Fiscal Climate Research Articles

Direct amplification of casework bloodstains using the Promega PowerPlex(®) 21 PCR amplification system.

A significant number of evidence items submitted to Forensic Science Service Tasmania (FSST) are blood swabs or bloodstained items. Samples from these items routinely undergo phenol:chloroform:isoamyl alcohol organic extraction and quantitative Polymerase Chain Reaction (qPCR) testing prior to PowerPlex(®) 21 amplification. This multi-step process has significant cost and timeframe implications in a fiscal climate of tightening government budgets, pressure towards improved operating efficiencies, and an increasing emphasis on rapid techniques better supporting intelligence-led policing. Direct amplification of blood and buccal cells on cloth and Whatman FTA™ card with PowerPlex(®) 21 has already been successfully implemented for reference samples, eliminating the requirement for sample pre-treatment. Scope for expanding this method to include less pristine casework blood swabs and samples from bloodstained items was explored in an endeavour to eliminate lengthy DNA extraction, purification and qPCR steps for a wider subset of samples. Blood was deposited onto a range of substrates including those historically found to inhibit STR amplification. Samples were collected with micro-punch, micro-swab, or both. The potential for further fiscal savings via reduced volume amplifications was assessed by amplifying all samples at full and reduced volume (25 and 13μL). Overall success rate data showed 80% of samples yielded a complete profile at reduced volume, compared to 78% at full volume. Particularly high success rates were observed for the blood on fabric/textile category with 100% of micro-punch samples yielding complete profiles at reduced volume and 85% at full volume. Following the success of this trial, direct amplification of suitable casework blood samples has been implemented at reduced volume. Significant benefits have been experienced, most noticeably where results from crucial items have been provided to police investigators prior to interview of suspects, and a coronial identification has been successfully completed in a short timeframe to avoid delay in the release of human remains to family members.

Public Service Motivation and Institutional-Occupational Motivations Among Undergraduate Students and ROTC Cadets

Given the current fiscal climate, budgetary pressures may have important implications for recruitment and retention of military personnel. In response to this issue, we join two literatures to study motivational differences in undergraduate college students and Reserve Officer Training Corps (ROTC) cadets: Moskos’ Institutional and Occupational (I-O) enlistment motivation model and Kim et al.’s revised Public Service Motivation (PSM) scale. We survey ROTC cadets and undergraduates at a mid-size public university and find that PSM is higher for ROTC cadets than regular undergraduates. We also find that for ROTC cadets, the institutional motivators for enlistment correlate positively with the rational, normative, and affective dimensions of PSM. In addition, we find increases in the Occupational motivator and the compassion PSM dimension reduce the likelihood of being an ROTC cadet whereas the Institutional motivator and the self-sacrifice PSM dimension are positively related with being an ROTC cadet.

Accreditation and Emergency Preparedness

Public health officials must frequently demonstrate the quality and value of public health services, especially during challenging fiscal climates. One of the ways that public health quality and accountability have been demonstrated is through the use of accreditation and standard setting initiatives. The objective of this analysis was to identify existing alignment opportunities between standards established by the Public Health Accreditation Board (PHAB) and the Centers for Disease Control and Prevention's (CDC's) public health preparedness (PHP) capabilities in order to optimize and leverage the connections for state and local public health professionals. During March-May 2012, a PHAB/PHP crosswalk was developed by a research team from the CDC's Office for State, Tribal, Local and Territorial Support and Office of Public Health Preparedness and Response's Division of State and Local Readiness to examine the intersection of the PHP capabilities and the PHAB standards. The PHAB/PHP crosswalk used the CDC Public Health Preparedness Capabilities: National Standards for State and Local Planning (PHP Capabilities) and the PHAB Standards and Measures, Version 1.0 (PHAB Standards) as its source documents. To help illustrate the results of the crosswalk, alignment was also depicted through a network graph to transform the results into a visual depiction of the linkages between PHP capabilities and PHAB standards. The most direct links to emergency preparedness were found in PHAB Domains 2 and 5. Opportunities for improved alignment were found throughout the standard documents, particularly in PHAB Domains 3, 8, and 11. The most direct links to accreditation were found in PHP capabilities 1, 2, 3, and 4. The results highlight the synergy between the infrastructure and foundational elements represented by accreditation and targeted programmatic activities supported by preparedness funding.

