The Social Cost of Contract

When private parties perform contracts, the public bears some of the costs. But what happens when society confronts unexpected contractual risks? During the COVID-19 pandemic, completing particular contracts—such as following through with weddings, conferences, and other large gatherings—will greatly increase the risk of rapidly spreading disease. A close reading of past cases illustrates that when social hazards sharply increase after formation, courts have sometimes rejected, reformed, and reinterpreted contracts so that parties who breach to reduce external harms are not left holding the bag. This Essay builds on that observation in making two contributions. Theoretically, it characterizes contracts as bargains that always involve the public. Law has three tools at hand to govern contract\u27s social cost: delineating subject matter about which parties can bargain, interacting with parties as a regulator, and, finally, interpreting and reforming in court. Post-hoc consideration of social costs is the least well-known, and most unsettled, mode of governing contract externalities. We ground that technique in its history as a specialized application of the law of contract public policy. Practically, this Essay advises parties negotiating whether and how to perform to consider the public’s health, since history teaches that, at least some of the time, courts will too

Nonparty Interests in Contract Law

Contract law has one overarching goal: to advance the legitimate interests of the contracting parties. For the most part, scholars, judges, and parties embrace this party primacy norm, recognizing only a few exceptions, such as mandatory rules that bar enforcement of agreements that harm others. This Article describes a distinct species of previously unnoticed contract law rules that advance nonparty interests, which it calls “nonparty defaults. In doing so, this Article makes three contributions to the contract law literature. First, it identifies nonparty defaults as a judicial technique. It shows how courts deviate from the party primary norm with surprising frequency through a variety of default rules, interpretation practices, and remedies. These defaults are meant to protect nonparties’ interests and benefit society at large. Second, it develops a normative account as to when common law courts adjudicating contract disputes are a suitable forum to identify and advance nonparty interests. Finally, it documents and explains the surprising durability of nonparty defaults, which the parties could, but rarely do, disclaim

Attachment to God as a Function of Mortality Salience and Intrinsic Religiosity

The present study examined the association between intrinsic religiosity and attachment to God following mortality salience. Participants (N = 158) consisted of Christian individuals who were asked to complete the Religious Orientation Scale (Allport & Ross, 1967) as a measure of intrinsic religiosity, a word search puzzle to prime either death-related or neutral words, and the Attachment to God Inventory (Beck & McDonald, 2004). A moderated regression found a significant interaction between MS and intrinsic religiosity on avoidant but not anxious attachment to God. Specifically, following reminders of death, low intrinsic individuals were more avoidant toward God compared to high intrinsic individuals. These findings suggest that MS is associated with bolstering religious beliefs in order to cope with existential anxieties

Production and optimization of 198/199 gold nanoparticles for potential use in cancer therapy [abstract]

Abstract only availableRadiopharmaceuticals are used to diagnose and treat a number of diseases such as bone cancer and non-Hodgkin's lymphoma. A radiopharmaceutical typically consists of a targeting molecule that selectively targets certain tumors. The targeting molecule is labeled with a radioactive atom(s) that delivers a dose of radiation to the tumor. The radioactive properties of Au-198 ([beta]- = 0.96 MeV; [gamma] = 411 KeV) and Au-199 ([beta]- = 0.45 MeV; [gamma] = 158 KeV) with their beta (therapeutic) and gamma (imaging) emission make them valuable candidates for both therapeutic and imaging applications. Gold nanoparticles have several properties that make them particularly interesting for use in radiopharmaceuticals. They are stable in vivo, have multiple atoms per particle and are small enough in size to deliver a radioactive dose directly to cancer cells. The purpose of this study was to gain a better understanding of the binding properties of the nanoparticles with reducing and stabilizing agents. This knowledge will aid in future attempts to label the particles with various antibodies and peptides for tumor targeted delivery of the drug. Next, investigate the relationship between particle size and the amount of reducing agent used was studied with varying amounts and types of carbohydrate stabilizers. Our goal is to establish a library of nanoparticles with varying sizes that can be conjugated with different biomolecules that are selective for receptors over expressed by the diseased tissue. In future studies we also plan to pursue an indirect method of preparing radioactive Au-199 nanoparticles at carrier free levels from beta decay of Pt-199.Life Sciences Undergraduate Research Opportunity Progra

