Raised on the Registry: The Irreparable Harm of Placing Children on Sex Offender Registries in the U.S.

Throughout the United States, children who are adjudicated delinquent for sexual offenses must comply with a complex and onerous array of legal requirements that apply to all individuals convicted of sexual offenses, regardless of age. Upon release from juvenile detention or prison, these young people are subject to registration laws that require them to continually update and disclose personal information, including a current photograph, height, weight, age, current address, school attendance, and place of employment. Registrants must update this information so that it remains current in each jurisdiction in which they reside, work, or attend school. Often, the requirement to register lasts for decades and even a lifetime, and failure to adhere to registration, community notification, or residency restriction laws can lead to a felony conviction for failure to register, with lasting consequences for a young person's life.The harm befalling young people placed on registries can be devastating. They experience severe psychological harm. They are stigmatized, isolated, and depressed. Many consider suicide, and some do ultimately end their lives. Children on the registry are sometimes denied access to education because residency restriction laws prevent them from being in or near a school; these youth often despair of ever finding employment, even while they are burdened with mandatory fees related to registration that can reach into the hundreds of dollars on an annual basis. Young registrants often cannot find housing that meets residency restriction rules, and so they and their families often experience periods of homelessness. Families of children on the registry also confront enormous obstacles in living together as a family—often because registrants are prohibited from living with other children.Finally, the impacts of being a young person subject to registration are multi-generational—affecting their parents, and later in life, their children and partners. The children of people placed on registries as children often cannot be dropped off at school by their parent, may be banned by law from hosting a birthday party involving other children at their home, and they are often harassed and ridiculed by their peers for their parents' long-past transgressions.Federal and state laws on sex offender registration and notification fail to take into account fundamental differences between children and adults. These include not only differences in cognitive capacity, which affect their culpability, but also differences in their amenability to rehabilitation, in the nature of their sexual behaviors and offenses and in the likelihood that they will reoffend. Indeed, there is no scientific foundation for the belief that children who are convicted of sexual offenses pose any danger of future sexual offending. Once detected, most adolescents who have engaged in sexually offensive behavior do not continue to engage in these behaviors. And contrary to common public perceptions, empirical evidence suggests that putting young people on registries does not advance community safety but instead overburdens law enforcement with large numbers of people to monitor, undifferentiated by their risk of recidivism.This report challenges the view that registration laws and related restrictions are an appropriate response for children convicted of sexual offenses. While the law does not formally recognize registration as a punishment, Nicole Pittman and Human Rights Watch's report illustrates through the stories of directly impacted individuals the irreparable harm done to young people subject to these policies and their loved ones

Building Quality Improvement Systems: Lessons from Three Emerging Efforts in the Youth-Serving Sector

Quality is fast becoming a policy priority in states and localities around the country. As a result, formal and informal networks of youth organizations are seeking and developing strategies to help them assess and improve performance. This report takes a close look at efforts underway in three networks and provides a preliminary framework for thinking about key questions when planning any kind of program quality improvement work in the youth-serving sector

The Impact of Student Motivation on Participation and Academic Performance in Distance Learning

This study investigated the impact of motivation on students’ participation and academic performance in distance learning. Distance learning continues to grow in popularity as more and more students enroll in distance education courses. These courses require more responsibility on the part of the student. Some students are unaware of the amount of work that is involved with these courses which can cause them to become overwhelmed and discouraged, possibly leading them to drop the course. Students need to be able to rely on their own individual abilities to be successful in distance learning (Hodges, 2005). At the same time, educators must also modify their instructional design when transitioning from face-toace instruction to web-based instruction (Lei & Gupta, 2010). Improved technologies can provide the means for instructors to increase the quality of learning in distance education. Technologies, such as asynchronous discussion boards allow instructors to become facilitators of learning while providing students with the opportunity to learn from one another through interaction. The use of asynchronous technologies has been known to provide several benefits for students. Those benefits include: (a) increasing student learning by helping students develop high-level concepts and skills, (b) decreasing the likelihood of procrastination, and (c) strengthening students’ self-motivation and responsibility (Abrami & Bures, 1996; Barker, 2003; Kitchen & McDougall, 1999). Twenty-nine upperclassmen and graduate students participated in this study during the summer of 2012. Using data gathered from the Motivated Strategies for Learning Questionnaire (MSLQ) and discussion board content, the researcher found student motivation to be associated with participation but not with academic performance. Also, associations were found to exist between participation and academic performance. In addition, self-efficacy, intrinsic and extrinsic goal orientation was found to be predictors of participation. The results indicate that some motivational constructs are contributing factors of student success in distance learning. Instructors and instructional designers should seek to include tools that can allow students to help themselves remain motivated while actively participating in the course. Future research should examine other learning strategies variables to determine if they may have an impact on participation and academic performance

