Non-voting Members Research Articles

European stroke organisation and European society for minimally invasive neurological therapy guideline on acute management of basilar artery occlusion.

The aim of the present European Stroke Organisation (ESO) guideline is to provide evidence-based recommendations on the acute management of patients with basilar artery occlusion (BAO). These guidelines were prepared following the Standard Operational Procedure of the ESO and according to the GRADE methodology. Although BAO accounts for only 1%-2% of all strokes, it has very poor natural outcome. We identified 10 relevant clinical situations and formulated the corresponding Population Intervention Comparator Outcomes (PICO) questions, based on which a systematic literature search and review was performed. The working group consisted of 10 voting members (five representing ESO and five ESMINT) and three non-voting junior members. The certainty of evidence was generally very low. In many PICOs, available data were scarce or lacking, hence, we provided expert consensus statements. First, we compared intravenous thrombolysis (IVT) to no IVT, but specific BAO-related data do not exist. Yet, historically, IVT was standard of care for BAO patients who were also included (albeit in small numbers) in IVT trials. Non-randomised studies of IVT-only cohorts showed high proportion of favourable outcomes. Expert Consensus suggests using IVT up to 24 h unless otherwise contraindicated. We further suggest IVT plus endovascular treatment (EVT) over direct EVT. EVT on top of best medical treatment (BMT) was compared to BMT alone within 6 and 6-24 h from last seen well. In both time windows, we observed a different effect of treatment depending on (a) the region where the patients were treated (Europe vs. Asia), (b) on the proportion of IVT in the BMT arm, and (c) on the initial stroke severity. In case of high proportion of IVT in the BMT group and in patients with NIHSS below 10, EVT plus BMT was not found better than BMT alone. Based on very low certainty of evidence, we suggest EVT + BMT over BMT alone (i.e. based on results of patients with at least 10 NIHSS points and a low proportion of IVT in BMT). For patients with an NIHSS below 10, we found no evidence to recommend EVT over BMT. In fact, BMT was non-significantly better and safer than EVT. Furthermore, we found a stronger treatment effect of EVT + BMT over BMT alone in proximal and middle locations of BAO compared to distal location. While recommendations for patients without extensive early ischaemic changes in the posterior fossa can, in general, follow those of other PICOs, we formulated an Expert Consensus Statement suggesting against reperfusion therapy in those with extensive bilateral and/or brainstem ischaemic changes. Another Expert Consensus suggests reperfusion therapy regardless of collateral scores. Based on limited evidence, we suggest direct aspiration over stent retriever as the first-line strategy of mechanical thrombectomy. As an Expert Consensus, we suggest rescue percutaneous transluminal angioplasty and/or stenting after a failed EVT procedure. Finally, based on very low certainty of evidence, we suggest add-on antithrombotic treatment during EVT or within 24 h after EVT in patients with no concomitant IVT and in whom EVT was complicated (defined as failed or imminent re-occlusion, or need for additional stenting or angioplasty).

Simplifying the injector's armamentarium: An international consensus regarding the use of gel science to differentiate hyaluronic acid fillers and guide treatment recommendations.

The Restylane portfolio of soft tissue fillers spans a wide range of indications, due in part to their complementary manufacturing technologies [non-animal stabilized hyaluronic acid (NASHA) and Optimal Balance Technology (OBT/XpresHAn)]. Using an array of products, injectors can achieve a holistic, natural looking effect for their patients. However, with a wide range of products it may be difficult to choose an optimal combination. Simplify and align global use recommendations for NASHA versus OBT products. Two pre-meeting surveys were completed by 11 key opinion leaders with international representation, with the goal of collecting information regarding their current injection practices for various anatomical regions of the face (i.e., temporal region, forehead, tear trough, lateral zygoma, anteromedial cheek, nose, pyriform aperture, nasolabial fold, perioral area, lips, labiomental crease, marionette lines, chin, and jawline). The data collected from these surveys was subsequently discussed in a consensus group meeting involving 11 voting members and 3 nonvoting members. Top product recommendations were identified for each anatomical area, along with secondary and tertiary recommendations that can also be used under defined circumstances. Recommendations were provided based on a consideration of elements such as patient features (e.g., skin thickness, bone structure), the desired aesthetic outcome, experience of the injector, and the preferred injection technique. A majority consensus regarding the top NASHA versus OBT product choice for each anatomical region of the face was reached. These recommendations represent international agreement regarding the use of Restylane products.

