Reassigning Cases on Remand in the Interests of Justice, for the Enforcement of Appellate Decisions, and for Other Reasons That Remain Unclear

Federal appellate courts have the authority to order reassignment of cases to different district judges as part of their supervisory authority over the district courts within their circuits. This Article examines the categories of cases in which the Eleventh Circuit has ordered reassignment to different district court judges on remand and explains the rationale underlying reassignment in each category. The more understandable cases address both the appearance and the presence of bias or impropriety by the original trial judge. This Article describes the general principles underlying the Eleventh Circuit’s reassignment practices and then questions why reassignment is necessary in cases involving government breaches of plea agreements where none of the usual reasons underlying reassignment seem to exist. In United States v. Torkington, the Eleventh Circuit extended the principle underlying reassignment beyond cases involving an erroneous refusal of the trial judge to recuse himself or herself. While the Torkington test addresses problems regarding the original trial judge’s bias, appearance of bias, recalcitrance, or missteps, there is an interesting deviation from these bases for reassignment in cases involving breached plea agreements. Relying on the United States Supreme Court’s decision in Santobello v. New York, the Eleventh Circuit holds that the available remedies in a case where the prosecution breaches a plea agreement by making sentencing arguments or recommendations it promised not to make are either for the defendant to be allowed to withdraw his guilty plea or for the case to be remanded for resentencing by a different judge. The Eleventh Circuit reasoned that the trial judge who heard the prosecutor’s improper sentencing argument cannot un-hear that argument when the case is remanded for resentencing. Yet, trial judges (and even lay jurors) are routinely presumed to be able to disregard improper evidence and arguments. The rationale for reassignment in breached plea agreement cases remains curiously unexplored and seemingly at odds with the rationales underlying reassignment in other scenarios. This Article suggests that the Eleventh Circuit may wish to consider formalizing its reassignment practices and criteria by local rule

Survival Data and Predictors of Functional Outcome an Average of 15 Years after the Fontan Procedure: The Pediatric Heart Network Fontan Cohort

ObjectiveMulticenter longitudinal outcome data for Fontan patients surviving into adulthood are lacking. The aim of this study was to better understand contemporary outcomes in Fontan survivors by collecting follow‐up data in a previously well‐characterized cohort.DesignBaseline data from the Fontan Cross‐Sectional Study (Fontan 1) were previously obtained in 546 Fontan survivors aged 11.9 ± 3.4 years. We assessed current transplant‐free survival status in all subjects 6.8 ± 0.4 years after the Fontan 1 study. Anatomic, clinical, and surgical data were collected along with socioeconomic status and access to health care.ResultsThirty subjects (5%) died or underwent transplantation since Fontan 1. Subjects with both an elevated (>21 pg/mL) brain natriuretic peptide and a low Child Health Questionnaire physical summary score (<44) measured at Fontan 1 were significantly more likely to die or undergo transplant than the remainder, with a hazard ratio of 6.2 (2.9–13.5). Among 516 Fontan survivors, 427 (83%) enrolled in this follow‐up study (Fontan 2) at 18.4 ± 3.4 years of age. Although mean scores on functional health status questionnaires were lower than the general population, individual scores were within the normal range in 78% and 88% of subjects for the Child Health Questionnaire physical and psychosocial summary score, and 97% and 91% for the SF‐36 physical and mental aggregate score, respectively. Since Fontan surgery, 119 (28%) had additional cardiac surgery; 55% of these (n = 66) in the interim between Fontan 1 and Fontan 2. A catheter intervention occurred in 242 (57%); 32% of these (n = 78) after Fontan 1. Arrhythmia requiring treatment developed in 118 (28%) after Fontan surgery; 58% of these (n = 68) since Fontan 1.ConclusionsWe found 95% interim transplant‐free survival for Fontan survivors over an average of 7 years of follow‐up. Continued longitudinal investigation into adulthood is necessary to better understand the determinants of long‐term outcomes and to improve functional health status.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110738/1/chd12193.pd

Myosin Sequestration Regulates Sarcomere Function, Cardiomyocyte Energetics, and Metabolism, Informing the Pathogenesis of Hypertrophic Cardiomyopathy

