bruce Coville Todd Strasser Todd Strasser Todd Strasser Todd Strasser Ann M. Davis Keiko Kasza Lindsay Caldwell Deborah Blumenthal Mo Willems Mo Willems Richard Peck Lois Duncan James Stevenson Barbara Park Carolyn Crimi Kalli Dakos 4. Krulik Richard Carlson Karin Ireland Beverly Hastings Peg Kehret Hila Colman Patricia Reilly Giff Ruth Pennebaker H. Gilmour Stef Donev Pat Edwards Wendy Cheyette Lewison Eileen Christelow Ruth Tenzer Feldman Margaret Peterson Haddix James Stevenson Avi Sue Stauffacher Sue Stauffacher Bruce Brooks J. Patrick Lewis John Bellairs Paul Zindel Laurie Calkhoven Carolyn Meyer John Peel Frank E. Heinlein Tana Reiff Heather Quarles Ulysses Moore Pat Hutchins Kelly McWilliams Carolyn Keene Barbara Linde Michelle Edwards Julie Sykes Julie Sykes Carol Gorman Carol Gorman Mike Venezia Keiko Kasza Julia Cunningham Patricia Coombs Jerry Pallotta Ellen Stoll Walsh 4. Double Act Double Crossing Double Date Double Dog Dare Double Dragon Trouble Double Dutch Double Fake (Winning Season) Double Fudge Double Header Double Helix: A Novel Double Identity Double Jeopardy Double Jinx Mystery, the Double Life Of Pocahontas, the Double Life Of Zoe Flynn, the Double Life, the Double Luck Double Or Nothing Double Play At Short Double Trouble Double Trouble Double Trouble In Walla Walla Double Trouble Monsters Double-Dare To Be Scared Double-Digit Club, the Doubles Doublet Affair Dough Boy Douglas MacArthur Douglas MacArthur: American. Reynolds Orlando Frizado Francie Alexander Jacqueline Wilson Carolyn Keene Sinclair Smith Jamie Gilson Kate McMullan Sharon M. Draper Rich Wallace Judy Blume Gail Herman Nancy Werlin Margaret Peterson Haddix H. Gilmour Carolyn Keene Jean Fritz Janet Lee Carey Justin Richards Chi Fa Lu Dennis Foon Matt Christopher Kirsten Hall Jenny Dale Andrew Clements Marcia Thornton Jones Robert D. San Souci Marion Dane Bauer Cass Hollander Fiona Buckley Peter Marino Jean Darby Barbara Silberdick Feinberg Jan Carr Robin Lee Graham Nancy Garden Jane Yolen Kristine L. Rosen Melissa Wiley Tessa Paul Jan Reynolds Avelyn Davidson Sandra Markle Trisha Magraw Will Hobbs Neal Shusterman Sharon Fear Norma Fox Mazer Juan Felipe Herrera Frank B. Hooks Harriet Ziefert Harriet Ziefert Gordon Korman Marissa Moss Meish Goldish Bill Brittain H. Ehrlich Ann Halam Janice Greene Dan Greenburg Robert Louis Stevenson Albert Marrin Scott P. Readers Dragonflight Dragonfly Emily Hutchinson Eric Kudalis Debbie Dadey Debbie Dadey Debbie Dadey Elizabeth Levy Larry Mike Garmon Peter Sessler Matthew Pitt Jay H. Smith Stephen Cosgrove Clive Cussler Timothy Zahn Timothy Zahn Timothy Zahn Lynne Cherry Timothy Zahn Paul Hindman Ann Bausum Laurence Yep Marianne Macdonald Dav Pilkey E. Konigsburg Marie Day Laurence Pringle Carole Wilkinson Nancy Luenn Lynne Bertrand David Bouchard Bruce Coville Maryann Dobeck Rebecca Rupp Laurence Yep Mary Pope Osborne Matthew Pittaluga Steven A. Buck Julia Campbell Laurence Yep Mark London Williams Walter Dean Myers Keith Taylor Cathryn Falwell Jackie French Koller Laurence Yep Roger Carr Anne McCaffrey Cheryl Coughlan Jen Green Emily K. Draugr Draw Cars Step By Step Draw Me A Star Draw Me A Story Drawing - Charcoal & Pastels Drawing A Blank Drawing From Nature Drawing In the Sand Drawing Lessons Drawing Lessons From A Bear Drawing Life In Motion Drawing Of the Three, the Drawing With Markers Drawing With Pencils Dread Locks Dread Mountain Dreadful Acts Dreadful Future Of Blossom. Gold Kristina Rodanas Jackie French Koller Ernest Drake Ernest Drake Anne McCaffrey Jack Prelutsky Vivian Vande Velde Jane Yolen Jane Yolen E. Thomson Anne McCaffrey Anne McCaffrey Bruce Coville David Calder Anne McCaffrey Laurence Yep Maureen Connolly Nancy Krulik Arthur G. Slade Doug DuBosque Eric Carle Max Winter Paige Henson Daniel Ehrenhaft Jim Arnosky Jerry Butler Tracy Mack David McPhail Jim Arnosky Stephen King Paige Henson Paige Henson Neal Shusterman Emily Rodda Philip Ardagh Richard Peck Kathryn Reiss Susan V. Applegate Tony Abbott Stephen Cosgrove Barbara Wersba Karen Rivers Louise Lawrence Jonathan London Fran Reed Paul Goble Audrey Osofsky Stephen King Cynthia Rylant Eve Bunting Elaine Greenstein Roni Schotter Richard Peck Sarah Dessen Sharon Shinn Ezra Jack Keats Trudi Strain Trueit Susan Musgrave Kathryn Lasky Jennifer Armstrong Ann Sreyts Ellen Conford Steve Voake Brendan January Shirley Neitzel Lynette Evans Brandon Marie Miller Marcia Leonard Robb Armstrong Robb Armstrong Jeff Savage Ann Graham Gaines Michael Sandler Joe Layden Dale Peck Richie Tankersley Cusick James Houston David Armentrout 3. Monjo Barbara Seuling Sarah Weeks Jenny Lombard Larry Bird Lynne Ewing Joaquin Burns Milton Meltzer Caroline B. Parker Andy MacDonald Patrick Merrick Junot Diaz Laura Amy Schlitz Garth Nix Bette Greene Terry Brooks Sharon M. Clifton Wisler Larry Weinberg Barbara Emberley Kimberly Jackson Carolyn Meyer James Boyd 2. Readers Dumpling Soup Dumpy La Rue Dumpy the Dump Truck Dunc And Amos &-Red Tattoos Dunc and Amos Go To the Dogs Dunc And Amos On Thin Ice Walter D. Neder Virginia Hamilton Deborah Kent Angela Royston Tad Hills Doreen Cronin Jez Alborough David Shannon Kirsten Hall Gaelyn Gordon Don Lessem Karen Wallace Ben M. Baglio Roger Carr Phyllis Reynolds Naylor Augusta Goldin Elizabeth Dana Jaffe Lori Haskins