Judge Posner Got It Right: Requiring Abortion Doctors to Have Hospital Admitting Privileges Places an Undue Burden on a Woman Seeking an Abortion

Anti-abortion activists have sought to undermine and restrict a woman\u27s right to choose ever since 1992, when the Supreme Court replaced Roe v. Wade\u27s strict scrutiny analysis with the looser undue burden test in Southeastern Pennsylvania v. Casey. Under Casey\u27s undue burden test, a state regulation cannot have the purpose or effect of placing a significant obstacle in the path of a woman seeking an abortion of a nonviable fetus. However, the Casey Court failed to define the types of regulations that would run afoul of the undue burden test and create a substantial obstacle in the path of a woman seeking an abortion. As a result of this ambiguity, anti-abortion advocates have spent the last two decades trying to test the boundaries of the undue burden test. One popular approach has been to promulgate incremental regulations that chip away at a woman\u27s right to seek an abortion. Targeted Regulation of Abortion Providers (TRAP) laws are one form of these incremental regulations. One such TRAP law is at issue in the Seventh Circuit\u27s case Planned Parenthood of Wisconsin Inc. v. Van Hollen. The TRAP law at issue was a Wisconsin law requiring abortion doctors to have admitting privileges at a hospital within thirty miles of a clinic where an abortion is performed. Although the question before the court was technically limited to whether the preliminary injunction prohibiting the Wisconsin law from going into effect was justified, Judge Posner reasoned that that law was unconstitutional and should be struck. When the Supreme Court decides to hear a case involving a similar admitting privileges TRAP law, the Court should use Judge Posner\u27s reasoning as a guide to strike down the law. These admitting privileges statutes are unconstitutional because: (1) these laws place an undue burden on a woman seeking an abortion by dramatically impacting the practical availability of abortion within a state; (2) these laws bear no rational relationship to their purported purpose of protecting maternal health; and (3) these laws violate equal protections of the law by singling out abortion doctors for increased oversight

Leveraging Predictive Policing Algorithms to Restore Fourth Amendment Protections in High-Crime Areas in a Post-Wardlow World

Rapid technological changes have led to an explosion in Big Data collection and analysis through complex computerized algorithms. Law enforcement has not been immune to these technological developments. Many local police departments are now using highly advanced predictive policing technologies to predict when and where crime will occur in their communities, and to allocate crime-fighting resources based on these predictions. Although predictive policing technology has an array of the potential uses, the scope of this Note is limited to addressing how the statistical outputs from these technologies can be used to restore eroded Fourth Amendment rights in alleged high-crime areas. As the use of sophisticated predictive policing software becomes more widespread, courts will need to address how the statistical outputs from this technology factor into the reasonable suspicion calculus when a police officer performs a Terry stop in an alleged “high-crime” area. This Note argues that uniform standards and best practices must be developed to guide law enforcement’s use of predictive policing software, and that this software should be leveraged as a tool to help restore eroded Fourth Amendment rights

Judge Posner Got It Right: Requiring Abortion Doctors to Have Hospital Admitting Privileges Places an Undue Burden on a Woman Seeking an Abortion

Anti-abortion activists have sought to undermine and restrict a woman\u27s right to choose ever since 1992, when the Supreme Court replaced Roe v. Wade\u27s strict scrutiny analysis with the looser undue burden test in Southeastern Pennsylvania v. Casey. Under Casey\u27s undue burden test, a state regulation cannot have the purpose or effect of placing a significant obstacle in the path of a woman seeking an abortion of a nonviable fetus. However, the Casey Court failed to define the types of regulations that would run afoul of the undue burden test and create a substantial obstacle in the path of a woman seeking an abortion. As a result of this ambiguity, anti-abortion advocates have spent the last two decades trying to test the boundaries of the undue burden test. One popular approach has been to promulgate incremental regulations that chip away at a woman\u27s right to seek an abortion. Targeted Regulation of Abortion Providers (TRAP) laws are one form of these incremental regulations. One such TRAP law is at issue in the Seventh Circuit\u27s case Planned Parenthood of Wisconsin Inc. v. Van Hollen. The TRAP law at issue was a Wisconsin law requiring abortion doctors to have admitting privileges at a hospital within thirty miles of a clinic where an abortion is performed. Although the question before the court was technically limited to whether the preliminary injunction prohibiting the Wisconsin law from going into effect was justified, Judge Posner reasoned that that law was unconstitutional and should be struck. When the Supreme Court decides to hear a case involving a similar admitting privileges TRAP law, the Court should use Judge Posner\u27s reasoning as a guide to strike down the law. These admitting privileges statutes are unconstitutional because: (1) these laws place an undue burden on a woman seeking an abortion by dramatically impacting the practical availability of abortion within a state; (2) these laws bear no rational relationship to their purported purpose of protecting maternal health; and (3) these laws violate equal protections of the law by singling out abortion doctors for increased oversight

