Equitable Estoppel and the Outer Boundaries of Federal Arbitration Law: The Alabama Supreme Court\u27s Retrenchment of an Expansive Federal Policy Favoring Arbitration

A consumer purchases a manufactured home from a commercial vendor.\u27 As part of the commercial transaction, the consumer and vendor execute a sales agreement containing the following arbitration clause: All disputes, claims, or controversies arising from or relating to this Contract or the relationships which result from this Contract... shall be resolved by binding arbitration .... ,, The manufacturer of the home is not a party to the sales contract. Rather, the manufacturer issues a separate warranty agreement in connection with the consumer\u27s purchase. When the consumer discovers defects in the home, the consumer sues both the commercial vendor and the manufacturer. The consumer and vendor arbitrate their dispute according to the terms of the sales contract. The manufacturer, however, did not execute an arbitration agreement with the consumer and was not a party to the original sales contract. Nevertheless, the nonsignatory manufacturer of the home attempts to compel arbitration of the consumer\u27s claims pursuant to the underlying sales agreement. Alabama courts have repeatedly confronted this fact pattern. On such facts, both Alabama and federal courts have struggled to determine whether the non-signatory may compel arbitration of the signatory\u27s claims pursuant to an underlying agreement containing an arbitration clause. Part II of this Note analyzes the federal courts\u27 use of equitable estoppel to force signatories to arbitrate claims against nonsignatories despite the lack of a written arbitration agreement between the parties. Part III of this Note examines the Alabama Supreme Court\u27s hostility towards arbitration. Alabama courts have resisted a full-scale adoption of federal arbitration policy. Indeed, Alabama courts have traditionally refused to apply the federal doctrine of equitable estoppel to compel arbitration with nonsignatories. Part III documents the clash between the federal doctrine of equitable estoppel and Alabama\u27s inveterate hostility to arbitration agreements. After longstanding resistance to federal principles, the Alabama Supreme Court recently acknowledged the viability of equitable estoppel in the case of Ex parte Isbell. But in Isbell, the Alabama Supreme Court acknowledged a version of equitable estoppel which is potentially narrower than the scope of the federal doctrine. Part III also examines the Alabama Supreme Court\u27s derivative version of equitable estoppel. The conclusion of this Note argues in favor of the Alabama court\u27s estoppel analysis as an appropriate retrenchment of an expansive federal policy favoring arbitration

Cephalometric Evaluation of Bionator Therapy in the Early Treatment of Class II Malocclusions

Early or two-phase orthodontic treatment of Class II malocclusions is a debated topic in orthodontic circles primarily because the benefits of early intervention have not been consistently reproduced among researchers. The present study was a retrospective analysis of cephalograms from patients with Class II, division 1 malocclusions at the start of treatment. These were 50 consecutively treated youths who received phase 1 (early) treatment with a Bionator appliance and later treatment with full appliances (all treated by a single clinician). The comparison group consisted subjects treated in a single phase with fixed Edgewise appliances only. Importantly, subjects in the two samples were matched, on a one-to-one basis, for demographic and cephalometric variables (ANB, SNA, SNB, NAP, FMA) to ensure comparability in the nature and severity of the malocclusions. The key question was whether the cephalometric results at the end of treatment were comparable between groups. Two-phase subjects were treated on average 1.4 years longer than the one-phase group, though this measure of clock time may obscure the greater ease of treatment chair side. Neither of out two integumental variables (Z angle, E plane) differed statistically, but two key skeletal variables did differ, namely ANB and NAP. ANB was significantly smaller ( = 2.6°) in the two-phase group than in the one-phase group ( = 3.7°), and NAP averaged 2.7º in the two-phase group compared to a mean of 4.8º in the one-phase group. Consequently, the two-phase group was discernibly more orthognathic at the end of treatment, with most of the correction coming from mandibular growth rather than maxillary restriction. None of the dental variables differed statistically except the position of the maxillary incisors which were slightly more proclined in the two-phase group, and this was due to operator preference. The two-phase subjects had a lower rate of premolar extraction (12% vs 84%) than the one-phase subjects. Overall, the two-phase group achieved a better bony facial profile, with the majority of the skeletal and dental correction occurring during the first phase of treatment. These favorable results contrast with published randomized clinical trials, possibly because of differences in patient selection and appliance design. Our results do support the value of early intervention, though it is not known whether the statistically significant improvements in the facial profile are large enough to be perceptible to the patient and parents

Patients’ Perceptions of Memory Functioning Before and After Surgical Intervention to Treat Medically Refractory Epilepsy.

