We describe and illustrate the use of a generalizable model for evaluating the cost-effectiveness of alternative cholesterol-lowering treatments. We combine standard incidence-based techniques for measuring the cost of illness with logistic risk functions from the Framingham Heart Study to project, for persons with known coronary risk characteristics, the likelihood of developing coronary heart disease (CHD) over a lifetime as well as a number of related outcomes, including the expected loss of years of life due to CHD, the expected lifetime direct and indirect costs of CHD, and the changes in these outcomes that would result from cholesterol-lowering treatment.

Background. We report here a study examining the relationships between insight and psychopathology, cognitive performance, brain volume and co-morbid depression in 251 patients experiencing a first episode of psychosis, who were then randomly assigned to 2 years of double-blind treatment with either olanzapine or haloperidol.

Method. Repeated measures of insight were obtained at baseline and 12, 24, 52 and 104 weeks by the Insight and Treatment Attitudes Questionnaire (ITAQ).

Results. Older age, female gender and white ethnicity were associated with more insight. Higher total, positive, negative and general psychopathology scores on the Positive and Negative Syndromes Scale (PANSS) were associated with less insight. Higher depression scores were associated with more insight. Better neurocognitive function and large brain volumes were associated with more insight. More insight throughout the study was associated with longer time to medication non-adherence. However, baseline insight was not significantly related to the probability of discontinuing the study before 2 years. Insight improved significantly over the course of the study, but the improvement in insight was not significantly different between the two antipsychotic treatment groups.

Conclusions. Multiple factors contribute to insight. Patients experiencing a first episode of psychosis who have little insight are at increased risk of discontinuing their medication.

The most frequent and visible sources of judicial policy are decisions in court cases in which judges create new solutions to problems and conflicts presented to them. Sometimes important policies are established in a single case or policy may develop gradually in a series of cases dealing with similar situations. This form of policy-making frequently occurs without much direct interaction between courts, legislatures, and executive agencies. Though the implementation of court policies may depend on the cooperation of other officials, the initiation and early shaping of a particular policy may be done almost exclusively by the courts.

The attainment of universal suffrage over various forms of voting restrictions has been one of the major accomplishments in the development of modern democratic institutions. Struggles for the vote have had to overcome restrictions based on factors such as sex, race and tenure of property. While gaps in the exercise of the franchise still remain, formal restrictions on voting in the United States have been largely removed.

However, an important question, largely uninvestigated, concerns the “costs” of the universal franchise in terms of the quality of government and its impact upon policy decisions. Do the disadvantages of universal suffrage offset advantages said to be gained, particularly in Western nations, such as increased legitimization of decisions and stability of regimes? Many of the past and present opponents of the extension of voting have argued that the poor results to be expected from the impact of universal suffrage far outweigh the advantages. Clearly, the problem of “costs” is important, for it is a crucial element in the argument over democracy and the vote.