Leveraging Predictive Policing Algorithms to Restore Fourth Amendment Protections in High-Crime Areas in a Post-Wardlow World

Rapid technological changes have led to an explosion in Big Data collection and analysis through complex computerized algorithms. Law enforcement has not been immune to these technological developments. Many local police departments are now using highly advanced predictive policing technologies to predict when and where crime will occur in their communities, and to allocate crime-fighting resources based on these predictions. Although predictive policing technology has an array of the potential uses, the scope of this Note is limited to addressing how the statistical outputs from these technologies can be used to restore eroded Fourth Amendment rights in alleged high-crime areas. As the use of sophisticated predictive policing software becomes more widespread, courts will need to address how the statistical outputs from this technology factor into the reasonable suspicion calculus when a police officer performs a Terry stop in an alleged “high-crime” area. This Note argues that uniform standards and best practices must be developed to guide law enforcement’s use of predictive policing software, and that this software should be leveraged as a tool to help restore eroded Fourth Amendment rights

Recent trends in breast cancer incidence in US white women by county-level urban/rural and poverty status

<p>Abstract</p> <p>Background</p> <p>Unprecedented declines in invasive breast cancer rates occurred in the United States between 2001 and 2004, particularly for estrogen receptor-positive tumors among non-Hispanic white women over 50 years. To understand the broader public health import of these reductions among previously unstudied populations, we utilized the largest available US cancer registry resource to describe age-adjusted invasive and <it>in situ </it>breast cancer incidence trends for non-Hispanic white women aged 50 to 74 years overall and by county-level rural/urban and poverty status.</p> <p>Methods</p> <p>We obtained invasive and <it>in situ </it>breast cancer incidence data for the years 1997 to 2004 from 29 population-based cancer registries participating in the North American Association of Central Cancer Registries resource. Annual age-adjusted rates were examined overall and by rural/urban and poverty of patients' counties of residence at diagnosis. Joinpoint regression was used to assess trends by annual quarter of diagnosis.</p> <p>Results</p> <p>Between 2001 and 2004, overall invasive breast cancer incidence fell 13.2%, with greater reductions among women living in urban (-13.8%) versus rural (-7.5%) and low- (-13.0%) or middle- (-13.8%) versus high- (-9.6%) poverty counties. Most incidence rates peaked around 1999 then declined after second quarter 2002, although in rural counties, rates decreased monotonically after 1999. Similar but more attenuated patterns were seen for <it>in situ </it>cancers.</p> <p>Conclusion</p> <p>Breast cancer rates fell more substantially in urban and low-poverty, affluent counties than in rural or high-poverty counties. These patterns likely reflect a major influence of reductions in hormone therapy use after July 2002 but cannot exclude possible effects due to screening patterns, particularly among rural populations where hormone therapy use was probably less prevalent.</p

Recent breast cancer trends among Asian/Pacific Islander, Hispanic, and African-American women in the US: changes by tumor subtype

Abstract available at publisher's website

Evaluating the effectiveness and cost-effectiveness of Dementia Care Mapping™ to enable person-centred care for people with dementia and their carers (DCM-EPIC) in care homes: study protocol for a randomised controlled trial

