Model For Other Jurisdictions Research Articles

Structure and Function of a Provincial Renal Pharmacy Program: Applying the Chronic Care Model to Address Equitable Access to Medication and Pharmacy Services.

We described the rationale, structure, design, and components of a provincial pharmacy services network for patients with kidney disease as a model for enabling equitable access and universal care to pharmacy services and medications across a wide range of clinical conditions, and geographic expanse in British Columbia (BC). These include minutes from 53 Pharmacy Services and Formulary (PS&F) Committee meetings held from 1999 to November 2022, documentation available on the British Columbia Renal (BCR) website, direct observation and participation in committee meetings, as well as interviews with key individuals involved in different aspects of the program. We reviewed documents and data describing the evolution, rationale, and functioning of the BCR provincial pharmacy services system and used a variety of sources as mentioned above. In addition, a qualitative thematic synthesis of reports of chronic care models (CCMs) was conducted to map the program components into the chronic disease management models. The components of the provincial pharmacy program (PPP) include (1) a PS&F committee, with interdisciplinary and geographical representation; (2) a community of dispensing pharmacies with standardized protocols and information; (3) a dedicated medication and pharmacy services budget, and regular evaluation of budget, outcomes, and performance; (4) provincial contracts for specific medications; (5) communication and education; and (6) information management system. Program components are described in the context of chronic disease management models. The PPP includes dedicated formularies for people with kidney disease at different points in the disease trajectory, including those on and off dialysis. Equitable access to medications is supported across the province. All medications and counseling services are provided to all patients registered in the program, through a robust distributed model, including community- and hospital-based pharmacies. Provincial contracts managed centrally ensure best economic value, and centralized education and accountability structures ensure sustainability. Limitations of the current report include lack of formal evaluation of the program on patient outcomes, but this is relative as the intention of this article is to describe the program which has existed for over 20 years and is fully functional. Formal evaluation of a complex system would include by costs, cost avoidance, provider, and patients' satisfaction. We are developing a formal plan for this reason. The PPP is embedded in the provincial infrastructure of BCR and enables the provision of essential medications and pharmacy services for patients with kidney disease throughout the spectrum. The leveraging of local and provincial resources, knowledge, and expertise to implement a comprehensive PPP, ensures transparency and accountability and may serve as a model for other jurisdictions.

20 Years of Legislation - How Australia Has Responded to the Challenge of Regulating Genetically Modified Organisms in the Clinic.

•In contrast to the prior voluntary system, since 2001, gene technology in Australia has been regulated under a legislated national Gene Technology Regulatory Scheme which is administered by the Gene Technology Regulator.•The Scheme provides science-based assessment of the potential risks of gene technology to the health and safety of people and the environment.•It complements the role of the Australian Therapeutic Goods Administration which regulates all therapeutic products in Australia to ensure they are safe and effective.•Recent reforms to the Scheme contribute to, and anticipate, the continued safe development and delivery of gene-based human therapeutics in Australia as a successful model for other jurisdictions.

Creation of State Antibiogram and Subsequent Launch of Public Health-Coordinated Antibiotic Stewardship in New Hampshire: Small State, Big Collaboration.

An antibiogram is a summary of antibiotic susceptibility patterns for selected bacterial pathogens and antibiotics. The New Hampshire Department of Health and Human Services' Division of Public Health Services (DPHS) sought to create an annual state antibiogram to monitor statewide antibiotic resistance trends, guide appropriate empiric antibiotic prescribing, and inform future statewide antibiotic stewardship. Through legislative authority, DPHS required hospital laboratories to report antibiogram data annually. DPHS convened an advisory group of infectious disease and pharmacy stakeholders and experts to develop a standardized reporting form for bacteria and antibiotic susceptibility, which was disseminated to all 26 hospitals in New Hampshire. We combined the reported data into a statewide antibiogram, and we created clinical messaging to highlight findings and promote rational antibiotic prescribing among health care providers. All hospital laboratories in New Hampshire submitted annual antibiogram data for 2016 and 2017, including more than 30 000 and 20 000 bacterial isolates recovered from urine and nonurine cultures, respectively, each year. The advisory group created clinical messages for appropriate treatment of common infectious syndromes, including uncomplicated urinary tract infections, community-acquired pneumonia, skin and soft-tissue infections, intra-abdominal infections, and health care-associated gram-negative aerobic infections. The statewide antibiograms and clinical messaging were widely disseminated. The small size of New Hampshire, a centralized public health structure, and close working relationships with hospitals and clinical partners allowed for efficient creation and dissemination of an annual statewide antibiogram, which has fostered public health-clinical partnerships and built a foundation for future state-coordinated antibiotic stewardship. This process serves as a model for other jurisdictions that are considering antibiogram development.

