When Torts Met Civil Procedure: A Curricular Coupling

Law students must become adept at understanding how various bodies of law interact-supporting, balancing, and even conflicting with each other. This article describes an attempt to achieve these goals by merging two canonical first-year courses, civil procedure and torts, into an integrated class titled ‘Introduction to Civil Litigation’. Our most pressing motivation was concern that students who study civil procedure and torts in isolation develop a skewed, unrealistic view of how law works in the real world. By combining these courses, we hoped to teach students early in their careers to approach problems more like practicing lawyers, who must deal with multiple bodies of law simultaneously. And while the course did yield a higher level of practice readiness, the experience also brought unexpected rewards to both students and faculty. As we developed and refined the course, we discovered that we were not just merging two courses. We were bringing together two different perspectives on how the law functions. We came to believe that more can be gained by viewing torts and civil procedure together than by studying them apart. Torts and Civil Procedure tell different sides of the same story

Clinical Utility of Random Anti–Tumor Necrosis Factor Drug–Level Testing and Measurement of Antidrug Antibodies on the Long-Term Treatment Response in Rheumatoid Arthritis

Objective: To investigate whether antidrug antibodies and/or drug non-trough levels predict the long-term treatment response in a large cohort of patients with rheumatoid arthritis (RA) treated with adalimumab or etanercept and to identify factors influencing antidrug antibody and drug levels to optimize future treatment decisions.  Methods: A total of 331 patients from an observational prospective cohort were selected (160 patients treated with adalimumab and 171 treated with etanercept). Antidrug antibody levels were measured by radioimmunoassay, and drug levels were measured by enzyme-linked immunosorbent assay in 835 serial serum samples obtained 3, 6, and 12 months after initiation of therapy. The association between antidrug antibodies and drug non-trough levels and the treatment response (change in the Disease Activity Score in 28 joints) was evaluated.  Results: Among patients who completed 12 months of followup, antidrug antibodies were detected in 24.8% of those receiving adalimumab (31 of 125) and in none of those receiving etanercept. At 3 months, antidrug antibody formation and low adalimumab levels were significant predictors of no response according to the European League Against Rheumatism (EULAR) criteria at 12 months (area under the receiver operating characteristic curve 0.71 [95% confidence interval (95% CI) 0.57, 0.85]). Antidrug antibody–positive patients received lower median dosages of methotrexate compared with antidrug antibody–negative patients (15 mg/week versus 20 mg/week; P = 0.01) and had a longer disease duration (14.0 versus 7.7 years; P = 0.03). The adalimumab level was the best predictor of change in the DAS28 at 12 months, after adjustment for confounders (regression coefficient 0.060 [95% CI 0.015, 0.10], P = 0.009). Etanercept levels were associated with the EULAR response at 12 months (regression coefficient 0.088 [95% CI 0.019, 0.16], P = 0.012); however, this difference was not significant after adjustment. A body mass index of ≥30 kg/m2 and poor adherence were associated with lower drug levels.  Conclusion: Pharmacologic testing in anti–tumor necrosis factor–treated patients is clinically useful even in the absence of trough levels. At 3 months, antidrug antibodies and low adalimumab levels are significant predictors of no response according to the EULAR criteria at 12 months

Influence of socioeconomic factors on pregnancy outcome in women with structural heart disease

