Probable Cause to Protect Children: The Connection Between Child Molestation and Child Pornography

The federal Circuit Courts of Appeal are divided regarding whether probable cause to search for evidence of child molestation provides probable cause to search for child pornography. This Note examines the relationship among the decisions of the Circuit Courts of Appeal, delves into the empirical evidence regarding the relationship between child pornography and child molestation, and analyzes how the “flexible, non-technical” probable cause standard properly interacts with this relationship. In United States v. Colbert, the U.S. Court of Appeals for the Eighth Circuit concluded that, because of the “intuitive relationship” between child molestation and child pornography, a warrant to search for evidence of child pornography based solely on evidence of child molestation is supported by probable cause. This Note argues that the Eighth Circuit appropriately balances the elastic probable cause standard, the policy concerns related to crimes against children, and the nexus between child molestation and child pornography in concluding that probable cause to search for evidence of child molestation provides probable cause to search for child pornography

Dead Men Tell No Tales: The Importance of the Summary Judgment Standard in the Deadly Force Case of \u3cem\u3eGonzalez v. City of Anaheim\u3c/em\u3e

Anaheim police officer Daron Wyatt shot and killed Adolph Gonzalez following a traffic stop and physical confrontation among Gonzalez and officers Wyatt, and Matthew Ellis. Gonzalez’s successors brought a 42 U.S.C. § 1983 claim alleging, among other claims, a violation of Gonzalez’s Fourth Amendment right to be free from the use of unreasonable and excessive force. In Gonzalez v. City of Anaheim, the Ninth Circuit held that inconsistencies in the officers’ testimony regarding the physical confrontation raised a genuine dispute of material fact concerning the immediacy of the threat that Gonzalez posed to the officers and others. As a result, the court held that summary judgment was not proper. This Comment argues that the majority appropriately applied a strict summary judgment standard that more broadly considers what constitutes a dispute of material fact because the defendants were the cause of the defendant’s death and the only surviving eyewitnesses. By allowing such cases to reach the jury, this summary judgment standard protects the constitutional rights of the deceased and prevents courts from improperly relying on one-sided, potentially self-serving testimony by state actors

Rethinking residue, an investigation of pharyngeal residue on flexible endoscopic evaluation of swallowing: the past, present, and future directions

This dissertation investigated measures of pharyngeal residue as seen on flexible endoscopic evaluation of swallowing (FEES). Research in this area of deglutology has been stalled due to measurement problems. The particular aims of this project were to compare visual analog scale ratings to categorical ratings of residue on FEES, and to investigate various measurement aspects. METHODS: Speech language pathologists were asked to rate residue from 81 swallows on FEES that demonstrated a wide range of residue severity for thin liquid, applesauce, and cracker boluses. A total of 33 clinicians rated the amount of residue at the time point after the first swallow, twice in a randomized fashion: the first time on a visual analog scale (VAS) and the second time categorically on a five point Likert scale. The results were analyzed for (1) inter/intra-rater agreement, (2) correlations between ratings and residue severity for each rating method, and (3) clusters of ratings to better define the scales and their clinical significance. A total of 2,673 VAS ratings and 2,673 categorical ratings were collected. RESULTS: (1) Both inter- and intra-rater reliability met acceptable levels of agreement, although intra-rater reliability on VAS ratings were slightly higher (r=0.8–0.9) than categorical ratings (k=0.7–0.8). Expert ratings were not significantly different from other clinicians’ ratings for any severity of any of the 3 boluses. (2) Residue ratings fit best on a curvilinear model; a quadratic fit of the data significantly improved the r2 values for each bolus type. (3) An increased residue amount, rated on either the VAS or categorical scale, was significantly associated with worse penetration-aspiration scale scores, but no significant relationship was found between the two methods of residue ratings and measures of quality of life or diet. Novel computerized methods are proposed for future measurement pursuits. CONCLUSION: The results of this dissertation suggest that residue is best measured on a scale with unequal intervals, and clinicians can be reliable in rating overall amount of residue on FEES after the first swallow. Novel computerized measurement approaches are useful building blocks for future research. It is hoped that with better measurement will come better understanding of residue, its risks, and consequences

Rethinking residue, an investigation of pharyngeal residue on flexible endoscopic evaluation of swallowing: the past, present, and future directions

