Construction Mortgage Financing in Ohio

This article consists of a review and analysis of the Yarborough decision and the open-end mortgage statute and an assessment of their probable impact upon current construction loan lending procedures. In addition, the authors offer various observations regarding the form in which disbursing agreements and construction mortgage deeds should be drafted. The structure of the article may be briefly described as follows: First, attention will be given to the three methods by which a mortgagee can preserve the priority of its mortgage lien over liens of mechanics men which attach to the mortgaged premises after the recording of the mortgage but before any disbursements are made thereunder. Special consideration will be given to the manner in which the Yarborough decision affects each method. Second, the writers will discuss the manner in which openend mortgages relate to: (1) non-statutory construction mortgages and (2) mechanics\u27 and other types of liens which attach to the mortgaged premises after the recording of an open-end mortgage but before any optional disbursements are made thereunder. In this connection, the use of open-end mortgages to secure construction loans will be considered. Third, the advisability of drafting an open-end mortgage which incorporates the provisions of § 1311.14 of the Mechanic\u27s Lien Statute will be examined. Fourth, the authors will discuss a proposed method by which a mortgagee can reasonably assure that its mortgage lien will take priority over any vendees\u27 liens which exist on the date of the recording of the mortgag

Factors Associated With C5 Palsy Following Cervical Spine Surgery: A Systematic Review.

Study Design: Systematic review. Objectives: C5 palsy (C5P) is a not uncommon and disabling postoperative complication with a reported incidence varying between 0% and 30%. Among others, one explanation for its occurrence includes foraminal nerve root tethering. Although different risk factors have been reported, controversy about its causation and prevention persists. Inconsistent study findings contribute to the persistent ambiguity leading to an assumption of a multifactorial nature of the underlying C5P pathophysiology. Here, we report the results of a systematic review on C5P with narrow inclusion criteria in the hope of elucidating risk factors for C5P due to a common pathophysiological mechanism. Methods: Electronic databases from inception to March 9, 2019 and references of articles were searched. Narrow inclusion criteria were applied to identify studies investigating demographic, clinical, surgical, and radiographic factors associated with postoperative C5P. Results: Sixteen studies were included after initial screening of 122 studies. Eighty-four risk factors were analyzed; 27 in ≥2 studies and 57 in single studies. The pooled prevalence of C5P was 6.0% (range: 4.2%-24.1%) with no consistent evidence that C5P was associated with demographic, clinical, or specific surgical factors. Of the radiographic factors assessed, specifically decreased foraminal diameter and preoperative cord rotation were identified as risk factors for C5P. Conclusion: Although risk factors for C5P have been reported, ambiguity remains due to potentially multifactorial pathophysiology and study heterogeneity. We found foraminal diameter and cord rotation to be associated with postoperative C5P occurrence in our meta-analysis. These findings support the notion that factors contributing to, and acting synergistically with foraminal stenosis increase the risk of postoperative C5P

Foraminal Ligaments Tether Upper Cervical Nerve Roots: A Potential Cause of Postoperative C5 Palsy.

Background Nerve root tethering upon dorsal spinal cord (SC) migration has been proposed as a potential mechanism for postoperative C5 palsy (C5P). To our knowledge, this is the first study to investigate this relationship by anatomically comparing C5-C6 nerve root translation before and after root untethering by cutting the cervical foraminal ligaments (FL). Objective The aim of this study is to determine if C5 root untethering through FL cutting results in increased root translation. Methods Six cadaveric dissections were performed. Nerve roots were exposed via C4-C6 corpectomies and supraclavicular brachial plexus exposure. Pins were inserted into the C5-C6 roots and adjacent foraminal tubercle. Translation was measured as the distance between pins after the SC was dorsally displaced 5 mm before and after FL cutting. Clinical feasibility of FL release was examined by comparing root translation between standard and extended (complete foraminal decompression) foraminotomies. Translation of root levels before and after FL cutting was compared by two-way repeated measures analysis of variance. Statistical significance was set at 0.05. Results Significantly more nerve root translation was observed if the FL was cut versus not-cut, p = 0.001; no difference was seen between levels, p = 0.33. Performing an extended cervical foraminotomy was technically feasible allowing complete FL release and root untethering, whereas a standard foraminotomy did not. Conclusion FL tether upper cervical nerve roots in their foramina; cutting these ligaments untethers the root and increases translation suggesting they could be harmful in the context of C5P. Further investigation is required examining the value of root untethering in the context of C5P