Gail Gibbons Janette Oke Janette Oke Eve Bunting Ann M. Gregory Judith Jango-Cohen Ray McClellan Jama Kim Rattigan Elizabeth Winthrop Julie Andrews Edwards Gary Paulsen Gary Paulsen Gary Paulsen 6. Rushford Joanna Campbell Peter Catalanotto David Moore Claudia Mills Alvin Silverstein Elaine Landau Johanna Hurwitz Sue Grafton 4. Giganti Janet Ahlberg Helen Fox Jemima Parry-Jones Gerald Hausman Sheryl McFarlane Clyde Robert Bulla Jack Higgins Jack Higgins Peter Merchant Paula Fox Rosemary Sutcliff Joseph Bruchac Anthony Horowitz Merebeth Switzer Deborah Kops Nora Martin Lauraine Snelling Evelyn Minshull Al Perkins Nancy Farmer Alvin Silverstein Sharon Gordon Don Freeman Helen Roney Sattler Grolier Educational Tomie dePaola Robert B. Gallant Nick Merriman Greg Lang Bobbie Kalman Barry Denenberg Jean Fritz Bobbie Kalman Marion Dane Bauer David M. Brownstone Stuart Schwartz Judith Viorst Katherine Goode Paul Showers Patricia Lakin Robert Daily David Brin Susanna Van Rose Steven L. Earth Day Earth Day Earth Day (True Book) Earth Dragon Awakes, the Earth From A To Z, the Earth Geeks Must Go! Earth In Space, the Earth Is Good, the Earth Is Mostly Ocean, the Earth Is Painted Green Earth Keepers Earth Magic Earth Mother Earth Movers Earth Movers (Blastoff! Earthquakes Earthquakes Earthquakes Earthquakes & Volcanoes Earthquakes (Forces Of Nature) Earthquakes (Natural Disasters Earthquakes (Simon) Earthquakes (True Book) Earthquakes (Watts Library) Larry Dane Brimner Donna Walsh Shepherd George R. Stewart Brian Knapp Frank Asch Gallimard Jeunesse Sheri Reda George Ancona David F. Stine Peter Riley Michael DeMunn Allan Fowler Barbara Brenner Joan Anderson Mallory Loehr Ellen Jackson David Armentrout M. Martin Paula Danziger Seymour Simon Carolyn Mackler Cynthia Pratt Nicolson Seymour Simon Sylvia Waugh Orson Scott Card Joanne Ryder Orson Scott Card Carolyn Sumners Valerie Wyatt Janet McNaughton Lee Sullivan Hill Margie Palatini Mary Pope Osborne Gail Herman Kathleen Duey Kristiana Gregory Laurie Myers Peg Kehret Jerry B. Branley Michele Ingber Drohan Lin Sutherland Peter Murray Luke Thompson Seymour Simon Paul P. East East Meets West Easter Easter Easter (True Book) Easter Cat, the Easter Cub, the Easter Island Easter Parade Easter Ribbit, the Eastern Forest, the Eastern Sun, Winter Moon Easy Avenue Easy To See Why Easy Work! Eaters Of the Dead Eating Apples Eating Crow Eating Disorders Eating Feet Eating Fractions Eating Ice Cream With-Werewolf Eating the Alphabet Eating the Plates Eaton Stanley & Mind Control Ebb And Flo And the New Friend Ebony Swan, the Echo Echoes Echoes Of Civil War: the Blue Echoes Of Civil War: the Gray Echoes Of the Elders Echoes Of the White Giraffe Echohawk Eclipse: Darkness in Daytime Eclipses Neil Morris Fiona Watt Janine Scott Roy A. Holmes Claire Llewellyn Elaine Pascoe John Himmelman Patricia Lauber Edith Pattou Joseph Rahim David F. Sanders Meindert DeJong Justine Korman Fontes Caroline Arnold Eloise Greenfield Bernice Chardiet Eileen Fielding Gary Paulsen Brian Doyle Fred Gwynne Eric A. Kimmel Sarah Hayes Pegeen Snow James Howe Alvin Silverstein Charlotte Foltz Jones Steven Kroll Michael Crichton Gail Saunders-Smith Lila Hopkins Trudi Strain Trueit Susan Manlin Katzman Bruce McMillan Phyllis Green Lois Ehlert Lucille Recht Penner David A. Educating Esme Education Of A Wandering Man Education Of Little Tree, the Education Of Mary Edward And the Pirates Edward Hopper Edward Hopper Edward In the Jungle Edward Lear (Poetry For. Edwina the Emu Edwina Victorious Edwina: the Dinosaur Edwurd Fudwupper Fibbed Big Eek! Eensy-Weensy Spider, the Eentsy, Weentsy Spider, the Eeny Meeny Miney Mole Effect Of Gamma Rays On Man. Steve Pollock Marion Morrison Geography Department Lerner Pamela Duncan Edwards David McPhail John Attanas Kathryn Cleven Sisson C. Adler Carolyn Haywood John Neufeld Tristan Boyer Binns Tom Streissguth Edgar Allan Poe Monica Kulling Mike Venezia Ben Bo Jack Higgins Holly Melton Stephanie Grace Whitson Rebecca Tingle Dick Francis Dan Gutman Alice K. Egypt Egypt Egypt (Economically-Countries) Egypt (Faces And Places) Egypt (Fiesta! Selsam Katherine Milhous Joyce Dunbar Jacqueline Turner Banks Stephanie Schumacher Ruth Rogg Miriam Moss Marcy Dunn Ramsey Janine Scott Mary Jane Auch Judy Delton Nikki Giovanni Jeff Reynolds Ann Heinrichs Alasdair Tenquist Patrick Ryan Christine Rodenbeck Ann Heinrichs Stuart A. Kallen Henry Pluckrose Helen Arnold Stephen Krensky Elaine Landau Peter Roop Zilpha Keatley Snyder Jeffrey Zuehlke Geography Department Lerner Stewart Ross Elizabeth Berg Natalie Nafouz Jane Louise Curry Shirley Climo Richard Platt Joyce Haynes John Guy Henrietta McCall Scott Steedman JoAnn Adinolfi Irene Franck Jacqueline Morley Lynne Ferguson Chapman Scott Steedman Stephanie Turnbull Emily Sands Susan Middleton Elya Louisa May Alcott Linda Dunlap Ann Whitford Paul D. Eleanor Roosevelt: Fighter Eleanor Roosevelt: First Lady Eleanor Roosevelt:First Lady. Hill Nicholasa Mohr Allen Say Geraldine McCaughrean Mary Dodson Wade Lloyd Alexander Mike Venezia Elizabeth Borton De Trevino William Durbin Sally Rose Caroline Arnold Marion Morrison Geography Department Lerner Heidi Chang Heidi Chang Audrey Wood Joan Zeier Christopher Paolini Barbara Cooney Joseph P. Lash Kristiana Gregory Monica Kulling Lisa Williams Kline Mary Winget Wiley Blevins James Lincoln Collier Mary Winget Lucile Davis Bill E. Elephants Swim Elephants: Gentle Land Giants Elevator Family, the Elevator Magic Eleven Elephants Going Up!

