Automatic and Indefinite Commitment of Insanity Acquittees: A Procedural Straitjacket

This Recent Development suggests that the Court erroneously decided Jones. Part II examines the Supreme Court\u27s constitutional analysis of commitment procedures and discusses postacquittal commitment in state and lower federal courts. Part III analyzes the Jones decision and the exception that it allows for the commitment of insanity acquittees. Part IV contends that prior to involuntary and indefinite commitment an insanity acquittee deserves the same standard of proof as a civil commitment candidate-proof of mental illness and dangerousness by clear and convincing evidence. Part IV also argues that absent proof by clear and convincing evidence of the acquittee\u27s need for confinement,the insanity acquittee is entitled to release or recommitment through civil commitment procedures at the expiration of the underlying maximum sentence for the offense. In addition, part IV submits that Jones should not control in jurisdictions in which the criminal defendant need create only a reasonable doubt of his insanity at the time of the offense to obtain acquittal

Tumour brain: pre‐treatment cognitive and affective disorders caused by peripheral cancers

People that develop extracranial cancers often display co-morbid neurological disorders, such as anxiety, depression and cognitive impairment, even before commencement of chemotherapy. This suggests bidirectional crosstalk between non-CNS tumours and the brain, which can regulate peripheral tumour growth. However, the reciprocal neurological effects of tumour progression on brain homeostasis are not well understood. Here, we review brain regions involved in regulating peripheral tumour development and how they, in turn, are adversely affected by advancing tumour burden. Tumour-induced activation of the immune system, blood–brain barrier breakdown and chronic neuroinflammation can lead to circadian rhythm dysfunction, sleep disturbances, aberrant glucocorticoid production, decreased hippocampal neurogenesis and dysregulation of neural network activity, resulting in depression and memory impairments. Given that cancer-related cognitive impairment diminishes patient quality of life, reduces adherence to chemotherapy and worsens cancer prognosis, it is essential that more research is focused at understanding how peripheral tumours affect brain homeostasis

The association between care integration and care quality

Objective: The study aims to analyze the relationship between care integration and care quality, and to examine if the relationship varies by patient risk. Data Sources and Study Setting: The key independent variables used validated measures derived from a provider survey of functional (i.e., administrative and clinical systems) and social (i.e., patient integration, professional cooperation, professional coordination) integration. Survey responses represented data from a stratified sample of 59 practice sites from 17 health systems. Dependent variables included three quality measures constructed from patient-level Medicare data: colorectal cancer screening among patients at risk, patient-level 30-day readmission, and a practice-level Healthcare Effectiveness Data and Information Set (HEDIS) composite measure of publicly reported, individual measures of ambulatory clinical quality performance. Data Collection/Extraction Method: We obtained quality- and beneficiary-level covariate data for the 41,966 Medicare beneficiaries served by the 59 practices in our survey sample. Study Design: We estimated hierarchical linear models to examine the association between care integration and care quality and the moderating effect of patients' clinical risk score. We graphically visualized the moderating effects at ±1 standard deviation of our z-standardized independent and moderating variables and performed simple slope tests. Principal Findings: Our analyses uncovered a strong positive relationship between social integration, specifically patient integration, and the quality of care a patient receives (e.g., a 1-point increase in a practice's patient integration was associated with 0.31-point higher HEDIS composite score, p &lt; 0.01). Further, we documented positive and significant associations between aspects of social and functional integration on quality of care based on patient risk. Conclusions: The findings suggest social integration matters for improving the quality of care and that the relationship of integration to quality is not uniform for all patients. Policymakers and practitioners considering structural integrations of health systems should direct attention beyond structure to consider the potential for social integration to impact outcomes and how that might be achieved.</p