Attorney Fee Arrangements: The U.S. and Western Perspectives

This article develops an analytical framework for viewing the rules on attorney fee arrangements that have been adopted in the United States and in major western European countries. In section II the paper explains the choice of economic agency theory as a starting point for developing this framework. Within the meaning of economic agency, the attorney is a dual agent, with duties to both the client and the judicial system. In section III the paper identifies five interests that form the basis for evaluating fee systems. These interests are derived from applying basic agency theory to the duties of the attorney as an agent of both the client and the judicial system, and extracting the more specific aspects of both types of duties. In sections IV and V the interest analysis is applied to three types of fee arrangements--the fixed fee, the hourly fee, and the contingency fee. We select these types of fee arrangements because they represents key distinct elements, one or more of which seems to be present in any of the fee systems used in the United States or in western Europe. The key distinct element of the fixed fee is that the attorney will be paid the amount agreed upon, without regard to effort or to risk. The key distinct element of the hourly fee is that the attorney will be compensated based on effort, as measured by time spent working, without regard to a fixed amount or to risk. The key distinct element of the contingency fee is that the attorney is compensated for assuming risk, without regard to an agreed upon amount or effort expended. By isolating the way these three distinct types of fee arrangements affect interests that are important in all of the western fees systems, we build a framework for evaluating the many fee arrangements that utilize and combine these key elements, such as the United Kingdom\u27s new conditional fee system. This framework avoids the dominant tendency of the literature to focus on the flaws of a particular fee system in isolation from its alternatives

Attorney Fee Arrangements: The U.S. and Western Perspectives

This article develops an analytical framework for viewing the rules on attorney fee arrangements that have been adopted in the United States and in major western European countries. In section II the paper explains the choice of economic agency theory as a starting point for developing this framework. Within the meaning of economic agency, the attorney is a dual agent, with duties to both the client and the judicial system. In section III the paper identifies five interests that form the basis for evaluating fee systems. These interests are derived from applying basic agency theory to the duties of the attorney as an agent of both the client and the judicial system, and extracting the more specific aspects of both types of duties. In sections IV and V the interest analysis is applied to three types of fee arrangements--the fixed fee, the hourly fee, and the contingency fee. We select these types of fee arrangements because they represents key distinct elements, one or more of which seems to be present in any of the fee systems used in the United States or in western Europe. The key distinct element of the fixed fee is that the attorney will be paid the amount agreed upon, without regard to effort or to risk. The key distinct element of the hourly fee is that the attorney will be compensated based on effort, as measured by time spent working, without regard to a fixed amount or to risk. The key distinct element of the contingency fee is that the attorney is compensated for assuming risk, without regard to an agreed upon amount or effort expended. By isolating the way these three distinct types of fee arrangements affect interests that are important in all of the western fees systems, we build a framework for evaluating the many fee arrangements that utilize and combine these key elements, such as the United Kingdom\u27s new conditional fee system. This framework avoids the dominant tendency of the literature to focus on the flaws of a particular fee system in isolation from its alternatives

Seminatural areas act as reservoirs of genetic diversity for crop pollinators and natural enemies across Europe

Despite increasing recognition of the importance of the multiple dimensions of biodiversity, including functional or genetic diversity as well as species diversity, most conservation studies on ecosystem service-providing insects focus on simple diversity measures such as species richness and abundance. In contrast, relatively little is known about the genetic diversity and resilience of pollinators or natural enemies of crop pests to population fragmentation and local extinction. The genetic diversity and demographic dynamics of remnant populations of beneficial insects in agricultural areas can be a useful indicator proving additional insights into their conservation status, but this is rarely evaluated. Although gene flow between agricultural and seminatural areas is key to maintaining genetic diversity, its extent and directionality remain largely unexplored. Here, we apply a pan-European sampling protocol to quantify genetic diversity and structure and assess gene flow between agricultural and nearby seminatural landscapes in populations of two key ecosystem service-providing insect species, the lady beetle Coccinella septempunctata, an important predator of aphids and other crop pests, and the bee pollinator Andrena flavipes. We show that A. flavipes populations are genetically structured at the European level, whereas populations of C. septempunctata experience widespread gene flow across the continent and lack any defined genetic structure. In both species, we found that there is high genetic connectivity between populations established in croplands and nearby seminatural areas and, as a consequence, they harbor similar levels of genetic diversity. Interestingly, demographic models for some regions support asymmetric gene flow from seminatural areas to nearby agricultural landscapes. Collectively, our study demonstrates how seminatural areas can serve as genetic reservoirs of both pollinators and natural enemies for nearby agricultural landscapes, acting as sources for recurrent recolonization and, potentially, contributing to enhancing ecosystem service and crop production resilience in the longer term

Mast cells regulate CD4+ T-cell differentiation in the absence of antigen presentation