Elective percutaneous coronary intervention in the elderly patient

Elderly patients account for an increasing number and proportion of patients requiring management of coronary artery disease. Whilst medical therapy remains the cornerstone of management, percutaneous coronary intervention (PCI) has been shown to improve symptoms of angina and quality of life in elderly patients. PCI is now a routine treatment for both acute and chronic coronary artery disease. In the last decade, a series of technological and therapeutic developments have reduced in-hospital complications following PCI. The transradial approach is associated with fewer vascular complications, reduced bed utilization and reduced time to ambulation. This has facilitated the introduction and expansion of outpatient PCI, which has been shown to be safe and effective in elderly patients. This article reviews the rationale for outpatient PCI in the elderly and the evidence for its effectiveness and safety

Moving Beyond the 2018 Minimum International Care Considerations for Osteoporosis Management in Duchenne Muscular Dystrophy (DMD)

Individuals living with Duchenne muscular dystrophy (DMD) are at significant risk of bone fragility due to osteoporosis, with the most potent drivers of fragility fractures in this context stemming from the aggressive myopathy and long term oral glucocorticoid therapy. Young people with DMD have a high fracture burden, with reported total and vertebral fracture rates that are four [1, 2] and 535 times [1] higher than those of healthy growing boys, respectively. Vertebral fractures can occur as early as six months following daily glucocorticoid initiation [3]. Up to 75% of young people with DMD sustain at least one fracture after eight years of glucocorticoid therapy [4]. Fractures in DMD can lead to devastating outcomes, including steeper rates of functional decline, premature and permanent loss of ambulation, chronic pain, and even death from fat embolism syndrome or adrenal crisis following long bone fractures [2, 5–8]. The potential for serious consequences and medical complications linked to fractures has driven efforts to develop effective guidelines for timely bone health surveillance and treatment with more recent efforts to develop fracture prevention strategies.To guide clinicians in the management of DMD and its related co-morbidities (including skeletal health), the first internationally-endorsed, minimum standards of care were published in 2010 under the moniker “Clinical Care Considerations” [9, 10]. This document recommends that osteoporosis monitoring include spine x-rays if back pain or kyphosis is present, followed by initiation of intravenous bisphosphonate therapy if vertebral fractures are identified [10]. In the years following the inaugural 2010 Clinical Care Considerations, studies were published showing that vertebral fractures, a key manifestation of bone fragility among children and adults living with glucorticoid-treated chronic conditions, were frequently asymptomatic, necessitating routine surveillance for early detection [3, 11]. It was also better appreciated that even a single long bone fracture can signal osteoporosis in a persistently high-risk setting such as DMD, and prompt initiation of bone protection therapy is important.With this new knowledge, the latest international, minimum standards of clinical care for DMD published in 2018, known as Care Considerations [12–14], recommended routine, standardized spine imaging for early detection of vertebral fractures, combined with more timely bone-targeted (bisphosphonate) intervention in the presence of vertebral or low trauma long bone fractures [12]. At the same time, the ever-changing therapeutic landscape for the treatment of the underlying condition calls for ongoing examination of the intimate relationship between muscle and bone development in DMD, including the effect of different DMD treatment approaches on the skeletal and endocrine systems. The overall goal of such focus is to harvest discussions about optimal management that will foster bone strength and prevent fractures in this high-risk setting across all underlying disease-targeted treatment paradigms for people with DMD

Moving beyond the 2018 minimum international care considerations for osteoporosis management in duchenne muscular dystrophy (DMD): Meeting report from the 3rd International Muscle-Bone Interactions Meeting 7th and 14th November 2022

This current manuscript summarizes the proceedings of the “Third Muscle-bone interactions in Duchenne Muscular Dystrophy Symposium: Moving Beyond the 2018 Minimum International Standards of Care for Osteoporosis Management”, an event co-organized by the World Duchenne Organization (www.worldduchenne.org) and the International Conference on Children’s Bone Health (www.theiscbh.org). This virtual symposium, held on November 7th and 14th 2022, brought together a total of 385 delegates representing 55 countries registered for the symposium, which included 239 clinicians, 70 researchers, 40 patient representatives and others from pharmaceutical companies and regulators. This symposium aimed to review the evidence base that informed the 2018 international minimum Care Considerations, best practices for implementation of these Care Considerations, and emerging knowledge that has arisen from research since the 2018 Care Considerations that shines light on the path forward. The online symposium and this report cover the following areas: 1. Current understanding of the bone morbidity in DMD, especially in relation to conventional glucocorticoid therapy. 2. The published, 2018 minimum international Care Considerations for osteoporosis monitoring and management in DMD. 3. Real world initiatives and challenges in the implementation of the 2018 minimum international Care Considerations for osteoporosis monitoring and management in DMD. 4. The need to consider strategies to move beyond the 2018 minimum international Care Considerations to prevent first fractures in DMD. 5. New therapies in DMD with potential impact on skeletal outcomes

