Increasing Budget Constraints Research Articles

Three months in a high-volume tertiary orthopaedic trauma unit: What is a registrar worth?

South Africa has a high burden of traumatic injuries that is predominantly managed in the public healthcare system, despite the relative disparity in human resources between the public and private sectors. Because of budget and theatre time constraints, the trauma waiting list often exceeds 50 - 60 patients who need urgent and emergent surgery in high-volume orthopaedic trauma centres. This situation is exacerbated by other surgical disciplines using orthopaedic theatre time for life-threatening injuries because of lack of own theatre availability. One of the proposed solutions to this problem is outsourcing of some of the cases to private medical facilities.To establish the volume of work done by an orthopaedic registrar during a 3-month trauma rotation, and to calculate the implant and theatre costs, as well as compare the salary of a registrar with the theoretical private surgeon fees for procedures performed by the registrar in the 3-month period.In a retrospective study, the surgical logbook of a single registrar during a 3-month rotation, from 14 January to 14 April 2019, was reviewed. Surgeon fees were calculated for these procedures, according to current medical aid rates, without additional modifier codes being added.During the 3-month study period, a total of 157 surgical procedures was performed, ranging from total hip arthroplasty to debridement of septic hands. Surgeon fees amounted to ZAR186 565.10 per month ‒ double the gross salary of a registrar. Total implant costs amounted to ZAR1 272 667. Theatre costs were ZAR1 301 976 for the 3-month period.Although this analysis was conducted over a short period, it highlights the significant amount of trauma work done by a single individual at a high-volume tertiary orthopaedic trauma unit. With increasing budget constraints, pressure on theatre time and a growing population, cost-effective expansion of resources is needed. From this study, it appears that increasing capacity in the state sector could be cheaper than private outsourcing, although a more in-depth analysis needs to be conducted.

The Effect of Unchallenged Tax Positions on Corporate Tax Aggressiveness: Evidence from Statute of Limitations Lapses

Tax authority resource constraints result in aggressive tax positions often going unchallenged. This study uses statute of limitations lapses to examine the effect of unchallenged tax positions on corporate tax aggressiveness. We first document that unchallenged tax positions are more likely when a firm claims less aggressive tax positions, when the tax authority has fewer resources, and when a firm has a more extensive geographic footprint. In our main analyses, we find that firms become less tax aggressive in years subsequent to positions going unchallenged, consistent with firms anticipating heightened tax authority scrutiny after disclosing unchallenged tax positions in their financial statements. In supplemental analyses, we find Internal Revenue Service (IRS) downloads of firms’ financial statements increase after firms disclose unchallenged tax positions, but tax settlements do not increase. Our findings shed light on a previously unexplored facet of taxpayer-tax authority interactions and are important in light of the increased budget constraints faced by tax authorities worldwide.

Student perceptions of online and in-person microbiology laboratory experiences in undergraduate medical education

ABSTRACT Background: Universities are facing increased budget constraints, often resulting in reduced funds to support microbiology laboratories. Online mock laboratory activities are often instituted as a cost-effective alternative to traditional wet labs for medical students. Objective: The purpose of this study was to examine students’ perceptions of online and in-person microbiology lab learning experiences. Design: We investigated undergraduate medical student perception of the in-person and online microbiology lab experience; 164 first-year medical students participated in newly designed online labs, while 83 second-year medical students continued to use in-person labs. An online survey was administered to collect student opinions of the lab experience. Results: In terms of student self-reported learning styles, those students who attended the lab in person were more likely to report a tactile learning style (33% vs 16%) while those students who learned the material online reported a visual learning style preference (77% vs 61%; n = 264). Students felt that the online microbiology lab was more convenient for their schedules when compared to the in-person lab. A greater proportion of online students (12%) felt that they encountered brand-new material on the final quiz than in-person students (1%; n = 245). Even so, 43% of the online educated students and 37% of the in-person educated students perceived their assigned lab experiences to be the optimal lab design, and over 89% of both groups reported a desire for at least some in-person instruction in a wet-laboratory environment. Conclusions: Our findings suggest that, while students are strongly supportive of digital online lab activities, the overwhelming majority of students still report a desire for a blend of online and in-person, hands-on laboratory activities. These findings will further research directed towards student perception of the lab experience and aid in the adaptation of microbiology curriculums to accommodate both student and university needs.

