The Coalition for Epidemic Preparedness Innovations (CEPI) and the Partnerships of Equitable Vaccine Access.

This article highlights and evaluates the role of CEPI and its contribution to global equitable access to COVID-19 vaccines through its established partnerships for vaccine development. The article adds to the understanding of how and when such partnerships can work for public health, especially under emergency citations.

The predictive performance of criminal risk assessment tools used at sentencing: Systematic review of validation studies.

Although risk assessment tools have been widely used to inform sentencing decisions, there is uncertainty about the extent and quality of evidence of their predictive performance when validated in new samples. Following PRISMA guidelines, we conducted a systematic review of validation studies of 11 commonly used risk assessment tools for sentencing. We identified 36 studies with 597,665 participants, among which were 27 independent validation studies with 177,711 individuals. Overall, the predictive performance of the included risk assessment tools was mixed, and ranged from poor to moderate. Tool performance was typically overestimated in studies with smaller sample sizes or studies in which tool developers were co-authors. Most studies only reported area under the curve (AUC), which ranged from 0.57 to 0.75 in independent studies with more than 500 participants. The majority did not report key performance measures, such as calibration and rates of false positives and negatives. In addition, most validation studies had a high risk of bias, partly due to inappropriate analytical approach used. We conclude that the research priority is for future investigations to address the key methodological shortcomings identified in this review, and policy makers should enable this research. More sufficiently powered independent validation studies are necessary.

Covid-19 and Worker Issues: Lessons From a University-based Ad-Hoc Network.

The Covid-19 pandemic has made clear the central role of the workplace in public health. Workers and working families have been particularly impacted by a public health and economic crisis that has revealed both structural shortcomings and opportunities for future preparedness. In response to the pandemic, a group of scholars, labor and anti-poverty advocates, activists, union representatives, frontline workers, and public health professionals gathered to share observations and create a forum for information sharing and collaboration. Conversations evolved with the pandemic to include policy solutions aimed at addressing the pandemic's health and economic impacts. In this paper, we summarize key lessons from the "Covid-19 and Workers" calls and suggest that ongoing collaboration among labor activists and academic and public health advocates may help to prepare for new public health crises and protect the safety and health of workers and communities.

Advancing Legal Preparedness through the Global Health Security Agenda.

The Global Health Security Agenda (GHSA) is a multilateral, multisectoral partnership comprised of more than 70 countries, international organizations, foundations, and businesses to strengthen global health security.

Valid or voodoo? A qualitative study of attorney perceptions of risk assessment in sentencing and plea bargaining.

Prior research largely has explored judicial perceptions of risk assessment in sentencing. Little is known about how other court actors, specifically, prosecutors and defense attorneys, perceive risk assessments in the sentencing process. Here, we report a qualitative study on the use of risk assessment by prosecutors and defense attorneys in Virginia. A prior survey (n = 70) pointed to a statistically significant difference in how prosecutors and defense attorneys view the role of recidivism risk in sentencing. On the basis of the results of this quantitative study, we collected follow-up qualitative data via interview (n = 30) to explain this unexpected difference. Analysis confirmed the survey findings that prosecutors and defense attorneys differ in their perceptions of risk assessment in sentencing. Results suggest that court actor perceptions vary as a function of professional role in the service of the identified client (the community or the defendant) and their interests. Although perceptions diverged on utility risk assessment in sentencing, both prosecutors and defense attorneys were outspoken in their skepticism of the Nonviolent Risk Assessment instrument that is used to predict recidivism risk in Virginia. This latter finding identifies obstacles that may emerge as jurisdictions adopt a risk-based approach to sentencing. We conclude with recommendations for addressing these barriers that may provide useful guidance on the implementation process.

Lost in translation: "Risks," "needs," and "evidence" in implementing the First Step Act.

In this article, we focus on two highly problematic issues in the manner in which the First Step Act of 2018 is being implemented by the Bureau of Prisons: an uncritical separation of "dynamic risks" and "criminogenic needs"; and a spurious reliance on "evidence-based" interventions to reduce recidivism risk. We argue that if the Act is to live up to its promise of being a game-changing development in efforts to reduce crime while simultaneously shrinking mass incarceration, "needs assessment" must be subject to vastly increased empirical attention, variable and causal risk factors must be identified and validly assessed, and interventions to reduce risk must be rigorously evaluated both for their fidelity of implementation and impact on recidivism. Rather than further proliferating programs that ostensibly reduce risk, we believe that serious consideration should be given to the Bureau of Prisons offering one signature, well-established cognitive-behavioral program that can simultaneously address multiple risk factors for moderate and high-risk prisoners.

Impact of risk assessment on judges' fairness in sentencing relatively poor defendants.