Cohen symptoms torn rotator cuff generic ritonavir 250 mg, 2015 the roles of cellular and organismal aging in the development of lateonset maladies symptoms 9 days post ovulation generic ritonavir 250 mg on line. Russell medications and mothers milk 2014 generic ritonavir 250mg free shipping, 1975 the dauer larva medicine 5000 increase cheap ritonavir 250mg amex, a postembryonic developmental variant of the nematode Caenorhabditis elegans medications list generic 250mg ritonavir free shipping. Appelbaum medications on a plane buy ritonavir 250 mg overnight delivery, 2013 Circadian clocks, rhythmic synaptic plasticity and the sleep-wake cycle in zebrafish. Wilson, 1988 Behavioral effects in adulthood of serotonin depletion by P-chlorophenylalanine given neonatally to male rats. Heller, 1997 Neonatal treatments with the serotonin uptake inhibitors clomipramine and zimelidine, but not the noradrenaline uptake inhibitor desipramine, disrupt sleep patterns in adult rats. Jin, 1998 lin-14 regulates the timing of synaptic remodelling in Caenorhabditis elegans. Kimura, 2014 Characteristics of sleep and wakefulness in wild-derived inbred mice. Kitamoto, 2010 the steroid molting hormone ecdysone regulates sleep in adult Drosophila melanogaster. Lacote, 1970 Ontogenesis of the states of sleep in rat, cat, and guinea pig during the first postnatal month. Panula, 2004 the orexin/hypocretin system in zebrafish is connected to the aminergic and cholinergic systems. Sehgal, 2014 A critical period of sleep for development of courtship circuitry and behavior in Drosophila. Wu, 2012 Two dopaminergic neurons signal to the dorsal fanshaped body to promote wakefulness in Drosophila. Tononi, 2011 Sleep and waking modulate spine turnover in the adolescent mouse cortex. Bour, 1981 Suppression of active sleep by chronic treatment with chlorimipramine during early postnatal development: effects upon adult sleep and behavior in the rat. Blumberg, 2008 Synchronous bursts of neuronal activity in the developing hippocampus: modulation Review 31 by active sleep and association with emerging gamma and theta rhythms. Blumberg, 2010 Neocortical activation of the hippocampus during sleep in infant rats. Schier, 2006 Hypocretin/orexin overexpression induces an insomnialike phenotype in zebrafish. Bringmann, 2011 Reduced activity of a sensory neuron during a sleep-like state in Caenorhabditis elegans. Bringmann, 2012 Reduced muscle contraction and a relaxed posture during sleep-like Lethargus. Shaw, 2011a Sleep deprivation during early-adult development results in long-lasting learning deficits in adult Drosophila. A Marks, 1999 Ponto-geniculo-occipital-wave suppression amplifies lateral geniculate nucleus cell-size changes in monocularly deprived kittens. Marks, 2002 Rapid eye movement sleep deprivation modifies expression of long-term potentiation in visual cortex of immature rats. Robinson, 2002 Stress response genes protect against lethal effects of sleep deprivation in Drosophila. Hart, 2014 Deep conservation of genes required for both Drosphila melanogaster and Caenorhabditis elegans sleep includes a role for dopaminergic signaling. Davis, 2005 Central administration of transforming growth factor-alpha and neuregulin-1 suppress active behaviors and cause weight loss in hamsters. McDearmon, 2008 the genetics of mammalian circadian order and disorder: implications for physiology and disease. Blumberg, 2012 Distinct retinohypothalamic innervation patterns predict the developmental emergence of species-typical circadian phase preference in nocturnal Norway rats and diurnal Nile grass rats. Cirelli, 2014 Sleep and the price of plasticity: from synaptic and cellular homeostasis to memory consolidation and integration. Raizen, 2015 Distinct mechanisms underlie quiescence during two Caenorhabditis elegans sleep-like states. Anness, 1978 Connectivity changes in a class of motoneurone during the development of a nematode. Brenner, 1986 the structure of the nervous system of the nematode Caenorhabditis elegans. Gan, 2012 Sleep contributes to dendritic spine formation and elimination in the developing mouse somatosensory cortex. Appelbaum, 2014 Altered behavioral performance and live imaging of circuit-specific neural deficiencies in a zebrafish model for psychomotor retardation. Klukowski the Rise and (Coming) Fall of "F-Cubed" Securities Litigation by George T. Morriss, Bruce Yandle & Andrew Dorchak State Revanchism: Can the Latest Efforts to Regulate Voice over Internet Protocol Be Stopped Fitzpatrick, Chairman Corporations, Securities & Antitrust Michael Fransella, Chairman Carrie Darling, Robert T. Wang Co-Chairmen Professional Responsibility & Legal Education Jack Park, Chairman Religious Liberties Becky Dummermuth, Chairman Telecommunications & Electronic Media Raymond L. Gifford, Chairman the Federalist Society for Law and Public Policy Studies is an organization of 40,000 lawyers, law students, scholars and other individuals located in every state and law school in the nation who are interested in the current state of the legal