Purpose Breast cancer patients aged 65+ (“older”) vary in frailty status. We tested whether a deficits accumulation frailty index predicted long-term mortality. Methods Older patients (n=1280) with non-metastatic, invasive breast cancer were recruited from 78 Alliance sites from 2004-2011, with follow-up to 2015. Frailty categories (robust, pre-frail, and frail) were based on 35 baseline illness and function items. Cox proportional hazards and competing risk models were used to calculate all-cause and breast cancer-specific mortality for up to 7-years, respectively. Potential covariates included demographic, psychosocial, and clinical factors, diagnosis year, and care setting. Results Patients were 65-91 years old. Most (76.6%) were robust; 18.3% were pre-frail, and 5.1% frail. Robust patients tended to receive more chemotherapy +/- hormonal therapy (vs. hormonal) than pre-frail or frail patients (45% vs. 37% and 36%, p=.06), and had the highest adherence to hormonal therapy. The adjusted hazard ratios for all-cause mortality (n=209 deaths) were 1.7 (95% CI 1.2-2.4) and 2.4 (95% CI 1.5-4.0) for pre-frail and frail vs. robust women, respectively, with an absolute mortality difference of 23.5%. The adjusted hazard of breast cancer death (n-99) was 3.1 (95% CI 1.6-5.8) times higher for frail vs. robust patients (absolute difference of 14%). Treatment differences didn't account for the relationships between frailty and mortality. Conclusions Most older breast cancer patients are robust and could consider chemotherapy where otherwise indicated. Patients who are frail or pre-frail have elevated long-term all-cause and breast-cancer mortality. Frailty indices could be useful for treatment decision-making and care planning with older patients.

Context:The law is a powerful public health tool with considerable potential to address the obesity issue. Scientific advances, gaps in the current regulatory environment, and new ways of conceptualizing rights and responsibilities offer a foundation for legal innovation. Methods:This article connects developments in public health and nutrition with legal advances to define promising avenues for preventing obesity through the application of the law.Findings: Two sets of approaches are defined: (1) direct application of the law to factors known to contribute to obesity and (2) original and innovative legal solutions that address the weak regulatory stance of government and the ineffectiveness of existing policies used to control obesity. Specific legal strategies are discussed for limiting children's food marketing, confronting the potential addictive properties of food, compelling industry speech, increasing government speech, regulating conduct, using tort litigation, applying nuisance law as a litigation strategy, and considering performance-based regulation as an alternative to typical regulatory actions. Finally, preemption is an overriding issue and can play both a facilitative and a hindering role in obesity policy. Conclusions:Legal solutions are immediately available to the government to address obesity and should be considered at the federal, state, and local levels. New and innovative legal solutions represent opportunities to take the law in creative directions and to link legal, nutrition, and public health communities in constructive ways.

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First explored are the nature of disasters-societal and individual, natural and manmade-and the place of both tort law and private insurance in providing compensation for disaster victims. Following brief discussions of disaster prevention and the sorts of private and public harms that are caused by disasters, five possible roles of government with respect to individual victim compensation are examined: 1) Facilitating the Receipt of Private Compensation for the Consequences of a Disaster; 2) Assuring Insurance Availability for Disaster Victims When the Market Fails to Do So; 3) Providing Victim Compensation Either When Government Should Have Prevented the Disaster or When It Is the Sort of Disaster We Aspire to Have Government Prevent; 4) Providing Victim Compensation as an Alternative to Tort Recovery; and 5) Providing Victim Assistance to Overwhelmed Communities For Reasons of Altruism and National Solidarity. Finally, brief attention is given to the type and level of victim compensation that government might assure.

Although a great deal has been written about charter schools, rather little attention has been given to their funding. The first part of this article raises four current issues in the funding of regular public schools across the U.S. and shows how these issues carry over to the funding of charter schools. The second part explores four additional issues that have arisen in the funding of charter schools that go to the core identity of charter schools and the nature of the students they enroll. In both parts, extra attention is paid to developments in California, one of the most active charter school states.