TheMoorovdoctrine and coercive control: Proving a ‘course of behaviour’ under s. 1 of the Domestic Abuse (Scotland) Act 2018

In 2019, a distinct offence of ‘abusive behaviour towards partner or ex-partner’ (‘domestic abuse’) came into force in Scotland via s. 1 of the Domestic Abuse (Scotland) Act 2018. This new offence has been celebrated for its meaningful incorporation of the concept of coercive control (Evan Stark has described the 2018 Act as ‘gold standard’ legislation) and may serve as a model for other jurisdictions looking to criminalise coercive and controlling behaviours. The practical effectiveness of the offence in Scotland, however, will hinge on how Scotland’s corroboration rule, and the accompanying Moorov doctrine (‘ Moorov’), are applied in this context. Drawing both on recent doctrinal developments and on a conceptual understanding of the dynamics of coercive control, this article offers the first in-depth analysis of how Moorov is likely to apply in s. 1 cases. It identifies developments that are likely to assist the prosecution, as well as potential barriers to the doctrine’s successful application, and argues that in certain cases judges and jurors will have difficulty seeing the ‘course of conduct’ required by Moorov without proper understanding of the policy underpinning the Act and the gendered nature of domestic abuse. The article considers how this understanding may be brought about, both within the confines of the current law and in terms of possible reform.

Development of Voluntary Assisted Dying Training in Victoria, Australia: A Model for Consideration

Background: Voluntary assisted dying was legalized in Victoria, Australia in June 2019, and was the first jurisdiction internationally to legislatively mandate training for doctors conducting eligibility assessments of patients. Mandatory training was designed as a safeguard to ensure compliance within the system, so that only eligible patients would gain access to voluntary assisted dying. Objective: This article outlines the development of training mandated for doctors prior to undertaking eligibility assessments for voluntary assisted dying. The training addressed required legal knowledge, including doctors’ roles, duties and legal protections, and also provided instruction on relevant clinical skills. Design: Training design was based on 2 main principles: to comprehensively impart the legal duties imposed by the legislation; and to be readily accessible for busy doctors. The law was first mapped into a curriculum, and circulated to medical colleges, societies and professional organizations as well as international experts for feedback. The training was converted into an online e-learning format and tested at a focus group of doctors. Results: The training comprises 9 modules including an assessment module. While the predominant focus of the modules is on law, they also contain some clinical components and links to further resources. Modules also contain videos, case studies and interactive exercises. The assessment consists of 30 questions, selected randomly from a question bank, with a pass mark of 90%. Conclusion: The Victorian legislatively-mandated voluntary assisted dying training provides standardized baseline knowledge to enhance the quality and consistency of decision-making by doctors. While further evaluation of this training is needed, it may provide a model for other jurisdictions considering making voluntary assisted dying lawful.

Development of Voluntary Assisted Dying Training in Victoria, Australia: A Model for Consideration.