This dissertation investigated measures of pharyngeal residue as seen on flexible endoscopic evaluation of swallowing (FEES). Research in this area of deglutology has been stalled due to measurement problems. The particular aims of this project were to compare visual analog scale ratings to categorical ratings of residue on FEES, and to investigate various measurement aspects. METHODS: Speech language pathologists were asked to rate residue from 81 swallows on FEES that demonstrated a wide range of residue severity for thin liquid, applesauce, and cracker boluses. A total of 33 clinicians rated the amount of residue at the time point after the first swallow, twice in a randomized fashion: the first time on a visual analog scale (VAS) and the second time categorically on a five point Likert scale. The results were analyzed for (1) inter/intra-rater agreement, (2) correlations between ratings and residue severity for each rating method, and (3) clusters of ratings to better define the scales and their clinical significance. A total of 2,673 VAS ratings and 2,673 categorical ratings were collected. RESULTS: (1) Both inter- and intra-rater reliability met acceptable levels of agreement, although intra-rater reliability on VAS ratings were slightly higher (r=0.8–0.9) than categorical ratings (k=0.7–0.8). Expert ratings were not significantly different from other clinicians’ ratings for any severity of any of the 3 boluses. (2) Residue ratings fit best on a curvilinear model; a quadratic fit of the data significantly improved the r2 values for each bolus type. (3) An increased residue amount, rated on either the VAS or categorical scale, was significantly associated with worse penetration-aspiration scale scores, but no significant relationship was found between the two methods of residue ratings and measures of quality of life or diet. Novel computerized methods are proposed for future measurement pursuits. CONCLUSION: The results of this dissertation suggest that residue is best measured on a scale with unequal intervals, and clinicians can be reliable in rating overall amount of residue on FEES after the first swallow. Novel computerized measurement approaches are useful building blocks for future research. It is hoped that with better measurement will come better understanding of residue, its risks, and consequences

The efficacy of the Masako (tongue-hold) maneuver

Thesis (M.S.)--Boston UniversityPurpose: Clinicians commonly recommend the tongue-hold maneuver, also called the Masako, as an exercise to strengthen swallowing muscles. Although this exercise is widely used, limited empirical data support this maneuver as an effective exercise. The goal ofthe present study is to observe, over multiple sessions, the effects ofthe tongue- hold maneuver as a 6-week exercise in subjects with dysphagia. The results ofthis study will help to address whether the tongue-hold maneuver is beneficial and, if so, which muscle groups are strengthened by this exercise. Methods: Five subjects with dysphagia and one healthy adult performed a set oftongue- hold maneuvers 3 times a day, 5 days per week, for 6 weeks. The number o f repetitions per set was individually calculated based on 80% of the maximal repetitions until fatigue. At baseline and 6 weeks, 4 measures were observed: a subject-reported quality-of-life swallowing scale, lingual strength, the amount of residue in the valleculae, and the pressures generated by pharyngeal muscles during a normal swallow. Four healthy adults who did not perform the tongue-hold maneuver were used as controls for the lingual measures, completing the measures of lingual strength at baseline, 3 weeks, and 6 weeks. Results: No overt trends in the subject-reported swallowing scale were noted; after 6 weeks of exercise, about half ranked their swallowing as worse and half ranked their swallowing as better. The treatment group demonstrated a non-significant overall2.3% increase in anteromedian lingual strength and 8.4% increase in posteromedian lingual strength. These changes did not set the treatment group apart from the control group, who demonstrated an increase of3.8% and 6.3% in the anteromedian and posteromedian positions, respectively. Regarding pharyngeal residue, 2 subjects did not show any changes in residue scores. However, the other 3 subjects demonstrated reduced residue in the valleculae with a cracker bolus. Out ofthe 3 subjects who were measured with manometry, 2 demonstrated higher oropharyngeal pressures on normal swallows after 6 weeks of exercise, although great variability was present. These results are limited by the small sample size and heterogeneity of the treatment group, as well as high variability in instrumental measurements. Conclusion: This study investigated the tongue-hold maneuver as an exercise and provides preliminary support for its use, with caution. Specifically, clinicians should be sure to prescribe regimens that fatigue swallowing muscles and push them past normal use. When using the Iowa Oral Performance Instrument (IOPI) as a tool, clinicians should also keep in mind that a learning effect is likely to occur over the first few trials. This pilot study suggests that clinicians should continue to prescribe the tongue-hold maneuver as an exercise with caution, as some patients may benefit from it while others may not. Further investigation is required

Metabolic syndrome does not affect sustained virologic response of direct-acting antivirals while hepatitis C clearance improves hemoglobin A1c.

AimTo determine whether successful treatment with directacting antivirals (DAA) is associated with improvements in hemoglobin A1c (HbA1c) and if type 2 diabetes mellitus (T2DM) or metabolic syndrome affects sustained virologic response (SVR).MethodsWe performed a retrospective analysis of all hepatitis C virus (HCV) patients at the VA Greater Los Angeles Healthcare System treated with varying DAA therapy between 2014-2016. Separate multivariable logistic regression was performed to determine predictors of HbA1c decrease ≥ 0.5 after DAA treatment and predictors of SVR 12-wk post treatment (SVR12).ResultsA total of 1068 patients were treated with DAA therapy between 2014-2016. The presence of T2DM or metabolic syndrome did not adversely affect SVR12. 106 patients had both HCV and T2DM. Within that cohort, patients who achieved SVR12 had lower mean HbA1c pre treatment (7.35 vs 8.60, P = 0.02), and lower mean HbA1c post-treatment compared to non-responders (6.55 vs 8.61, P = 0.01). The mean reduction in HbA1c after treatment was greater for those who achieved SVR12 than for non-responders (0.79 vs 0.01, P = 0.03). In adjusted models, patients that achieved SVR12 were more likely to have a HbA1c decrease of ≥ 0.5 than those that did not achieve SVR12 (adjusted OR = 7.24, 95%CI: 1.22-42.94).ConclusionIn HCV patients with T2DM, successful treatment with DAA was associated with a significant reduction in HbA1c suggesting that DAA may have a role in improving insulin sensitivity. Furthermore, the presence of T2DM or metabolic syndrome does not adversely affect SVR12 rates in patients treated with DAA

Do changes in health reveal the possibility of undiagnosed pancreatic cancer? Development of a risk-prediction model based on healthcare claims data.

