Federal Tax Consequences of Virtual World Transactions

This article discusses the tax consequences of transactions involving Massive Multiplayer Online Role Playing Games (“MMORPGs”). MMORPGs have recently grown in popularity and developed significant economic activity. Virtual goods used in these games are traded for both real and virtual currency. While few dispute that a sale of virtual goods for real currency is a taxable event, more complex tax issues arise concerning transactions that occur solely within virtual worlds. This article analyzes the tax consequences and policy issues surrounding such transactions

Data Privacy and Breach Reporting: Compliance with Various State Laws

This Article discusses state laws requiring notification of a party whose personal information is held by a business or government agency when the third party’s security is breached and an unauthorized person accesses the personal information. In the wake of the 2005 ChoicePoint data breach, over half of the states passed legislation requiring that companies notify the affected parties after breach of personal information. Most of the state statutes followed the model set forth by California’s Security Breach Notification Act of 2002. However, significant variations exist between the different statutes, which can create compliance problems. This Article specifically illustrates the relevant differences, analyzes the effect of the statutes, and discusses the policy implications of such legislation

Schnittstelle Notaufnahme: Interdisziplinäre Perspektiven

Zusammenfassung: Die Notaufnahme des Basler Universitätsspitals wird interdisziplinär als "Notfallstation" geführt. Das dort praktizierte "Basler Modell" wird schlaglichtartig beleuchtet. Ethische Fragestellungen, insbesondere die Frage nach dem Sistieren einer Behandlung, sollten frühzeitig und interdisziplinär besprochen werden. Da das Ziel der Versorgung in der präklinischen Phase zumeist der möglichst rasche Transport in ein geeignetes Zielkrankenhaus ist, bietet sich oft erst im Reanimationsraum der Notfallstation erstmals die Chance, diese Fragen überhaupt auszusprechen. Hier können entscheidungsrelevante Zusatzinformationen berücksichtigt werden wie etwa der mutmaßliche Wille des Patienten, aber auch die Prognose. Die unterschiedlichen Standards der präklinischen und der klinischen Phase können an der Schnittstelle Notfallstation zu Konflikten führen. Hier ist die Kommunikation des Teamleaders mit dem Rettungsteam, aber auch mit den Kollegen der anderen Disziplinen von entscheidender Bedeutun

Organisation der Notfallstation: Umfeld und Leistungsauftrag bestimmen das Organisationskonzept

Zusammenfassung: Untersuchungsziel: Organisationsformen von Notfallstationen wurden analysiert, um Gestaltungsgrundsätze abzuleiten. Methoden: Organisation und Leistungsauftrag der klinischen Notfallmedizin wurden anhand einer Literaturrecherche verglichen. Dabei wurden organisatorische Grundmuster in Abhängigkeit von der Anwesenheit von Spezialisten (Spezialisierung) und der Einbindung in die Spitalorganisation (Integration) entwickelt und aufgrund etablierter Effizienzkriterien vergleichend bewertet. Ergebnisse: Klinische Notfallstationen unterscheiden sich hinsichtlich Autonomiegrad, Leistungsbreite und Leistungstiefe. Vier Archetypen wurden abgegrenzt: Das Profit-Center als ertragsorientierte Wirtschaftseinheit, das Service-Center als auftragserfüllende Organisationseinheit, die funktionelle Organisation als fachlich abgegrenzte Einheit und die modulare Organisation, die sich durch eine zentrale Notfalleinheit und rasch mobilisierbare Spezialistenteams auszeichnet. Schlussfolgerungen: Es gibt keinen Königsweg. Jede organisatorische Lösung bietet in Abhängigkeit von Umfeldbedingungen und Leistungsauftrag Vor- und Nachteile. Die organisatorischen Grundmuster bieten eine Orientierungshilfe, wobei Leistungsvolumen und -spektrum wichtige Determinanten darstelle

Accuracy of plain radiography in detecting fractures in older individuals after low-energy falls: current evidence

