Regulating Viatical Settlements: Is the Invisible Hand Picking the Pockets of the Terminally Ill?

The newly emerging viatical settlement industry has attracted considerable attention from both insurance regulators and advocates for the terminally ill. In a viatical settlement, a terminally ill person names a viatical settlement company as beneficiary under his life insurance policy in exchange for an immediate lump-sum cash payment of less than face value of the policy. To date, viatical settlement payments to people with AIDS (PWAs) have been disturbingly low as a percentage of the face value of PWA policies. This Note examines the few enacted viatical settlement regulations and the National Association of Insurance Commissioners\u27 model regulations as they particularly relate to PWAs). Acknowledging the importance of viatical settlements as a source of income for financially-strapped PWAs, this Note argues for a regulatory scheme in which PWAs receive greater protections and higher payouts than they receive in the current unregulated market, while still allowing viatical companies a reasonable return commensurate with the actual risks and costs of the viatical business. Part I argues that consumer protection rationales justify licensing and disclosure regulations. Part II explores controversial proposals for minimum payout regulations of viatical settlement providers and concludes that such regulations, if carefully crafted, are warranted. Finally, Part III examines the advent of accelerated benefits provisions in life insurance policies as alternatives to viatical settlements

Role of extracellular histones in the cardiomyopathy of sepsis

The purpose of this study was to define the relationship in polymicrobial sepsis (in adult male C57BL/6 mice) between heart dysfunction and the appearance in plasma of extracellular histones. Procedures included induction of sepsis by cecal ligation and puncture and measurement of heart function using echocardiogram/Doppler parameters. We assessed the ability of histones to cause disequilibrium in the redox status and intracellular [Ca2+]i levels in cardiomyocytes (CMs) (from mice and rats). We also studied the ability of histones to disturb both functional and electrical responses of hearts perfused with histones. Main findings revealed that extracellular histones appearing in septic plasma required C5a receptors, polymorphonuclear leukocytes (PMNs), and the Nachtâ , LRRâ , and PYDâ domainsâ containing protein 3 (NLRP3) inflammasome. In vitro exposure of CMs to histones caused loss of homeostasis of the redox system and in [Ca2+]i, as wellas defects in mitochondrial function. Perfusion of hearts with histones caused electrical and functional dysfunction. Finally, in vivo neutralization of histones in septic mice markedly reduced the parameters of heart dysfunction. Histones caused dysfunction in hearts during polymicrobial sepsis. These events could be attenuated by histone neutralization, suggesting that histones may be targets in the setting of sepsis to reduce cardiac dysfunction.â Kalbitz, M., Grailer, J. J., Fattahi, F., Jajou, L., Herron, T. J., Campbell, K. F., Zetoune, F. S., Bosmann, M., Sarma, J. V., Huberâ Lang, M., Gebhard, F., Loaiza, R., Valdivia, H. H., Jalife, J., Russell, M. W., Ward, P. A. Role of extracellular histones in the cardiomyopathy of sepsis. FASEB J. 29, 2185â 2193 (2015). www.fasebj.orgPeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154273/1/fsb2fj14268730.pd

Effect of a shelf-furnished screen on space utilisation and social behaviour of indoor group-housed cats (Felis silvestris catus)