Voluntary assisted dying was legalized in Victoria, Australia in June 2019, and was the first jurisdiction internationally to legislatively mandate training for doctors conducting eligibility assessments of patients. Mandatory training was designed as a safeguard to ensure compliance within the system, so that only eligible patients would gain access to voluntary assisted dying. This article outlines the development of training mandated for doctors prior to undertaking eligibility assessments for voluntary assisted dying. The training addressed required legal knowledge, including doctors' roles, duties and legal protections, and also provided instruction on relevant clinical skills. Training design was based on 2 main principles: to comprehensively impart the legal duties imposed by the legislation; and to be readily accessible for busy doctors. The law was first mapped into a curriculum, and circulated to medical colleges, societies and professional organizations as well as international experts for feedback. The training was converted into an online e-learning format and tested at a focus group of doctors. The training comprises 9 modules including an assessment module. While the predominant focus of the modules is on law, they also contain some clinical components and links to further resources. Modules also contain videos, case studies and interactive exercises. The assessment consists of 30 questions, selected randomly from a question bank, with a pass mark of 90%. The Victorian legislatively-mandated voluntary assisted dying training provides standardized baseline knowledge to enhance the quality and consistency of decision-making by doctors. While further evaluation of this training is needed, it may provide a model for other jurisdictions considering making voluntary assisted dying lawful.

Multidisciplinary Team Reviews of Drug Overdose Deaths and the Use of Minigrants to Advance Recommendations: A Statewide Pilot in Rhode Island.

Rhode Island has been significantly impacted by the opioid epidemic, ranking 11th in unintentional drug overdose rates in the United States in 2017. Illicit fentanyl was involved in the majority of these deaths. To enhance surveillance of this epidemic, the RI Department of Health piloted in-depth, multidisciplinary, and multiagency team reviews of drug overdose deaths. The goals were to identify gaps in policies and programming and develop recommendations to prevent future deaths. Time-sensitive minigrants were offered to nonprofit organizations as a novel way to further the recommendations put forth from these reviews. Legal agreements between select state agencies and institutions enabled broad team representation and the sharing of information during each meeting. Reviews, revolving around a common theme, were conducted for up to 10 deaths each quarter. Recommendations for prevention were generated by the team and summarized in a report to the Governor's Overdose Prevention and Intervention Task Force and the public within 1 month of each meeting. Announcements of minigrant opportunities and funding to advance the community-specific recommendations were paired with each meeting. From November 2016 through May 2018, the pilot team convened 7 times, generated 78 recommendations, and distributed 31 minigrants. Early process evaluations of these grants have shown positive impact within local environments. Following the pilot phase, state legislation for these reviews was passed in June 2018. The RI Department of Health was able to successfully pilot a multidisciplinary review process for overdose deaths and has recently institutionalized this process through legislation. The successful implementation of many of the team's community-oriented recommendations, supported through a minigrant process, highlights the impact that small financial investments can have to address the opioid epidemic and may be a model for other jurisdictions seeking to advance recommendations from these types of reviews.

Parole Release and Supervision: Critical Drivers of American Prison Policy

Decisions tied to parole release, supervision, and revocation are major determinants of the ebb and flow of prison populations across two-thirds of US states. We argue that parole release, as an institution, has been an underacknowledged force in American incarceration and reincarceration policy and an important contributor to the nation's buildup to mass incarceration. In paroling states, no court or state agency holds greater power than parole boards over time actually served by the majority of offenders sent to prison. We examine the leverage exercised by parole boards through their discretionary release decisions and their powers to sanction violators of parole conditions. We note the state-by-state diversity and complexity associated with parole-release decisions and the absence of successful state systems that might serve as a model for other jurisdictions. We highlight the procedural shortfalls universally associated with parole decision-making. We discuss the long reach of parole supervision and the pains it imposes on those subject to its jurisdiction, including the substantial financial burdens levied on parolees. We then turn to the prospects for parole reform and outline a comprehensive blueprint for improving parole release in America.

A population-based analysis of urban-rural disparities in advanced pancreatic cancer management and outcomes.

