Callejo v. Bancomer, S.A.: The Need for a Commercial Activity Exception to the Act of State Doctrine

The ability of the United States courts to adjudicate claims against foreign sovereigns is limited by the Foreign Sovereign Immunities Act of 1976 ( FSIA ) and the act of state doctrine. In Dunhill, a plurality of the Court held that the concept of an act of state should not be extended to include the repudiation of a purely commercial obligation. Recently, the Fifth Circuit in Callejo v. Bancomer, S.A. examined the plurality\u27s commercial activity exception in Dunhill, yet declined to decide whether to adopt the exception with respect to the act of state doctrine. This Note analyzes the commercial activity exception to the act of state doctrine as espoused in Dunhill and examines the Fifth Circuit\u27s treatment of the exception in Callejo. Although the Callejo court avoided a decision on the validity of the exception, this Note argues that the facts in Callejo indicate that such a decision was necessary. The Note concludes that a rule-oriented approach to the situation should have been utilized and that, under such an approach, the Callejo plaintiffs\u27 claims should have been adjudicated

Callejo v. Bancomer, S.A.: The Need for a Commercial Activity Exception to the Act of State Doctrine

The ability of the United States courts to adjudicate claims against foreign sovereigns is limited by the Foreign Sovereign Immunities Act of 1976 ( FSIA ) and the act of state doctrine. In Dunhill, a plurality of the Court held that the concept of an act of state should not be extended to include the repudiation of a purely commercial obligation. Recently, the Fifth Circuit in Callejo v. Bancomer, S.A. examined the plurality\u27s commercial activity exception in Dunhill, yet declined to decide whether to adopt the exception with respect to the act of state doctrine. This Note analyzes the commercial activity exception to the act of state doctrine as espoused in Dunhill and examines the Fifth Circuit\u27s treatment of the exception in Callejo. Although the Callejo court avoided a decision on the validity of the exception, this Note argues that the facts in Callejo indicate that such a decision was necessary. The Note concludes that a rule-oriented approach to the situation should have been utilized and that, under such an approach, the Callejo plaintiffs\u27 claims should have been adjudicated

Framework for primary care organizations: the importance of a structural domain

Purpose. Conceptual frameworks for primary care have evolved over the last 40 years, yet little attention has been paid to the environmental, structural and organizational factors that facilitate or moderate service delivery. Since primary care is now of more interest to policy makers, it is important that they have a comprehensive and balanced conceptual framework to facilitate their understanding and appreciation. We present a conceptual framework for primary care originally developed to guide the measurement of the performance of primary care organizations within the context of a large mixed-method evaluation of four types of models of primary care in Ontario, Canada. Methods. The framework was developed following an iterative process that combined expert consultation and group meet-ings with a narrative review of existing frameworks, as well as trends in health management and organizational theory. Results. Our conceptual framework for primary care has two domains: structural and performance. The structural domain describes the health care system, practice context and organization of the practice in which any primary care organization operates. The performance domain includes features of health care service delivery and technical quality of clinical care. Conclusion. As primary care evolves through demonstration projects and reformed delivery models, it is important to evalu-ate its structural and organizational features as these are likely to have a significant impact on performance

Heart failure diagnosis in primary health care: clinical characteristics of problematic patients. A clinical judgement analysis study

BACKGROUND: Early detection of chronic heart failure has become increasingly important since the introduction of effective treatment. However, clinical diagnosis of heart failure is known to be difficult, especially in mild cases or early in the course of the disease. The purpose of this study is to analyse how patient characteristics contribute to difficulties in diagnosing systolic heart failure. METHODS: Design: A Clinical Judgement Analysis study of 40 case vignettes based on authentic patients, including relevant clinical data except echocardiography. Setting: Primary health care and two cardiology outpatient clinics in Stockholm. Subjects: 70 participants with different types of clinical experience; 27 specialists in general practice, 22 cardiologists, and 21 medical students. Main outcome measures: The assessed probability of heart failure for each case vignette, and the disagreement between the participants. The number of clinical variables (cues) indicative of heart failure in the case vignettes. RESULTS: The ten case vignettes with the least diverging assessments more often had increased relative cardiac volume and atrial fibrillation. No further specific clinical patterns could be found in subgroups of the case vignettes. The ten case vignettes with the most diverging assessments were those with an intermediate number of clinical variables. The case vignettes with the least diverging assessments more often represented patients with cardiac enlargement and atrial fibrillation. CONCLUSION: Diagnosing mild heart failure is difficult, as these patients are not easy to characterise. In our study, a larger number of positive cues resulted in more diagnostic conformity among the participants, and the most important information was cardiac enlargement. The importance of more objective diagnostic methods in diagnosing suspected cases of heart failure should be emphasised

Biofield Therapies: Helpful or Full of Hype? A Best Evidence Synthesis

Biofield therapies (such as Reiki, therapeutic touch, and healing touch) are complementary medicine modalities that remain controversial and are utilized by a significant number of patients, with little information regarding their efficacy. This systematic review examines 66 clinical studies with a variety of biofield therapies in different patient populations. We conducted a quality assessment as well as a best evidence synthesis approach to examine evidence for biofield therapies in relevant outcomes for different clinical populations. Studies overall are of medium quality, and generally meet minimum standards for validity of inferences. Biofield therapies show strong evidence for reducing pain intensity in pain populations, and moderate evidence for reducing pain intensity hospitalized and cancer populations. There is moderate evidence for decreasing negative behavioral symptoms in dementia and moderate evidence for decreasing anxiety for hospitalized populations. There is equivocal evidence for biofield therapies' effects on fatigue and quality of life for cancer patients, as well as for comprehensive pain outcomes and affect in pain patients, and for decreasing anxiety in cardiovascular patients. There is a need for further high-quality studies in this area. Implications and future research directions are discussed