Education’s many “opens”

The concept of openness is multifaceted and can be addressed from a wide range of different angles. Here we focus on openness in education, with a particular focus on knowledge production and access. We thus also focus on the academic publishing industry, which is in constant flux and has seen considerable changes in recent years, partly due to rapid technological changes. Ultimately, the discussion is narrowed down to focus on AJET’s approach to openness as an example of open access publishing. The question is raised of how can we grow open access publishing in a higher education sector characterised by increasing budget constraints in order to make access to knowledge as open as possible to as many potential readers as possible.

Day Case Orthognathic Surgery: The First known case series. A new era?

Aim: We present a unique case series of over 95 day case orthognathic osteotomies. These cases were operated on by a single experienced oral and maxillofacial surgeon, over a five-year period. This is, to our knowledge, the first data set of its kind. We aim to show that in an era of increased budget constraints, day case orthognathic surgery is not only possible but potentially a new model for the future.

Exploring Key Indicators of Residual Value Risks in China’s Public–Private Partnership Projects

Public–private partnerships (PPPs) are gaining popularity in China because of governments’ increasing budget constraints and the urgent need to develop infrastructure since 2014. However, residual value risk (RVR) is a significant threat to the success of PPP projects and challenges the governance capability of China’s government, where key risk indicators (KRIs) can be used as a measure to reveal the potential presence, level, or trend of RVR. To help the public sector obtain estimated value as specified in a concession agreement when the projects are transferred back to the government at the end of the PPP agreement or in earlier termination due to RVR, this paper proposes and refines a KRI conceptual model composed of seven risk dimensions and 61 indicators. A structured questionnaire survey with PPP experts investigated the relative significance of those 61 KRIs for RVR management in PPPs. Although the survey results show that all KRIs are important, seven risk dimensions contribute differently to the exposure of RVR. A confirmatory factor analysis (CFA) was used to test whether the proposed conceptual model fit the observed set of collected data in a predictable way by goodness-of-fit indices, and to further consolidate the KRIs. The refined KRI model uses 41 KRIs based on survey and CFA results, indicating that residual value (RV) of a PPP project is strongly influenced by effective maintenance, long-term sustainable development, and reasonable profitability and refinanceability. The KRIs including high-quality design work in the early stages of PPP projects, construction quality and public service quality, comparatively low operation costs during the operation period, and feasible technologies adopted by private sectors have a greater value in corresponding dimensions. These 41 KRIs have the ability to indicate trends of losses of RV in PPPs, control weaknesses for RVR management in PPPs, and obtain long-term and sustainable development through PPP projects.

Optimal targeting under budget constraints in a humanitarian context

The combination of conflict, food insecurity, and displacement generates competing claims for financial resources that stretch the donors' ability to provide funding and the humanitarian organizations' capacity to provide social assistance. The paper uses Receiver Operating Characteristic curves and related indexes to determine the optimal targeting strategy of a food voucher program for refugees. The estimations focus on the 2014 food vouchers administered by the World Food Programme to Syrian refugees in Jordan. The analysis uses data collected by the United Nations High Commissioner for Refugees. Based on a poverty model, Receiver Operating Characteristic curves are used to optimize coverage and leakage rates under budget constraints. The paper shows how policy makers can use these instruments to fine-tune targeting using coverage rates, budgets, or poverty lines as guiding principles to increase the overall efficiency of a program. As humanitarian organizations operate under increasing budget constraints and increasing demands for efficiency, the proposed approach addresses both concerns.

