The Ethical Responsibilities of Estate Planning Attorneys in the Representation of Non-Traditional Couples

This Article examines an estate planning attorney\u27s ethical responsibilities when representing one type of non-traditional family: a non-traditional couple. Currently, there are four recognized ethical theories regarding the legal representation of individuals: individual representation; joint representation; intermediary representation; and family representation. This Article explores each of these ethical theories in connection with the representation of traditional couples. These ethical theories are then applied to the representation of nontraditional couples. Although any one of these ethical models may be utilized, this Article concludes that a modified version of family representation provides the estate planning attorney with the most appropriate ethical standard for her representation of non-traditional couples

The Evolution of Data Science: A New Mode of Knowledge Production

Is data science a new field of study or simply an extension or specialization of a discipline that already exists, such as statistics, computer science, or mathematics? This article explores the evolution of data science as a potentially new academic discipline, which has evolved as a function of new problem sets that established disciplines have been ill-prepared to address. The authors find that this newly-evolved discipline can be viewed through the lens of a new mode of knowledge production and is characterized by transdisciplinarity collaboration with the private sector and increased accountability. Lessons from this evolution can inform knowledge production in other traditional academic disciplines as well as inform established knowledge management practices grappling with the emerging challenges of Big Data

Pediatric Impedance Cardiography: Temporal Stability and Intertask Consistency

The pathogenic processes responsible for cardiovascular disease have their origins in childhood. Although children\u27s measures of heart rate and blood pressure have been found to be reliable, the reliability of impedance cardiography derived measures have not been evaluated. Thirty-three children, ages 8-11 participated in two sessions. Stressors included serial subtraction, isometric handgrip, and mirror-image tracing. Results indicated the impedance measures showed moderately high temporal stability (average scores r(avg) = 74; difference scores r(avg) = .53) and intertask consistency (average scores r(avg) = .78; difference scores r(avg) = .53). Blood pressure demonstrated the lowest reliability; Heather index, preejection period, and stroke volume demonstrated the highest. These findings suggest children\u27s cardiovascular reactivity to laboratory stressors can be reliably and consistently assessed using impedance cardiography

The Validity of Online Patient Ratings of Physicians

Background: Information from ratings sites are increasingly informing patient decisions related to health care and the selection of physicians. Objective: The current study sought to determine the validity of online patient ratings of physicians through comparison with physician peer review. Methods: We extracted 223,715 reviews of 41,104 physicians from 10 of the largest cities in the United States, including 1142 physicians listed as “America’s Top Doctors” through physician peer review. Differences in mean online patient ratings were tested for physicians who were listed and those who were not. Results: Overall, no differences were found between the online patient ratings based upon physician peer review status. However, statistical differences were found for four specialties (family medicine, allergists, internal medicine, and pediatrics), with online patient ratings significantly higher for those physicians listed as a peer-reviewed “Top Doctor” versus those who were not. Conclusions: The results of this large-scale study indicate that while online patient ratings are consistent with physician peer review for four nonsurgical, primarily in-office specializations, patient ratings were not consistent with physician peer review for specializations like anesthesiology. This result indicates that the validity of patient ratings varies by medical specialization

Circadian Rhythms of the Autonomic Nervous System: Scientific Implication and Practical Implementation

Circadian rhythms are omnipresent in almost any biosignal. In this chapter, we join them with the need for practical tools for screening in preventive settings and point out heart rate variability (HRV), a measure of autonomic nervous system activity, as a chronobiologic, unspecific index of mental and physical health. We discuss methods to calculate the circadian variation of HRV measures, particularly the cosinor procedure. We present reference values for circadian variation parameters of HRV and data concerning reproducibility. Furthermore, we show data giving first evidence of HRV as a comprehensive health index by showing altered circadian variation patterns of HRV depending on mental (trait dysthymia) as well as physical (inflammatory markers) health. Finally, we present examples of disturbed chronobiology of HRV in clinical and preventive settings and its practical application in medical consultation

Factors Associated with Sustained Exergaming: Longitudinal Investigation.

International audienceBACKGROUND: Exergaming is technology-driven physical activity (PA) which, unlike traditional video game play, requires that participants be physically active to play the game. Exergaming may have potential to increase PA and decrease sedentary behavior in youth, but little is known about sustained exergaming.OBJECTIVE: The objectives of this study were to describe the frequency, correlates, and predictors of sustained exergaming.METHODS: Data were available in AdoQuest (2005-11), a longitudinal investigation of 1843 grade 5 students in Montréal, Canada. This analysis used data from grade 9 (2008-09) and 11 (2010-11). Participants at Time 1 (T1; mean age 14 years, SD 0.8 ) who reported past-week exergaming (n=186, 19.1% of AdoQuest sample) completed mailed self-report questionnaires at Time 2 (T2; mean age 16 years, SD 0.8). Independent sociodemographic, psychological, and behavioral correlates (from T2)/predictors (from T1 or earlier) were identified using multivariable logistic regression.RESULTS: Of 186 exergamers at T1, 81 (44%) reported exergaming at T2. Being female and having higher introjected regulation (ie, a type of PA motivation indicative of internalizing PA as a behavior) were independent correlates. None of the predictors investigated were associated with sustained exergaming.CONCLUSIONS: Almost half of grade 9 exergamers sustained exergaming for 2 years. Exergaming may be a viable approach to help adolescents engage in and sustain PA during adolescence. Sex and PA motivation may be important in the sustainability of exergaming

