The Five Indicia of Virtual Property

[Excerpt] “Many Americans use “it” every day. Although it is intangible, it may be worth thousands of dollars. Because we can both control it and prevent other people from controlling it, we assume, without much thought, that we own it. Sometimes we pay someone a monthly fee to hold it for us. Sometimes, simply by using it, we increase its value. When we finish using it, we often sell it. “It” is virtual property, and it may take the form of an email address, a website, a bidding agent, a video game character, or any number of other intangible, digital commodities. If it were to be damaged or stolen, the immediate questions would be: (1) how should a court identify it; and (2) what degree of legal protection should it receive? Because no court or legislature in the United States yet has recognized virtual property interests, a combination of contract and custom currently controls the relationship between Internet users and service providers. […] The question therefore becomes, how should courts identify protectable virtual property interests? Partially due to the dramatic success of Massively Multiplayer Online Games (MMOGs)9 and the rise of secondary markets for virtual characters and treasures from those games, a recent frenzy of legal scholarship has struggled to resolve this question. This note supports the legal recognition of virtual property interests, as already convincingly justified by the legal analogy to traditional property interests set forth by Professor Joshua Fairfield, buttressed by the practical reality that virtual property has significant economic value. Building on these rationales, this note proposes five indicia, common to most forms of virtual property, which a court should use to identify legally protectable virtual property interests on the Internet. These indicia are: (1) rivalry; (2) persistence; (3) interconnectivity; (4) secondary markets; and (5) value-added-by-users. This note cautions, however, against applying this newfound definition indiscriminately against the interests of the very entities without whom the property would not exist: the businesses hosting the remotely accessed computer resources (i.e., the service providers). […] Part III of this note applies the five indicia to the well-established framework of traditional property to illustrate this balancing process. Throughout the development of the law in this area, courts must retain the freedom and flexibility to craft appropriate equitable remedies on a case-by-case basis, and special attention should be directed to the practical issues commonly faced by Internet service providers. The ultimate purpose of virtual property jurisprudence should be to strike a balance that provides legal redress to users whose legitimate virtual property interests have been violated while simultaneously reducing liability and disincentives to service providers who promote and sustain the growth of the Internet.

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Reduced inhibitory effect of imipramine on radiolabeled serotonin uptake into platelets in geriatric depression

Tritiated imipramine binding, uptake of radiolabeled serotonin, and inhibition of uptake by imipramine in vitro were studied in platelets obtained from four groups of subjects: 1. (1) normal controls 50 years of age or younger, 2. (2) patients with major depression 50 years of age or younger, 3. (3) normal controls 60 years of age or older, 4. (4) patients with major depression 60 years of age or older. Depression in both age groups was associated with a substantial decrease in the number of [ 3H]imipramine binding sites; the elderly depressed patients exhibited a small but significant ( p < 0.05) reduction in platelet [ 3H]serotonin uptake. However, the inhibition of serotonin uptake into platelets by imipramine was markedly reduced only in the elderly depressed patients. This reduced sensitivity to imipramine may explain the reduced responsiveness of patients with geriatric depression to the therapeutic effects of imipramine and other tricyclic antidepressants