order. The Fedearlist Society takes no position on particular legal or public policy questions, but is founded on the principles that the state exists to preserve freedom, that the separation of governmental powers is central to our constitution and that it is emphatically the province and duty of the judiciary to say what the law is, not what it should be. The Federalist Society takes seriously its responsibility as a non-partisan institution engaged in fostering a serious dialogue about legal issues in the public square. We publish original scholarship on timely and contentious issues in the legal or public policy world, in an effort to widen understanding of the facts and principles involved and to continue that dialogue. Positions taken on specific issues in publications, however, are those of the author, not reflective of an organization stance. Engage presents articles, white papers, speeches, reprints and panels on a number of important issues, but these are contributions to larger ongoing conversations. We invite readers to submit opposing perspectives or views to be considered for publication, and to share their general responses, thoughts and criticisms by writing to us at info@fed-soc. The Federalist Society For Law and Public Policy Studies Directors/Officers Steven G. Leo Senior Vice President & Faculty Director Lee Liberman Otis Lawyers Division Dean Reuter, Practice Groups Director Lisa Budzynski, Lawyers Chapters Director Mia Reynolds, State Courts Project Director David C. Ubben Development Patty Price, Director Cindy Searcy, Associate Director Ellen Fuller, Assistant Director Information Technology Director C. Aigner Membership Director Terry Archambeault Office Management Rhonda Moaland, Director Matt Nix, Assistant Director ngage, the journal of the Federalist Society Practice Groups, provides original scholarship on current, important legal and policy issues. This is the first issue following on the close of our year-long twenty-fifth anniversary celebration. Audio and video recordings from all the panels, speaking engagements, and debates from our 25th National Lawyers Convention are now online. Publication details appear on the individual webpage for each panel in our new Multimedia Archive. We hope all these new features provide our members with the high standard of scholarship and excellence that they have come to expect from the Federalist Society. As always, readers can expect upcoming issues of Engage to feature articles on matters of importance to them. We hope that you find the work in these pages well-crafted and informative, and strongly encourage you to send us your feedback at info@ fed-soc. E Volume 9, Issue 1 Engage February 2008 Administrative Law & Regulation Climate Change Litigation Since Mass v. Casey* A lthough Congress failed to pass climate change legislation in 2007, the year was nevertheless highly significant for climate change litigation. Many courts are increasingly willing to interpret existing statutes (particularly the Clean Air Act and the National Environmental Policy Act) to require federal agencies to address some aspect of global warming. At the same time, they generally have proven far more reluctant to frame judicial climate change relief under federal or state common law nuisance theories. Nevertheless, a pattern is clearly emerging in which states and private groups that are impatient with federal efforts to deal with global climate change on the international level seek to force U. At this point, it is by no means safe to assume that these efforts will be found by the courts to be preempted by federal law. Here the Agency noted in particular that the United States was determined to promote a global strategy for addressing climate change issues, and that unilateral American action in this area would undermine that goal. But even if regulation does reduce emissions-to some indetermine degree, given events elsewhere in the world-the Court never explains why that makes it likely that the injury in fact-the loss of land-will be redressed. The "special solicitude" shown to Massachusetts here suggests that this standing analysis, as noted by the dissenters, is limited to this case. At the same time, there are twenty-four states and the District of Columbia with coastlines, oceanic or tidal, that might be affected by sea levels. By effectively granting state governments a new, special standing status, the Court has all but guaranteed additional litigation by those states determined to force federal policy on the global climate change issue. Indeed, as discussed below, some lower court decisions that consider Massachusetts v. This aspect points to a narrower impact than the victorious states and environmental groups might have anticipated. It adopted regulations in 2004, addressing the greenhouse gases of carbon dioxide, methane, nitrous oxide, and hydrofluorocarbons. The court also considered whether the California program is barred on foreign policy preemption grounds. It concluded that "[t]o the extent [the] United States has articulated a concrete policy with respect to its international approach to control of greenhouse gas emissions from the motor vehicle sector," it is found in the "G8 Summit Report of 2007 which provides that the member states will ask their