A monoclonal antibody against lymphocyte function-associated antigen-1 decreases HIV-1 replication by inducing the secretion of an antiviral soluble factor

Background: Lymphocyte Function-Associated Antigen-1 (LFA-1) likely plays a role in the pathogenesis of against HIV-1 and is known to facilitate cell-to-cell transmission of the virus. A monoclonal antibody specific for LFA-1 (Cytolin®) was evaluated as a potential therapeutic in pilot studies performed in the mid-1990s. These uncontrolled human studies suggested that administration of this anti-LFA-1 antibody to HIV-1 infected individuals could provide a modest benefit by decreasing circulating HIV-1 RNA and increasing CD4+ T cell counts. At the time, it was proposed that when bound to cytolytic T cells, the antibody inhibited lysis of activated CD4+ T cells. Given the renewed interest in monoclonal antibody therapy for HIV-1 infected individuals, we investigated possible mechanisms of action of this antibody in vitro. Methods: To assess whether this anti-LFA-1 antibody binds to HIV-1, a virus capture assay was performed. Binding of the antibody to cells was assessed using flow cytometry. Inhibition of HIV-1 replication was determined in culture by measuring the amount of p24 produced by ELISA. After co-culture of the antibody with peripheral blood mononuclear cells, supernatants were assayed for cytokines and chemokines using various immunoassays. Results: Our experiments demonstrate that anti-LFA-1 antibody binds to CCR5 and CXCR4 utilizing strains of HIV-1. It also binds to CD8+ T cells and dendritic cells. When bound to virus prior to infection, there is no decrease in HIV-1 replication, suggesting it does not directly inhibit viral replication via virus binding. When bound to cells, it does not inhibit lysis of CD4+ T cells, as was originally hypothesized. Binding to cells does appear to induce the production of a soluble factor that inhibits HIV-1 replication. We determined that this soluble factor was not any of the cytokines or chemokines with known anti-HIV-1 activity. Further, the antibody does not appear to induce any common immune modulating cytokines or chemokines. Conclusions: These results suggest that one possible mechanism of action of this anti-LFA-1 antibody is to inhibit HIV-1 replication via the production of a soluble antiviral factor that is induced upon binding to cells

Alterations in Cortical Activation Among Individuals With Chronic Ankle Instability During Single-Limb Postural Control

Context: Chronic ankle instability (CAI) is characterized by repetitive ankle sprains and perceived instability. Whereas the underlying cause of CAI is disputed, alterations in cortical motor functioning may contribute to the perceived dysfunction. Objective: To assess differences in cortical activity during single-limb stance among control, coper, and CAI groups. Design: Cross-sectional study. Setting: Biomechanics laboratory. Patients or Other Participants: A total of 31 individuals (10 men, 21 women; age = 22.3 ± 2.4 years, height = 169.6 ± 9.7 cm, mass = 70.6 ± 11.6 kg), who were classified into control (n = 13), coper (n = 7), and CAI (n = 11) groups participated in this study. Intervention(s): Participants performed single-limb stance on a force platform for 60 seconds while wearing a 24-channel functional near-infrared spectroscopy system. Oxyhemoglobin (HbO2) changes in the supplementary motor area (SMA), precentral gyrus, postcentral gyrus, and superior parietal lobe were measured. Main Outcome Measure(s): Differences in averages and standard deviations of HbO2 were assessed across groups. In the CAI group, correlations were analyzed between measures of cortical activation and Cumberland Ankle Instability Tool (CAIT) scores. Results: No differences in average HbO2 were present for any cortical areas. We observed differences in the standard deviation for the SMA across groups; specifically, the CAI group demonstrated greater variability than the control (r = 0.395, P = .02; 95% confidence interval = 0.34, 0.67) and coper (r = 0.38, P = .04; 95% confidence interval = −0.05, 0.69) groups. We demonstrated a strong correlation that was significant in the CAI group between the CAIT score and the average HbO2 of the precentral gyrus (ρ = 0.64, P = .02) and a strong correlation that was not significant between the CAIT score and the average HbO2 of the SMA (ρ = 0.52, P = .06). Conclusions: The CAI group displayed large differences in SMA cortical-activation variability. Greater variations in cortical activation may be necessary for similar static postural-control outcomes among individuals with CAI. Consequently, variations in cortical activation for these areas provide evidence for an altered neural mechanism of postural control among populations with CAI