Given the significant morbidity burden associated with advanced pancreatic cancer (APC), its management is complex and frequently requires multidisciplinary care. Because of potential geographical barriers to healthcare access, we aimed to determine the effect of rurality on management and outcomes of APC patients. Patients diagnosed with APC from 2008 to 2015 and received Gemcitabine (Gem), Gemcitabine plus nab-Paclitaxel (Gem/Nab), or FOLFIRINOX at any 1 of 6 British Columbia cancer centers across the province were reviewed. Using postal codes, the Google Maps Distance Matrix determined the distance from each patient's residence to the closest cancer center. Rural and urban status were defined as patients living ≥ 100 and < 100km from the closest treatment site, respectively. Univariate and Cox regression analyses were applied to examine whether rurality resulted in variations in management and outcomes. In total, we identified 659 patients: median age 68 years, 54.3% men, and 76.6% metastatic disease. For treatment, 67.7, 9.2, and 23.0% received Gem, Gem/Nab, and FOLFIRINOX, respectively. However, there were no differences in baseline clinical characteristics between rural and urban patients (all p > 0.05). Also, there were no significant variations in treatment patterns. For example, time from diagnosis to oncology appointment and time from appointment to treatment were 31.5 and 29.5days for ruralpatients and 28.6 and 40.1days for urbanpatients, respectively (all p > 0.05). Use of Gem/Nab (10.1% vs 9.1%) and FOLFIRINOX (21.0% vs 23.5%) were similar regardless of rurality. In multivariate Cox regression, risk of death was similar between rural and urban groups (HR 0.864, 95% CI 0.619-1.206, p = 0.09). Our findings suggest that there is no correlation between rurality and outcomes in APC. The strategic and geographic allocation of cancer care delivery across the province of British Columbia may serve as a model for other jurisdictions that experience disparities in the outcomes of cancers that often require complex multidisciplinary care.

Examining the Role of Fire Prevention on Hoarding Response Teams: Vancouver Fire and Rescue Services as a Case Study

Hoarded homes present a significant threat to the safety of occupants of the home and adjacent homes as well as emergency responders. Extreme accumulation of combustible materials raises the fuel load and prevents egress. Despite having regulatory tools related to fire prevention, fire departments generally lack the necessary background to address the many challenges related to the complex mental health problem of hoarding. Using Vancouver as a case study, this paper highlights the role of Vancouver Fire and Rescue Services in the City’s coordinated hoarding response and outlines their fire code inspections protocol developed for use in hoarding cases. On the basis of fire inspection reports, we compare the processes and outcomes of complaint-driven hoarding inspections with standard annual fire inspections of restaurants. Hoarding cases take longer to resolve and are more challenging, but inspectors achieved satisfactory status in 94% of cases without prosecution. About 20% of hoarding complaints do not involve fire code violations. Although this approach requires an investment and engagement with other community agencies, it represents a useful model for other jurisdictions.

A population-based analysis of urban-rural disparities in advanced pancreatic cancer (APC) management and outcomes.

e18049 Background: The high morbidity burden associated with APC means that its management is complex and frequently requires multidisciplinary care. Because of potential geographical barriers to healthcare access, we aimed to determine the effect of rurality on management and outcomes of APC patients. Methods: Patients diagnosed with APC (locally advanced or metastatic disease) from 2008 to 2015 and received gemcitabine (gem), gem plus nabpaclitaxel (gem/nab), or FOLFIRINOX at any 1 of 6 British Columbia cancer centers were reviewed. Using postal codes, the Google Maps Distance Matrix determined the distance from each patient’s residence to the closest cancer center. Rural and urban status were defined as patients living &gt; / = 100 km and &lt; 100 km to the closest treatment site, respectively. Different cut points were used in sensitivity analyses. Patients were also stratified according to Canadian census population sizes. Univariate and Cox regression analyses were applied to examine whether rurality resulted in variations in management and outcomes. Results: In total, we identified 659 patients: median age 68 years, 54.3% men, and 45.7% metastatic disease. Among them, 19.3% lived rurally. For treatment, 67.7%, 9.2%, and 23.1% received gem, gem/nab, and FOLFIRINOX, respectively. There were no differences in baseline clinical characteristics between rural and urban patients (all p &gt; 0.05). Time from diagnosis to oncology appointment and time from appointment to treatment were 31.5 and 29.5 days for rural patients and 28.6 and 40.1 days for urban patients, respectively (all p &gt; 0.05). In multivariate Cox regression, risk of death was similar between rural and urban groups (HR 0.864, 95% CI 0.619-1.206, p = 0.390). Furthermore, regression analysis found that population size did not pose a signficiant impact on APC outcomes (all p &gt; 0.05). Conclusions: There was no correlation between rurality and outcomes in APC. The strategic and geographic allocation of cancer care delivery across 6 comprehensive treatment centers in British Columbia may serve as a model for other jurisdictions, particularly those that currently face outcome disparities in cancers that often require complex multidisciplinary care