governments to: `. In this respect, the court disallowed both arguments advanced ("without offer of proof ") by the Solicitor General before the Supreme Court in Massachusetts v. Crombie the Central Valley Chrysler Jeep decision built upon a similar decision issued on September 12, 2007 by the U. The Vermont decision is notable because it was the first trial to host a battle of experts. Environmental Defense and Union of Concerned Scientists recommended a minimum of $13. In September 2006, the State of California sued the six largest automobile manufacturers, claiming that the emissions from their products, automobile exhaust, contributed to global warming and was therefore a public nuisance under both federal common law and California state common law. The automobile manufacturers asked the court at the outset to dismiss the case because, among other reasons, the complaint raised "nonjusticiable claims" reserved for resolution by the political branches of government. In September 2007, a federal judge agreed that the complaint was non-justiciable and dismissed the case. Carr,37 asks the question of whether a court can decide a case "`without [making] an initial policy determination of a kind clearly for nonjudicial discretion. While the court found sufficient for dismissal the requirement that it would have otherwise needed to make an impermissible policy decision, it also found other grounds to reinforce its decision to dismiss the case. Carr requires a court to consider whether there has been a textually demonstrable constitutional commitment of the issues to the political branches of government-such as, in this case, the Commerce Clause and foreign affairs powers of the Constitution. The court distinguished a raft of trans-boundary pollution cases presented by California, and concluded that none of these cases implicated the number of national and international policy issues presented by climate change challenges. American Electric Power,41 the Attorneys General from eight states and the City of New York, along with two environmental groups, sued American Electric Power Co. Judge Loretta Preska, on September 15, 2005, dismissed the case because it raised non-justiciable political questions. In her decision, she found that explicit statements from both the legislative and executive branch, dating back to the earliest consideration of climate change issues, indicated a specific refusal to impose limits on carbon dioxide emissions. Applying the standard for determining non-justiciability, the court found that the case would require it to make an initial policy determination as to how to address global climate change, and that this responsibility was vested in the political branches of government, not in the courts. In June, 2007, the Second Circuit ordered supplemental briefing on the impact of Massachusetts v. Murphy Oil42 At the end of August, a district court judge in Mississippi dismissed a class-action lawsuit brought by some individuals against energy companies, including coal, electric utility, and chemical companies. The lawsuit was filed by Ned Comer, and other Gulf Coast residents who suffered storm damage from Hurricane Katrina. It alleged that the energy companies knew that their emissions produced the conditions whereby a storm of the strength and size of Katrina would form and strike the Gulf Coast. In dismissing the case, Judge Louis Guirola determined that the plaintiffs did not have standing. Ruling from the bench, he noted that the alleged injuries are "attributable to a larger group that [is] not before this Court, not only within this nation but outside of our jurisdictional boundaries as well. While the Court was willing to extend "special solicitude" to the states in that case, the dismissal of the Comer case suggests that non-state plaintiffs will not similarly benefit. While it was the coalition of coal company defendants that brought the motion to dismiss the case against them, the judge, on his own initiative, dismissed the remaining defendants as well. Climate Change Science Program for failing to prepare a periodic scientific assessment of climate change, as required by the Global Change Research Act of 1990. February 2008 9 Point-Counterpoint: House Representation for the District of Columbia A Capital Offense Against the Constitution By Matthew J. Franck* Not only are the "People" in each state the choosers of representatives, but their right of suffrage is defined here in such a way as to key it to choices locally made in each state, in respect of its legislature. The District of Columbia, not being a state, not only cannot have a "People" of a state to do the choosing of its representative, it also does not have a "State Legislature" with "Electors" among those people who can qualify to be the voters in a congressional election. A state legislature is the creature of a state constitution, and the qualifications of the voters in state legislative elections are set by that constitution and/or by the laws made by that legislature. Its next clause requires that a House member be "an Inhabitant of that State" he has been elected to represent.