OBJECTIVE: Use of risk assessment instruments in the criminal justice system is controversial. Advocates emphasize that risk assessments are more transparent, consistent, and accurate in predicting re-offending than judicial intuition. Skeptics worry that risk assessments will increase socioeconomic disparities in incarceration. Ultimately, judges make decisions-not risk assessments. This study tests whether providing risk assessment information interacts with a defendant's socioeconomic class to influence judges' sentencing decisions. HYPOTHESES: Tentatively, socioeconomic status was expected to have a main effect; without an interaction with risk assessment information. METHOD: Judges (N = 340) with sentencing experience were randomly assigned to review 1 of 4 case vignettes and sentence the defendant to probation, jail, or prison. Information in the vignettes was held constant, except the defendant's socioeconomic status and whether risk assessment information was provided. RESULTS: Risk assessment information reduced the likelihood of incarceration for relatively affluent defendants, but the same information increased the likelihood of incarceration for relatively poor defendants. This finding held after controlling for the sex, race, political orientation, and jurisdiction of the judge. CONCLUSIONS: Cuing judges to focus on risk may re-frame how they process socioeconomic status-a variable with opposite effects on perceptions of blameworthiness for past crime versus perceptions of risk for future crime. Providing risk assessment information may have transformed low socioeconomic status from a circumstance that reduced the likelihood of incarceration (by mitigating perceived blameworthiness) to a factor that increased the likelihood of incarceration (by increasing perceived risk). Under some circumstances, risk assessment information may increase sentencing disparities. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Risk assessment in sentencing and plea bargaining: The roles of prosecutors and defense attorneys.

Research on risk assessment in sentencing has focused heavily on the role of judges. Ignoring the role of other courtroom actors in the sentencing process, however, leaves unexamined the potentially significant effects on judicial decision making of arguments made by prosecutors and defense attorneys at sentencing hearings. Unduly focusing on judges also overlooks the vast majority of sentences arrived at through negotiated guilty pleas. We explored the extent to which considerations of risk are made among prosecutors and defense attorneys when advocating for given sentences in open court or during plea negotiations. We surveyed all prosecutors and defense attorneys in 14 judicial circuits in Virginia and found that most prosecutors and defense attorneys at least "sometimes" explicitly invoked actuarial risk estimates both at sentencing hearings and during plea negotiations. However, defense attorneys were much more likely than prosecutors to be averse to the use of risk assessment in either form of case disposition.

Evolving Public Views On The Likelihood Of Violence From People With Mental Illness: Stigma And Its Consequences.

Highly publicized acts of violence routinely spark reactions that place blame on the perpetrator's presumed mental illness. Despite solid evidence that people with mental illness are unlikely to be dangerous, such prejudice can lead to support for inappropriately using legal means to force people into treatment. We examined trends in public perceptions of violence and support for coerced treatment across a twenty-two-year period using data from three National Stigma Studies. The studies gave respondents one of three vignettes describing people who met clinical criteria for mental disorders or one describing a person with nonclinical "daily troubles." Perceptions regarding potential violence and support for coercion generally rose over time-significantly so for schizophrenia. By 2018 over 60 percent of respondents saw people who met criteria for schizophrenia as dangerous to others, and 44-59 percent supported coercive treatment. Sixty-eight percent saw people with alcohol dependence as dangerous to others, and 26-38 percent supported coercion. Lower but substantial percentages were reported for people with depression and, remarkably, for those with nonclinical "daily troubles," who were viewed as dangerous. These findings reflect political discourse, not scientific data, and could lead to policies that would be ineffective and misdirect the search for the underlying roots of violence while unnecessarily increasing stigma toward people with mental illness.

Risk and resources: A qualitative perspective on low-level sentencing in Virginia.

Virginia's sentencing guidelines include alternative sanctions based on the use of a quantitative instrument called the Nonviolent Risk Assessment (NVRA) that identifies individuals convicted of drug and property crimes that are considered to be at lower risk of recidivism. Although nondispositive, the NVRA affords judges the discretion to grant alternative sentences to eligible low-risk defendants. In this study, we explore how judges make use of the NVRA instrument when sentencing individuals convicted of low-level drug and property crimes. Through semistructured interviews (N = 24) and inductive thematic analysis, the research team identified contextual factors that influence the use of the NVRA results, including: the availability of alternative programs in a community, the role of court actors, particularly prosecutors, in shaping the sentencing outcomes, as well as an individual judge's willingness to defer to or reject negotiated plea agreements offered by the prosecutor. Our research shows that while some judges are aware of and embrace the benefits of the instrument, others lack knowledge altogether of its function and empirical basis. We identified seven themes that account for variation in how actuarial risk is utilized in the sentencing process. Our findings provide insight into the practical challenges of using risk-based assessment as a tool for the sentencing of low-level convictions. As more states adopt risk-based approaches to sentencing, studying Virginia, which has gone farther than other states in legislating this strategy, becomes increasingly important.