A population-based analysis of urban-rural disparities in advanced pancreatic cancer (APC) management and outcomes.

254 Background: Given the significant morbidity burden associated with APC, its management is complex and frequently requires multidisciplinary care. Because of potential geographical barriers to healthcare access, we aimed to determine the effect of rurality on management and outcomes of APC patients. Methods: Patients diagnosed with APC (locally advanced or metastatic disease) from 2008 to 2015 and received gemcitabine (gem), gem plus nab-paclitaxel (gem/nab), or FOLFIRINOX at any 1 of 6 British Columbia cancer centers across the province were reviewed. Using postal codes, the Google Maps Distance Matrix determined the distance from each patient’s residence to the closest cancer center. Rural and urban status were defined as patients living &gt;= 100 km and &lt; 100 km from the closest treatment site, respectively. Univariate and Cox regression analyses were applied to examine whether rurality resulted in variations in management and outcomes. Results: In total, we identified 667 patients: median age 68 years, 54.3% men, and 45.7% metastatic disease. Among them, 19.5% lived rurally and 80.5% resided in urban areas. For treatment, 67.8%, 9.4%, and 22.8% received gem, gem/nab, and FOLFIRINOX, respectively. However, there were no differences in baseline clinical characteristics between rural and urban patients (all p &gt; 0.05). Also, there were no significant variations in treatment patterns. For example, time from diagnosis to oncology appointment and time from appointment to treatment were 31.6 and 29.5 days for rural patients and 28.7 and 39.9 days for urban patients, respectively (all p &gt; 0.05). Use of gem/nab (9.8 vs 9.4%) and FOLFIRINOX (20.5 vs 23.3%) were similar regardless of rurality. In multivariate Cox regression, risk of death was similar between rural and urban groups (HR 1.34, 95% CI 0.95-1.87, p = 0.09). Conclusions: Our findings suggest that there is no correlation between rurality and outcomes in APC. The strategic and geographic allocation of cancer care delivery across the province of British Columbia may serve as a model for other jurisdictions that experience disparities in the outcomes of cancers that often require complex multidisciplinary care.

Advancing Urban Multimodal Transportation System Performance Management

As in many cities, congestion in Washington, D.C., is one of the top concerns of residents, businesses, travelers, and policy makers. Monitoring and communicating system performance from a mobility perspective is challenging, particularly when dealing with the multimodal nature of travel in urban areas. The District Department of Transportation has identified a set of performance measures for multimodal mobility—including congestion—that are based on available data and is making these metrics available to the public and to policy makers through an innovative visualization tool. The study’s approach, measures, and visualization component provide a model for other jurisdictions to consider adopting when seeking to better understand and convey the challenges, opportunities, and interdependencies of multimodal travel.