Prior to 1989 treatment 5th metatarsal base fracture cheap 250 mg ritonavir free shipping, appropriate vaccination consisted of a single dose of live vaccine administered on or after the first birthday treatment zinc poisoning 250mg ritonavir visa. Now medicine joint pain buy ritonavir 250mg cheap, a routine two-dose schedule is recommended: the first dose medicine organizer box buy ritonavir 250 mg on line, which is 93 to 98% effective treatment 7th march bournemouth ritonavir 250mg sale, at 12 to 15 months of age and the second dose at entry to primary school medications ranitidine purchase 250 mg ritonavir mastercard. By 2001, all children from kindergarten through the 12th grade should have a second dose. Most adults are considered to have been appropriately vaccinated if they received one dose of vaccine administered on or after their first birthday. Some adults, however, who are at increased risk of measles (health care workers with direct patient contact, students in college, international travelers) should receive a second dose of vaccine unless they have documentation of prior physician-diagnosed measles or serologic evidence of immunity. Persons embarking on foreign travel should ideally have received two doses or have other evidence of measles immunity. Persons born before 1957 are usually immune as a result of natural infection and do not require vaccination, although vaccination is not contraindicated if they are believed to be susceptible. During outbreaks of measles in institutions, all persons at risk who have not received two doses or who lack other evidence of measles immunity should be vaccinated. Patients with anaphylactic reactions to eggs can be vaccinated without prior skin testing. In approximately 5 to 15% of susceptible recipients of measles vaccine, temperatures of 39. The overall rate of reactions after the second dose of a measles-containing vaccine is substantially lower than after the first dose. Encephalopathy or encephalitis following measles vaccination has been reported at a rate lower than the background or expected rate. Rubella Rubella (see Chapter 382) vaccine is indicated for susceptible adults born in 1957 or later and for susceptible women of any age who are considering becoming pregnant. Persons without a prior history of vaccination on or after the first birthday or laboratory evidence of immunity should be considered susceptible. Follow-up of 305 susceptible women who received rubella vaccines within 3 months of the estimated date of conception has failed to reveal any evidence of defects compatible with congenital rubella syndrome in their offspring. Nevertheless, vaccine is contraindicated in pregnant women on theoretic grounds, and conception should be delayed for 3 months after rubella vaccination. Arthralgia, usually of the small peripheral joints, develops in up to 40% of susceptible adults, and frank arthritis develops in 10 to 20%. Joint symptoms usually begin 1 to 3 weeks following vaccination and persist for 1 day to 3 weeks. Very rarely have chronic recurrent or persistent joint symptoms developed following vaccination, but controlled studies have shown that the incidence of these events in vaccinees is similar to that of non-vaccinees. Other infrequent adverse events include transient peripheral neuritis and pain in the arms and legs. Rubella vaccine is contraindicated for persons with moderate to severe acute febrile illnesses and for persons with reduced immunocompetence. Rubella vaccine is grown in human diploid cells and can be administered without problems to persons with allergy to eggs. Mumps Mumps (see Chapter 384) vaccine is indicated for all persons, especially susceptible males, without a prior history of vaccination on or after the first birthday, physician-diagnosed mumps, or laboratory evidence of immunity. Most persons born prior to 1957 can be considered immune as a result of natural infection, although vaccination is not contraindicated if such persons are thought to be susceptible. In clinical trials, a single dose of vaccine has induced seroconversion in more than 90% of recipients. Adverse events following mumps vaccine are uncommon-fever, parotitis, and allergic manifestations. Mumps vaccine is contraindicated for pregnant women on theoretic grounds, for persons with moderate to severe acute febrile illnesses, and for persons with altered immunocompetence. Patients with anaphylactic reactions to eggs can be vaccinated without skin testing (see Measles earlier). Varicella A live attenuated varicella vaccine (Oka strain) was licensed in March 1995. The vaccine protects 70 to 90% of recipients against any disease and more than 95% of recipients against severe disease. Breakthrough infections in persons who have previously seroconverted have been reported in 2 to 4% per year following vaccination with the licensed product. Such breakthroughs are typically mild and average fewer than 50 lesions as compared with several hundred lesions in unvaccinated persons with varicella. Breakthrough illnesses do not appear to increase in incidence or severity with increasing time since vaccination, a finding compatible with long-term protection following initial vaccination. Persons 13 years or older require two doses at least 4 weeks apart to achieve seroconversion rates of approximately 99%, a rate comparable to that in younger children after one dose. The most common side effect is soreness