Producción CientíficaBackground: Given their unique capacity for antigen uptake, processing, and presentation, antigen-presenting cells (APCs) are critical for initiating and regulating innate and adaptive immune responses. We have previously shown the role of nicotinamide adenine dinucleotide (NAD+) in T-cell differentiation independently of the cytokine milieu, whereas the precise mechanisms remained unknown. Objective: The objective of this study is to further dissect the mechanism of actions of NAD+ and determine the effect of APCs on NAD+-mediated T-cell activation. Methods: Isolated dendritic cells and bone marrow–derived mast cells (MCs) were used to characterize the mechanisms of action of NAD+ on CD4+ T-cell fate in vitro. Furthermore, NAD+-mediated CD4+ T-cell differentiation was investigated in vivo by using wild-type C57BL/6, MC−/−, MHC class II−/−, Wiskott-Aldrich syndrome protein (WASP)−/−, 5C.C7 recombination-activating gene 2 (Rag2)−/−, and CD11b-DTR transgenic mice. Finally, we tested the physiologic effect of NAD+ on the systemic immune response in the context of Listeria monocytogenes infection. Results: Our in vivo and in vitro findings indicate that after NAD+ administration, MCs exclusively promote CD4+ T-cell differentiation, both in the absence of antigen and independently of major APCs. Moreover, we found that MCs mediated CD4+ T-cell differentiation independently of MHC II and T-cell receptor signaling machinery. More importantly, although treatment with NAD+ resulted in decreased MHC II expression on CD11c+ cells, MC-mediated CD4+ T-cell differentiation rendered mice resistant to administration of lethal doses of L monocytogenes. Conclusions: Collectively, our study unravels a novel cellular and molecular pathway that regulates innate and adaptive immunity through MCs exclusively and underscores the therapeutic potential of NAD+ in the context of primary immunodeficiencies and antimicrobial resistance.National Institutes of Health (grants R01NS073635 , R01MH110438 , R01HL096795 , U01HL126497 and R01AG039449)Instituto de Salud Carlos III (grant PI10/02 511)Fundación Ramón Areces (grant CIVP16A1843

Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis

Background & Aims: Spontaneous portosystemic shunts (SPSS) frequently develop in liver cirrhosis. Recent data suggested that the presence of a single large SPSS is associated with complications, especially overt hepatic encephalopathy (oHE). However, the presence of >1 SPSS is common. This study evaluates the impact of total cross-sectional SPSS area (TSA) on outcomes in patients with liver cirrhosis. Methods: In this retrospective international multicentric study, CT scans of 908 cirrhotic patients with SPSS were evaluated for TSA. Clinical and laboratory data were recorded. Each detected SPSS radius was measured and TSA calculated. One-year survival was the primary endpoint and acute decompensation (oHE, variceal bleeding, ascites) was the secondary endpoint. Results: A total of 301 patients (169 male) were included in the training cohort. Thirty percent of all patients presented with >1 SPSS. A TSA cut-off of 83 mm2 was used to classify patients with small or large TSA (S-/L-TSA). Patients with L-TSA presented with higher model for end-stage liver disease score (11 vs. 14) and more commonly had a history of oHE (12% vs. 21%, p <0.05). During follow-up, patients with L-TSA experienced more oHE episodes (33% vs. 47%, p <0.05) and had lower 1-year survival than those with S-TSA (84% vs. 69%, p <0.001). Multivariate analysis identified L-TSA (hazard ratio 1.66; 95% CI 1.02–2.70, p <0.05) as an independent predictor of mortality. An independent multicentric validation cohort of 607 patients confirmed that patients with L-TSA had lower 1-year survival (77% vs. 64%, p <0.001) and more oHE development (35% vs. 49%, p <0.001) than those with S-TSA. Conclusion: This study suggests that TSA >83 mm2 increases the risk for oHE and mortality in patients with cirrhosis. Our results support the clinical use of TSA/SPSS for risk stratification and decision-making in the management of patients with cirrhosis. Lay summary: The prevalence of spontaneous portosystemic shunts (SPSS) is higher in patients with more advanced chronic liver disease. The presence of more than 1 SPSS is common in advanced chronic liver disease and is associated with the development of hepatic encephalopathy. This study shows that total cross-sectional SPSS area (rather than diameter of the single largest SPSS) predicts survival in patients with advanced chronic liver disease. Our results support the clinical use of total cross-sectional SPSS area for risk stratification and decision-making in the management of SPSS.Jonel Trebicka is supported by grants from the Deutsche Forschungsgemeinschaft (SFB TRR57, CRC1382), Cellex Foundation and European Union’s Horizon 2020 research and innovation program GALAXY study (No. 668031), LIVERHOPE (No. 731875) and MICROB-PREDICT (No. 825694) and the Cellex Foundation. Joan Genescà is a recipient of a Research Intensification grant from Instituto de Salud Carlos III, Spain. The study was partially funded by grants PI15/00066, and PI18/00947 from Instituto de Salud Carlos III and co-funded by European Union (ERDF/ESF, “Investing in your future”). Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivasis supported by Instituto de Salud Carlos III. Macarena Simón-Talero is a recipient of the grant JR 17/00029 from Instituto de Salud Carlos II

Evolution of spontaneous portosystemic shunts over time and following aetiological intervention in patients with cirrhosis.

