Some Aspects of Estate Planning in Tennessee

Not many years ago a large New York bank circulated privately booklet with the provocative title The Passing of the Simple Will. The choice of the title and the text itself underlined the complexities which surround the owner of property and his advisers when they jointly attempt to plan the disposition of a modern estate for modem needs. The now almost legendary owner of Blackacre could, indeed, write a simple will, quite effective and satisfactory as a plan for the disposition \u27and use of the family property. One need scarcely recite the changes which have taken place in more recent times: the special characteristics of the relatively newer types of property interests, such as insurance, and the specific legal conditions and prohibitions which encircle them have received expert attention elsewhere in this symposium. The estate planner, be he owner or professional consultant, has become a tightrope walker precariously balanced between whatis possible and what is desirable. That which is desirable from the family standpoint, and may also be legally proper, all too often runs afoul of federal or state tax law, or both. This paper has limited objectives. They are (1) to examine a typical family situation in need of estate planning, proposing one out of many possible practical solutions, and (2) to assemble and discuss with reference to the proposed plan a modest selection of Tennessee statutes and cases illustrating some of the considerations peculiar to Tennessee which the estate planner in this state must take into account if his plan is to be workable. Thus these pages do not purport to be a complete treatise one state planning and death taxes in Tennessee, certainly not a digest of the Tennessee law of wills and trusts, and least of all a course of instruction for Tennessee draftsmen of wills and trust agreements. All these matters are considered, of course, but, so far as possible, in the way and in the sense that they may be expected to appear as practical considerations affecting wills and trusts in day to day experience, whether in the administration, planning or drafting phases. To save time, familiarity with federal income, estate and gift taxes is assumed

Some Aspects of Estate Planning in Tennessee

Not many years ago a large New York bank circulated privately booklet with the provocative title The Passing of the Simple Will. The choice of the title and the text itself underlined the complexities which surround the owner of property and his advisers when they jointly attempt to plan the disposition of a modern estate for modem needs. The now almost legendary owner of Blackacre could, indeed, write a simple will, quite effective and satisfactory as a plan for the disposition \u27and use of the family property. One need scarcely recite the changes which have taken place in more recent times: the special characteristics of the relatively newer types of property interests, such as insurance, and the specific legal conditions and prohibitions which encircle them have received expert attention elsewhere in this symposium. The estate planner, be he owner or professional consultant, has become a tightrope walker precariously balanced between whatis possible and what is desirable. That which is desirable from the family standpoint, and may also be legally proper, all too often runs afoul of federal or state tax law, or both. This paper has limited objectives. They are (1) to examine a typical family situation in need of estate planning, proposing one out of many possible practical solutions, and (2) to assemble and discuss with reference to the proposed plan a modest selection of Tennessee statutes and cases illustrating some of the considerations peculiar to Tennessee which the estate planner in this state must take into account if his plan is to be workable. Thus these pages do not purport to be a complete treatise one state planning and death taxes in Tennessee, certainly not a digest of the Tennessee law of wills and trusts, and least of all a course of instruction for Tennessee draftsmen of wills and trust agreements. All these matters are considered, of course, but, so far as possible, in the way and in the sense that they may be expected to appear as practical considerations affecting wills and trusts in day to day experience, whether in the administration, planning or drafting phases. To save time, familiarity with federal income, estate and gift taxes is assumed

Prophylactic Anticonvulsants in Intracerebral Hemorrhage

Background and Purpose Prophylactic anticonvulsants are routinely prescribed in the acute setting for intracerebral hemorrhage (ICH) patients, but some studies have reported an association with worse outcomes. We sought to characterize the prevalence and predictors of prophylactic anticonvulsant administration after ICH as well as guideline adherence. We also sought to determine whether prophylactic anticonvulsants were independently associated with poor outcome. Methods We performed a retrospective study of primary ICH in our two academic centers. We used a propensity matching approach to make treated and non-treated groups comparable. We conducted multiple logistic regression analysis to identify independent predictors of prophylactic anticonvulsant initiation and its association with poor outcome as measured by modified Rankin score. Results We identified 610 patients with primary ICH, of whom 98 were started on prophylactic anticonvulsants. Levetiracetam (97%) was most commonly prescribed. Age (OR 0.97, 95% CI 0.95–0.99, p < .001), lobar location (OR 2.94, 95% CI 1.76–4.91, p < .001), higher initial National Institutes of Health Stroke Scale (NIHSS) score (OR 2.31, 95% CI 1.40–3.79, p = .001), craniotomy (OR 3.06, 95% CI 1.51–6.20, p = .002), and prior ICH (OR 2.36, 95% CI 1.10–5.07, p = .028) were independently associated with prophylactic anticonvulsant initiation. Prophylactic anticonvulsant use was not associated with worse functional outcome [modified Rankin score (mRS) 4–6] at hospital discharge or with increased case-fatality. There was no difference in prescribing patterns after 2010 guideline publication. Discussion Levetiracetam was routinely prescribed following ICH and was not associated with worse outcomes. Future investigations should examine the effect of prophylactic levetiracetam on cost and neuropsychological outcomes as well as the role of continuous EEG in identifying subclinical seizures