at the injection site, which is reported in 25 to 35% of recipients 13 years or older. Varicella-like rashes at the injection site (median of two lesions) have been reported in 3% of recipients in this age group after the first dose and in 1% after the second dose. The incidence of herpes zoster (shingles) is substantially lower than would be expected after natural varicella (see Chapter 383). Although more severe events occurring in temporal relation to the vaccine have been reported very rarely, a causal relationship has not been established. Transmission of vaccine virus to a contact is extremely rare and appears to take place only with vaccinees in whom a varicella-like rash has developed. Persons with a prior history of varicella disease can be considered immune and do not need vaccination. Whereas a negative or unknown history of disease is predictive of susceptibility in children, many adults with such histories are immune. Serologic screening of adults in some situations may be cost-effective, provided that identified susceptible adults are vaccinated. The vaccine is contraindicated in the immunocompromised, those with anaphylactic allergies to vaccine components, and pregnant women. Varicella vaccine is more temperature sensitive than other vaccines used in the United States. Hepatitis B Hepatitis B (see Chapter 149) vaccine is the first vaccine that can prevent cancer (an estimated 800 persons per year in the United States die of hepatitis B-related liver cancer; many times more do so in the developing world). It can also prevent acute and chronic complications of hepatitis B, including an estimated 4000 deaths annually from cirrhosis and 250 deaths annually from fulminant hepatic disease in the United States. Hepatitis B vaccine, the first licensed vaccine made by using recombinant techniques, produces adequate antibody responses in more than 90% of normal adults and more than 95% of normal infants, children, and adolescents when administered in a three-dose series. The dosage depends on the product, the age group, and the underlying clinical condition and can be determined by consulting the package insert. The duration of vaccine-conferred immunity is not known, although follow-up of vaccinees for 11 years indicates persistence of protection against clinically significant infections. Because strategies targeting hepatitis B vaccine use only to high-risk populations have not had a significant impact on hepatitis B incidence, universal vaccination is now recommended. Among adults receiving plasma-derived vaccine, the risk of Guillain-Barre syndrome is increased after the first dose, but the overall increase, if real, is very small and is outweighed by the substantial benefits of vaccination. Recombinant vaccine, which is now the standard, does not appear to increase the risk of Guillain-Barre syndrome. Influenza Annual influenza (see Chapter 379) vaccination is indicated for adults at high risk of complications from the disease: persons with chronic cardiopulmonary disorders, residents of nursing homes or other chronic care facilities, persons aged 65 or older, patients with other chronic diseases (such as diabetes mellitus, kidney dysfunction, hemoglobinopathies, and immunosuppression) who have required regular medical follow-up or hospitalization in the prior year, and children receiving long-term aspirin therapy. Women who will be in the second or third trimester of pregnancy during the influenza season (usually late December through mid-March) should also be vaccinated. In addition, transmission of influenza to high-risk patients can be reduced by annually vaccinating health care workers and household contacts of high-risk patients. Current vaccines contain whole or split inactivated viruses of three major antigenic types-A (H3N2), A (H1N1), and B. Provided that the match is good, vaccine efficacy is usually 70 to 90% in normal healthy young adults. Efficacy is substantially lower, often between 20 and 40%, in the institutionalized elderly; nevertheless, it appears to be 60 to 80% protective against pneumonia and death. Ideally, vaccines should be administered between October and mid-November of each year, although earlier in the autumn suffices if circumstances require. Fever, malaise, and myalgia may begin 6 to 12 hours after vaccination and persist for 1 to 2 days, although such reactions are most common in children exposed to vaccine for the first time. If current influenza vaccines cause Guillain-Barre syndrome, it is likely to be very rare, on the order of 1 case per million doses. A live attenuated trivalent influenza vaccine for intranasal administration may soon become available. Pneumococcal Vaccine Pneumococcal vaccine consists of purified polysaccharide capsular antigens from the 23 types of Streptococcus pneumoniae that are responsible for 85 to 90% of the bacteremic disease in the United States (see Chapter 319). Most adults, including the elderly and patients with alcoholic cirrhosis and diabetes mellitus, have a two-fold or greater rise in type-specific antibodies within 2 to 3 weeks of vaccination. Although the serologic response is generally acceptable, estimates of vaccine efficacy in preventing disease vary widely. There is good evidence that vaccination is approximately 60% effective