BackgroundOlder individuals sustaining low-energy falls (LEF) and presenting to the emergency department (ED) demand straightforward diagnostic measures for injury detection. Plain radiography (XR) series for diagnosis of fall-related injuries are standard of care, but frequently subsequent CT examination is required for diagnostic assurance. A systematic database search of diagnostic accuracy of XR for detection of fractures in older LEF patients was performed.MethodsWe searched PubMed, Embase, Cochrane Library, WHO International Clinical Trial Platform, and Clinical trials.gov databases from inception to January 2020 for studies including older patients (>= 65 years) with LEF and obtaining CT examination and XR of the skeleton in an ED setting.ResultsFrom 8944 references screened, 11 studies met the criteria for inclusion. Performance of XR for detection of fractures of the pelvic ring and hip was analyzed in nine studies, two studies investigated XR performance to detect rib fractures, and two studies compared diagnostic accuracy of thoracolumbar spine XR. Sensitivity estimates ranged from 10% to 58% and specificity estimates from 55% to 100%. Clinical and statistical heterogeneity was significant among included studies, with an overall considerable risk of bias.DiscussionHigh-quality evidence on accurate imaging strategies in older patients with LEF is lacking to date. XR is missing a reasonable amount of fractures of the pelvic ring, rib cage, and thoracic and lumbar spine. However, the utility of first-line CT imaging and the benefit of diagnosing every fracture is unknown, demanding high-quality prospective trials considering patient-oriented outcome as well

Symptoms, toxicities, and analytical results for a patient after smoking herbs containing the novel synthetic cannabinoid MAM-2201

We report a case of intoxication by the synthetic cannabinoid MAM-2201 ([1-(5-fluoropentyl)-1H-indol-3-yl](4-methyl-1-naphthalenyl)-methanone). A 31-year-old man smoked about 300mg of a herbal blend. He experienced an acute transient psychotic state with agitation, aggression, anxiety, and vomiting associated with a sympathomimetic syndrome. MAM-2201 was detected and quantified in a plasma sample using liquid chromatography-tandem mass spectrometry (LC-MS-MS). The level was 49ng/ml 1h after smoking. The use of other drugs was analytically excluded. The presence of MAM-2201 was confirmed in the herbal blend using gas chromatography-mass spectrometry (GC-MS) and LC-high resolution MS. This is the first description of an analytically confirmed intoxication and of the determination of MAM-2201 in human blood plasm

FAMOCA, Family online counseling for families with parental cancer

Parental cancer is a huge challenge to affected patients and their families. Often, affected parents of minor children are totally overwhelmed by the new diagnosis and need support, particularly concerning the communication with their spouse and children. Therefore, the aim of this research project was the evaluation of the feasibility and the effects of a web-based counseling intervention during the first months of cancer treatment, aimed at the improvement of coping at the level of children, couples, and the family. Publication 1 describes the set-up of the web-based program in a family affected by parental cancer immediately after diagnosis. The web-based program consisted of four modules of four weeks each, individualized for each family member. The publication demonstrates that web-based counseling is a feasible option for all family members with parental cancer. Publication 2 focuses on the feasibility of the web-based program and its effects on participating children. The children’s first stage adjustment to parental cancer did not show detrimental patterns. The major “lesson learned” in this setting was the challenge to contact and motivate families in need, not only starting, but also keeping up on the program. Publication 3 examined the feasibility and the effects on psychological adjustment focusing on challenges of the couple, using psychometric testing in patients and their partners before and after initial therapy, both on the program and on the control group. No comparisons to controls were possible. Signs of anxiety were present in patients and partners in the first phase of cancer treatment. A slight improvement in anxiety and psychological wellbeing was shown at follow-up. Taken together, feasibility was shown, but the effects on participants in this web-based counseling intervention could not be compared to controls due to low numbers in both groups

Does information structuring improve recall of discharge information? A cluster randomized clinical trial

The impact of the quality of discharge communication between physicians and their patients is critical on patients' health outcomes. Nevertheless, low recall of information given to patients at discharge from emergency departments (EDs) is a well-documented problem. Therefore, we investigated the outcomes and related benefits of two different communication strategies: Physicians were instructed to either use empathy (E) or information structuring (S) skills hypothesizing superior recall by patients in the S group.; For the direct comparison of two communication strategies at discharge, physicians were cluster-randomized to an E or a S skills training. Feasibility was measured by training completion rates. Outcomes were measured in patients immediately after discharge, after 7, and 30 days. Primary outcome was patients' immediate recall of discharge information. Secondary outcomes were feasibility of training implementation, patients' adherence to recommendations and satisfaction, as well as the patient-physician relationship.; Of 117 eligible physicians, 80 (68.4%) completed the training. Out of 256 patients randomized to one of the two training groups (E: 146 and S: 119) 196 completed the post-discharge assessment. Patients' immediate recall of discharge information was superior in patients in the S-group vs. E-group. Patients in the S-group adhered to more recommendations within 30 days (p = .002), and were more likely to recommend the physician to family and friends (p = .021). No differences were found on other assessed outcome domains.; Immediate recall and subsequent adherence to recommendations were higher in the S group. Feasibility was shown by a 69.6% completion rate of trainings. Thus, trainings of discharge information structuring are feasible and improve patients' recall, and may therefore improve quality of care in the ED