Disparities and guideline adherence in drugs of abuse screening in intracerebral hemorrhage

OBJECTIVE: To characterize the pattern of urine drug screening in a cohort of intracerebral hemorrhage (ICH) patients at our academic centers. METHODS: We identified cases of primary ICH occurring from 2009 to 2011 in our academic centers. Demographic data, imaging characteristics, processes of care, and short-term outcomes were ascertained. We performed logistic regression to identify predictors for screening and evaluated preguideline and postguideline reiteration screening patterns. RESULTS: We identified 610 patients with primary ICH in 2009-2011; 379 (62.1%) were initially evaluated at an outside hospital. Overall, 142/610 (23.3%) patients were screened, with 21 positive for cocaine and 3 for amphetamine. Of patients <55 years of age, only 65/140 (46.4%) were screened. Black patients <55 years of age were screened more than nonblack patients <55 years of age (38/61 [62.3%] vs 27/79 [34.2%]; p = 0.0009). In the best multivariable model, age group (p = 0.0001), black race (p = 0.4529), first Glasgow Coma Scale score (p = 0.0492), current smoking (p < 0.0001), and age group × black race (p = 0.0097) were associated with screening. Guideline reiteration in 2010 did not improve the proportion <55 years of age who were screened: 42/74 (56.8%) were screened before and 23/66 (34.9%) after (p = 0.01). CONCLUSIONS: We found disparities in drugs of abuse (DOA) screening and suboptimal guideline adherence. Systematic efforts to improve screening for DOA are warranted. Improved identification of sympathomimetic exposure may improve etiologic classification and influence decision-making and prognosis counseling

Network Dynamics Mediate Circadian Clock Plasticity

A circadian clock governs most aspects of mammalian behavior. Although its properties are in part genetically determined, altered light-dark environment can change circadian period length through a mechanism requiring de novo DNA methylation. We show here that this mechanism is mediated not via cell-autonomous clock properties, but rather through altered networking within the suprachiasmatic nuclei (SCN), the circadian “master clock,” which is DNA methylated in region-specific manner. DNA methylation is necessary to temporally reorganize circadian phasing among SCN neurons, which in turn changes the period length of the network as a whole. Interruption of neural communication by inhibiting neuronal firing or by physical cutting suppresses both SCN reorganization and period changes. Mathematical modeling suggests, and experiments confirm, that this SCN reorganization depends upon GABAergic signaling. Our results therefore show that basic circadian clock properties are governed by dynamic interactions among SCN neurons, with neuroadaptations in network function driven by the environment

Opportunistic Sampling of Roadkill as an Entry Point to Accessing Natural Products Assembled by Bacteria Associated with Non-anthropoidal Mammalian Microbiomes

Few secondary metabolites have been reported from mammalian microbiome bacteria despite the large numbers of diverse taxa that inhabit warm-blooded higher vertebrates. As a means to investigate natural products from these microorganisms, an opportunistic sampling protocol was developed, which focused on exploring bacteria isolated from roadkill mammals. This initiative was made possible through the establishment of a newly created discovery pipeline, which couples laser ablation electrospray ionization mass spectrometry (LAESIMS) with bioassay testing, to target biologically active metabolites from microbiome-associated bacteria. To illustrate this process, this report focuses on samples obtained from the ear of a roadkill opossum (Dideiphis virginiana) as the source of two bacterial isolates (Pseudomonas sp. and Serratia sp.) that produced several new and known cyclic lipodepsipeptides (viscosin and serrawettins, respectively). These natural products inhibited biofilm formation by the human pathogenic yeast Candida albicans at concentrations well below those required to inhibit yeast viability. Phylogenetic analysis of 16S rRNA gene sequence libraries revealed the presence of diverse microbial communities associated with different sites throughout the opossum carcass. A putative biosynthetic pathway responsible for the production of the new serrawettin analogues was identified by sequencing the genome of the Serratia sp. isolate. This study provides a functional roadmap to carrying out the systematic investigation of the genomic, microbiological, and chemical parameters related to the production of natural products made by bacteria associated with non-anthropoidal mammalian microbiomes. Discoveries emerging from these studies are anticipated to provide a working framework for efforts aimed at augmenting microbiomes to deliver beneficial natural products to a host.Research reported in this publication was supported by the National Institutes of Health, National Institute of Allergy and Infectious Diseases (1R21AI101487) (R.H.C. and B.S.S.). X-ray data were collected by L. Thomas in the OU Macromolecular Crystallography Laboratory, which is supported, in part, by an Institutional Development Award from the National Institutes of Health, General Medical Sciences (P20GM103640). The C. albicans SC5314 culture was kindly provided by A. Dongari-Bagtzoglou, University of Connecticut Health Center. The LC-ESIMS instrument used for this project was funded in part by a Challenge Grant from the Office of the Vice President for Research, University of Oklahoma, Norman Campus, and an award through the Shimadzu Equipment Grant Program (R.H.C.).Ye