against bacteremic pneumococcal disease, which accounts for an estimated 50,000 cases annually. However, evidence regarding efficacy against pneumonia in high-risk populations is not clear. Regardless, the preponderance of information supports the use of pneumococcal vaccine in high-risk populations, including all persons older than 65 years. Immunity may decrease 5 or more years after initial vaccination; boosters should therefore be considered at that time for adults at highest risk of disease, such as asplenic patients, as well as for those who lose antibody rapidly, such as patients with nephrotic syndrome or renal failure. Persons older than 65 years who received a dose more than 5 years earlier when they were younger than 65 years should be revaccinated. Fewer than 1% of vaccinees experience severe local reactions or systemic illness such as fever and malaise. Because of the rarity of severe reactions in revaccinated patients, persons with indications for vaccination but with unknown histories of prior vaccination should be vaccinated. Approximately two thirds of patients later admitted with pneumococcal disease had been hospitalized for other reasons within the preceding 5 years. Poliomyelitis the last documented cases of indigenously acquired poliomyelitis (see Chapters 389 and 476) caused by wild polioviruses in the United States were reported in 1979. Between 1980 and 1994, the overall risk of acquiring vaccine-associated polio was 1 case for every 2. The risk is more than 3000 times higher for immunodeficient persons than normal recipients. Vaccine polioviruses may spread from recipients to contacts, and cases among the latter account for more than one third of the total vaccine-associated cases. A goal has been established to eradicate wild poliovirus from the world by the end of 2000. Between 1988, when the goal was announced, and 1997, cases of polio reported world-wide have decreased by 85% and indigenous wild poliovirus transmission has been eliminated from the Americas since late 1991. The major indication for adult vaccination is travel to areas where wild poliovirus is endemic or epidemic. Health care personnel who come in contact with wild viruses should be immune to polio. The sequential schedule requires four doses to obtain the full benefits of both vaccines. Hepatitis A Two inactivated hepatitis A (see Chapter 149) vaccines are available in the United States. Seroconversion rates after a single dose of either vaccine in persons older than 2 years exceed 95%. The most common side effect has been tenderness and soreness at the injection site. Although rare and more serious adverse events have been reported in temporal association with vaccination, a causal relationship has not been established. The vaccine is indicated primarily for persons traveling to countries, primarily the developing world, with high or intermediate endemicity for hepatitis A. In addition, children living in communities with high rates of endemic hepatitis A (anti-hepatitis A prevalence of 30 to 40% by 5 years of age) should be vaccinated. Health care workers have not been shown to be at higher risk than the general population for hepatitis A and do not need routine immunization. Although food handlers are not at increased risk of hepatitis A when compared with the general population, the consequences of infection or suspected infection in this group, which can lead to extensive public health investigations, may make vaccination cost-effective in some settings. Hepatitis A vaccine should be given to children 2 years of age or older to control outbreaks in communities with high rates of prior infection and be considered for communities with intermediate levels of prior infection (anti-hepatitis A seroprevalence of 10 to 25% by 5 years of age). In 1999, the Advisory Committee on Immunization Practices voted to recommend universal vaccination of children who reside in states or counties with an average annual incidence rate of hepatitis A between 1987 and 1997 of 20/100,000 population. Universal vaccination may also be considered for areas with average annual incidence rates between 10 and 20/100,000. All schedules call for a second dose at least 6 months after the first dose with a permissible range for one of the products as long as 18 months after the initial dose. Vaccines are not indicated for children younger than 2 years because of the absence of adequate data on safety and efficacy. The vaccine contains lipidated recombinant outer-surface protein A (OspA) of Borrelia burgdorferi, the cause of Lyme disease in the United States. The vaccine works by inducing antibodies against OspA, an antigen expressed on the surface of the spirochete in the tick vector. Expression of OspA is either very limited or absent when spirochetes infect humans. When an infected tick feeds on blood with antibodies to OspA, the blood kills the spirochetes in the tick gut prior to the time transmission can take place. The vaccine was found to be 49% effective after two doses at 0 and 1 month and 76% effective after three doses at 0, 1, and 12 months in persons 15 to 70 years of age. Efficacy was higher against asymptomatic infection, 83% and 100%, after two or three doses, respectively.

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