Primary Care Validation of a Single-Question Alcohol Screening Test

BACKGROUND Unhealthy alcohol use is prevalent but under-diagnosed in primary care settings. OBJECTIVE To validate, in primary care, a single-item screening test for unhealthy alcohol use recommended by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). DESIGN Cross-sectional study. PARTICIPANTS Adult English-speaking patients recruited from primary care waiting rooms. MEASUREMENTS Participants were asked the single screening question, "How many times in the past year have you had X or more drinks in a day?", where X is 5 for men and 4 for women, and a response of >1 is considered positive. Unhealthy alcohol use was defined as the presence of an alcohol use disorder, as determined by a standardized diagnostic interview, or risky consumption, as determined using a validated 30-day calendar method. MAIN RESULTS Of 394 eligible primary care patients, 286 (73%) completed the interview. The single-question screen was 81.8% sensitive (95% confidence interval (CI) 72.5% to 88.5%) and 79.3% specific (95% CI 73.1% to 84.4%) for the detection of unhealthy alcohol use. It was slightly more sensitive (87.9%, 95% CI 72.7% to 95.2%) but was less specific (66.8%, 95% CI 60.8% to 72.3%) for the detection of a current alcohol use disorder. Test characteristics were similar to that of a commonly used three-item screen, and were affected very little by subject demographic characteristics. CONCLUSIONS. The single screening question recommended by the NIAAA accurately identified unhealthy alcohol use in this sample of primary care patients. These findings support the use of this brief screen in primary care.National Institute on Alcohol Abuse and Alcoholism (R01-AA010870

From High School to the Future

For Chicago Public School (CPS) graduates, grades are a more important predictor of college enrollment and graduation than college entrance test scores, according to a study from the Consortium on Chicago School Research at the University of Chicago. This study also found substantial differences across colleges in graduation rates among highly qualified CPS graduates, suggesting that the colleges students attend matters a great deal. The study paints a discouraging picture of college success for CPS graduates. Despite the fact that nearly 80% of seniors state they expect to graduate from a four-year college, only about one-third enroll in a 4-year college within a year of high school graduation, and only 35% of those who enroll received a bachelor's degree within 6 years. The study found that boys are less likely to enter and graduate from college than girls with similar abilities. Also, CPS Latino graduates attend college below both national and Illinois averages for Latino high school graduates

The On-Track Indicator as a Predictor of High School Graduation

This indicator identifies students as on-track if they earn at least five full-year course credits and no more than one semester F in their first year of high school. On-track students are more than three and one-half times more likely to graduate from high school in four years than off-track students. The indicator is a more accurate predictor of graduation than students' previous achievement test scores or their background characteristics. Perhaps the most important finding from this report is that failures during the first year of high school make a student much less likely to graduate. Based on their findings, the authors believe that parents and teachers should carefully monitor students' grades, especially in the first semester of freshman year, when there are still many opportunities to improve grades. Helping students make a successful transition to high school during the first semester could make students more likely to graduate. This report also finds that on-track students are not necessarily the students with the highest achievement test scores. Many students with strong achievement fail to graduate, and many students who have demonstrated weaker achievement succeed in graduating. Finally, this report concludes that the particular school a student attends plays a large role in whether the student is on-track. While we expect schools to have students with differing levels of preparation for high school, differences in the number of students on-track at each school remained even when the authors controlled for students' eighth-grade test scores and socioeconomic status. This suggests that school climate and structure play a significant role in whether students succeed in high school. Schools can use the on-track indicator, which makes use of readily available data on course credits and failures, to understand what aspects of the school may be leading students to drop out

The Predictive Validity of the Early Warning System Tool

The Early Warning System (EWS) is a tool developed by the National High School Center to collect data on indicators including attendance, GPA, course failures and credits earned. These indicators have been found to be highly predictive of a student’s likelihood of dropping out of high school in large, urban areas. The EWS tool was studied in two suburban schools. With the exception of attendance data, findings suggest that the indicators and suggested threshold for risk determination are predictive in suburban contexts

Checking in : Adoption and Safe Families Act, permanency, and child well-being

This literature review is a modest attempt to interpret current strengths regarding popular permanency policies and methods, as they relate to child well-being and permanency goals, while highlighting potential opportunities for reform. The section following the introduction discusses an important piece of permanency legislation, the Adoption and Safe Families Act. Following, will be a discussion of a child\u27s best interests and placement types. In an attempt to gain the most unbiased picture of child well-being, this review will call upon individuals directly affected by out-of-home care: children and families

