***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Circles of Support & Accountability ( COSA ) started 15 years ago in Ontario , Canada , as an alternate means of social support to high-risk sexual offenders released at the end of their sentences without any community supervision . The pilot project in South- Central Ontario has since assisted almost 200 offenders . Projects based on this model are now in place in the United Kingdom , several jurisdictions in the United States , and throughout Canada . Initial research into the efficacy of the COSA pilot project showed that participation reduced sexual recidivism by 70 % or more in comparison with both matched controls and actuarial norms . The current study sought to replicate these findings using an independent Canadian national sample . A total of 44 high-risk sexual offenders , released at sentence completion and involved in COSA across Canada , were matched to a group of 44 similar offenders not involved in COSA .  The average follow-up time was 35 months . Recidivism was defined as having a charge or conviction for a new offense . Results show that offenders in COSA had an 83 % reduction in sexual recidivism , a 73 % reduction in all types of violent recidivism , and an overall reduction of 71 % in all types of recidivism in comparison to the matched offenders . These findings suggest that participation in COSA is not site-specific and provide further evidence for the position that trained and guided community volunteers can and do assist in markedly improving offenders ’ chances for successful reintegration In 2008 , the Minnesota Department of Corrections implemented Minnesota Circles of Support and Accountability ( MnCOSA ) , a  sex offender reentry program based on the Circles of Support and Accountability ( COSA ) model developed in Canada during the 1990s . Using a r and omized experimental design , this study evaluates the effectiveness of MnCOSA by conducting a cost-benefit analysis and comparing recidivism outcomes in the MnCOSA ( N = 31 ) and control groups ( N = 31 ) . Despite the small total sample size ( N = 62 ) , the results from Cox regression models suggest that MnCOSA significantly reduced three of the five recidivism measures examined . By the end of 2011 , none of the MnCOSA offenders had been rearrested for a new sex offense compared with one offender in the control group . Because of less recidivism observed among MnCOSA participants , the results from the cost-benefit analysis show the program has produced an estimated US$ 363,211 in costs avoided to the state , result ing in a benefit of US$ 11,716 per participant . For every dollar spent on MnCOSA , the program has generated an estimated benefit of US$ 1.82 ( an 82 % return on investment ) 
    Output:
    
The majority reported measures of recidivism , particularly reconviction .
The 4 studies with controls generally reported that participation in Circles was associated with lower recidivism although there were few statistically significant differences .
Few studies examined changes in risk or psychosocial outcomes .