Percutaneous Cortical Screw Fixation as a Method for Posterior Spinal Stabilization

Objective Novel minimally invasive surgery (MIS) approaches and instrumentation such as cortical screws (CS) have recently become commonplace for treating spinal disease. CS comparability to pedicle screws (PS) with respect to safety and mechanical stability, however, have yet to be determined. To our knowledge, this is the first report to describe a percutaneous CS fixation technique with subsequent open anatomical dissection and describe its feasibility compared to PS fixation. Methods Fresh frozen cadavers were used for fluoroscopy-guided placement of a total of 20 percutaneous PS and CS. Standard percutaneous PS fixation was performed in cadavers from L1-L5 on one-side followed by CS being placed on the other side. Open anatomical dissection was then performed to confirm placement and compare pedicle breach incidence between PS and CS. Results Both percutaneous PS and CS were easily placed without difficulty. Dissection revealed no breaches of either construct, and as such no statistical comparison was possible. At one-level however, a CS was seen breaching the posterior-third lateral vertebral body (VB) just under the superior end-plate. Two screw threads exposed were visualized well away from any entering and/or exiting foraminal or paraspinal neurovascular structures. Conclusion Here, we report a novel study of percutaneous CS insertion with open cadaveric dissection comparing it to PS, incorporating the advantages of both MIS and CS fixation. Although feasible and technically comparable to PS in this report, further study comparing these two techniques and rigorous patient selection for its application are necessary

Research-Based Web Design & Usability Guidelines [2006 edition]

The new edition of the U.S. Department of Health and Human Services’ (HHS) Research-Based Web Design and Usability Guidelines. These guidelines reflect HHS’ commitment to identifying innovative, research-based approaches that result in highly responsive and easy-to-use Web sites for the public. These guidelines help move us in that direction by providing practical, yet authoritative, guidance on a broad range of Web design and communication issues. Having access to the best available research helps to ensure we make the right decisions the first time around and reduces the possibility of errors and costly mistakes

Virological and serological surveillance for type A influenza in the black-legged kittiwake (Rissa tridactyla)

<p>Abstract</p> <p>Background</p> <p>The epidemiology of avian influenza viruses (AIVs) in gulls is only partially known. The role of the world's most numerous gull species, the black-legged kittiwake (<it>Rissa tridactyla</it>), as a potential AIV reservoir species has been unclear. The prevalence of AIV and humoral response against AIV were therefore studied in a colony of apparently healthy black-legged kittiwakes breeding in a nesting cliff in the South West Barents Region of Norway (70°22' N, 31°10' E), in 2008 and 2009.</p> <p>Results</p> <p>AIVs were detected from the oropharynx and cloaca in low amounts, with prevalences of 15% and 5%, in 2008 and 2009, respectively. Direct, partial sequencing of the hemagglutinin (HA) gene revealed that the H4 subtype was present. In 2009, antibodies to influenza A virus were detected in sera from 57 of 80 adult birds. In contrast, none of the three-week-old chicks (n = 18) tested seropositive. Hemagglutination inhibition (HI) assays demonstrated that the adult kittiwakes primarily had antibodies specific to the gull-associated H13 and H16 subtypes, with antibodies to H16 being most common.</p> <p>Conclusions</p> <p>These results support that the highly pelagic black-legged kittiwake is a reservoir of AIV. The serological findings suggest that H16 might be the main AIV subtype in the black-legged kittiwake. Further studies are needed to understand the ecology of AIV in the black-legged kittiwake and in gulls in general.</p