NACSD RECOMMENDATIONS FOR OLDER ADULT DISASTER PREPAREDNESS, RESPONSE, AND RECOVERY

Abstract This presentation shares the recommendations drafted by the National Advisory Committee on Seniors and Disasters (NACSD). This federal advisory committee provides advice and guidance to the Assistant Secretary for Preparedness and Response within the U.S. Department of Health and Human Services (HHS) and the HHS Secretary. The NACSD is comprised of seven non-federal members with expertise in geriatric disaster planning, preparedness, response, or recovery and ten federal (non-voting) members who are ex officio representatives from agencies within HHS and other Executive Branch departments. The voting members drafted recommendations intended to address the immediate and persistent challenges in public health emergency preparedness, response, and recovery affecting older adults in the United States. Numerous meetings with federal and non-federal subject matter experts from various disciplines were held to develop the recommendations. The NACSD was also tasked with evaluating issues and programs and providing findings, advice, and recommendations to the Secretary of Health and Human Services to support and enhance all-hazards public health and medical preparedness, response, and recovery activities related to meeting the unique needs of older adults and their families across the entire spectrum of their wellbeing. The NACSD evaluated and provided input concerning the medical and public health needs of older adults related to preparation for, response to, and recovery from all-hazards emergencies; and may provide advice and consultation with respect to State emergency preparedness and response activities relating to older adults.

ACS members elected to the National Academy of Sciences in 2023

The US National Academy of Sciences (NAS) has elected 120 new US-based members and 23 international members “in recognition of their distinguished and continuing achievements in original research.” Election to the NAS is considered one of the highest scientific honors in the US. These additions bring the total number of active US-based NAS members to 2,565 and the total number of international members—nonvoting members with citizenship outside the US—to 526. Of the newly elected NAS members and international members, 16 are also members of the American Chemical Society. The new US members are Helen Berman , Rutgers University; Catherine L. Drennan , Massachusetts Institute of Technology; Miguel A. Garcia-Garibay , University of California, Los Angeles; Jeffrey Hubbell , University of Chicago; Jeffery Kelly , Scripps Research; Jeffrey R. Long , University of California, Berkeley; Nancy Makri , University of Illinois Urbana- Champaign; Teri W. Odom , Northwestern University; Helen Piwnica-Worms

The 47-Year history of the City of Portland, Oregon's noise review board and its successful model of addressing community noise issues

The City of Portland Oregon has a successful history of over 40 years of operating a quasi-judicial Noise Review Board to help address and resolve urban environmental noise pollution. This paper explores the successes and failures of the unique Noise Review Board. The paper notes the potential for use of this governmental approach to address community noise in other large and medium sized cities. The Portland Noise Review Board is 6 members. It includes three technical professionals and three citizens at large to collaborate on noise in the urban environment. The technical professionals are 1) a professional in the Acoustical Sciences 2) A professional from the construction industry, and 3) the acoustical expert for the City of Portland , their Noise Control Officer. The Noise Control Officer is a non-voting member and staffs the government board. The five voting members administer quasi-judicial code decisions and offer the City's elected officials an experienced body to address environmental noise issues. The Noise Review Board plays a key role in the urban planning of Portland by offering guidance to the City Council on emerging sources of noise pollution, such as garbage trucks, leaf blowers, outdoor concert venues, and the Portland International Raceway.