Purpose:One risk associated with epilepsy surgery is memory loss, but perhaps more important is how patients perceive changes in their memories. This longitudinal study evaluated changes in memory self-reports and investigated how self-reports relate to changes on objective memory measures in temporal or extratemporal epilepsy patients who underwent surgery. Methods: Objective memory (Wechsler Memory Scale–Revised) and subjective memory self-reports (Memory Assessment Clinics Self-Rating Scale) were individually assessed for 136 patients ∼6 months before and 6 months after surgery. A measure of depressive affect (Beck Depression Inventory–2nd Edition) was used to control variance attributable to emotional distress. Results: Despite a lack of significant correlational relationships between objective and subjective memory for the entire sample, significant correlations between objective memory scores and self-reports did emerge for a subset of patients who evidenced memory decline. Differences also were found in the subjective memory ratings of temporal lobe versus extratemporal patients. Temporal lobe patients rated their memories more negatively than did extratemporal patients and were more likely to report significant improvements in their memory after surgery. Conclusions: In general, patients were not accurate when rating their memories compared to other adults. However, patients with significant declines in their memories were sensitive to actual changes in their memories over time relative to their own personal baselines

Cognitive outcome two years after frontal lobe resection for epilepsy – A prospective longitudinal study

AbstractPurposeTo investigate cognitive outcomes after frontal lobe resection (FLR) for epilepsy in a consecutive single centre series.MethodsNeuropsychological examinations were performed prior to and two years (mean test interval 2.5 years) after surgery in 30 consecutive patients who underwent FLR. Cognitive outcome was evaluated with particular consideration to the site of surgery (lateral, premotor/SMA [supplementary motor area], mesial/orbital). Cognitive domains assessed were speed, language, memory, attention, executive functions and intelligence. 25 healthy controls were assessed at corresponding time points (mean test interval 3.0 years). Analyses were made both at group and individual levels.ResultsAt baseline the patients performed below controls in variables depending on speed, executive functions, global and verbal intelligence. Two years after surgery, the analyses at the subgroup level indicated that the lateral resection group had less improvement than the controls in global intelligence, FSIQ (p=.037). However, at the individual level, the majority of the change scores (74–100%) were classified as within the normal range for all but one variable. The exception was the variable “Comprehension” (measuring verbal reasoning ability) with reliable declines in 44% (8/18) of the patients. This pattern of decline was observed in the lateral (4/7 patients) and premotor/SMA (4/7 patients) resection groups. Seizure outcome and side of surgery did not influence these results.ConclusionThe main finding was cognitive stability at group level two years after FLR. A reliable decline in verbal reasoning ability was rather common at an individual level, but only in the lateral and premotor/SMA resection groups. The lateral resection group also had less improvement than the controls in global intelligence

Efficacy of Trastuzumab in Routine Clinical Practice and After Progression for Metastatic Breast Cancer Patients: The Observational Hermine Study

Results of the Hermine study examining the use of trastuzumab for metastatic breast cancer patients in routine practice, including patients who received trastuzumab treatment beyond progression, are reported. The cardiac safety of trastuzumab in this setting is also reported

Extending basic principles of measurement models to the design and validation of Patient Reported Outcomes

A recently published article by the Scientific Advisory Committee of the Medical Outcomes Trust presents guidelines for selecting and evaluating health status and health-related quality of life measures used in health outcomes research. In their article, they propose a number of validation and performance criteria with which to evaluate such self-report measures. We provide an alternate, yet complementary, perspective by extending the types of measurement models which are available to the instrument designer. During psychometric development or selection of a Patient Reported Outcome measure it is necessary to determine which, of the five types of measurement models, the measure is based on; 1) a Multiple Effect Indicator model, 2) a Multiple Cause Indicator model, 3) a Single Item Effect Indicator model, 4) a Single Item Cause Indicator model, or 5) a Mixed Multiple Indicator model. Specification of the measurement model has a major influence on decisions about item and scale design, the appropriate application of statistical validation methods, and the suitability of the resulting measure for a particular use in clinical and population-based outcomes research activities

A feasibility study exploring the role of pre-operative assessment when examining the mechanism of ‘chemo-brain’ in breast cancer patients