Exercise training in patients with chronic respiratory diseases: are cardiovascular comorbidities and outcomes taken into account? a systematic review

Patients with chronic obstructive pulmonary disease (COPD), asthma and interstitial lung diseases (ILD) frequently suffer from cardiovascular comorbidities (CVC). Exercise training is a cornerstone intervention for the management of these conditions, however recommendations on tailoring programmes to patients suffering from respiratory diseases and CVC are scarce. This systematic review aimed to identify the eligibility criteria used to select patients with COPD, asthma or ILD and CVC to exercise programmes; assess the impact of exercise on cardiovascular outcomes; and identify how exercise programmes were tailored to CVC. PubMed, Scopus, Web of Science and Cochrane were searched. Three reviewers extracted the data and two reviewers independently assessed the quality of studies with the Quality Assessment Tool for Quantitative Studies. MetaXL 5.3 was used to calculate the individual and pooled effect sizes (ES). Most studies (58.9%) excluded patients with both stable and unstable CVC. In total, 26/42 studies reported cardiovascular outcomes. Resting heart rate was the most reported outcome measure (n = 13) and a small statistically significant effect (ES = -0.23) of exercise training on resting heart rate of patients with COPD was found. No specific adjustments to exercise prescription were described. Few studies have included patients with CVC. There was a lack of tailoring of exercise programmes and limited effects were found. Future studies should explore the effect of tailored exercise programmes on relevant outcome measures in respiratory patients with CVC.publishe

Endothelin-1 precursor peptides correlate with severity of disease and outcome in patients with community acquired pneumonia

<p>Abstract</p> <p>Background</p> <p>Circulating levels of endothelin-1 are increased in sepsis and correlate with severity of disease. A rapid and easy immunoassay has been developed to measure the more stable ET-1 precursor peptides proET-1. The objective of this study was to assess the diagnostic and prognostic value of proET-1 in a prospective cohort of mainly septic patients with community-acquired pneumonia.</p> <p>Methods</p> <p>We evaluated 281 consecutive patients with community acquired pneumonia. Serum proET-1 plasma levels were measured using a new sandwich immunoassay.</p> <p>Results</p> <p>ProET-1 levels exhibited a gradual increase depending on the clinical severity of pneumonia as assessed by the pneumonia severity index (PSI) and the CURB65 scores (p < 0.001 and p < 0.01). The diagnostic accuracy to predict bacteraemia of procalcitonin (AUC 0.84 [95% 0.74–0.93]) was superior than C-reactive protein (AUC 0.67 [95%CI 0.56–0.78]) and leukocyte count (AUC 0.66 [95%CI 0.55–0.78]) and in the range of proET-1(AUC of 0.77 [95%CI 0.67–0.86]). ProET-1 levels on admission were increased in patients with adverse medical outcomes including death and need for ICU admission. ROC curve analysis to predict the risk for mortality showed a prognostic accuracy of proET-1 (AUC 0.64 [95%CI 0.53–0.74]), which was higher than C-reactive protein (AUC 0.51 [95%CI 0.41–0.61]) and leukocyte count (AUC 0.55 [95%CI 0.44–0.65]) and within the range of the clinical severity scores (PSI AUC 0.69 [95%CI 0.61–0.76] and CURB65 0.67 [95%CI 0.57–0.77]) and procalcitonin (AUC 0.59 [95% 0.51–0.67]). ProET-1 determination improved significantly the prognostic accuracy of the CURB65 score (AUC of the combined model 0.69 [95%CI 0.59–0.79]). In a multivariate logistic regression model, only proET1 and the clinical severity scores were independent predictors for death and for the need for ICU admission.</p> <p>Conclusion</p> <p>In community-acquired pneumonia, ET-1 precursor peptides correlate with disease severity and are independent predictors for mortality and ICU admission. If confirmed in future studies, proET-1 levels may become another helpful tool for risk stratification and management of patients with community-acquired pneumonia.</p> <p>Trial registration</p> <p>ISRCTN04176397</p