MP57-11 RACIAL AND GENDER DIVERSITY ON AMERICAN UROLOGICAL ASSOCIATION (AUA) AND EUROPEAN UROLOGICAL ASSOCIATION (EAU) GUIDELINE PANELS

You have accessJournal of UrologyCME1 Apr 2023MP57-11 RACIAL AND GENDER DIVERSITY ON AMERICAN UROLOGICAL ASSOCIATION (AUA) AND EUROPEAN UROLOGICAL ASSOCIATION (EAU) GUIDELINE PANELS Matthew Holten, Zahrah Shakur, Shahnaz Sultan, Nissrine Nakib, Christopher Warlick, and Philipp Dahm Matthew HoltenMatthew Holten More articles by this author , Zahrah ShakurZahrah Shakur More articles by this author , Shahnaz SultanShahnaz Sultan More articles by this author , Nissrine NakibNissrine Nakib More articles by this author , Christopher WarlickChristopher Warlick More articles by this author , and Philipp DahmPhilipp Dahm More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003310.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Equity and acceptability are important domains when it comes to clinical guideline development, requiring broad stakeholder representation. We conducted this study to assess the panel composition on the two most important guideline developers in urology. METHODS: Based on a predefined protocol we identified all current AUA and EAU guideline documents from the organizations’ respective websites. Two members of the research team independently and in duplicate abstracted information on the guideline topic, number of panel members (voting and non-voting), support staff and consultants. We determined the panel members’ likely gender (woman, man, or non-binary) and racialization (white [not racialized] or non-white [racialized]) based on name, internet picture, pronouns used, bios available, and gender listed on their profile. Racialization data was further validated using the Ethnicity Estimator algorithm. RESULTS: We included 31 AUA and 20 EAU guidelines in this study. The median panel size was 19 (interquartile range [IQR]: 17; 21), including a median of 12 (IQR: 10; 14) voting and 7 (IQR: 4; 8) non-voting members. Panel composition of voting members was largely male (median: 83.3%; IQR: 72.7%; 92.9%) and white (median: 88.2%; IQR: 83.3%; 92.9%). About one in five guideline panels did not include a single female (11; 21.6%) or racialized individual (10; 19.6%). Overall, only 11 of 617 (1.8%) voting members were racialized women. When comparing oncology and non-oncology related guidelines, female (26.4% versus 25.8%; p=0.129) and non-white representation (21.9% versus 28.4%; p=0.129) was similar. For AUA and EAU guideline panels, female representation was similar (26.1% versus 25.8%; p=0.946) whereas racialized individuals were more frequent on AUA guidelines (29.3% versus 20.9%; p=0.048). CONCLUSIONS: As in other arenas of urology (such as the general workforce and academic leadership), female and racialized individuals are underrepresented on guideline panels of the two major professional organizations. More transparency in the panel member selection process and intentional efforts to promote gender parity and diversity are needed. Source of Funding: Departmental © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e788 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Holten More articles by this author Zahrah Shakur More articles by this author Shahnaz Sultan More articles by this author Nissrine Nakib More articles by this author Christopher Warlick More articles by this author Philipp Dahm More articles by this author Expand All Advertisement PDF downloadLoading ...

Management of patients with advanced prostate cancer—metastatic and/or castration-resistant prostate cancer: Report of the Advanced Prostate Cancer Consensus Conference (APCCC) 2022

