Repairing Family Law

Scholars in the burgeoning field of law and emotion have paid surprisingly little attention to family law. This gap is unfortunate because law and emotion has the potential to bring great insights to family law. This Article begins to fill this void, and inaugurate a larger debate about the central role of emotion in family law, by exploring the intriguing and significant consequences for the regulation of families that flow from a theory of intimacy first articulated by psychoanalytic theorist Melanie Klein. According to Klein, individuals love others, inevitably transgress against those they love out of hate and aggression, feel guilt about the transgression, and then seek to repair the damage. This Article argues that the legal process embodied in the substance, procedure, and practice of traditional family law is at odds with the human process of love, hate, guilt, and reparation. In contexts as far ranging as divorce, child welfare, and adoption, family law is predicated on a binary model of love and hate, with no accounting for guilt and the drive to reparation. This Love-Hate Model actively thwarts the cycle of intimacy, greatly diminishing the opportunity for repair in familial relationships. In short, reparation as a normative goal receives far too little attention in family law. Although several important reforms have begun to move family law away from the Love-Hate Model, these reforms are undertheorized and incomplete and sometimes actively challenged. An overarching theory is needed both to undergird current reforms and to encourage others, thus moving family law more fully in a reparative direction. To replace the prevailing Love-Hate Model, this Article proposes a Reparative Model of family law that would recognize the full cycle of emotions and facilitate the reparative drive. A Reparative Model would modify the substance of family law to recognize the ongoing relationships that often persist even after legal relationships are altered. It would reform the process of family law by de-emphasizing adversarial decisionmaking. And it would change the practice of family law by reconceiving the role of the family law attorney. Ultimately, the Reparative Model yields new perspectives on a range of theoretical and practical problems in contemporary family law, providing a framework for the law to account for the full, and complex, emotional reality of familial relationships

Agriculture and Nutrition in Bangladesh: Mapping Evidence to Pathways

Background: Although much work has been done on the theoretical links between agriculture and nutrition, there is limited understanding of the evidence from observational and experimental research studies on the impacts of agriculture programs on nutrition outcomes. Objective: To assess the emphasis of the literature on different agriculture–nutrition pathways in Bangladesh. Methods: Twenty databases and Web sites were searched, yielding more than 2400 resources that were pared down through an iterative, eliminative process to 60 articles. These articles were then rated for quality and mapped to 1 of the 6 agriculture–nutrition pathways. Results: The body of evidence reveals gaps in knowledge in all of the pathways, but especially in the areas of agriculture as a source of livelihoods, and women’s role as intermediaries between agriculture and good nutrition and health within their household. Conclusion: More research is needed on the links between agriculture and nutrition in country-specific settings, particularly as regards the role of women. Nutrition-related outcomes, such as dietary diversity and women’s empowerment, need to be measured more explicitly when evaluating the impact of agricultural production systems and development initiatives.Department for International Development (DFID)UKAI

Intracellular retention of ABL kinase inhibitors determines commitment to apoptosis in CML cells

Clinical development of imatinib in CML established continuous target inhibition as a paradigm for successful tyrosine kinase inhibitor (TKI) therapy. However, recent reports suggested that transient potent target inhibition of BCR-ABL by highdose TKI (HD-TKI) pulse-exposure is sufficient to irreversibly commit cells to apoptosis. Here, we report a novel mechanism of prolonged intracellular TKI activity upon HD-TKI pulse-exposure (imatinib, dasatinib) in BCR-ABL-positive cells. Comprehensive mechanistic exploration revealed dramatic intracellular accumulation of TKIs which closely correlated with induction of apoptosis. Cells were rescued from apoptosis upon HD-TKI pulse either by repetitive drug wash-out or by overexpression of ABC-family drug transporters. Inhibition of ABCB1 restored sensitivity to HD-TKI pulse-exposure. Thus, our data provide evidence that intracellular drug retention crucially determines biological activity of imatinib and dasatinib. These studies may refine our current thinking on critical requirements of TKI dose and duration of target inhibition for biological activity of TKIs.Daniel B. Lipka, Marie-Christine Wagner, Marek Dziadosz, Tina Schnöder, Florian Heidel, Mirle Schemionek, Junia V. Melo, Thomas Kindler, Carsten Müller-Tidow, Steffen Koschmieder and Thomas Fische