Dexamethasone as Abortive Treatment for Refractory Seizures or Status Epilepticus in the Inpatient Setting

Refractory seizures or status epilepticus (RS/SE) continues to be a challenge in the inpatient setting. Failure to abort a seizure with antiepileptic drugs (AEDs) may lead to intubation and treatment with general anesthesia exposing patients to complications, extending hospitalization, and increasing the cost of care. Studies have shown a key role of inflammatory mediators in seizure generation and termination. We describe 4 patients with RS/SE that was aborted when dexamethasone was added to conventional AEDs: a 61-year-old female with temporal lobe epilepsy who presented with delirium, nonconvulsive status epilepticus, and oculomyoclonic status; a 56-year-old female with history of traumatic left frontal lobe hemorrhage who developed right face and hand epilepsia partialis continua followed by refractory focal clonic seizures; a 51-year-old male with history of traumatic intracranial hemorrhage who exhibited left-sided epilepsia partialis continua; and a 75-year-old female with history of breast cancer who manifested nonconvulsive status epilepticus and refractory focal clonic seizures. All patients continued experiencing RS/SE despite first- and second-line therapy, and one patient continued to experience RS/SE despite third-line therapy. Failure to abort RS/SE with conventional therapy motivated us to administer intravenous dexamethasone. A 10-mg load was given (except in one patient) followed by 4.0- 5.2 mg q6h. All clinical and electrographic seizures stopped 3-4 days after starting dexamethasone. When dexamethasone was discontinued 1-3 days after seizures stopped, all patients remained seizure-free on 2-3 AEDs. The cessation of RS/SE when dexamethasone was added to conventional antiseizure therapy suggests that inflammatory processes are involved in the pathogenesis of RS/SE

Part I. SARS-CoV-2 triggered \u27PANIC\u27 attack in severe COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has produced a world-wide collapse of social and economic infrastructure, as well as constrained our freedom of movement. This respiratory tract infection is nefarious in how it targets the most distal and highly vulnerable aspect of the human bronchopulmonary tree, specifically, the delicate yet irreplaceable alveoli that are responsible for the loading of oxygen upon red cell hemoglobin for use by all of the body\u27s tissues. In most symptomatic individuals, the disease is a mild immune-mediated syndrome, with limited damage to the lung tissues. About 20% of those affected experience a disease course characterized by a cataclysmic set of immune activation responses that can culminate in the diffuse and irreversible obliteration of the distal alveoli, leading to a virtual collapse of the gas-exchange apparatus. Here, in Part I of a duology on the characterization and potential treatment for COVID-19, we define severe COVID-19 as a consequence of the ability of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to trigger what we now designate for the first time as a ‘Prolific Activation of a Network-Immune-Inflammatory Crisis’, or ‘PANIC’ Attack, in the alveolar tree. In Part II we describe an immunotherapeutic hypothesis worthy of the organization of a randomized clinical trial in order to ascertain whether a repurposed, generic, inexpensive, and widely available agent is capable of abolishing ‘PANIC’; thereby preventing or mitigating severe COVID-19, with monumental ramifications for world health, and the global pandemic that continues to threaten it

Application of an evidence-based, out-patient treatment strategy for COVID-19: Multidisciplinary medical practice principles to prevent severe disease☆

The COVID-19 pandemic has devastated individuals, families, and institutions throughout the world. Despite the breakneck speed of vaccine development, the human population remains at risk of further devastation. The decision to not become vaccinated, the protracted rollout of available vaccine, vaccine failure, mutational forms of the SARS virus, which may exhibit mounting resistance to our molecular strike at only one form of the viral family, and the rapid ability of the virus(es) to hitch a ride on our global transportation systems, means that we are will likely continue to confront an invisible, yet devastating foe. The enemy targets one of our human physiology’s most important and vulnerable life-preserving body tissues, our broncho-alveolar gas exchange apparatus. Notwithstanding the fear and the fury of this microbe\u27s potential to raise existential questions across the entire spectrum of human endeavor, the application of an early treatment intervention initiative may represent a crucial tool in our defensive strategy. This strategy is driven by evidence-based medical practice principles, those not likely to become antiquated, given the molecular diversity and mutational evolution of this very clever “world traveler

Part II. high-dose methotrexate with leucovorin rescue for severe COVID-19: An immune stabilization strategy for SARS-CoV-2 induced \u27PANIC\u27 attack

