Kissing the Security Blanket Goodbye: How the SECURE Act Will Affect IRA Beneficiaries’ Long-Term Financial Security

The Setting Every Community Up for Retirement Enhancement Act (the SECURE Act) offers many forms of new support for retirement savings to help more Americans better prepare for their retirement. It also includes a provision that eliminates the stretch payout option for the beneficiaries of inherited individual retirement arrangements (IRAs). Prior to the SECURE Act, beneficiaries of inherited IRAs were able to capitalize on the tax-deferred savings vehicles for the remainder of their lifetimes. After the SECURE Act, the period of tax-deferred investment for beneficiaries was limited to ten years. In eliminating the stretch payout option, Congress opted for a relatively small amount of short-term revenue rather than the long-term financial security of both the IRA owner and the beneficiaries of the IRA based upon closing a perceived loophole. This decision ultimately will generate a small amount of revenue, while simultaneously having a largely detrimental impact on the beneficiaries of inherited IRAs. This Note argues that Congress should reinstate the stretch payout option for the beneficiaries of inherited IRAs to encourage saving and, in turn, protect retirees and their beneficiaries

Saints and Sinners: Is an Insurance Policy Required to Indemnify the Church for the Wrongful Acts of Sexual Misconduct by Priests?

On September 19, 2018, the United States Court of Appeals for the Second Circuit’s holding in Hartford Roman Catholic Diocesan Corp. v. Interstate Fire & Casualty Co. created two circuit splits regarding the interpretation of Interstate Fire and Casualty Co.’s insurance policy provisions, particularly in the context of indemnification for sexual abuse settlements. Hartford held that in insurance policy interpretation the presence of an occurrence is determined by a subjective test of expectation from the standpoint of the insured. The Second Circuit also held that the assault and battery exclusion excluded only those insureds that committed the assault and battery, not all insureds on the policy. As a result, the Second Circuit ruled in favor of the Archdiocese and concluded that it was entitled to coverage for its claims. This Comment argues that the Second Circuit’s interpretation accurately applied the rules of insurance policy interpretation, as well as the rules of grammar, to correctly interpret these policy provisions

Toward a Phenomenology of Place and Place-Making: Interpreting Landscape, Lifeworld and Aesthetics

Places and place-making are two significant notions in current environmental and architectural literature. Phenomenological research, which is concerned with the essential nature of human experience and consciousness, indicates that the notion of place crystallizes and focuses one essential aspect of human existence - the inescapable requirement to always be somewhere..

Adolescents and Young Adults with Chronic or End-Stage Kidney Disease

Adolescents and young adults face unique and complex physical, psychological, and family challenges. Despite improvements in care for chronic kidney disease (CKD) and end-stage kidney disease (ESKD), long-term mortality for children, adolescents, and young adults with CKD remains substantially higher than their healthy counterparts. In this article, we discuss the complex challenges that adolescent and young adult CKD/ESKD patients face. Adolescents have different CKD etiologies and progress along a course dissimilar to the adult population, but have similar multifarious comorbidities. In the setting of puberty and learning to become self-sufficient, adolescence is a critical time for growth and psychosocial development. Physiological complications of CKD underlie many of the long-term outcomes. CKD-mineral and bone disorder and anemia are particularly challenging given that they are exacerbated by the rapid growth of adolescents. Endocrine imbalances and malnutrition can delay and limit growth. All of these factors, together with family dynamics and socioeconomic status, contribute to the poor long-term outcomes and decreased quality of life (QoL) for these patients and their families. Care for the adolescent CKD/ESKD population is uniquely challenging, but research has identified ways in which we can continue to improve long-term outcomes and QoL for adolescents with CKD/ESKD

Have First-Year Emergency Medicine Residents Achieved Level 1 on Care-Based Milestones?

BACKGROUND: Residents in Accreditation Council for Graduate Medical Education accredited emergency medicine (EM) residencies were assessed on 23 educational milestones to capture their progression from medical student level (Level 1) to that of an EM attending physician (Level 5). Level 1 was conceptualized to be at the level of an incoming postgraduate year (PGY)-1 resident; however, this has not been confirmed. OBJECTIVES: Our primary objective in this study was to assess incoming PGY-1 residents to determine what percentage achieved Level 1 for the 8 emergency department (ED) patient care-based milestones (PC 1-8), as assessed by faculty. Secondary objectives involved assessing what percentage of residents had achieved Level 1 as assessed by themselves, and finally, we calculated the absolute differences between self- and faculty assessments. METHODS: Incoming PGY-1 residents at 4 EM residencies were assessed by faculty and themselves during their first month of residency. Performance anchors were adapted from ACGME milestones. RESULTS: Forty-one residents from 4 programs were included. The percentage of residents who achieved Level 1 for each subcompetency on faculty assessment ranged from 20% to 73%, and on self-assessment from 34% to 92%. The majority did not achieve Level 1 on faculty assessment of milestones PC-2, PC-3, PC-5a, and PC-6, and on self-assessment of PC-3 and PC-5a. Self-assessment was higher than faculty assessment for PC-2, PC-5b, and PC-6. CONCLUSIONS: Less than 75% of PGY-1 residents achieved Level 1 for ED care-based milestones. The majority did not achieve Level 1 on 4 milestones. Self-assessments were higher than faculty assessments for several milestones

SAMHD1 is a single-stranded nucleic acid binding protein with no active site-associated nuclease activity.