The Classification of Violence Risk.

(Reprinted with permission from Behav. Sci. Law 24: 721-730, 2006).

Judicial appraisals of risk assessment in sentencing.

The assessment of an offender's risk of recidivism is emerging as a key consideration in sentencing policy in many US jurisdictions. However, little information is available on how actual sentencing judges view this development. This study surveys the views of a population sample of judges in Virginia, the state that has gone further than any other in legislatively mandating risk assessment for certain drug and property offenders. Results indicate that a strong majority of judges endorse the principle that sentencing eligible offenders should include a consideration of recidivism risk. However, a strong majority also report the availability of alternatives to imprisonment in their jurisdictions to be inadequate at best. Finally, most judges oppose the adoption of a policy requiring them to provide a written reason for declining to impose alternative interventions on "low-risk" offenders.

Predeployment predictors of psychiatric disorder-symptoms and interpersonal violence during combat deployment.

BACKGROUND: Preventing suicides, mental disorders, and noncombat-related interpersonal violence during deployment are priorities of the US Army. We used predeployment survey and administrative data to develop actuarial models to identify soldiers at high risk of these outcomes during combat deployment. METHODS: The models were developed in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) Pre-Post Deployment Study, a panel study of soldiers deployed to Afghanistan in 2012-2013. Soldiers completed self-administered questionnaires before deployment and one (T1), three (T2), and nine months (T3) after deployment, and consented to administrative data linkage. Seven during-deployment outcomes were operationalized using the postdeployment surveys. Two overlapping samples were used because some outcomes were assessed at T1 (n = 7,048) and others at T2-T3 (n = 7,081). Ensemble machine learning was used to develop a model for each outcome from 273 predeployment predictors, which were compared to simple logistic regression models. RESULTS: The relative improvement in area under the receiver operating characteristic curve (AUC) obtained by machine learning compared to the logistic models ranged from 1.11 (major depression) to 1.83 (suicidality).The best-performing machine learning models were for major depression (AUC = 0.88), suicidality (0.86), and generalized anxiety disorder (0.85). Roughly 40% of these outcomes occurred among the 5% of soldiers with highest predicted risk. CONCLUSIONS: Actuarial models could be used to identify high risk soldiers either for exclusion from deployment or preventive interventions. However, the ultimate value of this approach depends on the associated costs, competing risks (e.g. stigma), and the effectiveness to-be-determined interventions.

Predicting Violent Behavior: What Can Neuroscience Add?

The ability to accurately predict violence and other forms of serious antisocial behavior would provide important societal benefits, and there is substantial enthusiasm for the potential predictive accuracy of neuroimaging techniques. Here, we review the current status of violence prediction using actuarial and clinical methods, and assess the current state of neuroprediction. We then outline several questions that need to be addressed by future studies of neuroprediction if neuroimaging and other neuroscientific markers are to be successfully translated into public policy.

Predicting Sexual Assault Perpetration in the U.S. Army Using Administrative Data.

INTRODUCTION: The Department of Defense uses a universal prevention framework for sexual assault prevention, with each branch implementing its own branch-wide programs. Intensive interventions exist, but would be cost effective only if targeted at high-risk personnel. This study developed actuarial models to identify male U.S. Army soldiers at high risk of administratively recorded sexual assault perpetration. METHODS: This study investigated administratively recorded sexual assault perpetration among the 821,807 male Army soldiers serving 2004-2009. Administrative data were also used to operationalize the predictors. Penalized discrete-time (person-month) survival analysis (conducted in 2016) was used to select the smallest possible number of stable predictors to maximize number of sexual assaults among the 5% of soldiers with highest predicted risk of perpetration (top-ventile concentration of risk). Separate models were developed for assaults against non-family and intra-family adults and minors. RESULTS: There were 4,640 male soldiers found to be perpetrators against non-family adults, 1,384 against non-family minors, 380 against intra-family adults, and 335 against intra-family minors. Top-ventile concentration of risk was 16.2%-20.2% predicting perpetration against non-family adults and minors and 34.2%-65.1% against intra-family adults and minors. Final predictors consisted largely of measures of prior crime involvement and the presence and treatment of mental disorders. CONCLUSIONS: Administrative data can be used to develop actuarial models that identify a high proportion of sexual assault perpetrators. If a system is developed to consolidate administrative predictors routinely, then predictions could be generated periodically to identify those in need of preventive intervention. Whether this would be cost effective, though, would depend on intervention costs, effectiveness, and competing risks.