The environment of the laboratory cat can be restrictive and may impact their welfare. Enrichment is often provided to alleviate welfare impacts but is seldom assessed or validated for efficacy. This study investigated the effect of novel room furniture (a screen) on the expression of agonistic and affiliative behaviours and space utilisation amongst colony-housed laboratory cats. Video footage of cats (N = 29) housed in social rooms (N = 4) was collected for 2 days before (baseline phase), 4 days during (test phase) and 2 days following (removal phase) introduction of the novel furniture. Space utilisation data were collected using scan sampling every 10 min and analysed using a generalised linear mixed effects model and Tukey’s HSD test. Behavioural data were collected using continuous sampling for 3 h a day in 6 × 30 min episodes and analysed using a Poisson generalised mixed effects model. Significantly more agonistic events occurred before the morning feed compared to after feeding within all phases (pre-feed mean = 0.227; post-feed mean = 0.026; P < 0.0001). However no significant differences were observed before the morning feed compared to after feeding between phases indicating that the screen had no effect on reducing pre-feed aggression at the morning feed. Agonistic behaviours occurred significantly less following the morning feed during the test phase when compared to the baseline phase (test post-feed mean = 0.011; baseline post-feed mean = 0.029; P = 0.0342). Significant differences were also observed on removal of the screen with agonistic behaviour increasing above baseline at the afternoon pre-feed time point, possibly indicative of aggression due to frustration or a rebound effect (removal pre-feed mean = 0.151; baseline pre-feed mean 0.048; P < 0.0001). Affiliative interactions between phases were not significantly affected by screen presence. Given the ratio of the screen to existing shelving (0.58:0.42) a statistical significant proportion of cats were found to be on the screen in the test phase of the study (P < 0.0001). This study suggests that exploiting the unused vertical space by the addition of stand-alone shelving should be considered a valuable resource for the cat by increasing useable space and reducing agonistic interactions

Atypical Neurophysiology Underlying Episodic and Semantic Memory in Adults with Autism Spectrum Disorder

Individuals with autism spectrum disorder (ASD) show atypicalities in episodic memory (Boucher et al. in Psychological Bulletin, 138 (3), 458-496, 2012). We asked participants to recall the colours of a set of studied line drawings (episodic judgement), or to recognize line drawings alone (semantic judgement). Cycowicz et al. (Journal of Experimental Child Psychology, 65, 171-237, 2001) found early (300 ms onset) posterior old-new event-related potential effects for semantic judgements in typically developing (TD) individuals, and occipitally focused negativity (800 ms onset) for episodic judgements. Our results replicated findings in TD individuals and demonstrate attenuated early old-new effects in ASD. Late posterior negativity was present in the ASD group, but was not specific to this time window. This non-specificity may contribute to the atypical episodic memory judgements characteristic of individuals with ASD

Delays between the onset of symptoms and first rheumatology consultation in patients with rheumatoid arthritis in the UK: an observational study

Objective To investigate delays from symptom onset to rheumatology assessment for patients with a new onset of rheumatoid arthritis (RA) or unclassified arthritis. Methods Newly presenting adults with either RA or unclassified arthritis were recruited from rheumatology clinics. Data on the length of time between symptom onset and first seeing a GP (patient delay), between first seeing a general practitioner (GP) and being referred to a rheumatologist (general practitioner delay) and being seen by a rheumatologist following referral (hospital delay) were captured. Results 822 patients participated (563 female, mean age 55 years). The median time between symptom onset and seeing a rheumatologist was 27.2 weeks (IQR 14.1–66 weeks); only 20% of patients were seen within the first 3 months following symptom onset. The median patient delay was 5.4 weeks (IQR 1.4–26.3 weeks). Patients who purchased over-the-counter medications or used ice/heat packs took longer to seek help than those who did not. In addition, those with a palindromic or an insidious symptom onset delayed for longer than those with a non-palindromic or acute onset. The median general practitioner delay was 6.9 weeks (IQR 2.3–20.3 weeks). Patients made a mean of 4 GP visits before being referred. The median hospital delay was 4.7 weeks (IQR 2.9–7.5 weeks). Conclusion This study identified delays at all levels in the pathway towards assessment by a rheumatologist. However, delays in primary care were particularly long. Patient delay was driven by the nature of symptom onset. Complex multi-faceted interventions to promote rapid help seeking and to facilitate prompt onward referral from primary care should be developed

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Regulating Viatical Settlements: Is the Invisible Hand Picking the Pockets of the Terminally Ill?