(Treasury Technology Management of Budget Liquidity and Their Role in Ensuring Sustainable Development of Agrarian Sector in the Conditions of Global Uncertainty)

Russian Abstract: В условиях нарастания политической и экономической неопределенности устойчивое функционирование стратегически значимых отраслей, к которым, в первую очередь, относится сельское хозяйство, определяет национальную безопасность государства. Сопоставление результатов производства сельскохозяйственной продукции с некоторыми странами мира свидетельствует об экстенсивном характере развития отрасли. Государственное участие в поддержке аграрного сектора сохраняется на достаточно низком уровне. В условиях существующей модели распределительных отношений снижение доходов бюджетов бюджетной системы Российской Федерации в связи с неблагоприятной конъюнктурой на сырьевых рынках, формирует риски неисполнения расходных обязательств, к которым, в частности, относятся программные мероприятия, направленные на поддержку аграрного сектора. Казначейские технологии управления бюджетной ликвидностью позволяют снизить бюджетные риски в условиях усиления бюджетных ограничений. Обосновано, что концентрация финансовых ресурсов на Едином банковском счете Казначейства России и размещение временно свободной бюджетной ликвидности в финансовых инструментах, формирует условия для повышения доли государственного участия в развитии отрасли на принципиально новом уровне. English Abstract: In the context of the rising of political and economic uncertainty, sustainable development of strategic industries, primarily agriculture, determines the national security state. Comparison of the results of agricultural production with some countries of the world testifies to the extensive nature of the industry. State participation in support of the agricultural sector is maintained at a low level. According to the model of income distribution in budgets of the budgetary system of the Russian Federation in connection with the unfavorable situation on the commodity markets, creates the risk of default of expenditure commitments, which include, in particular, the policy measures aimed at supporting the agricultural sector. Treasury technologies of budget liquidity management can reduce the fiscal risks in the face of increasing budget constraints. It is proved that the concentration of financial resources on a single bank account Russian Treasury and the placement of temporarily free budget liquidity in financial tools, creates the conditions for increasing the share of state participation in the development of the industry to a fundamentally new level.

Guideline Adherence Regarding the Use of Expensive Drugs in Daily Practice: The Examples of Trastuzumab in Breast Cancer and Bortezomib in Multiple Myeloma

Background: The present study was designed to obtain insights into guideline adherence regarding the use of expensive drugs in The Netherlands in daily practice and into the patients' perspective on the decision-making process. Material and Methods: A retrospective review of medical charts regarding the use of trastuzumab in early and metastatic breast cancer (EBC/MBC) and bortezomib in multiple myeloma (MM) was conducted. Prescription according to clinical practice guidelines was assessed. The review was supplemented with patient interviews. Results: Of 702 adjuvant-treated EBC patients, 97% had a documented human epidermal growth factor receptor 2 (HER2) testing (23% HER2 positive). 92% (147/160) of the HER2-positive EBC patients were treated with trastuzumab. Of 594 MBC patients, 81% had a documented HER2 testing (19% HER2 positive). 82% (75/91) of the HER2-positive MBC patients were treated with trastuzumab. Of 68 MM patients, 50% were treated with bortezomib. Reasons not to treat were consistent with the guidelines. Patients were generally satisfied with the decision-making process; improvements in patient education were suggested (e.g., repeating the information given, adding information on side effects). Conclusions: Guidelines were generally well followed with respect to trastuzumab and bortezomib, indicating that funding did not influence the treatment decisions of physicians. In view of the growing numbers of both cancer patients and expensive new anticancer drugs, and increasing budget constraints, it is unclear whether the present-day policies will guarantee a similar level of guideline adherence. Patient involvement in decision-making could be increased by improving the patient education on treatment.

Civic crowd-funding: a potential test of the voluntary theory of public finance for public capital goods

There have been many innovations in public finance in the 21st century to address increasing budget constraints and increasing demands from government. One innovation has been civic crowd-funding which began in 2009. This is predicated on the voluntary commitment of funds by individual and institutional donors and investors for specific projects. This paper explores this new approach to funding capital projects and grounds it within a discussion of the Voluntary Theory of Public Finance. There is a lack of research on civic crowd-funding and a lack of theoretical approaches to it. This paper draws these connections and develops future directions of research that includes the continuing application of this approach, the increasing engagement of citizens in the administrative process of government and increasing budget constraints.