Physical activity in older Asian Indians living in the Unites States : barriers and motives

This paper investigates the motives for (Study 1) and barriers to (Study 2) participation in physical activity by older Asian Indian immigrants to the United States. In Study 1, 100 older Asian Indians living in the United States completed the Participation Motivation Questionnaire for Older Adults. The most highly reported motives for participation were based around medical reasons and keeping healthy and active. Analyses of variance showed significant differences in reasons for participation in physical activity based on gender and age. In Study 2, 10 sedentary older Asian Indians living in the United States participated in focus group discussions. They viewed physical activity as being an integral part of everyday activity. Barriers identified included existing health problems, risk of injury, and issues associated with their new lifestyles in the United States. These culture-specific findings should be considered when developing interventions to encourage physical activity

Open Hamstring Tendon Excision Following a Distal Semitendinosus Avulsion Tear: A Technique Video

Background: Hamstring injuries are commonly considered the number one reason for delayed return to play and return to sport (RTS) across several sport disciplines. Traditionally, they are treated conservatively. However, recent literature has shown surgical intervention to improve recovery and expedite RTS. One potential explanation behind this phenomenon is conservative treatment does not address the disrupted length-tendon relationship, which can cause hamstring re-injury. Indications: Operative indications for tendon excision include patients with distal semitendinosus avulsions tear with retraction, especially patients who had already failed conservative management. Elite athletes with distal hamstring tears who have experienced a delayed RTS or desired activity level should also be considered for distal hamstring excision. Technique Description: A distal 4-cm incision, which was longitudinal in line with the semitendinosus, was made over the posterior knee at the measured level of the avulsed tendon stump, 2 cm proximal to the knee flexion crease. Blunt dissection was used for the subcutaneous layers, and the overlying hypertrophic and fibrotic tendon sheath was sharply incised. The torn and retracted tendon tissue was exteriorized. An allis clamp was used to provide tension on the distal semitendinosus, and mobilization of the avulsed tendon was performed. Sheath tissue surrounding the injured tendon was removed. The stump was whipstitched to provide further traction, and the hypertrophied portion of the tendon was excised. An open tendon stripper was implemented to exercise both limbs of the semitendinosus. The subcutaneous tissue and skin were closed, and an incisional wound vac was placed. Discussion/Conclusion: Distal avulsion tears of semitendinosus tendons can lead to unsatisfactory results with conservative treatment, with delayed RTS and recurrence of symptoms. Resection of hamstring tendon tissue may eliminate the recurrence of injury, along with inflammation, fibrosis, and hemorrhage associated with retraction reinjuries. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication

Same admission cardiac catheterization and cardiac surgery: is there an increased incidence of acute kidney injury?

BACKGROUND: Acute kidney injury (AKI) is predictive of increased long-term mortality after cardiac surgery. Patients often undergo surgery after cardiac catheterization during the same admission for reasons of instability and threatening anatomy as well as nonurgent reasons such as patient convenience. We hypothesized that patients undergoing cardiac catheterization and cardiac surgery during the same admission are more likely to develop AKI after cardiac surgery than patients for whom surgery is performed on a later admission. METHODS: We prospectively enrolled 668 nonemergent adult cardiac surgical cases. Patients having heart catheterization were divided into two groups: cardiac catheterization followed by cardiac surgery during the same hospital admission (same admission) or catheterization followed by surgery during a later admission (later admission). The AKI was defined by an increase in serum creatinine from baseline by 50% or greater or 0.3 (mg/dL) or greater. Univariable and multivariable logistic regression and propensity-matched analyses were conducted. RESULTS: The incidence of AKI was significantly higher in the patients who had same admission cardiac catheterization and surgery (50.2%) compared with patients who had surgery on a later admission (33.7%, p = 0.009). The adjusted odds ratio for surgery on a later admission was 1.54 (95% confidence interval: 1.11 to 2.13) suggesting a 54% increased risk of AKI. Propensity-matched results were similar with 1.58 (95% confidence interval: 1.13 to 2.22). CONCLUSIONS: When cardiac catheterization and cardiac surgery occur during the same hospitalization, there is an increased risk for postoperative AKI. After cardiac catheterization, discharge and readmission for nonurgent surgery should be considered as such an approach might reduce the risk of AKI