Specific Deterrence Revisited: A Quasi-experiment on Sentence Severity and Recidivism

This paper examines the utility of using a unique variation produced by a ruling in the Maryland sentencing guidelines as an instrumental variable in future research. The guidelines specify that at age 26 an offender's juvenile record is discounted from the calculations, resulting in a lower sentencing grid placement and a shorter sentence. I examine in depth the appropriateness of this treatment rule as an instrumental variable for research and find that it is an effective instrument. The study also examines preliminary results produced by using an instrumental variable to estimate a relationship between sentence severity and recidivism. The use of instrumental variables corrects for the selection bias present in other studies in this area by allowing me to compare individuals affected by the treatment rule. The results indicate a slight deterrent effect of imprisonment; overall, increasing sentence length decreases future rates of recidivism

A review of valve surgery for rheumatic heart disease in Australia

Background: Globally, rheumatic heart disease (RHD) remains an important cause of heart disease. In Australia it particularly affects older non-Indigenous Australians and Aboriginal Australians and/or Torres Strait Islander peoples. Factors associated with the choice of treatment for advanced RHD remain variable and poorly understood. Methods: The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database was analysed. Demographics, co-morbidities, pre-operative status and valve(s) affected were collated and associations with management assessed. Results: Surgical management of 1384 RHD and 15843 non-RHD valve procedures was analysed. RHD patients were younger, more likely to be female and Indigenous Australian, to have atrial fibrillation (AF) and previous percutaneous balloon valvuloplasty (PBV). Surgery was performed on one valve in 64.5%, two valves in 30.0% and three valves in 5.5%. Factors associated with receipt of mechanical valves in RHD were AF (OR 2.69) and previous PBV (OR 1.98) and valve surgery (OR 3.12). Predictors of valve repair included being Indigenous (OR 3.84) and having fewer valves requiring surgery (OR 0.10). Overall there was a significant increase in the use of mitral bioprosthetic valves over time. Conclusions: RHD valve surgery is more common in young, female and Indigenous patients. The use of bioprosthetic valves in RHD is increasing. Given many patients are female and younger, the choice of valve surgery and need for anticoagulation has implications for future management of RHD and related morbidity, pregnancy and lifestyle plans