The newly emerging viatical settlement industry has attracted considerable attention from both insurance regulators and advocates for the terminally ill. In a viatical settlement, a terminally ill person names a viatical settlement company as beneficiary under his life insurance policy in exchange for an immediate lump-sum cash payment of less than face value of the policy. To date, viatical settlement payments to people with AIDS (PWAs) have been disturbingly low as a percentage of the face value of PWA policies. This Note examines the few enacted viatical settlement regulations and the National Association of Insurance Commissioners\u27 model regulations as they particularly relate to PWAs). Acknowledging the importance of viatical settlements as a source of income for financially-strapped PWAs, this Note argues for a regulatory scheme in which PWAs receive greater protections and higher payouts than they receive in the current unregulated market, while still allowing viatical companies a reasonable return commensurate with the actual risks and costs of the viatical business. Part I argues that consumer protection rationales justify licensing and disclosure regulations. Part II explores controversial proposals for minimum payout regulations of viatical settlement providers and concludes that such regulations, if carefully crafted, are warranted. Finally, Part III examines the advent of accelerated benefits provisions in life insurance policies as alternatives to viatical settlements

Segregation of seizure traits in C57 black mouse substrains using the repeated-flurothyl model.

Identifying the genetic basis of epilepsy in humans is difficult due to its complexity, thereby underlying the need for preclinical models with specific aspects of seizure susceptibility that are tractable to genetic analyses. In the repeated-flurothyl model, mice are given 8 flurothyl-induced seizures, once per day (the induction phase), followed by a 28-day rest period (incubation phase) and final flurothyl challenge. This paradigm allows for the tracking of multiple phenotypes including: initial generalized seizure threshold, decreases in generalized seizure threshold with repeated flurothyl exposures, and changes in the complexity of seizures over time. Given the responses we previously reported in C57BL/6J mice, we analyzed substrains of the C57BL lineage to determine if any of these phenotypes segregated in these substrains. We found that the generalized seizure thresholds of C57BL/10SNJ and C57BL/10J mice were similar to C57BL/6J mice, whereas C57BL/6NJ and C57BLKS/J mice showed lower generalized seizure thresholds. In addition, C57BL/6J mice had the largest decreases in generalized seizure thresholds over the induction phase, while the other substrains were less pronounced. Notably, we observed only clonic seizures during the induction phase in all substrains, but when rechallenged with flurothyl after a 28-day incubation phase, ∼80% of C57BL/6J and 25% of C57BL/10SNJ and C57BL/10J mice expressed more complex seizures with tonic manifestations with none of the C57BL/6NJ and C57BLKS/J mice having complex seizures with tonic manifestations. These data indicate that while closely related, the C57BL lineage has significant diversity in aspects of epilepsy that are genetically controlled. Such differences further highlight the importance of genetic background in assessing the effects of targeted deletions of genes in preclinical epilepsy models

C57BL substrain differences in generalized seizure thresholds.

<p>The latency to a generalized seizure (generalized seizure threshold (GST)) on each seizure trial was determined for 5 C57BL substrains (n = 12 mice/substrain: 10SNJ, 10J, 6J, 6NJ, and KSJ) by exposure to 10% flurothyl during eight induction trials followed by a 28-day rest period and a single flurothyl retest. The baseline GST of 10SNJ mice and 10J mice were similar to that of 6J mice, whereas 6NJ and KSJ mice have significantly lower initial GST (<i>P</i><0.01). For all C57BL substrains, there is a significant decrease in GST following repeated seizures (<i>P</i><0.0001), which was independent of their initial GST. On flurothyl rechallenge, GST did not differ from their corresponding last seizure (seizure trial 8). ¹significantly different from 10SNJ, 10J, and 6J (<i>P</i><0.01); ²significantly different from 10SNJ and 10J (<i>P</i><0.01); ³significantly different from KSJ (<i>P</i><0.01); ⁴significantly different from all other substrains (<i>P</i><0.05); ⁵significantly different from 10SNJ, 6J, and KSJ (<i>P</i><0.05); ⁶significantly different from 10SNJ and KSJ (<i>P</i><0.05); ⁷significantly different from 6J, 6NJ, and KSJ (<i>P</i><0.05); ⁸significantly different from 10SNJ, 10J, and KSJ (<i>P</i><0.05).</p

Illustration of haplotype diversity between 10J, 6J and KSJ mice.

<p>Each horizontal bar represents one of the mouse chromosome haplotypes. Differential shading between segments depict ancestral haplotype blocks consistent with the default parameters described on the mouse phylogeny viewer website. Differences in shading between lines show regions of genetic divergence between strains.</p