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Whatever the wisdom or folly of the belief, Americans who live in violence-affected neighborhoods often believe they need a gun for self-defense. Yet many are, due to age or criminal record, unable to legally possess a firearm. The result is a Catch-22 they describe as either being "caught with a gun . . . [or] dead without one." Indeed, Chicago, Philadelphia, and other cities imprison thousands of mostly young, Black men each year for non-violent gun offenses. These offenses do not involve firing or wielding a gun, but simply being found in possession of one—commonly, during a routine traffic stop where police discover a firearm under the seat of the car. Research indicates that mandating prison sentences for gun possession is not an effective tool for reducing gun violence. Yet, as this Comment describes, the painful status quo has proven difficult to change, even for "progressive prosecutors" elected to reform criminal justice. This Comment draws on first-hand interviews to detail how progressive prosecutors handle gun possession cases in practice. While these prosecutors advance some important changes, reforms remain limited by practical and political realities. To aid in breaking through these barriers, this Comment proposes a new cost-benefit framework called "Burden-Adjusted Violence Averted" (BAVA). BAVA yields the simple insight that we should invest in policies that do the most to reduce gun violence with the least pain and inequity. Imprisoning people for simple gun possession is deeply burdensome. And, in comparison to community-based anti-violence interventions, it is less likely to make our cities safe.

Treatment of chronic illness accounts for over 90 % of Medicare spending. Chronic lymphedema places over 3 million Americans at risk of recurrent cellulitis. Health insurers and legislators have taken an active role in fighting attempts to mandate the treatment of lymphedema for fear that provision of the physical therapy and compression materials would result in large and uncontrollable claim costs. The author knows of no open source of lymphedema treatment cost data based on population coverage or claims. Published studies compare cost of treatment versus cost of non-treatment for a select group of lymphedema patients. They do not provide the data necessary for insurance underwriters' estimations of expected claim costs for a larger general population with a range of severities, or for legislators' evaluations of the costs of proposed mandates to cover treatment of lymphedema according to current medical standards. These data are of interest to providers, advocates and legislators in Canada, Australia and England as well as the U.S. The Commonwealth of Virginia has had a lymphedema treatment mandate since 2004. Reported data for 2004-2013, representing 80 % of the Virginia healthcare insurance market, contains claims and utilization data and claims-based estimates of the premium impact of its lymphedema mandate. The average actual annual lymphedema claim cost was $1.59 per individual contract and $3.24 per group contract for the years reported, representing 0.053 and 0.089 % of average total claims. The estimated premium impact ranged 0.00-0.64 % of total average premium for all mandated coverage contracts. In this study actual costs are compared with pre-mandate state mandate commission estimates for proposed lymphedema mandates from Virginia, Massachusetts and California. Ten years of insurance experience with a lymphedema treatment mandate in Virginia shows that costs of lymphedema treatment are an insignificant part of insured healthcare costs, and that treatment of lymphedema may reduce costs of office visits and hospitalizations due to lymphedema and lymphedema-related cellulitis. Estimates based on more limited data overestimate these costs. Lymphedema treatment is a potent tool for reduction in healthcare costs while improving the quality of care for cancer survivors and others suffering with this chronic progressive condition.

The understanding, prevention, and treatment of pain is of great importance to medical science. Children were asked to immerse their hands in cold water until they were unable to tolerate the pain of the cold. The length of time that they kept their hands immersed is a measure of pain tolerance. Two factors were studied. One factor is a child's Coping Style (CS) with the pain (attenders pay attention to the pain, distracters think of other things), and it was assessed at a baseline trial. The other factor is Treatment (TMT), one of three counseling interventions (a null intervention, counseling to attend, or counseling to distract), and was randomly applied prior to the response. The covariate is a baseline measure of pain tolerance prior to the intervention. Distracters, taught to distract, tolerated the pain much better than any other group. No strategy improved attenders' pain tolerance. This article analyzes this data from a predictive Bayesian viewpoint. The assumption of constant variance is not met on the original scale, and some of the data is censored; furthermore, the censoring model is unknown. Simultaneous transformation of the response and baseline is used to search for a scale where the variance is constant. Predictive inference is used to provide interpretable inferences. A sensitivity analysis is used to determine whether the treatment of the censored data matters. Without the sensitivity analysis, we are left wondering whether the conclusions rest on a true underlying treatment effect or on cases of questionable quality. In spite of a devil's-advocate effort to produce an alternative model which leads to contradictory conclusions, no such model was found.

Robert Weiß ; Manfred Heinrich ; Zsfassung in engl. Sprache u.d.T.: The Round Table: the Liquidator in bankruptcy of "real" socialism ; Volltext // Exemplar mit der Signatur: München, Bayerische Staatsbibliothek -- 4 Z 68.247-1991,1/12