Caring for the Incarcerated: An Orthopedic Perspective

According to the 1976 Supreme Court case of Estelle v Gamble, the government is required to provide prisoners access to the necessary care for known, serious medical needs. Failure to do so violates the Eighth Amendment prohibiting the imposition of "cruel and unusual punishment." Currently, more than 2.5 million Americans are imprisoned, the highest per capita rate in the world. In the current fiscal climate and with burgeoning health care costs for society as a whole, providing care for prisoners poses both moral and logistical challenges. From an orthopedic standpoint, caring for the incarcerated raises uniquely challenging issues due to the nature of this patient population and their types of musculoskeletal conditions.

Caring for the Incarcerated: An Orthopedic Perspective

According to the 1976 Supreme Court case of Estelle v Gamble, the government is required to provide prisoners access to the necessary care for known, serious medical needs. Failure to do so violates the Eighth Amendment prohibiting the imposition of "cruel and unusual punishment." Currently, more than 2.5 million Americans are imprisoned, the highest per capita rate in the world. In the current fiscal climate and with burgeoning health care costs for society as a whole, providing care for prisoners poses both moral and logistical challenges. From an orthopedic standpoint, caring for the incarcerated raises uniquely challenging issues due to the nature of this patient population and their types of musculoskeletal conditions.

Should general practices open for longer?

The government wants general practices to open longer for scheduled care. James P Kingsland says this will reduce pressure on emergency services, but Peter Swinyard thinks it is unaffordable in...

Fiscal consolidation and climate policy: An overlapping generations perspective

This paper examines the distributional and efficiency impacts of public debt consolidation financed through a carbon tax employing a dynamic general-equilibrium model with overlapping generations of the U.S. economy. The numerical model features government taxes and spending and a multi-sectoral production structure including intermediate production, specific detail on the energy sector both in terms of primary energy carriers and energy-intensive industries, and sector- and fuel-specific carbon inputs. In contrast to revenue-neutral carbon tax swaps, using the carbon revenue for deficit reduction implies a relaxation of future public budgets as debt repayment results in lower future interest obligations. While intergenerational welfare impacts depend importantly on what tax recycling instrument is used, we find that combining public debt consolidation with a carbon policy entails the possibility of sustained welfare gains for future generations. If social discount rates are sufficiently low or if social preferences exhibit a large aversion with respect to intergenerational inequality, combining fiscal consolidation and climate policy may offer the chance for societal gains even without considering potential benefits from averted climate change.

Commentary: Let’s send the DOE to Alpha Centauri

The announcement of an Earth-mass planet orbiting the closest Sunlike star has renewed discussion of the costs and benefits of an interstellar probe. The planet, Alpha Centauri Bb, is in an extremely hot orbit, but its existence increases the probability that a planet with a liquid-water ocean orbits Alpha Centauri. Data from NASA’s Kepler telescope now show that there are about as many habitable-zone, Earth-sized planets as stars, and in April NASA decided to fund a follow-up spacecraft, the Transiting Exoplanet Survey Satellite. Before this decade is out, we will probably discover an ocean-bearing planet orbiting a nearby star. When we do, should we send a mission?

