Drafting a composite indicator of validity for regulatory models and legal systems

The aim of this paper is to lay the groundwork for the creation of a composite indicator of the validity of regulatory systems. The composite nature of the indicator implies a) that its construction is embedded in the long-standing theoretical debate and framework of legal validity; b) that it formally contains other sub-indicators whose occurrence is essential to the determination of validity. The paper suggests, in other words, that validity is a second-degree property, i.e., one that occurs only once the justice, efficiency, effectiveness, and enforceability of the system have been checked

A primary care, multi-disciplinary disease management program for opioid-treated patients with chronic non-cancer pain and a high burden of psychiatric comorbidity

BACKGROUND: Chronic non-cancer pain is a common problem that is often accompanied by psychiatric comorbidity and disability. The effectiveness of a multi-disciplinary pain management program was tested in a 3 month before and after trial. METHODS: Providers in an academic general medicine clinic referred patients with chronic non-cancer pain for participation in a program that combined the skills of internists, clinical pharmacists, and a psychiatrist. Patients were either receiving opioids or being considered for opioid therapy. The intervention consisted of structured clinical assessments, monthly follow-up, pain contracts, medication titration, and psychiatric consultation. Pain, mood, and function were assessed at baseline and 3 months using the Brief Pain Inventory (BPI), the Center for Epidemiological Studies-Depression Scale scale (CESD) and the Pain Disability Index (PDI). Patients were monitored for substance misuse. RESULTS: Eighty-five patients were enrolled. Mean age was 51 years, 60% were male, 78% were Caucasian, and 93% were receiving opioids. Baseline average pain was 6.5 on an 11 point scale. The average CESD score was 24.0, and the mean PDI score was 47.0. Sixty-three patients (73%) completed 3 month follow-up. Fifteen withdrew from the program after identification of substance misuse. Among those completing 3 month follow-up, the average pain score improved to 5.5 (p = 0.003). The mean PDI score improved to 39.3 (p < 0.001). Mean CESD score was reduced to 18.0 (p < 0.001), and the proportion of depressed patients fell from 79% to 54% (p = 0.003). Substance misuse was identified in 27 patients (32%). CONCLUSIONS: A primary care disease management program improved pain, depression, and disability scores over three months in a cohort of opioid-treated patients with chronic non-cancer pain. Substance misuse and depression were common, and many patients who had substance misuse identified left the program when they were no longer prescribed opioids. Effective care of patients with chronic pain should include rigorous assessment and treatment of these comorbid disorders and intensive efforts to insure follow up

Representing and Evaluating Legal Narratives with Subscenarios in a Bayesian network

In legal cases, stories or scenarios can serve as the context for a crime when reasoning with evidence. In order to develop a scientifically founded technique for evidential reasoning, a method is required for the representation and evaluation of various scenarios in a case. In this paper the probabilistic technique of Bayesian networks is proposed as a method for modeling narrative, and it is shown how this can be used to capture a number of narrative properties. Bayesian networks quantify how the variables in a case interact. Recent research on Bayesian networks applied to legal cases includes the development of a list of legal idioms: recurring substructures in legal Bayesian networks. Scenarios are coherent presentations of a collection of states and events, and qualitative in nature. A method combining the quantitative, probabilistic approach with the narrative approach would strengthen the tools to represent and evaluate scenarios. In a previous paper, the development of a design method for modeling multiple scenarios in a Bayesian network was initiated. The design method includes two narrative idioms: the scenario idiom and the merged scenarios idiom. In this current paper, the method of Vlek, et al. (2013) is extended with a subscenario idiom and it is shown how the method can be used to represent characteristic features of narrative