BACKGROUND & AIMS Spontaneous portosystemic shunts (SPSS) develop frequently in cirrhosis. Changes over time and the effect of aetiological interventions on SPSS are unknown, so we aimed to explore the effect of these variables on SPSS evolution. METHODS Patients with cirrhosis from the Baveno VI-SPSS cohort were selected provided a follow-up abdominal CT or MRI scan was available. Clinical and laboratory data were collected at baseline and follow-up. Imaging tests were reviewed to evaluate changes in the presence and size of SPSS (large (L)-SPSS was ≥8 mm) over time. Regarding alcohol- or HCV-related cirrhosis, two populations were defined: cured patients (abstinent from alcohol or successful HCV therapy), and non-cured patients. RESULTS A total of 617 patients were included. At baseline SPSS distribution was 22% L-SPSS, 30% small (S)-SPSS, and 48% without (W)-SPSS. During follow-up (median follow-up of 63 months), SPSS distribution worsened: L-SPSS 26%, S-SPSS 32%, and W-SPSS 42% (p <0.001). Patients with worse liver function during follow-up showed a simultaneous aggravation in SPSS distribution. Non-cured patients (n = 191) experienced a significant worsening in liver function, more episodes of liver decompensation and lower transplant-free survival compared to cured patients (n = 191). However, no differences were observed regarding SPSS distribution at inclusion and at follow-up, with both groups showing a trend to worsening. Total shunt diameter increased more in non-cured (52%) than in cured patients (28%). However, total shunt area (TSA) significantly increased only in non-cured patients (74 to 122 mm2, p <0.001). CONCLUSIONS The presence of SPSS in cirrhosis increases over time and parallels liver function deterioration. Aetiological intervention in these patients reduces liver-related complications, but SPSS persist although progression is decreased. IMPACT AND IMPLICATIONS There is no information regarding the evolution of spontaneous portosystemic shunts (SPSS) during the course of cirrhosis, and especially after disease regression with aetiological interventions, such as HCV treatment with direct-acting antivirals or alcohol abstinence. These results are relevant for clinicians dealing with patients with cirrhosis and portal hypertension because they have important implications for the management of cirrhosis with SPSS after disease regression. From a practical point of view, physicians should be aware that in advanced cirrhosis with portal hypertension, after aetiological intervention, SPSS mostly persist despite liver function improvement, and complications related to SPSS may still develop

Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis.

BACKGROUND & AIMS Spontaneous portosystemic shunts (SPSS) frequently develop in liver cirrhosis. Recent data suggested that the presence of a single large SPSS is associated with complications, especially overt hepatic encephalopathy (oHE). However, the presence of >1 SPSS is common. This study evaluates the impact of total cross-sectional SPSS area (TSA) on outcomes in patients with liver cirrhosis. METHODS In this retrospective international multicentric study, CT scans of 908 cirrhotic patients with SPSS were evaluated for TSA. Clinical and laboratory data were recorded. Each detected SPSS radius was measured and TSA calculated. One-year survival was the primary endpoint and acute decompensation (oHE, variceal bleeding, ascites) was the secondary endpoint. RESULTS A total of 301 patients (169 male) were included in the training cohort. Thirty percent of all patients presented with >1 SPSS. A TSA cut-off of 83 mm2 was used to classify patients with small or large TSA (S-/L-TSA). Patients with L-TSA presented with higher model for end-stage liver disease score (11 vs. 14) and more commonly had a history of oHE (12% vs. 21%, p <0.05). During follow-up, patients with L-TSA experienced more oHE episodes (33% vs. 47%, p <0.05) and had lower 1-year survival than those with S-TSA (84% vs. 69%, p <0.001). Multivariate analysis identified L-TSA (hazard ratio 1.66; 95% CI 1.02-2.70, p <0.05) as an independent predictor of mortality. An independent multicentric validation cohort of 607 patients confirmed that patients with L-TSA had lower 1-year survival (77% vs. 64%, p <0.001) and more oHE development (35% vs. 49%, p <0.001) than those with S-TSA. CONCLUSION This study suggests that TSA >83 mm2 increases the risk for oHE and mortality in patients with cirrhosis. Our results support the clinical use of TSA/SPSS for risk stratification and decision-making in the management of patients with cirrhosis. LAY SUMMARY The prevalence of spontaneous portosystemic shunts (SPSS) is higher in patients with more advanced chronic liver disease. The presence of more than 1 SPSS is common in advanced chronic liver disease and is associated with the development of hepatic encephalopathy. This study shows that total cross-sectional SPSS area (rather than diameter of the single largest SPSS) predicts survival in patients with advanced chronic liver disease. Our results support the clinical use of total cross-sectional SPSS area for risk stratification and decision-making in the management of SPSS