Dedicating new real estate transfer taxes for energy efficiency: A revenue option for scaling up Green Retrofit Programs

As the labor market in the U.S. remains weak, with high unemployment and sluggish job growth, policymakers at various levels of government are looking for new ways to support job growth and investment during an increasingly tight fiscal climate. Policies that promote the “Green Economy” in general and energy efficiency in particular remain politically popular as potential win–win solutions that will create jobs and curb greenhouse gas emissions. Yet, efforts to promote energy efficiency in the residential sector through rebates and incentives alone have yet to reach critical mass. This paper outlines a policy option for state and local governments to use real estate transfer taxes to generate stronger incentives for home buyers to undertake significant retrofit projects at the time of sale. The economic impact of the proposed energy efficiency transfer tax (EETT) is then modeled for the State of North Carolina, using standard input–output techniques. Ultimately, based on housing sales figures from 2010, a new EETT of 2.5 percent on home purchases would generate a net positive increase of approximately 3485 direct construction jobs and 5900 annually total jobs for the state.

The Global HIV Epidemic: Current Status and Challenges

Three decades after the first reported cases of AIDS we have within our reach sufficient evidence to substantially alter the HIV epidemic at a country level regardless of mode of transmission of HIV. There are a growing number of countries demonstrating control of the epidemic. Human rights violations and/or legislation relating to sexual orientation, status of minors, injecting drug use and sex work together with stigma and discrimination remain key barriers to knowledge of HIV status and access to appropriate services. The use of anti-retrovirals prophylactically to reduce sexual and vertical transmission and systemically to treat infected infants and adults is central to the optimism in responses to the epidemic. In the current fiscal climate careful thought needs to be given to how to efficiently optimise combinations of what is available to have the biggest impact in the context of limited human and infrastructure resources.

Mint to Be Green: The Essential Role of Public Banks in Mobilizing Capital Towards a Low-Carbon Economy

Continuous and large-scale investment is needed to fund the transition to a low-carbon economy. Given the current fiscal economic climate and the sheer scale of capital required, governments alone do not have the capacity to fund this transition. Instead, as estimated by the UNFCCC, more than 80 percent of the needed capital will be supplied by the private sector. However, there are significant market and investment barriers that deter private investors from financing low-carbon solutions. For this reason, governments must intervene to mobilize private investment towards a low-carbon economy. They can do so through public banks. Public banks have an essential role in enabling a swift transition.In Europe, public banks have been one of the leading developers, implementers and diffusers of low-carbon financial instruments. As a result, the banks are shaping the course of private investment and accelerating investment flows into socially beneficial as well as profitable activities. By contrast, Canada has a striking institutional gap as it lacks any public banks with even a partial low-carbon mission. This has contributed to a comparatively weak financial and investment sector in terms of low-carbon investment. As such, it is recommended that Canada establish public investment banks, first in key provinces and then at the federal level.

Does the fiscal climate accommodate traditional advocacy as a science-funding strategy?

Does the fiscal climate accommodate traditional advocacy as a science-funding strategy?

Commentary

Given the current fiscal climate limiting both government and industry support for health research, philanthropic support of health research is increasingly relevant because it provides some of the critical "risk capital" that stimulates innovation, helps translate basic research findings into clinical applications, helps support the career development of investigators, builds new infrastructure, and helps fill key funding gaps. Unfortunately, because of the philanthropic sector's diversity and scope, it is challenging to track the sector's health research investments. The authors briefly review the landscape of philanthropic organizations, identify several success stories resulting from philanthropic investments, and finally underscore the importance of gaining more knowledge about the sector through purposeful data collection efforts such as those of the Health Research Alliance (HRA), a consortium of nonprofit funders of biomedical research and training. Recent HRA efforts of this type are highlighted in this commentary and described in detail in the report by Myers et al in this issue of Academic Medicine.