Amicus Briefs and the Sherman Act: Why Antitrust Needs a New Deal

Power to interpret the Sherman Act, and thus power to make broad changes to antitrust policy, is currently vested in the Supreme Court. But reevaluation of existing competition rules requires economic evidence, which the Court cannot gather on its own, and technical economic savvy, which it lacks. To compensate for these deficiencies, the Court has turned to amicus briefs to supply the economic information and reasoning behind its recent changes to antitrust policy. This Article argues that such reliance on amicus briefs makes Supreme Court antitrust adjudication analogous to administrative notice-and-comment rulemaking. When the Court pays careful attention to economic evidence and arguments presented in amicus briefs, it moves the process away from a traditional Article III case or controversy and towards rulemaking under the Administrative Procedure Act (APA) where any interested party can influence the decision. In doing so, the Court sacrifices some of the epistemological benefits of Article III’s standing requirements. In the case of antitrust, those costs are probably outweighed by how much the Court benefits from hearing the amici’s economic arguments. But while the Court’s hybrid rulemaking – quasi-administrative and quasi-judicial – may improve upon the traditional judicial model, it cannot realize the full benefits of APA rulemaking. The awkwardness of using amicus curiae briefs like comments on a rulemaking suggests a more dramatic shift in authority over the Sherman Act is necessary. Power to interpret the Act in the first instance should go to an administrative agency

Antitrust Scrutiny for the Occupations: North Carolina Dental and Its Impact on U.S. Licensing Boards

The American system of occupational licensing is under attack. The current regime – which allows for almost total self-regulation – has weathered sustained criticism from consumer advocate groups, academics, politicians, and even the White House itself. But the recent U.S. Supreme Court opinion in North Carolina Board of Dental Examiners v. FTC,1 portends a sea change in how almost a third of American workers are regulated. The case has made it possible for aggrieved individuals and government enforcers to bring suits against most state licensing boards, challenging their restrictions as violating federal competition law. The case has prompted two responses: a flood of antitrust suits against boards, and a panic among states as they scramble to protect licensing boards from antitrust liability. This article describes the current system of professional regulation in the U.S., explains the North Carolina Dental opinion and its legal impact, and discusses states’ likely responses. The upshot is that in order to protect occupational licensing from antitrust suit, states will have to reform their regulatory systems in ways that will improve the fairness and efficiency of American occupational licensing laws

Cunningham v. California - CASE COMMENT

Sixth Amendment--Allocation of Fact-finding in Sentencing.--Apprendi v. New Jersey spawned a series of Supreme Court sentencing decisions which, when viewed together, are at best confusing and at worst contradictory. Commentators and courts have struggled to find a coherent governing principle uniting Apprendi, Blakely v. Washington, and United States v. Booker. The holding in Apprendi, originally described as a bright-line rule, has proved anything but. Last Term, in Cunningham v. California, the Court added another chapter to the Apprendi saga when it declared unconstitutional California\u27s Determinate Sentencing Law (DSL). Justice Ginsburg authored the majority opinion that overturned the California Supreme Court\u27s determination that the DSL did not differ in any constitutionally relevant way from the Federal Sentencing Guidelines, as revised by Booker . Although at first blush Cunningham seems to be an ode to meaningless formalism, reading between the lines of its opinions exposes a substantive debate about what the Sixth Amendment means and why it matters

Foxes at the Henhouse: Occupational Licensing Boards Up Close

The dark side of occupational licensing-its tendency to raise prices to consumers with dubious effects on service quality, its enormous payout to licensees, and its ability to shut many willing workers out of the workforce-has begun to receive significant attention. But little has been said about the legal institutions that create and administer this web of professional entry and practice rules. State-level licensing boards regulate nearly one-third of American workers, yet, until now, there has been no systematic attempt to understand who serves on these boards and how they operate. This Article undertakes an ambitious and comprehensive study of all 1,790 licensing boards in the U.S. and identifies their statutory membership. The results are clear: nearly all of them are controlled by professionals holding a license issued by the board itself This self-regulation is disturbing enough if one expects at least some governmental involvement in decisions that are known to redistribute income, block labor entry, and harm consumers. But now the practitioner-dominated licensing board is not just an urgent policy problem, but a legal one. A recent Supreme Court case has placed these boards and their members in the cross hairs of federal antitrust liability, precipitating a legal crisis for the states. This Article identifies the enormous scope of the Court\u27s opinion in North Carolina State Board of Dental Examiners v. FTC, opines on the meaning of its somewhat cryptic holding, and suggests steps that states can take to reform their boards with an eye to both antitrust immunity and more reasonable occupational regulation

Antitrust\u27s High-Tech Exceptionalism

American competition policy has four big problems: Amazon, Apple, Facebook, and Google. These companies each reign over a sector of the digital marketplace, controlling both the consumer experience and the possibility of competitive entry. This Essay argues that the conventional account of how antitrust law allowed this consolidation of market power - that it failed to evolve to address the market realities of the technology sector-is incomplete. Not only did courts fail to adapt antitrust law from its smoke-stack roots, but they gave big tech special dispensation under traditional antitrust doctrine. Swayed by prevailing utopic views about digital markets in the early 2000s -that they were uniquely dynamic, innovative, and competitive -these courts carved out special exceptions to antitrust rules about tying and the duty to deal with competitors. The tech companies have used this blank check to entrench their market power and keep start-ups from becoming what they themselves once were: the next big thing