For Richer, Not Poorer: Premarital Waivers of Spousal Support in California

California law is fairly straightforward with respect to premarital agreements that seek to alter community property rights in the event of a divorce. But it is unclear and unsettled with respect to those agreements that seek to limit or waive spousal support. Although California prohibits courts from enforcing premarital waivers of spousal support if it would be unconscionable to do so at the time of enforcements, courts have not articulated a clear standard for what that means. California made its first attempt to do so in In re Marriage of Facter. This Article considers that decision in illustrating how current law, which does not clearly define unconscionability, allows courts to arbitrarily decide when such a waiver is fair. This Article argues that, instead, courts must consider the balance between freedom of contract and public policy embodied in the California Family Code. Finally, this Article concludes by proposing a set of policy-based guidelines that courts and the legislature can consider in determining the enforceability of such waivers under existing law

Pulmonary Nocardiosisin an ImmunocompetentHost

Introduction: • Nocardia is known to cause severe pulmonary or disseminated infection in immunocompromised patients, but can cause infection in immunocompetent patients. Providers should consider Nocardiosis in immunocompetent patients with prolonged and unexplained respiratory failure. • The preferred therapy for pulmonary Nocardiosis is a sulfa antibiotic for 3-6 months. Toxicity from prolonged use of alternative agents presents a therapeutic challenge in those with sulfa allergy. Case Report: • An 85 year-old woman with a history of paroxysmal atrial fibrillation and heart failure with preserved EF presented to her primary care provider with 1 week of cough and progressive dyspnea. Chest x-ray (CXR) was normal, and echocardiogram demonstrated known HFpEFwithout new abnormalities. • Two months later, she presented to the hospital with progressive dyspnea, chest tightness, and was found to be hypoxic. CXR on admission showed bilateral consolidations as well as mediastinal and hilar adenopathy. She was treated with ceftriaxone & azithromycin for presumed community-acquired pneumonia (CAP). • Due to treatment failure, a CT Chest was obtained and showed a mass-like consolidation in the right middle lobe; she was discharged with a several-week prednisone taper for treatment of presumed cryptogenic organizing pneumonia. • Two weeks later, she returned for worsening dyspnea, chest pressure, malaise, and hypoxia. She was again treated for CAP and discharged. • One month later, she was admitted for similar symptoms, and a CT-guided lung biopsy showed several small clusters of long Gram-positive bacteria consistent with Nocardia spp. Tissue culture was positive for Nocardia cyriacigeorgicacomplex. • The patient was offered a challenge of her sulfa allergy (reported as a rash), but refused. She was started on linezolid in anticipation of a 6 month course of therapy. • Her hospitalization was complicated by cardiac & renal dysfunction. Due to severely impaired quality of life, the patient elected for hospice care and died approximately 2 weeks after discharge. Discussion: • Nocardiosis most commonly presents as a pulmonary infection as inhalation is the primary route of exposure. • More than half of all reported Nocardiosis cases are associated with preexisting immunocompromise such as organ transplantation, AIDS, diabetes, chronic granulomatous disease and alcoholism. More recently published case reports depict Nocardia infections in immunocompetent patients with a prior history of lung disease, such as chronic obstructive pulmonary disease, allergic bronchopulmonary aspergillosis, and bronchiectasis. • Our patient was neither immunocompromised, nor had a prior history of lung disease, though was an elderly person. Immunosenescenceis associated with decline in innate as well as T-cell immunity, which may have imparted risk to our patient. • The mainstay for treatment of Nocardia infections is trimethoprim-sulfamethoxazole (TMP-SMX). Alternative oral agents include minocycline, amoxicillin-clavulanate, and linezolid. • Had our patient not chosen the route of hospice care, close monitoring for linezolid toxicity would have been necessary with possible TMP-SMX re-challenge for long term therapy.https://digitalcommons.psjhealth.org/psv_internal/1007/thumbnail.jp

The explanatory and heuristic power of mathematics

Mathematics is, and has been for a very long time, one of the most successful autonomous fields of research. However, the last five centuries have seen it become so deeply interwoven in virtually every area of scientific inquiry to convince Kant that “in any special doctrine of nature there can be only as much proper science as there is mathematics therein” (Kant 1786/2004, 6; emphases in original). While the distinction between pure and applied mathematics remains somewhat elusive, philosophers have been interested in understanding the nature of each. Moreover, the idea that there are actually two uses of mathematics, an explanatory and a heuristic one, has begun to feature more and more prominently in recent philosophical debates

Perfil antropométrico e dietético de crianças de duas escolas públicas de Volta Redonda-RJ

Este estudo visou avaliar o estado nutricional e dietético de crianças em duas escolas públicas de Volta Redonda-RJ. O estudo foi transversal, sendo realizado com 151 crianças, com faixa etária de 6 a 10 anos. Foi avaliado o estado nutricional (estatura/idade, peso/idade e Índice de Massa Corporal-IMC) e aplicado um questionário sócioeconômico e outro de freqüência alimentar. Os resultados mostraram que a maioria das crianças apresentou estatura adequada para a idade e apesar da maioria apresentar eutrofia referente ao peso por idade, houve presença de peso elevado e risco de baixo peso. Com relação ao IMC, as meninas (35,56%) apresentaram maior índice de excesso de peso em relação aos meninos (26,23%). A freqüência alimentar apontou elevado consumo de batata frita, bolo com cobertura e com recheio, e baixo consumo de salgados, leites, óleos, cereais, vegetais e carnes. Pode-se concluir que neste estudo o IMC foi o indicador antropométrico mais sensível para diagnosticar a prevalência de inadequação nutricional, sendo essa prevalência maior nas meninas. O consumo alimentar destas crianças está inadequado devido à baixa ingestão de alguns grupos alimentares importantes para o seu desenvolvimento e crescimento adequado

Utilization of low value fish in the development of convenience foods

Formulation studies on different fishery products like fish noodles, fishballs and fish sausage were conducted to develop, from low market value marine species and excess catch, convenience foods that are protein-rich, palatable and acceptable. These products will generate technology into home-based industries for the fishermen s family. The study shows that consumer-type fish products can be developed from mixtures of fishes of low commercial value. Results of chemical, microbial, sensory, costs and return analysis and storage stability of the processed products are presented

Association between lowering restriction levels during the coronavirus outbreak and physical activity among adults: a longitudinal observational study in Brazil

OBJECTIVE The COVID-19 pandemic has had significant consequences on public health and lifestyle and has negatively affected mental health and the level of physical activity worldwide. This study examined the impact of reopening fitness centers and nonessential services and introducing flexible measures to ensure social distancing on physical activity and mental health. MATERIALS AND METHODS This was a longitudinal study. A self-administered questionnaire, including personal, behavioral, physical activity, perception of health, and mood state disorder information, was answered by 128 Brazilians in June 2020 (during severe restrictive measures) and again in April 2021 (after fitness centers and nonessential services were reopened). RESULTS The restriction level adopted in April 2021 was significantly lower than that in June 2020 (p<0.001). The level of physical activity (p<0.001) and health status perception (p<0.001) decreased from June 2020 to April 2021. The median values for depression and anxiety did not differ across the study period. CONCLUSIONS The level of physical activity was reduced during the COVID-19 pandemic, and anxiety and depression were not improved following less restrictive social distancing measures and the reopening of fitness centers. Thus, the return to a prepandemic level of physical activity and mental health status may not be automatic. The results presented herein suggest that the decrease in physical activity observed in the population may be challenging in the postpandemic period