Discursive institutionalism and policy stasis in simple and compound polities: the cases of Estonian fiscal policy and United States climate change policy

Discursive institutionalism is the ‘newest’ of the new institutionalisms. The majority of work employing discursive institutionalism as a framework has so far focused on how it contributes to understanding policy change. Until now, however, little attention has been paid to how discursive institutionalism can help to explain the equally significant phenomenon of policy stasis. This imbalance is addressed here through a discursive institutionalist analysis of two cases of policy stasis: Estonian fiscal policy and United States climate change policy. It is argued that policy stasis – far from being a passive and inactive state – actually involves a large amount of discursive activity by multiple actors. This activity creates, legitimates and perpetuates policy discourses, which ultimately entrench governmental commitments to policy stasis. The article proceeds in three parts. First, a theoretical model is advanced which builds on existing discursive institutionalist literature to modify the theory towards explaining policy stasis. This model is then applied to the two case studies and it is shown how, and to what extent, ‘discourse’ operates as a causal factor. Finally, it is shown how different institutional contexts affect the causal processes whereby the policy discourse becomes streamlined or complexified depending on the ‘simple’ or ‘compound’ characteristics of the polity. It is concluded that discursive institutionalism is a useful theory for understanding policy stasis in its various forms in both simple and compound polities, and that the role of ‘discourse’ in explaining such situations is deserving of greater scholarly attention.

Reexamining Public Pension Plans

Although the present fiscal climate may create the temptation to rush ahead with aggressive cost-cutting measures, a knee-jerk reaction in response to the immediate budget or political environment is unlikely to result in a public sector retirement program that meets the long-term needs of employers, employees or taxpayers. States and municipalities still need to assess the extent to which benefits provide an “adequate” retirement income, examine how the plan distributes retirement risks between employers and employees and evaluate whether the plan is still meeting the employer’s workforce management goals. Careful planning and quality analysis are the keys to a successful plan redesign effort.

Implementation and Spread of Interventions Into the Multilevel Context of Routine Practice and Policy: Implications for the Cancer Care Continuum

The promise of widespread implementation of efficacious interventions across the cancer continuum into routine practice and policy has yet to be realized. Multilevel influences, such as communities and families surrounding patients or health-care policies and organizations surrounding provider teams, may determine whether effective interventions are successfully implemented. Greater recognition of the importance of these influences in advancing (or hindering) the impact of single-level interventions has motivated the design and testing of multilevel interventions designed to address them. However, implementing research evidence from single- or multilevel interventions into sustainable routine practice and policy presents substantive challenges. Furthermore, relatively few multilevel interventions have been conducted along the cancer care continuum, and fewer still have been implemented, disseminated, or sustained in practice. The purpose of this chapter is, therefore, to illustrate and examine the concepts underlying the implementation and spread of multilevel interventions into routine practice and policy. We accomplish this goal by using a series of cancer and noncancer examples that have been successfully implemented and, in some cases, spread widely. Key concepts across these examples include the importance of phased implementation, recognizing the need for pilot testing, explicit engagement of key stakeholders within and between each intervention level; visible and consistent leadership and organizational support, including financial and human resources; better understanding of the policy context, fiscal climate, and incentives underlying implementation; explication of handoffs from researchers to accountable individuals within and across levels; ample integration of multilevel theories guiding implementation and evaluation; and strategies for long-term monitoring and sustainability.

Leaving the “Big Deal”: Consequences and Next Steps

Many libraries are facing difficult fiscal climates with serials inflation, budget cutbacks, and reductions in allocations requiring difficult collection management decisions. Libraries may find their flexibility to plan and react unduly restricted due to being contracted to one or more “Big Deals,” in which they are obligated to buy large, inflexible title lists from big publishers for a set price. This presentation discusses the experience of Southern Illinois University–Carbondale and the University of Oregon in leaving “Big Deals,” provides data on impacts on interlibrary loans, community response, and collection budgets, details the steps required before and after the decision, and describes the benefits that other libraries could achieve by following the example of these two members of the Association of Research Libraries.