OBJECTIVE: Cardiac disease is the leading cause of indirect maternal mortality. The aim of this study was to analyse to what extent socioeconomic factors influence the outcome of pregnancy in women with heart disease.  METHODS: The Registry of Pregnancy and Cardiac disease is a global prospective registry. For this analysis, countries that enrolled ≥10 patients were included. A combined cardiac endpoint included maternal cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, hospitalisation for cardiac reason or intervention. Associations between patient characteristics, country characteristics (income inequality expressed as Gini coefficient, health expenditure, schooling, gross domestic product, birth rate and hospital beds) and cardiac endpoints were checked in a three-level model (patient-centre-country).  RESULTS: A total of 30 countries enrolled 2924 patients from 89 centres. At least one endpoint occurred in 645 women (22.1%). Maternal age, New York Heart Association classification and modified WHO risk classification were associated with the combined endpoint and explained 37% of variance in outcome. Gini coefficient and country-specific birth rate explained an additional 4%. There were large differences between the individual countries, but the need for multilevel modelling to account for these differences disappeared after adjustment for patient characteristics, Gini and country-specific birth rate.  CONCLUSION: While there are definite interregional differences in pregnancy outcome in women with cardiac disease, these differences seem to be mainly driven by individual patient characteristics. Adjustment for country characteristics refined the results to a limited extent, but maternal condition seems to be the main determinant of outcome

Community prevalence of SARS-CoV-2 in England from April to November, 2020: results from the ONS Coronavirus Infection Survey

Background: Decisions about the continued need for control measures to contain the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rely on accurate and up-to-date information about the number of people testing positive for SARS-CoV-2 and risk factors for testing positive. Existing surveillance systems are generally not based on population samples and are not longitudinal in design. Methods: Samples were collected from individuals aged 2 years and older living in private households in England that were randomly selected from address lists and previous Office for National Statistics surveys in repeated crosssectional household surveys with additional serial sampling and longitudinal follow-up. Participants completed a questionnaire and did nose and throat self-swabs. The percentage of individuals testing positive for SARS-CoV-2 RNA was estimated over time by use of dynamic multilevel regression and poststratification, to account for potential residual non-representativeness. Potential changes in risk factors for testing positive over time were also assessed. The study is registered with the ISRCTN Registry, ISRCTN21086382. Findings: Between April 26 and Nov 1, 2020, results were available from 1 191 170 samples from 280327 individuals; 5231 samples were positive overall, from 3923 individuals. The percentage of people testing positive for SARS-CoV-2 changed substantially over time, with an initial decrease between April 26 and June 28, 2020, from 0·40% (95% credible interval 0·29–0·54) to 0·06% (0·04–0·07), followed by low levels during July and August, 2020, before substantial increases at the end of August, 2020, with percentages testing positive above 1% from the end of October, 2020. Having a patient facing role and working outside your home were important risk factors for testing positive for SARS-CoV-2 at the end of the first wave (April 26 to June 28, 2020), but not in the second wave (from the end of August to Nov 1, 2020). Age (young adults, particularly those aged 17–24 years) was an important initial driver of increased positivity rates in the second wave. For example, the estimated percentage of individuals testing positive was more than six times higher in those aged 17–24 years than in those aged 70 years or older at the end of September, 2020. A substantial proportion of infections were in individuals not reporting symptoms around their positive test (45–68%, dependent on calendar time. Interpretation: Important risk factors for testing positive for SARS-CoV-2 varied substantially between the part of the first wave that was captured by the study (April to June, 2020) and the first part of the second wave of increased positivity rates (end of August to Nov 1, 2020), and a substantial proportion of infections were in individuals not reporting symptoms, indicating that continued monitoring for SARS-CoV-2 in the community will be important for managing the COVID-19 pandemic moving forwards

The Meaningful Participation of ‘Stakeholders’ in Global Drug Policy Debates—A Policy Comment