Diagnostic yield of renal biopsies: a retrospective single center review

<p>Abstract</p> <p>Background</p> <p>Previous studies have examined the spectrum of diseases identified with a kidney biopsy and the complications of the procedure. However, few studies have examined the utility of the test to clarify the diagnosis and guide treatment of pediatric patients. This retrospective, single-center chart review was performed to test the hypothesis that at least 80% of native kidney biopsies provide clinically valuable information that rationally guides diagnosis and patient management.</p> <p>Methods</p> <p>200 biopsies performed between January 1, 2000 and June 30, 2008 were reviewed. A scheme composed of six categories was devised to classify the utility of each kidney biopsy.</p> <p>Results</p> <p>196 complete case files were available for review. Twenty-four (12.2%) biopsies did not shed light on the diagnosis and were unhelpful in patient management – 21 biopsies (10.7%) were non-diagnostic and 3 (1.5%) failed to yield enough tissue for examination. The number of unhelpful biopsies did not cluster in any specific disease entity.</p> <p>Conclusion</p> <p>Our findings provide guidance to nephrologists about the total risk of a kidney biopsy, including uninformative results, when seeking informed consent for the procedure. The results suggest an appropriate balance has been reached which maximizes the use of kidney biopsies while minimizing the risk of this invasive procedure (word count: 202).</p

A Low Area, Switched-Resistor Based Fractional-N Synthesizer Applied to a MEMS-Based Programmable Oscillator

Abstract-MEMS-based oscillators have recently become a topic of interest as integrated alternatives are sought for quartz-based frequency references. When seeking a programmable solution, a key component of such systems is a low power, low area fractional-N synthesizer, which also provides a convenient path for compensating changes in the MEMS resonant frequency with temperature and process. We present several techniques enabling efficient implementation of this synthesizer, including a switched-resistor loop filter topology that avoids a charge pump and boosts effective resistance to save area, a high gain phase detector that lowers the impact of loop filter noise, and a switched capacitor frequency detector that provides initial frequency acquisition. The entire synthesizer with LC VCO occupies less than 0.36 sq. mm in 0.18 m CMOS. Chip power consumption is 3.7 mA at 3.3 V supply (20 MHz output, no load). Index Terms-MEMS, fractional-N synthesizer, reference frequency, phase-locked loop (PLL), loop filter, high gain phase detector, switched resistor, switched capacitor, frequency acquisition, frequency detection, phase detection, oscillator, temperature stable

Recurrent Die-Offs of Adult Coho Salmon Returning to Spawn in Puget Sound Lowland Urban Streams

Several Seattle-area streams in Puget Sound were the focus of habitat restoration projects in the 1990s. Post-project effectiveness monitoring surveys revealed anomalous behaviors among adult coho salmon returning to spawn in restored reaches. These included erratic surface swimming, gaping, fin splaying, and loss of orientation and equilibrium. Affected fish died within hours, and female carcasses generally showed high rates (>90%) of egg retention. Beginning in the fall of 2002, systematic spawner surveys were conducted to 1) assess the severity of the adult die-offs, 2) compare spawner mortality in urban vs. non-urban streams, and 3) identify water quality and spawner condition factors that might be associated with the recurrent fish kills. The forensic investigation focused on conventional water quality parameters (e.g., dissolved oxygen, temperature, ammonia), fish condition, pathogen exposure and disease status, and exposures to metals, polycyclic aromatic hydrocarbons, and current use pesticides. Daily surveys of a representative urban stream (Longfellow Creek) from 2002–2009 revealed premature spawner mortality rates that ranged from 60–100% of each fall run. The comparable rate in a non-urban stream was <1% (Fortson Creek, surveyed in 2002). Conventional water quality, pesticide exposure, disease, and spawner condition showed no relationship to the syndrome. Coho salmon did show evidence of exposure to metals and petroleum hydrocarbons, both of which commonly originate from motor vehicles in urban landscapes. The weight of evidence suggests that freshwater-transitional coho are particularly vulnerable to an as-yet unidentified toxic contaminant (or contaminant mixture) in urban runoff. Stormwater may therefore place important constraints on efforts to conserve and recover coho populations in urban and urbanizing watersheds throughout the western United States