Background and objectiveEarly detection methods for pancreatic cancer are lacking. We aimed to develop a prediction model for pancreatic cancer based on changes in health captured by healthcare claims data.MethodsWe conducted a case-control study on 29,646 Medicare-enrolled patients aged 68 years and above with pancreatic ductal adenocarcinoma (PDAC) reported to the Surveillance Epidemiology an End Results (SEER) tumor registries program in 2004-2011 and 88,938 age and sex-matched controls. We developed a prediction model using multivariable logistic regression on Medicare claims for 16 risk factors and pre-diagnostic symptoms of PDAC present within 15 months prior to PDAC diagnosis. Claims within 3 months of PDAC diagnosis were excluded in sensitivity analyses. We evaluated the discriminatory power of the model with the area under the receiver operating curve (AUC) and performed cross-validation by bootstrapping.ResultsThe prediction model on all cases and controls reached AUC of 0.68. Excluding the final 3 months of claims lowered the AUC to 0.58. Among new-onset diabetes patients, the prediction model reached AUC of 0.73, which decreased to 0.63 when claims from the final 3 months were excluded. Performance measures of the prediction models was confirmed by internal validation using the bootstrap method.ConclusionModels based on healthcare claims for clinical risk factors, symptoms and signs of pancreatic cancer are limited in classifying those who go on to diagnosis of pancreatic cancer and those who do not, especially when excluding claims that immediately precede the diagnosis of PDAC

Equilibrium to off-equilibrium crossover in homogeneous active matter

We study the crossover between equilibrium and off-equilibrium dynamical universality classes in the Vicsek model near its ordering transition. Starting from the incompressible hydrodynamic theory of Chen et al \cite{chen2015critical}, we show that increasing the activity leads to a renormalization group (RG) crossover between the equilibrium ferromagnetic fixed point, with dynamical critical exponent $z = 2$, and the off-equilibrium active fixed point, with $z = 1.7$ (in $d=3$). We run simulations of the classic Vicsek model in the near-ordering regime and find that critical slowing down indeed changes with activity, displaying two exponents that are in remarkable agreement with the RG prediction. The equilibrium-to-off-equilibrium crossover is ruled by a characteristic length scale beyond which active dynamics takes over. Such length scale is smaller the larger the activity, suggesting the existence of a general trade-off between activity and system's size in determining the dynamical universality class of active matter.Comment: 10 pages, 4 figure

Race affects SVR12 in a large and ethnically diverse hepatitis C-infected patient population following treatment with direct-acting antivirals: Analysis of a single-center Department of Veterans Affairs cohort.

Hepatitis C virus (HCV) infection is a major cause of chronic liver disease. HCV cure has been linked to improved patient outcomes. In the era of direct-acting antivirals (DAAs), HCV cure has become the goal, as defined by sustained virological response 12 weeks (SVR12) after completion of therapy. Historically, African-Americans have had lower SVR12 rates compared to White people in the interferon era, which had been attributed to the high prevalence of non-CC interleukin 28B (IL28B) type. Less is known about the association between race/ethnicity and SVR12 in DAA-treated era. The aim of the study is to evaluate the predictors of SVR12 in a diverse, single-center Veterans Affairs population. We conducted a retrospective study of patients undergoing HCV therapy with DAAs from 2014 to 2016 at the VA Greater Los Angeles Healthcare System. We performed a multivariable logistic regression analysis to determine predictors of SVR12, adjusting for age, HCV genotype, DAA regimen and duration, human immunodeficiency virus (HIV) status, fibrosis, nonalcoholic fatty liver disease (NAFLD) fibrosis score, homelessness, mental health, and adherence. Our cohort included 1068 patients, out of which 401 (37.5%) were White people and 400 (37.5%) were African-American. Genotype 1 was the most common genotype (83.9%, N = 896). In the adjusted models, race/ethnicity and the presence of fibrosis were statistically significant predictors of non-SVR. African-Americans had 57% lower odds for reaching SVR12 (adj.OR = 0.43, 95% CI = 1.5-4.1) compared to White people. Advanced fibrosis (adj.OR = 0.40, 95% CI = 0.26-0.68) was also a significant predictor of non-SVR. In a single-center VA population on DAAs, African-Americans were less likely than White people to reach SVR12 when adjusting for covariates