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is caused by pathogenic variants in sarcomere protein genes that evoke hypercontractility, poor relaxation, and increased energy consumption by the heart and increased patient risks for arrhythmias and heart failure. Recent studies show that pathogenic missense variants in myosin, the molecular motor of the sarcomere, are clustered in residues that participate in dynamic conformational states of sarcomere proteins. We hypothesized that these conformations are essential to adapt contractile output for energy conservation and that pathophysiology of HCM results from destabilization of these conformations. METHODS: We assayed myosin ATP binding to define the proportion of myosins in the super relaxed state (SRX) conformation or the disordered relaxed state (DRX) conformation in healthy rodent and human hearts, at baseline and in response to reduced hemodynamic demands of hibernation or pathogenic HCM variants. To determine the relationships between myosin conformations, sarcomere function, and cell biology, we assessed contractility, relaxation, and cardiomyocyte morphology and metabolism, with and without an allosteric modulator of myosin ATPase activity. We then tested whether the positions of myosin variants of unknown clinical significance that were identified in patients with HCM, predicted functional consequences and associations with heart failure and arrhythmias. RESULTS: Myosins undergo physiological shifts between the SRX conformation that maximizes energy conservation and the DRX conformation that enables cross-bridge formation with greater ATP consumption. Systemic hemodynamic requirements, pharmacological modulators of myosin, and pathogenic myosin missense mutations influenced the proportions of these conformations. Hibernation increased the proportion of myosins in the SRX conformation, whereas pathogenic variants destabilized these and increased the proportion of myosins in the DRX conformation, which enhanced cardiomyocyte contractility, but impaired relaxation and evoked hypertrophic remodeling with increased energetic stress. Using structural locations to stratify variants of unknown clinical significance, we showed that the variants that destabilized myosin conformations were associated with higher rates of heart failure and arrhythmias in patients with HCM. CONCLUSIONS: Myosin conformations establish work-energy equipoise that is essential for life-long cellular homeostasis and heart function. Destabilization of myosin energy-conserving states promotes contractile abnormalities, morphological and metabolic remodeling, and adverse clinical outcomes in patients with HCM. Therapeutic restabilization corrects cellular contractile and metabolic phenotypes and may limit these adverse clinical outcomes in patients with HCM

Reassigning Cases on Remand in the Interests of Justice, for the Enforcement of Appellate Decisions, and for Other Reasons That Remain Unclear

Federal appellate courts have the authority to order reassignment of cases to different district judges as part of their supervisory authority over the district courts within their circuits. This Article examines the categories of cases in which the Eleventh Circuit has ordered reassignment to different district court judges on remand and explains the rationale underlying reassignment in each category. The more understandable cases address both the appearance and the presence of bias or impropriety by the original trial judge. This Article describes the general principles underlying the Eleventh Circuit’s reassignment practices and then questions why reassignment is necessary in cases involving government breaches of plea agreements where none of the usual reasons underlying reassignment seem to exist. In United States v. Torkington, the Eleventh Circuit extended the principle underlying reassignment beyond cases involving an erroneous refusal of the trial judge to recuse himself or herself. While the Torkington test addresses problems regarding the original trial judge’s bias, appearance of bias, recalcitrance, or missteps, there is an interesting deviation from these bases for reassignment in cases involving breached plea agreements. Relying on the United States Supreme Court’s decision in Santobello v. New York, the Eleventh Circuit holds that the available remedies in a case where the prosecution breaches a plea agreement by making sentencing arguments or recommendations it promised not to make are either for the defendant to be allowed to withdraw his guilty plea or for the case to be remanded for resentencing by a different judge. The Eleventh Circuit reasoned that the trial judge who heard the prosecutor’s improper sentencing argument cannot un-hear that argument when the case is remanded for resentencing. Yet, trial judges (and even lay jurors) are routinely presumed to be able to disregard improper evidence and arguments. The rationale for reassignment in breached plea agreement cases remains curiously unexplored and seemingly at odds with the rationales underlying reassignment in other scenarios. This Article suggests that the Eleventh Circuit may wish to consider formalizing its reassignment practices and criteria by local rule

Assessing the global and regional impact of primary cardiomyopathies: The Global Burden of Diseases, Injuries and Risk Factors (GBD 2010) Study

Primary cardiomyopathies affect individuals of all ages and ethnic groups in all regions of the world and are associated with significant morbidity and mortality. Though these conditions are globally prevalent, lack of rigorous epidemiological analysis on a worldwide scale has prevented accurate estimates of the burden of this subset of cardiac diseases on regional populations. The Global Burden of Diseases, Injuries and Risk Factors (GBD 2010) Study was designed to address such analytical shortfalls by delivering data-driven estimates of epidemiological parameters for nearly 200 diseases and injuries, including the primary cardiomyopathies. The methodology utilized to generate GBD 2010 disease burden estimates for the primary cardiomyopathies is described. Preliminary epidemiologic data for the study's 21 global regions is then presented and discussed, along with evaluation of challenges and future opportunities in addressing the burden of primary cardiomyopathies