Background Up to 90 % of people living with dementia in care homes experience one or more behaviours that staff may describe as challenging to support (BSC). Of these agitation is the most common and difficult to manage. The presence of agitation is associated with fewer visits from relatives, poorer quality of life and social isolation. It is recommended that agitation is treated through psychosocial interventions. Dementia Care Mapping™ (DCM™) is an established, widely used observational tool and practice development cycle, for ensuring a systematic approach to providing person-centred care. There is a body of practice-based literature and experience to suggests that DCM™ is potentially effective but limited robust evidence for its effectiveness, and no examination of its cost-effectiveness, as a UK health care intervention. Therefore, a definitive randomised controlled trial (RCT) of DCM™ in the UK is urgently needed. Methods/design A pragmatic, multi-centre, cluster-randomised controlled trial of Dementia Care Mapping (DCM™) plus Usual Care (UC) versus UC alone, where UC is the normal care delivered within the care home following a minimum level of dementia awareness training. The trial will take place in residential, nursing and dementia-specialist care homes across West Yorkshire, Oxfordshire and London, with residents with dementia. A random sample of 50 care homes will be selected within which a minimum of 750 residents will be registered. Care homes will be randomised in an allocation ratio of 3:2 to receive either intervention or control. Outcome measures will be obtained at 6 and 16 months following randomisation. The primary outcome is agitation as measured by the Cohen-Mansfield Agitation Inventory, at 16 months post randomisation. Key secondary outcomes are other BSC and quality of life. There will be an integral cost-effectiveness analysis and a process evaluation. Discussion The protocol was refined following a pilot of trial procedures. Changes include replacement of a questionnaire, whose wording caused some residents distress, to an adapted version specifically designed for use in care homes, a change to the randomisation stratification factors, adaption in how the staff measures are collected to encourage greater compliance, and additional reminders to intervention homes of when mapping cycles are due, via text message. Trial registration Current Controlled Trials ISRCTN82288852. Registered on 16 January 2014. Full protocol version and date: v7.1: 18 December 2015

Cost-effectiveness of easy-access, risk-informed oral pre-exposure prophylaxis in HIV epidemics in sub-Saharan Africa: a modelling study.

BACKGROUND: Approaches that allow easy access to pre-exposure prophylaxis (PrEP), such as over-the-counter provision at pharmacies, could facilitate risk-informed PrEP use and lead to lower HIV incidence, but their cost-effectiveness is unknown. We aimed to evaluate conditions under which risk-informed PrEP use is cost-effective. METHODS: We applied a mathematical model of HIV transmission to simulate 3000 setting-scenarios reflecting a range of epidemiological characteristics of communities in sub-Saharan Africa. The prevalence of HIV viral load greater than 1000 copies per mL among all adults (HIV positive and negative) varied from 1·1% to 7·4% (90% range). We hypothesised that if PrEP was made easily available without restriction and with education regarding its use, women and men would use PrEP, with sufficient daily adherence, during so-called seasons of risk (ie, periods in which individuals are at risk of acquiring infection). We refer to this as risk-informed PrEP. For each setting-scenario, we considered the situation in mid-2021 and performed a pairwise comparison of the outcomes of two policies: immediate PrEP scale-up and then continuation for 50 years, and no PrEP. We estimated the relationship between epidemic and programme characteristics and cost-effectiveness of PrEP availability to all during seasons of risk. For our base-case analysis, we assumed a 3-monthly PrEP cost of US$29 (drug$11, HIV test $4, and$14 for additional costs necessary to facilitate education and access), a cost-effectiveness threshold of $500 per disability-adjusted life-year (DALY) averted, an annual discount rate of 3$100 per DALY averted, a discount rate of 7% per annum, the use of PrEP outside of seasons of risk, and reduced uptake of risk-informed PrEP. FINDINGS: In the context of PrEP scale-up such that 66% (90% range across setting-scenarios 46-81) of HIV-negative people with at least one non-primary condomless sex partner take PrEP in any given period, resulting in 2·6% (0·9-6·0) of all HIV negative adults taking PrEP at any given time, risk-informed PrEP was predicted to reduce HIV incidence by 49% (23-78) over 50 years compared with no PrEP. PrEP was cost-effective in 71% of all setting-scenarios, and cost-effective in 76% of setting-scenarios with prevalence of HIV viral load greater than 1000 copies per mL among all adults higher than 2%. In sensitivity analyses with a $100 per DALY averted cost-effectiveness threshold, a 7% per year discount rate, or with PrEP use that was less well risk-informed than in our base case, PrEP was less likely to be cost-effective, but generally remained cost-effective if the prevalence of HIV viral load greater than 1000 copies per mL among all adults was higher than 3%. In sensitivity analyses based on additional setting-scenarios in which risk-informed PrEP was less extensively used, the HIV incidence reduction was smaller, but the cost-effectiveness of risk-informed PrEP was undiminished. INTERPRETATION: Under the assumption that making PrEP easily accessible for all adults in sub-Saharan Africa in the context of community education leads to risk-informed use, PrEP is likely to be cost-effective in settings with prevalence of HIV viral load greater than 1000 copies per mL among all adults higher than 2%, suggesting the need for implementation of such approaches, with ongoing evaluation. FUNDING: US Agency for International Development, US President's Emergency Plan for AIDS Relief, and Bill & Melinda Gates Foundation