The HIV-1 restriction factor SAMHD1 is a tetrameric enzyme activated by guanine nucleotides with dNTP triphosphate hydrolase activity (dNTPase). In addition to this established activity, there have been a series of conflicting reports as to whether the enzyme also possesses single-stranded DNA and/or RNA 3\u27-5\u27 exonuclease activity. SAMHD1 was purified using three chromatography steps, over which the DNase activity was largely separated from the dNTPase activity, but the RNase activity persisted. Surprisingly, we found that catalytic and nucleotide activator site mutants of SAMHD1 with no dNTPase activity retained the exonuclease activities. Thus, the exonuclease activity cannot be associated with any known dNTP binding site. Monomeric SAMHD1 was found to bind preferentially to single-stranded RNA, while the tetrameric form required for dNTPase action bound weakly. ssRNA binding, but not ssDNA, induces higher-order oligomeric states that are distinct from the tetrameric form that binds dNTPs. We conclude that the trace exonuclease activities detected in SAMHD1 preparations arise from persistent contaminants that co-purify with SAMHD1 and not from the HD active site. An in vivo model is suggested where SAMHD1 alternates between the mutually exclusive functions of ssRNA binding and dNTP hydrolysis depending on dNTP pool levels and the presence of viral ssRNA

Using Xbox kinect motion capture technology to improve clinical rehabilitation outcomes for balance and cardiovascular health in an individual with chronic TBI

Background Motion capture virtual reality-based rehabilitation has become more common. However, therapists face challenges to the implementation of virtual reality (VR) in clinical settings. Use of motion capture technology such as the Xbox Kinect may provide a useful rehabilitation tool for the treatment of postural instability and cardiovascular deconditioning in individuals with chronic severe traumatic brain injury (TBI). The primary purpose of this study was to evaluate the effects of a Kinect-based VR intervention using commercially available motion capture games on balance outcomes for an individual with chronic TBI. The secondary purpose was to assess the feasibility of this intervention for eliciting cardiovascular adaptations. Methods A single system experimental design (n = 1) was utilized, which included baseline, intervention, and retention phases. Repeated measures were used to evaluate the effects of an 8-week supervised exercise intervention using two Xbox One Kinect games. Balance was characterized using the dynamic gait index (DGI), functional reach test (FRT), and Limits of Stability (LOS) test on the NeuroCom Balance Master. The LOS assesses end-point excursion (EPE), maximal excursion (MXE), and directional control (DCL) during weight-shifting tasks. Cardiovascular and activity measures were characterized by heart rate at the end of exercise (HRe), total gameplay time (TAT), and time spent in a therapeutic heart rate (TTR) during the Kinect intervention. Chi-square and ANOVA testing were used to analyze the data. Results Dynamic balance, characterized by the DGI, increased during the intervention phase χ 2 (1, N = 12) = 12, p = .001. Static balance, characterized by the FRT showed no significant changes. The EPE increased during the intervention phase in the backward direction χ 2 (1, N = 12) = 5.6, p = .02, and notable improvements of DCL were demonstrated in all directions. HRe (F (2,174) = 29.65, p = \u3c .001) and time in a TTR (F (2, 12) = 4.19, p = .04) decreased over the course of the intervention phase. Conclusions Use of a supervised Kinect-based program that incorporated commercial games improved dynamic balance for an individual post severe TBI. Additionally, moderate cardiovascular activity was achieved through motion capture gaming. Further studies appear warranted to determine the potential therapeutic utility of commercial VR games in this patient population. Trial registration Clinicaltrial.gov ID - NCT0288928

Development of a Unique Student Pharmacist Internship in a Primary Care Provider System

Purpose: To describe a unique pharmacy intern program in a group of federally qualified health center (FQHC) outpatient primary care provider clinics. Summary: A pharmacy intern program was created at the North Central Nursing Clinics in Indiana, a group of four FQHC outpatient primary care provider facilities. Intern-performed tasks included: Prior authorization (PA) requests, medication assistance program (MAP) applications, sample procurement and inventory, and contraceptive devices for implantation inventory management. Interns interacted with clinic administration, nurse practitioners, and medical staff to complete their assigned responsibilities. Over a one-year period, the interns completed documentation on more than 2000 charts during a combined 12 h a week. Interns identified the interprofessional interactions as the most beneficial experience, while providers acknowledged no difference in the processing of paperwork during the transition of duties from pharmacy fellow to intern. Conclusion: This unique pharmacy intern program was successfully created and implemented in a primary care provider office, resulting in learning opportunities for pharmacy interns, as well as operational efficiencies to fellows, providers, and the organization