Governance, organization, accountability and sustainability of a region-wide school-based deworming program in Loreto, Peru

Chau Cuica was the name given by the regional government of Loreto in Peru for its school-based deworming program which was initiated in 2012 with a donation of mebendazole from an international non-governmental organization.Embedded in the program from the start was a sentinel surveillance component which consisted of 16 sentinel schools representing Loreto’s seven provinces.Coverage rates varied between 35% and 61% over the first two years of the program (and seven deworming cycles). Initial prevalences of soil-transmitted helminth infections were high, with 82.4% of schoolchildren having at least one infection and prevalences of both Ascaris lumbricoides and Trichuris trichiura infections both exceeding 60%. After two years, these prevalences had dropped to 56% for any STH infection, 38% for A. lumbricoides and 34% for T. trichiura. Importantly, the proportions of children with moderate and heavy infections also dropped. Both the regional Ministry of Health and the Ministry of Education were jointly charged to implement this deworming program. The program’s costs were estimated to be approximately 22 cents (USD) per child per deworming cycle. The responsibility for the surveillance component was initially undertaken by research partners from a local NGO and a Canadian university, which transferred gradually over the course of the deworming program to being entirely the responsibility of the Ministry of Health.This regional deworming program may serve as a model for other jurisdictions that are planning a school-based deworming program with an integrated surveillance component to monitor impact.

CORR Insights(®): do 360-degree feedback survey results relate to patient satisfaction measures?

I t has been impossible to escape the term ‘‘pay-for-performance’’ in the medical world in recent years. Understanding what this term implies is far more difficult given the uncertainty surrounding the way healthcare reform will shape the practice of medicine in the United States. Rewarding physicians based on patient satisfaction is one model for the implementation of payfor-performance, however, the measurement and improvement of satisfaction is an evolving field [6]. In the current study, Hageman and colleagues report on the correlation of 360-degree feedback and patient satisfaction and find that coworker ratings on this survey correlate well with patient perceptions. The business world has employed multisource feedback (of which the 360-degree survey is one type) as a tool for managers for many years [2], and this evaluation method has been explored as an adjunct in resident education [9]. As far back as 1999, the College of Physicians and Surgeons of Alberta piloted a voluntary multisource feedback program, the Physician Achievement Review, which was shown to change physician behavior based on the results of the survey given to coworkers, staff, and patients [3]. The Physician Achievement Review program now has become mandatory on a 5-year cycle and serves as a model for other jurisdictions. Other examples of successful implementations of 360-degree feedback exist in medical education and in practice [4].

Underground Coal Gasification: A Regulatory Framework for Alberta

Underground Coal Gasification (UCG) is a new emerging clean coal technology. It holds promise for reaching and making use of very deep coal seams that technically could not otherwise have been mined at these depths. UCG technology and knowledge developed significantly during the 20th century. Countries around the world with large coal deposits sustain and promote UCG research and launch projects with the intention to commercially deploy UCG. Alberta currently hosts two UCG projects, and a third project is under consideration. The development of these projects suggested the need for a UCG specific regulatory approval process. In 2011, Alberta enacted specific UCG legislation. This article deals with recent developments in UCG technology and its regulations. The aim of this article is to present Alberta’s current UCG regulatory framework as a model for other jurisdictions.

Lessons Learned From the Implementation of a Time-Limited, Large-Scale Nicotine Replacement Therapy Giveaway Program in New York City

Since 2006, the New York City (NYC) Department of Health and Mental Hygiene has conducted the Nicotine Patch and Gum Program (NPGP) in collaboration with 311, NYC's non-emergency information line. In two prior years, the program was conducted in collaboration with the New York State (NYS) Smokers' Quitline and with community-based organizations. The NPGP is an annual, brief, population-based nicotine replacement therapy (NRT) giveaway for NYC residents, complementing the NYS Quitline's year-round NRT distribution program. Since 2006, 168,000 smokers have enrolled, with the largest number of enrollees in 2010 (n = 40,000) and the smallest number in 2009 (n = 28,000). A 2003 program evaluation demonstrated that smokers who received NRT through the NPGP had higher quit rates than smokers who did not receive NRT; these results were replicated in 2006 and 2008. Lessons learned from implementing the NPGP include: 1) time-limited NRT interventions are important complements to year-round NRT distribution; 2) expanding NRT distribution to light smokers increases treatment reach; and 3) employing multiple enrollment mechanisms, including telephone and online options, extends program reach to diverse groups of smokers. The NPGP provides a model for other jurisdictions considering implementing time-limited, population-based NRT programs as a complementary strategy to enhance ongoing tobacco control efforts.

