Sex Offender Civil Commitment to Prison Post-\u3cem\u3eKingsley\u3c/em\u3e

Today, an estimated 5400 people are civilly committed under state and federal sex offender programs. This Note surveys these civil commitment regimes and finds that seventeen jurisdictions (sixteen states and the federal government) have enacted legislative schemes that authorize the indefinite civil detention of people charged with, or previously convicted of, sex offenses to prisons or prison-like facilities—often for their entire lives. By charting the pervasiveness of sex offender civil commitment to prison, this Note provides new evidence that these sex offender civil commitment statutes are, in fact, punitive and, therefore, unconstitutional. Moreover, this Note argues that the Supreme Court’s decision in Kingsley v. Hendrickson calls into question the Court’s logic in upholding sex offender civil commitment regimes in prior cases. Traditionally, civil commitment jurisprudence has turned on whether the legislature intends to punish—not merely confine—sex offenders. Kingsley, however, suggests that confinement may be found punitive based solely on the objective harshness of the conditions of incarceration, regardless of whether any state actor intended for the conditions to be punitive. If incarceration conditions may now constitute punishment regardless of governmental intent, it follows that the government may be punishing thousands of sex offenders without authorization. Indeed, as this Note shows, convicted prisoners and committed sex offenders commonly experience identical conditions of confinement

Aggressive Regimens for Multidrug-Resistant Tuberculosis Decrease All-Cause Mortality

Rationale: A better understanding of the composition of optimal treatment regimens for multidrug-resistant tuberculosis (MDR-TB) is essential for expanding universal access to effective treatment and for developing new therapies for MDR-TB. Analysis of observational data may inform the definition of an optimized regimen. Objectives: This study assessed the impact of an aggressive regimen–one containing at least five likely effective drugs, including a fluoroquinolone and injectable–on treatment outcomes in a large MDR-TB patient cohort. Methods: This was a retrospective cohort study of patients treated in a national outpatient program in Peru between 1999 and 2002. We examined the association between receiving an aggressive regimen and the rate of death. Measurements and Main Results: In total, 669 patients were treated with individualized regimens for laboratory-confirmed MDR-TB. Isolates were resistant to a mean of 5.4 (SD 1.7) drugs. Cure or completion was achieved in 66.1% (442) of patients; death occurred in 20.8% (139). Patients who received an aggressive regimen were less likely to die (crude hazard ratio [HR]: 0.62; 95% CI: 0.44,0.89), compared to those who did not receive such a regimen. This association held in analyses adjusted for comorbidities and indicators of severity (adjusted HR: 0.63; 95% CI: 0.43,0.93). Conclusions: The aggressive regimen is a robust predictor of MDR-TB treatment outcome. TB policy makers and program directors should consider this standard as they design and implement regimens for patients with drug-resistant disease. Furthermore, the aggressive regimen should be considered the standard background regimen when designing randomized trials of treatment for drug-resistant TB

Sex Offender Civil Commitment to Prison Post-\u3cem\u3eKingsley\u3c/em\u3e

Today, an estimated 5400 people are civilly committed under state and federal sex offender programs. This Note surveys these civil commitment regimes and finds that seventeen jurisdictions (sixteen states and the federal government) have enacted legislative schemes that authorize the indefinite civil detention of people charged with, or previously convicted of, sex offenses to prisons or prison-like facilities—often for their entire lives. By charting the pervasiveness of sex offender civil commitment to prison, this Note provides new evidence that these sex offender civil commitment statutes are, in fact, punitive and, therefore, unconstitutional. Moreover, this Note argues that the Supreme Court’s decision in Kingsley v. Hendrickson calls into question the Court’s logic in upholding sex offender civil commitment regimes in prior cases. Traditionally, civil commitment jurisprudence has turned on whether the legislature intends to punish—not merely confine—sex offenders. Kingsley, however, suggests that confinement may be found punitive based solely on the objective harshness of the conditions of incarceration, regardless of whether any state actor intended for the conditions to be punitive. If incarceration conditions may now constitute punishment regardless of governmental intent, it follows that the government may be punishing thousands of sex offenders without authorization. Indeed, as this Note shows, convicted prisoners and committed sex offenders commonly experience identical conditions of confinement

Multidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method

Debate persists about monitoring method (culture or smear) and interval (monthly or less frequently) during treatment for multidrug-resistant tuberculosis (MDR-TB). We analysed existing data and estimated the effect of monitoring strategies on timing of failure detection. We identified studies reporting microbiological response to MDR-TB treatment and solicited individual patient data from authors. Frailty survival models were used to estimate pooled relative risk of failure detection in the last 12 months of treatment; hazard of failure using monthly culture was the reference. Data were obtained for 5410 patients across 12 observational studies. During the last 12 months of treatment, failure detection occurred in a median of 3 months by monthly culture; failure detection was delayed by 2, 7, and 9 months relying on bimonthly culture, monthly smear and bimonthly smear, respectively. Risk (95% CI) of failure detection delay resulting from monthly smear relative to culture is 0.38 (0.34–0.42) for all patients and 0.33 (0.25–0.42) for HIV-co-infected patients. Failure detection is delayed by reducing the sensitivity and frequency of the monitoring method. Monthly monitoring of sputum cultures from patients receiving MDR-TB treatment is recommended. Expanded laboratory capacity is needed for high-quality culture, and for smear microscopy and rapid molecular tests

Multidrug-Resistant Tuberculosis Treatment Failure Detection Depends on Monitoring Interval and Microbiological Method Multidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method behalf of the Col

Citation Multidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method. ABSTRACT Debate persists about monitoring method (culture or smear) and interval (monthly or less frequently) during treatment for multidrug-resistant tuberculosis (MDR-TB). We analysed existing data and estimated the effect of monitoring strategies on timing of failure detection. We identified studies reporting microbiological response to MDR-TB treatment and solicited individual patient data from authors. Frailty survival models were used to estimate pooled relative risk of failure detection in the last 12 months of treatment; hazard of failure using monthly culture was the reference. Data were obtained for 5410 patients across 12 observational studies. During the last 12 months of treatment, failure detection occurred in a median of 3 months by monthly culture; failure detection was delayed by 2, 7, and 9 months relying on bimonthly culture, monthly smear and bimonthly smear, respectively. Risk (95% CI) of failure detection delay resulting from monthly smear relative to culture is 0.38 (0.34-0.42) for all patients and 0.33 (0.25-0.42) for HIV-co-infected patients. Failure detection is delayed by reducing the sensitivity and frequency of the monitoring method. Monthly monitoring of sputum cultures from patients receiving MDR-TB treatment is recommended. Expanded laboratory capacity is needed for high-quality culture, and for smear microscopy and rapid molecular tests. @ERSpublications Monthly culture monitoring is crucial to earlier detection of treatment failure in MDR-TB patient

Multivariable, time-varying Cox proportional hazards analysis of aggressive regimen and time to death.

<p>Multivariable, time-varying Cox proportional hazards analysis of aggressive regimen and time to death.</p

Treatment outcomes of 669 patients enrolled in individualized treatment for MDR-TB in Peru between February 1999 and July 2002. (Adapted from Mitnick et al., 2008) [20].

<p>Treatment outcomes of 669 patients enrolled in individualized treatment for MDR-TB in Peru between February 1999 and July 2002. (Adapted from Mitnick et al., 2008) <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0058664#pone.0058664-Mitnick2" target="_blank">[20]</a>.</p

Univariate, time-varying Cox proportional hazards analysis of aggressive regimen and time to death.

1<p>Continuous variable, mean (standard deviation) presented.</p>2<p><18.5 in women; <20 in men; or malnutrition established clinically.</p>3<p>≤30% in women; ≤36% in men; when missing, also used hemoglobin ≤10 in women and ≤12 in men.</p>4<p>Dyspnea; resting respiratory rate greater than 26/minute.</p>5<p>Resistance to the following 12 drugs or drug classes was tested: capreomycin, cycloserine, ethambutol, ethionamide, isoniazid, kanamycin or amikacin, PAS, pyrazinamide, rifampicin, streptomycin, first-generation fluoroquinolones (ciprofloxacin, ofloxacin), and later-generation fluoroquinolones (gatifloxacin, levofloxacin, moxifloxacin).</p>6<p>Isolate resistant to at least isoniazid, rifampin, fluoroquinolone, and injectable (kanamycin, capreomycin, or amikacin).</p>7<p>This includes the following comorbidities: cardiovascular disease (12), diabetes mellitus (18), hepatitis or cirrhosis (10), epilepsy/seizures (11), renal insufficiency (7), psychiatric disorder (116), ever smoked (66), ever used/abused alcohol or other substance (52).</p