This policy comment seeks to address three key questions relating to the participation of civil society in international drug policymaking. Firstly, who are the relevant ‘stakeholders’ and what options do they have to participate in drug policy discussions at the United Nations level? Secondly, have certain ‘stakeholders’ been able to positively influence the direction of global drug policies? And thirdly, who are the ‘most affected’ communities and what could be done to improve their meaningful engagement in the definition of drug policies that directly impact their lives? Unpacking the terminology around civil society, stakeholders, and most affected communities, the chapter argues for a clearer distinction between ‘rights-holders’ and ‘duty-bearers’. Masking the inherent power imbalances between the different stakeholders risks underplaying the rights of affected communities and legitimising a place at the table for corporations as ‘equal actors’ in spite of fundamentally different interests. The commentary concludes that the increased involvement over the past decade of civil society as well as other United Nations entities around the 2016 United Nations General Assembly Special Session on the World Drug Problem (UNGASS) has markedly influenced the global drug policy debate by shifting more attention towards health, human rights and development concerns.Cette contribution vise à répondre à trois questions essentielles concernant la participation de la société civile dans l’élaboration de la politique internationale en matière de drogues. D’abord, qui sont les « acteurs » pertinents, et quels sont leurs possibilités de participation aux débats sur le sujet aux Nations Unies ? Ensuite, certaines de ces parties prenantes sont-elles parvenues à influencer de manière positive l’orientation des politiques anti-drogue internationales ? Et troisièmement, qui sont les communautés les plus affectées et quelles actions pourraient être entreprises pour améliorer leur participation effective à l’élaboration des politiques anti-drogue qui affectent directement leurs vies ? À partir d’un examen de la terminologie entourant les notions de société civile, d’acteurs ou de parties prenantes, et des communautés les plus touchées, l’auteure prône une distinction plus claire entre les « détenteurs de droits » et les « porteurs d’obligation ». Le masquage des déséquilibres de pouvoir inhérents entre les différentes parties prenantes risque de minorer les droits des communautés touchées et de légitimer une place à la table des négociations pour les entreprises en tant qu’« acteurs égaux » en dépit d'intérêts fondamentalement différents. En conclusion, l’auteure de cet article montre que l’implication croissante, cette dernière décennie, de la société civile et de certaines institutions des Nations Unies autour de la Session extraordinaire de l'Assemblée générale des Nations unies sur le problème mondial de la drogue (UNGASS) de 2016 a influencé de manière marquante le débat international sur la drogue en portant plus d’attention aux questions liées à la santé, aux droits humains et au développement.En la presente reflexión política se pretenden abordar tres preguntas fundamentales relacionadas con la participación de la sociedad civil en la formulación de políticas internacionales de drogas. En primer lugar, ¿cuáles son las “partes interesadas” pertinentes y qué posibilidades tienen estas de participar en las discusiones sobre políticas de drogas en el marco de las Naciones Unidas? En segundo lugar, ¿han sido capaces algunas “partes interesadas” de influenciar positivamente la orientación de las políticas de drogas mundiales? Y en tercer lugar, ¿cuáles son las comunidades “más afectadas” por dichas políticas y cómo podría ampliarse su compromiso significativo en la definición de aquellas políticas que tienen repercusiones directas en sus propias vidas? Mediante el desglose de la terminología existente en torno a la sociedad civil, las partes interesadas y las comunidades más afectadas, el presente capítulo aboga por un distinción más clara entre los “titulares de derechos” y los ‘titulares de obligaciones”. El ocultamiento de los desequilibrios de poder intrínsecos que existen entre las distintas partes interesadas podría disminuir los derechos de las comunidades afectadas y legitimar que las empresas ocupen un lugar en los debates como “protagonistas plenos”, a pesar de tener intereses fundamentalmente distintos. Esta reflexión concluye que en la última década, la participación creciente de la sociedad civil y de otras entidades de la ONU en torno al Período extraordinario de sesiones de 2016 de la Asamblea General de las Naciones Unidas sobre el problema mundial de las drogas (UNGASS), ha ejercido una influencia notable en el debate sobre las políticas internacionales de drogas, al trasladar una mayor atención hacia las cuestiones de la salud, los derechos humanos y el desarrollo

The meaningful participation of ‘stakeholders’ in global drug policy debates—a policy comment.

