36 research outputs found
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1 in 8 Californians with a Criminal Record is Potentially Eligible for Full Record Clearance
Assembly Bill 1076 proposes to extend automatic record clearance in California to certain eligible arrests and convictions. If passed, the California Department of Justice (CA DOJ) would, beginning in 2021, identify persons eligible for relief and grant relief without requiring the person to file a petition. The California Policy Lab (CPL) created a computer program to identify eligible arrests and convictions using CA DOJ’s Automated Criminal History System (ACHS). We found that 1 in 8 Californians with a criminal record are potentially eligible to have their full record cleared. Further, approximately 81% of persons with a criminal record are potentially eligible for relief of at least one arrest or conviction (approximately 1.8 million persons in the study cohort).This work has been supported, in part, by the University of California Multicampus Research Programs and Initiatives grant MRP-19-600774
Stand by Me: Using an Enhanced Recovery After Surgery (ERAS) Checklist to Guide Early Mobility of Postoperative Craniotomy Patients on a Progressive Care Unit
Native Voices Rising: A Case for Funding Native-led Change
Native American organizations face enormous challenges to their communities, their lands and environment, and their basic rights as Indigenous peoples. They face these challenges with limited support from the broad spectrum of America's philanthropic institutions. Far too many foundations simply give little to nothing at all in support of Native causes, a situation that requires corrective action designed to close the enormous gap between foundation giving and the needs of Native communities. The low level of charitable foundation funding (.3%) going to Native causes, and the need to garner more support for Native organizing and advocacy work, in particular, prompted the Common Counsel Foundation and Native Americans in Philanthropy to jointly sponsor this research project that is focused on Native organizations which undergird the following five movements: Environmental Justice, Subsistence in Alaska, Native Engagement in the Urban Context, Media and Voter Engagement. The organizations varied considerably in experience and the methods they use to pursue change. They fulfill many roles in their respective communities, such as: advocates, organizers, service providers, and community builders. A key role is that they serve as places where people can acquire knowledge and skills that enable them to assume leadership roles in the organization and in the community. Leadership development is essential to maintaining and advancing these movements. Most importantly, Native self-determination and sovereignty is reinforced through the work of these organizations. To accomplish these goals, three sets of data were compiled. First, Native organizations in the targeted movements were contacted to obtain basic information that could be used to write brief thumbnail sketches about their organizations that included mission statements, current organizing and advocacy efforts, and contact information. Second, in-depth interviews were conducted with approximately 10 organizational leaders in each of the five movements to build a deeper understanding of how the organizations pursue their organizing and advocacy agendas, and seek change in their communities. Third, case studies of ten exemplary organizations, two in each movement, were compiled to illustrate the magnitude of the work. Representatives of 501(c)3 organizations, organizations using fiscal agents, and a few tribal governments and village councils participated in the study. In total, 146 organizations responded. Representatives from 49 of these organizations gave more intensive, in-depth interviews. Thumbnail sketches of all 146 organizations, the 10 case studies, as well as contextual information about each movement are contained in the full report
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The role of drug resistance in poor viral suppression in rural South Africa: findings from a population-based study.
BACKGROUND:Understanding factors driving virological failure, including the contribution of HIV drug resistance mutations (DRM), is critical to ensuring HIV treatment remains effective. We examine the contribution of drug resistance mutations for low viral suppression in HIV-positive participants in a population-based sero-prevalence survey in rural South Africa. METHODS:We conducted HIV drug resistance genotyping and ART analyte testing on dried blood spots (DBS) from HIV-positive adults participating in a 2014 survey in North West Province. Among those with virologic failure (> 5000 copies/mL), we describe frequency of DRM to protease inhibitors (PI), nucleoside reverse transcriptase inhibitors (NRTI), and non-nucleoside reverse transcriptase inhibitors (NNRTI), report association of resistance with antiretroviral therapy (ART) status, and assess resistance to first and second line therapy. Analyses are weighted to account for sampling design. RESULTS:Overall 170 DBS samples were assayed for viral load and ART analytes; 78.4% of men and 50.0% of women had evidence of virologic failure and were assessed for drug resistance, with successful sequencing of 76/107 samples. We found ≥1 DRM in 22% of participants; 47% were from samples with detectable analyte (efavirenz, nevirapine or lopinavir). Of those with DRM and detectable analyte, 60% showed high-level resistance and reduced predicted virologic response to ≥1 NRTI/NNRTI typically used in first and second-line regimens. CONCLUSIONS:DRM and predicted reduced susceptibility to first and second-line regimens were common among adults with ART exposure in a rural South African population-based sample. Results underscore the importance of ongoing virologic monitoring, regimen optimization and adherence counseling to optimize durable virologic suppression
Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens
Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019
Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019.
Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019
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Proposition 47: Effects of a California Drug Law Reform on Hospital Visits and Racial and Geographic Disparities in Criminal Justice Involvement
Disparate rates of felony drug arrests and convictions across race and geography have implications for inequalities in health and social outcomes linked to criminal justice exposure. California Proposition 47 (Prop 47), passed in 2014, reduced drug possession offenses classified as felonies or wobblers (with prosecutorial discretion to file felony or misdemeanor charges) to misdemeanors. This dissertation examines three effects of Prop 47: 1) whether racial/ethnic disparities in drug arrests declined; 2) whether eliminating prosecutorial discretion for charging drug possession as a felony or misdemeanor reduced geographic disparities in felony convictions; and 3) unintended consequences with regards to drug-related hospital visits. For objective 1: using data on all drug arrests made in California from 2011-2016, we compared the immediate and one year post-policy changes in racial disparities in drug arrests between Whites, Blacks, and Latinos, controlling for secular and seasonal trends. For objective 2: after propensity score matching arrests made in the year after the implementation of Prop 47 to similar arrests in the year prior to Prop 47, we used mixed models to estimate the change in county variance in the probability of felony conviction. For objective 3: Incorporating data on all drug-related hospital visits in California from 2011-2015 with drug arrests data, we use county fixed effects models to estimate expected rates in the 10-months post-policy, and calculate the difference compared to observed rates. We use linear regression to test whether county-level changes in drug arrest rates were associated with changes in drug-related hospital visit rates. In the month following passage, absolute Black-White disparities in monthly felony drug arrests decreased from 81 to 44 per 100,000 and continued to decrease over time. The probability of a felony conviction among those arrested for Prop 47 drug offenses declined by 14 percentage points (95% CI: -0.16, -0.12), from 0.21 (95% CI: 0.19, 0.24) to 0.07 (95% CI: 0.06, 0.08). Counties with higher felony conviction probabilities pre-Prop 47 declined most, reducing cross-county variance, with no evidence of increases in felony convictions for concurrent offenses. Declines in arrests were not associated with increases in drug-related hospital visits