Hard Cases Make Good Law: The Intellectual History of Prior Acquittal Sentencing

(Excerpt) This Article attempts to answer those questions both historically and theoretically. On a historical level, it traces the heretofore unexamined course of the congressional, judicial, and administrative actions leading from a pre-1970s sentencing regime that viewed any use of extra-trial evidence in sentencing as constitutionally suspect to the 1997 case that embraced prior acquittal sentencing as a foregone conclusion. On a more theoretical level, the Article traces the justification for prior acquittal sentencing to two doctrinal tensions: the differing goals of trials and sentencing and the semiotic gap between acquittal and innocence. As outside forces exerted pressure on those two tensions, the case for prior acquittal sentencing grew more compelling. In response, Congress twice chose to modify the statutory regime governing prior acquittal sentencing, codifying it in more categorical terms. Each codification encouraged judges to mechanize their use of prior acquitted conduct at sentencing, at times leading to instances of prior acquittal sentencing blatantly at odds with the regime’s underlying logic. The Sentencing Guidelines continued that mechanization, effectively rendering the use of prior acquitted conduct at sentencing automatic. In the wake of Booker and Watts, however, judges have a new opportunity to reassert discretion in the area of prior acquittal sentencing. This Article concludes by exhorting sentencing judges to do so actively by: (1) scrutinizing evidence of prior acquitted conduct for indicia of reliability and (2) balancing the good of accuracy in sentencing with the compelling public policy reasons weighing against any introduction of prior acquitted conduct at sentencing

Combination topical therapy for initial treatment of vulvar lichen sclerosus in adult women

INTRODUCTION: Vulvar lichen sclerosus (LS) is characterized by thinning of the epithelium, and whitening of the vulvar skin which can lead to the characteristic symptoms of burning and itching. There is no cure for vulvar LS and topical corticosteroids are first-line treatment. The aims of this thesis are to propose a study to determine whether topical combination therapy with an ultra-potent corticosteroid and calcineurin inhibitor leads to greater improvement in symptoms and clinical appearance of disease than traditional first-line treatment with an ultra-potent corticosteroid alone, and to evaluate relapse rates between the combination therapy group compared to the topical corticosteroid only group. REVIEW OF LITERATURE: The ultra-potent corticosteroid clobetasol propionate is currently the first-line treatment for women with LS however not all patients achieve remission, and many patients have relapses. Topical calcineurin inhibitors such as tacrolimus are considered to be second-line treatments for vulvar LS and may eliminate the side effects of thinning that can occur with long-term therapy with corticosteroids. METHODS: A single-center randomized control trial will be conducted with post-menopausal women recruited from the dermatology and gynecology at Boston Medical Center. The patients will be randomized to either three months treatment with daily clobetasol propionate in the morning and tacrolimus ointment in the evening, or clobestasol propionate in the morning with a vehicle ointment in the evening. The patients will be evaluated for improvement in symptoms of burning and itching, and for clinical appearance of erythema, whitening of the skin, and hyperkeratosis, purpuric lesions and excoriations. The patients will also be followed for a year post-treatment for signs of relapse. CONCLUSION: The incidence of vulvar LS is increasing and may be under-reported. Though corticosteroids are an effective treatment for most patients, combination therapy with topical tacrolimus may increase the proportion of patients who achieve remission for vulvar LS and will improve their quality of life

Comparative Effectiveness of Step-up Therapies in Children with Asthma Prescribed Inhaled Corticosteroids : A Historical Cohort Study

This work was supported by the Respiratory Effectiveness Group. Acknowledgments We thank the Respiratory Effectiveness Group for funding this work, Annie Burden for assistance with statistics, and Simon Van Rysewyk and Lisa Law for assistance with medical writing.Peer reviewedPostprin