This policy comment seeks to address three key questions relating to the participation of civil society in international drug policymaking. Firstly, who are the relevant ‘stakeholders’ and what options do they have to participate in drug policy discussions at the United Nations level? Secondly, have certain ‘stakeholders’ been able to positively influence the direction of global drug policies? And thirdly, who are the ‘most affected’ communities and what could be done to improve their meaningful engagement in the definition of drug policies that directly impact their lives? Unpacking the terminology around civil society, stakeholders, and most affected communities, the chapter argues for a clearer distinction between ‘rights-holders’ and ‘duty-bearers’. Masking the inherent power imbalances between the different stakeholders risks underplaying the rights of affected communities and legitimising a place at the table for corporations as ‘equal actors’ in spite of fundamentally different interests. The commentary concludes that the increased involvement over the past decade of civil society as well as other United Nations entities around the 2016 United Nations General Assembly Special Session on the World Drug Problem (UNGASS) has markedly influenced the global drug policy debate by shifting more attention towards health, human rights and development concerns.Cette contribution vise à répondre à trois questions essentielles concernant la participation de la société civile dans l’élaboration de la politique internationale en matière de drogues. D’abord, qui sont les « acteurs » pertinents, et quels sont leurs possibilités de participation aux débats sur le sujet aux Nations Unies ? Ensuite, certaines de ces parties prenantes sont-elles parvenues à influencer de manière positive l’orientation des politiques anti-drogue internationales ? Et troisièmement, qui sont les communautés les plus affectées et quelles actions pourraient être entreprises pour améliorer leur participation effective à l’élaboration des politiques anti-drogue qui affectent directement leurs vies ? À partir d’un examen de la terminologie entourant les notions de société civile, d’acteurs ou de parties prenantes, et des communautés les plus touchées, l’auteure prône une distinction plus claire entre les « détenteurs de droits » et les « porteurs d’obligation ». Le masquage des déséquilibres de pouvoir inhérents entre les différentes parties prenantes risque de minorer les droits des communautés touchées et de légitimer une place à la table des négociations pour les entreprises en tant qu’« acteurs égaux » en dépit d'intérêts fondamentalement différents. En conclusion, l’auteure de cet article montre que l’implication croissante, cette dernière décennie, de la société civile et de certaines institutions des Nations Unies autour de la Session extraordinaire de l'Assemblée générale des Nations unies sur le problème mondial de la drogue (UNGASS) de 2016 a influencé de manière marquante le débat international sur la drogue en portant plus d’attention aux questions liées à la santé, aux droits humains et au développement.En la presente reflexión política se pretenden abordar tres preguntas fundamentales relacionadas con la participación de la sociedad civil en la formulación de políticas internacionales de drogas. En primer lugar, ¿cuáles son las “partes interesadas” pertinentes y qué posibilidades tienen estas de participar en las discusiones sobre políticas de drogas en el marco de las Naciones Unidas? En segundo lugar, ¿han sido capaces algunas “partes interesadas” de influenciar positivamente la orientación de las políticas de drogas mundiales? Y en tercer lugar, ¿cuáles son las comunidades “más afectadas” por dichas políticas y cómo podría ampliarse su compromiso significativo en la definición de aquellas políticas que tienen repercusiones directas en sus propias vidas? Mediante el desglose de la terminología existente en torno a la sociedad civil, las partes interesadas y las comunidades más afectadas, el presente capítulo aboga por un distinción más clara entre los “titulares de derechos” y los ‘titulares de obligaciones”. El ocultamiento de los desequilibrios de poder intrínsecos que existen entre las distintas partes interesadas podría disminuir los derechos de las comunidades afectadas y legitimar que las empresas ocupen un lugar en los debates como “protagonistas plenos”, a pesar de tener intereses fundamentalmente distintos. Esta reflexión concluye que en la última década, la participación creciente de la sociedad civil y de otras entidades de la ONU en torno al Período extraordinario de sesiones de 2016 de la Asamblea General de las Naciones Unidas sobre el problema mundial de las drogas (UNGASS), ha ejercido una influencia notable en el debate sobre las políticas internacionales de drogas, al trasladar una mayor atención hacia las cuestiones de la salud, los derechos humanos y el desarrollo