Doing the right things and doing things right: inpatient drug surveillance assisted by clinical decision support

Increased budget constraints and a continuous focus on improved quality require an efficient inpatient drug surveillance process. We describe a hospital-wide drug surveillance strategy consisting of a multidisciplinary evaluation of...

Economic Sustainability of DBO Water Based on Wastewater Projects in the U.S.: Three Case Studies

AbstractAs public utility owners face increased budget constraints and greater expectations, alternative project delivery methods will increasingly be used to fast track projects, reduce costs, promote innovation, and ensure proper performance for water and wastewater facilities. The goals of public utility owners and U.S. federal tax regulations suggest why design-build-operate (DBO) projects have been selected over other procurement processes. The research reported in this paper contributes to the body of knowledge and benefits industry practitioners, by identifying tax regulations and best practices that when jointly considered improve the project delivery selection process, while enhancing risk-mitigation efforts on DBO water and wastewater projects. A procurement selection process using multiple-criteria decision and financial risk analyses is presented to select the most economically sustainable delivery method given each project’s characteristics. A present value analysis establishes a range of val...

An Assessment of the Implementation of Performance Budgeting in Poland with Reference to the Experiences of Other Countries

Since the last global financial crisis, public expenditures have been experiencing increasing budget constraints. Therefore, public authorities search for solutions that would foster efficient and transparent expenditures at both the national and local government levels. One of the tools at their disposal is the performance-based budget, which is not, however, cheap or easy to implement. The aim of this paper is an assessment of the implementation of performance budgeting in Poland, and a formulation of proposals de lege ferenda. The assessment discusses selected aspects and conclusions which emerge from the experiences of other countries. The main thesis, set forth in the conclusion of this article, is that in many countries, including Poland, the implementation of a performance-based budget takes place at the national level, not at the local government level, which seems to be questionable, or even incorrect.

Practice Education Partnership (PEP): An innovative model for clinical education

Recently, the American Association of Colleges of Nursing (AACN) reported that more than 32,000 qualified applicants to baccalaureate and graduate nursing programs were turned away by U.S. nursing schools due to insufficient numbers of nursing faculty in combination with not enough clinical sites, classroom space, or clinical instructors, and increasing budget constraints. Almost three quarters (71.0%) of the nursing schools identified faculty shortages as a reason for not accepting all qualified applicants.

Racionamento dos cuidados de saúde: problemática inerente

Limited resources in the health sector force a process of choice between alternative health care programs and services and patients or groups of patients who will receive care. In the absence of a price mechanism, the priority-setting process serves to allocate scarce resources among competing uses, and is thus a form of rationing. Traditionally, implicit approaches have dominated the health sector's decision-making, mostly by physicians. However, in the face of increasing budget constraints and rising patient expectations, more explicit and socially acceptable priority-setting practices are needed. Internationally, the development of explicit prioritization has proven difficult and controversial.

Using a productivity-based physician compensation program at an academic health center: a case study.

With increased budget constraints, academic health centers (AHCs) have turned their focus on physician compensation. While many AHCs are concerned that compensation programs driven primarily by revenue generation will have a negative impact on their academic mission, little information is available to support this. The authors examined the effects on teaching and clinical productivity of an innovative compensation program for pediatrics primary care faculty at an AHC and related those effects to national standards for productivity. A baseline productivity and compensation assessment was conducted for a group of 35 academic general pediatricians. The data were compared with Medical Group Management Association (MGMA) figures for general pediatricians. A productivity-based faculty compensation program using the work component of the relative-value unit (RVU) as the measure of productivity was designed and implemented. Productivity and compensation were measured after the first year of the program and compared with the baseline assessment. The numbers of hours precepting students and residents and the students' evaluations of their clinical experiences before and after implementation of the program were compared. The baseline assessment showed that over half of the faculty had productivity that fell below the MGMA 25th percentile, while the majority had compensation that exceeded this percentile. After implementation of the compensation program, 89% of the faculty increased their clinical productivity. The times faculty spent precepting and students' evaluations before and after program implementation were unchanged. Successful productivity-based physician compensation programs can be developed for AHCs.