Here, in Part II of a duology on the characterization and potential treatment for COVID-19, we characterize the application of an innovative treatment regimen for the prevention of the transition from mild to severe COVID-19, as well as detail an intensive immunotherapy intervention hypothesis. We propose as a putative randomized controlled trial that high-dose methotrexate with leucovorin (HDMTX-LR) rescue can abolish \u27PANIC\u27, thereby \u27left-shifting\u27 severe COVID-19 patients to the group majority of those infected with SARS-CoV-2, who are designated as having mild, even asymptomatic, disease. HDMTX-LR is endowed with broadly pleiotropic properties and is a repurposed, generic, inexpensive, and widely available agent which can be administered early in the course of severe COVID-19 thus rescuing the critical and irreplaceable gas-exchange alveoli. Further, we describe a preventative treatment intervention regimen for those designated as having mild to moderate COVID-19 disease, but who exhibit features which herald the transition to the severe variant of this disease. Both of our proposed hypothesis-driven questions should be urgently subjected to rigorous assessment in the context of randomized controlled trials, in order to confirm or refute the contention that the approaches characterized herein, are in fact capable of exerting mitigating, if not abolishing, effects upon SARS-CoV-2 triggered \u27PANIC Attack\u27. Confirmation of our immunotherapy hypothesis would have far-reaching ramifications for the current pandemic, along with yielding invaluable lessons which could be leveraged to more effectively prepare for the next challenge to global health

Mosaic BRAF fusions are a recurrent cause of congenital melanocytic naevi targetable by MEK inhibition

Among children with multiple congenital melanocytic naevi (CMN), 25% have no established genetic cause, of which many develop a hyperproliferative and severely pruritic phenotype resistant to treatment. Gene fusions have been reported in individual cases of CMN. Here, we study 169 CMN patients, 38 of whom were double wild-type for NRAS/BRAF mutations. Nineteen of these 38 patients had sufficient tissue to undergo RNAseq, which revealed mosaic BRAF fusions in 11/19 patients and mosaic RAF1 fusions in 1/19. Recurrently, fusions involved the loss of the 5’ regulatory domain of BRAF or RAF1 but preserved the kinase domain. We validated all cases and detected the fusions in two separate naevi in 5/12 patients, confirming clonality. The absence of the fusion in blood in 8/12 patients indicated mosaicism. Primary culture of BRAF-fusion naevus cells from 3/12 patients demonstrated highly increased MAPK activation, despite only mildly increased BRAF expression, suggesting additional mechanisms of kinase activation. Trametinib quenched MAPK hyperactivation in vitro and treatment of two patients caused rapid improvement in bulk tissue, improving bodily movement, and reducing inflammation and severe pruritus. These findings offer a genetic diagnosis to an additional group of patients and trametinib as a treatment option for the severe associated phenotypes

Differential Expression of Alpha 4 Integrins on Effector Memory T Helper Cells during Bordetella Infections. Delayed Responses in Bordetella pertussis

Bordetella pertussis (B. pertussis) is the causative agent of whooping cough, a respiratory disease that is reemerging worldwide. Mechanisms of selective lymphocyte trafficking to the airways are likely to be critical in the immune response to this pathogen. We compared murine infection by B. pertussis, B. parapertussis, and a pertussis toxin-deleted B. pertussis mutant (BpΔPTX) to test the hypothesis that effector memory T-helper cells (emTh) display an altered pattern of trafficking receptor expression in B. pertussis infection due to a defect in imprinting. Increased cell recruitment to the lungs at 5 days post infection (p.i.) with B. parapertussis, and to a lesser extent with BpΔPTX, coincided with an increased frequency of circulating emTh cells expressing the mucosal-associated trafficking receptors α4β7 and α4β1 while a reduced population of these cells was observed in B. pertussis infection. These cells were highly evident in the blood and lungs in B. pertussis infection only at 25 days p.i. when B. parapertussis and BpΔPTX infections were resolved. Although at 5 days p.i., an equally high percentage of lung dendritic cells (DCs) from all infections expressed maturation markers, this expression persisted only in B. pertussis infection at 25 days p.i. Furthermore, at 5 days p.i with B. pertussis, lung DCs migration to draining lymph nodes may be compromised as evidenced by decreased frequency of CCR7+ DCs, inhibited CCR7-mediated in vitro migration, and fewer DCs in lung draining lymph nodes. Lastly, a reduced frequency of allogeneic CD4+ cells expressing α4β1 was detected following co-culture with lung DCs from B. pertussis-infected mice, suggesting a defect in DC imprinting in comparison to the other infection groups. The findings in this study suggest that B. pertussis may interfere with imprinting of lung-associated trafficking receptors on T lymphocytes leading to extended survival in the host and a prolonged course of disease