The Power of Evidence: Improving the Effectiveness of Government by Investing in More Rigorous Evaluation

The current fiscal climate is focusing attention on the need for more efficient government. However, we have remarkably little rigorous information on which are the most cost-effective strategies for achieving common goals like delivering high quality education in deprived neighbourhoods or reducing carbon emissions. This paper argues that randomised impact evaluations can provide an effective way to generate the information needed to make government more effective. Advances in the theory and practice of running randomised evaluations mean that a wider range of questions can be answered than ever before. Elsewhere in the world, fundamental questions are being answered about how humans behave, which in turn are being used to design new policies which themselves are rigorously tested. By learning from these results, and by conducting more randomised evaluations on issues important to UK policy (both at home and abroad) it will be possible to design more effective policies and do more with less.

Nutrition Professionals Are Obligated to Follow Ethical Guidelines when Conducting Industry-Funded Research

Although disclosure of all funding sources, including those from industry, is mandatory for publication, it is no longer adequate. Given the skepticism surrounding industry-funded research, we need guidelines for communication with funding organizations and publication venues, and we need to safeguard and preserve research and scientific integrity.

Strategies for Recruitment and Retention of Participants in Clinical Trials

CLINICAL TRIALS AND THE CONSEQUENT BENEFITS TO society are in jeopardy in the United States because of a decline in the ability to recruit patients in a timely manner to trials addressing key clinical issues. Current initiatives (eg, the Clinical Trials Transformation Initiative and the proposed National Center for Advancing Translational Sciences) and the recent Institute of Medicine report each recognize that successful recruitment and retention of participants in clinical trials is critical for improving the efficiency and effectiveness of phase 3 and 4 clinical trials and that action to ensure adequate enrollment is urgently needed. Too often trial enrollment fails or is significantly delayed, leading to substantial additional costs to the sponsor. Of particular concern is the failure of US trials to meet desired participant enrollment and the trend toward increasing emphasis on recruitment abroad. The National Heart, Lung, and Blood Institute (NHLBI) and cosponsors convened a workshop on December 7 and 8, 2010, in Bethesda, Maryland, to review, compile, and recommend successful recruitment and retention strategies in phase 3 and 4 clinical trials. Barriers to successful recruitment and key recommendations were discussed, including policies, guidelines, and reimbursement for studies involving human research participants and clinical trial enrollment experience and practice. Seventy-five participants included clinical researchers, private advocacy groups, federal sponsors, regulatory agencies, and industry. Several critical barriers to successful recruitment were identified. First, the importance of health care professionals as gatekeepers for clinical trial participation cannot be overstated. However, many clinicians are either not aware of active trials or do not refer their patients for participation in trials. Some have questioned the ethics of physicians involving their own patients in clinical trials, whereas others note the challenge of achieving equipoise when physicians have firm opinions about treatment choices. This is compounded by patients’ lack of knowledge about clinical trials for which they may be eligible, availability of experimental intervention in the community, and entrenched cultural and historical views and suspicions of clinical research. Second, the financial realities of funding clinical trials must be estimated accurately and met. Understated infrastructure needs or reimbursement costs associated with recruitment and retention can lead to failure. Substantial costs are necessary to enroll and retain diverse populations, and these additional costs compete for available funds in a fiscal climate in which cost containment is expected. Women and minority populations are more difficult and more costly to recruit and retain in trials because, for women, the costs of child care, transportation, and even usual health care are often out-of-pocket additional expenses for their participation. For minorities, extra time is needed to gain individual and community acceptance. Balancing the need to enroll these understudied populations and developing outreach strategies to support their participation is an ongoing challenge. Third, administrative burdens and regulatory requirements present unprecedented challenges, even for experienced trialists. Institutional policies that govern clinical investigation often create barriers for clinician investigators rather than encouraging their participation. Moreover, the entire concept of indirect costs related to clinical trials needs review, critical analysis, and optimization. Clinical trials are essential to evaluate new therapies and improve health care. Successful enrollment is pivotal for the success of every trial. The following are recommendations to help promote enrollment success.