Predictors of Success in Large Enrollment Introductory Courses: An Examination of the Impact of Learning Communities and Virtual Learning Resources on Student Success in an Introductory Level Sociology Course

ued to cut funding for post-secondary education, while changes in the college population due to growing numbers of non-traditional students have resulted in increased demands on higher education. Specifically, older students who have competing role obligations have motivated professors and instructors to restructure their classroom practices to allow more flexibility. This trend, combined with the growth in the college student population, increased course enrollment, and increasing budget constraints, finds educators searching for new and effective teaching modalities that are timeand cost-efficient. At the same time, it is ill-advised to forge headlong into new teaching pedagogies without evidence to support their effectiveness. The current research project addresses the effectiveness of using some of these new advancements in a large-enrollment introductory course to examine their impact on outcome.

Meeting Report of the Seventh IASLC Lung Cancer Biology Workshop. Molecular Biology and Pharmacogenetic Research in the Treatment of Lung Cancer: Barcelona, Spain, April 30– May 3, 2001

Last spring, the 7th IASLC Lung Cancer Biology Workshop was held in Barcelona, Spain. With innovation and technology as the key concepts, the Workshop aimed to gain insight into genetic abnormalities and novel therapeutic techniques. The participants in the Workshop came from all over the world and included experts in both basic and clinical research. It was a unique opportunity to bring together these essential points of view and bridge the gap between the laboratory and the hospital. The Workshop touched on many of the numerous genetic alterations that play a role in the development and progression of lung cancer, the knowledge of which has increased steadily during recent years. Various participants dealt with such aspects as inactivation of tumor suppressor genes by mutation and/or loss of heterozygosity, the activation of oncogenes and epigenic silencing by methylation of gene promoters. The Workshop also focused on defining an extensive characterization of genetic alterations in lung cancer and outlining different repertoires of genetic alterations that could be useful in defining novel pharmacological approaches. Differentially expressed transcripts can be identified and isolated by different methods, such as differential display, representational difference analysis, enzymatic degradation, subtraction, suppression subtractive hybridization and cDNA micro-array analysis. Some of these techniques allow for the recovery of abundantly expressed transcripts (those encoding cytoskeletal proteins) and of low-copy-number mRNAs (those encoding transcription factors). We are on the verge of being able to use rapid bioinformatic methods that could have immediate clinical relevance. The solution to today’s increased budget constraints may lie in using gene markers to dictate the more cost-effective, appropriate treatment approaches. One of the hurdles in cancer treatment, especially in metastatic non-small-cell lung cancer, is the inherent or acquired drug resistance of the tumor. In addition to current clinical trials, it is clear that a better understanding of the cell biology of drug resistance could aid immensely in * Corresponding author. Tel.: +34-93-497-8925; fax: +3493-497-8950. E-mail address: rrosell@ns.hugtip.scs.es (R. Rosell).

Intramuscular Opioid Injections: A Step in the Wrong Direction

Intramuscular Opioid Injections: A Step in the Wrong Direction

Managing change: facilities management at the Pamela Youde Nethersole Eastern Hospital

Increasing budget constraints, the introduction of new clinical protocols and technologies, and changing community needs and expectations are changing Hong Kong’s health care system. These unprecedented changes are creating powerful and urgent needs for many of Hong Kong’s hospitals to explore alternative approaches to designing and managing their hospital environments. The paper starts by reviewing these changing conditions and then suggests that hospital facilities management professionals must think and act anew. The paper concludes that hospital administrators at the Pamela Youde Nethersole Eastern Hospital in Hong Kong are responding to these corporate challenges by developing a facilities management support response.