Background: Women receiving chemotherapy treatment for breast cancer may experience problems with their memory and attention (cognition), which is distressing and interferes with quality of life. It is unclear what causes or contributes to the problems they report: psychological distress, fatigue, coping style, or specific biological changes for example to pro inflammatory cytokines. Research shows however, that approximately a third of women with breast cancer perform poorly on tests of cognition before commencing chemotherapy. We aimed to examine the acceptability and relevance of pre-surgical assessments (bloods, brain imaging, cognitive tests and self-report questionnaires) when investigating the phenomenon of ‘chemo-brain’ and investigate whether inflammatory markers mediate chemotherapy-induced neuropsychological impairments in women treated for breast cancer. Methods: Women with early stage breast cancer completed neuropsychological and quality of life assessments at T1 (pre-surgery), T2 (post-surgery before chemotherapy) and T3 (6 months later). Blood cytokine levels were measured at the same time points and brain imaging was performed at T1 and T3. Results: In total, 14/58 women participated (8 chemotherapy, 6 non-chemotherapy). Prior to the start of chemotherapy a decline in cognitive performance compared to baseline was observed in one participant. At T3 women who received chemotherapy reported poorer quality of life and greater fatigue. Increases in soluble tumour necrosis factor receptor II (sTNFRII), interleukin-6, interleukin-10 and vascular endothelial growth factor occurred post chemotherapy only. Levels of sTNFRII were inversely correlated with grey matter volume (GMV) of the right posterior insula in both groups. At T3, the chemotherapy group displayed a greater reduction in GMV in the subgenual and dorsal anterior cingulate, and the inferior temporal gyrus. Conclusions: Pre-operative recruitment to the study was challenging; however, the lack of significant changes in blood cytokine levels and neuropsychological tests at T2 implies that post surgery may be a valid baseline assessment, but this needs further investigation in a larger study. The preliminary results support the hypothesis that chemotherapy induced fatigue is mediated by a change in peripheral cytokine levels which could explain some symptoms of ‘chemo brain’ experienced by patients

The relation of object naming and other visual speech production tasks: A large scale voxel-based morphometric study.

We report a lesion–symptom mapping analysis of visual speech production deficits in a large group (280) of stroke patients at the sub-acute stage (<120 days post-stroke). Performance on object naming was evaluated alongside three other tests of visual speech production, namely sentence production to a picture, sentence reading and nonword reading. A principal component analysis was performed on all these tests' scores and revealed a ‘shared’ component that loaded across all the visual speech production tasks and a ‘unique’ component that isolated object naming from the other three tasks. Regions for the shared component were observed in the left fronto-temporal cortices, fusiform gyrus and bilateral visual cortices. Lesions in these regions linked to both poor object naming and impairment in general visual–speech production. On the other hand, the unique naming component was potentially associated with the bilateral anterior temporal poles, hippocampus and cerebellar areas. This is in line with the models proposing that object naming relies on a left-lateralised language dominant system that interacts with a bilateral anterior temporal network. Neuropsychological deficits in object naming can reflect both the increased demands specific to the task and the more general difficulties in language processing

Functional MRI evidence for the decline of word retrieval and generation during normal aging

International audienceThis fMRI study aimed to explore the effect of normal aging on word retrieval and generation. The question addressed is whether lexical production decline is determined by a direct mechanism, which concerns the language operations or is rather indirectly induced by a decline of executive functions. Indeed, the main hypothesis was that normal aging does not induce loss of lexical knowledge, but there is only a general slowdown in retrieval mechanisms involved in lexical processing , due to possible decline of the executive functions. We used three tasks (verbal fluency, object naming , and semantic categorization). Two groups of participants were tested (Young, Y and Aged, A), without cognitive and psychiatric impairment and showing similar levels of vocabulary. Neuropsychological testing revealed that older participants had lower executive function scores, longer processing speeds, and tended to have lower verbal fluency scores. Additionally, older participants showed higher scores for verbal automa-tisms and overlearned information. In terms of behav-ioral data, older participants performed as accurate as younger adults, but they were significantly slower for the semantic categorization and were less fluent for verbal fluency task. Functional MRI analyses suggested that older adults did not simply activate fewer brain regions involved in word production, but they actually showed an atypical pattern of activation. Significant correlations between the BOLD (Blood Oxygen Level Dependent) signal of aging-related (A > Y) regions and cognitive scores suggested that this atypical pattern of the activation may reveal several compensatory mechanisms (a) to overcome the slowdown in retrieval, due to the decline of executive functions and processing speed and (b) to inhibit verbal automatic processes. The BOLD signal measured in some other aging-dependent regions did not correlate with the behavioral and neuro-psychological scores, and the overactivation of these uncorrelated regions would simply reveal dedifferentia-tion that occurs with aging. Altogether, our results suggest that normal aging is associated with a more difficult access to lexico-semantic operations and representations by a slowdown in executive functions, without any conceptual loss