An Overview of Government Ethics Standards

Federal, state and local governments impose detailed ethics restrictions on their employees. The substantive ethics restrictions vary in their details across federal, state and local jurisdictions. Some place significant restrictions on the kinds of partisan political activities their employees can engage in; others do not. The precise contours of gift restrictions vary considerably, from how broadly the gift ban is defined to how many exceptions exist. While most jurisdictions have anti-nepotism statutes, there is considerable variation regarding what types of relatives are covered. These variations reflect the fact that ethics standards are generally the result of legislative action, and legislatures often come up with different solutions to the same problem. This memorandum describes restrictions on the financial interests, associations and activities of current and former government employees that fit under the rubric of “government ethics.” It does not catalog every government ethics restriction adopted by all federal, state and local jurisdictions. Instead, it uses as a template the standards that apply to the federal government’s executive branch. The federal executive branch ethics standards may not be a perfect model for other jurisdictions to emulate, but it is a mature system of government ethics regulation, having been developed and implemented over several decades. It provides one example of what a comprehensive system of ethics regulation looks like. Part II of this memorandum describes in some detail the full range of ethics restrictions that apply to federal executive branch employees, from conflicts of interest to restrictions on the types of work they can perform after leaving the government. In discussing government ethics, it is important to focus not just on substantive restrictions but also on the mechanisms and structures that implement those restrictions. Ethics laws are not self-executing, and a jurisdiction that has tough ethics standards but fails to implement them leaves itself vulnerable to corruption and abuse. The third part of this memorandum discusses these different designs for implementing government ethics restrictions. The fourth part of the memorandum then examines the degree to which other jurisdictions have adopted variations of these restrictions. For example, with regard to financial interests, the federal government imputes to the employee the financial interests of some – but not all family members: the employee’s spouse and minor children. Other jurisdictions have taken a broader approach, imputing the interests of domestic partners, adult children, siblings, parents, or members of an employee’s household. While there is a consensus that governments should regulate the financial interests of their employees, there is not a consensus about how broadly or narrowly to define those interests.

The role of science in MPA establishment in California: a personal perspective

SummaryCalifornia has now largely completed a process for establishing marine protected areas (MPAs) that may be considered a model for other jurisdictions seeking to meet obligations under the Convention on Biological Diversity. In the Californian process, a team of scientists established guidelines on the size and spacing of MPAs, as well as requirements for habitat representation and replication. The final outcomes, in terms of proportion of the coast encompassed by MPAs and the distribution and sizes of MPAs, were largely a result of decisions taken by the advisory scientists, rather than by the designated decision makers. Future legislation must recognize the uncertainties associated with benefits of MPAs and specifically allow for adaptive management including explicit experimental tests of uncertainties. The science team should define at the outset the major uncertainties about impacts, and deliberate experimentation and adaptive management should be essential parts of each design. Future legislation should be much more specific about the objectives of the MPAs and specify the percentage of the area that should be set aside as MPAs. Finally, quantitative models rather than guidelines should be used to evaluate the consequences of alternative designs.

Juvenile Detention Reform in New York City: Measuring Risk Through Research

This article is excerpted from Jennifer Fratello, Annie Salsich, &amp; Sara Mogulescu's longer article of the same name published by the Vera Institute of Justice in April 2011. In 2006, faced with the challenges of a juvenile justice system nearing crisis, New York City officials concluded that they had to rethink the city's juvenile detention policies and practices. The development and implementation of the risk-assessment instrument (RAI) and community-based alternatives to detention (ATD) programs represent an important shift in New York City's juvenile detention policy. The RAI provides reliable guidance on risks of failure to appear or rearrest. The ATDs provide effective program alternatives to detention for moderate-risk youth. Given early outcomes, it appears that New York City's reform effort could serve as a model for other jurisdictions seeking to improve outcomes for youth while preserving public safety.