BackgroundInnovations in imaging and molecular characterisation together with novel treatment options have improved outcomes in advanced prostate cancer. However, we still lack high-level evidence in many areas relevant to making management decisions in daily clinical practise. The 2022 Advanced Prostate Cancer Consensus Conference (APCCC 2022) addressed some questions in these areas to supplement guidelines that mostly are based on level 1 evidence. ObjectiveTo present the voting results of the APCCC 2022. Design, setting, and participantsThe experts voted on controversial questions where high-level evidence is mostly lacking: locally advanced prostate cancer; biochemical recurrence after local treatment; metastatic hormone-sensitive, non-metastatic, and metastatic castration-resistant prostate cancer; oligometastatic prostate cancer; and managing side effects of hormonal therapy. A panel of 105 international prostate cancer experts voted on the consensus questions. Outcome measurements and statistical analysisThe panel voted on 198 pre-defined questions, which were developed by 117 voting and non-voting panel members prior to the conference following a modified Delphi process. A total of 116 questions on metastatic and/or castration-resistant prostate cancer are discussed in this manuscript. In 2022, the voting was done by a web-based survey because of COVID-19 restrictions. Results and limitationsThe voting reflects the expert opinion of these panellists and did not incorporate a standard literature review or formal meta-analysis. The answer options for the consensus questions received varying degrees of support from panellists, as reflected in this article and the detailed voting results are reported in the supplementary material. We report here on topics in metastatic, hormone-sensitive prostate cancer (mHSPC), non-metastatic, castration-resistant prostate cancer (nmCRPC), metastatic castration-resistant prostate cancer (mCRPC), and oligometastatic and oligoprogressive prostate cancer. ConclusionsThese voting results in four specific areas from a panel of experts in advanced prostate cancer can help clinicians and patients navigate controversial areas of management for which high-level evidence is scant or conflicting and can help research funders and policy makers identify information gaps and consider what areas to explore further. However, diagnostic and treatment decisions always have to be individualised based on patient characteristics, including the extent and location of disease, prior treatment(s), co-morbidities, patient preferences, and treatment recommendations and should also incorporate current and emerging clinical evidence and logistic and economic factors. Enrolment in clinical trials is strongly encouraged. Importantly, APCCC 2022 once again identified important gaps where there is non-consensus and that merit evaluation in specifically designed trials. Patient summaryThe Advanced Prostate Cancer Consensus Conference (APCCC) provides a forum to discuss and debate current diagnostic and treatment options for patients with advanced prostate cancer. The conference aims to share the knowledge of international experts in prostate cancer with healthcare providers worldwide. At each APCCC, an expert panel votes on pre-defined questions that target the most clinically relevant areas of advanced prostate cancer treatment for which there are gaps in knowledge. The results of the voting provide a practical guide to help clinicians discuss therapeutic options with patients and their relatives as part of shared and multidisciplinary decision-making. This report focuses on the advanced setting, covering metastatic hormone-sensitive prostate cancer and both non-metastatic and metastatic castration-resistant prostate cancer. Twitter summaryReport of the results of APCCC 2022 for the following topics: mHSPC, nmCRPC, mCRPC, and oligometastatic prostate cancer. Take-home messageAt APCCC 2022, clinically important questions in the management of advanced prostate cancer management were identified and discussed, and experts voted on pre-defined consensus questions. The report of the results for metastatic and/or castration-resistant prostate cancer is summarised here.

The (not so) quiet period: Communication by ECB decision-makers during monetary policy blackout days☆

We use confidential data to provide an empirical primer on the European Central Bank’s (ECB) monetary policy quiet period between 2008 and 2021. Breaches of blackout rules happen regularly and their frequency is heterogeneous across ECB Governing Council members. We document that quiet period breaches trigger high-frequency market reactions that are up to more than twice as large as the median market reaction to speeches in inter-meeting periods. Controlling for member and time fixed effects, we find that breaches respond to absolute inflation deviations of policy-makers’ constituencies from the ECB’s target and to interest rate spreads inside the euro area. We also exploit plausibly exogenous variation in the ECB’s rotational voting schedule to show that non-voting members do not engage in strategic communication during the quiet period to lock in their voting peers.

For director-at-large: Will E. Lynch

Coastal Georgia Section. Georgia Southern University, Savannah, Georgia. Academic record: Kalamazoo College, BA, 1986; Wayne State University, PhD, 1991. Honors: ACS Service Award, Coastal Georgia Section, 1999; Armstrong Atlantic State University Alumni Award for Service to the Discipline, 2004; Sigma Xi. Professional positions (for the past 10 years): Georgia Southern University, department chair and professor, 2018–22, interim dean of the College of Science and Mathematics 2022-; Armstrong State University, professor, 2005–18, department head, 2006–18. Service in ACS national offices: Council Policy Committee, voting member, 2019–22, non-voting member, 2005–07; Committee on Strategic Planning, member, 2019–; Committee on Strategic Planning, Goal 1 Subcommittee, chair, 2022; Committee on Strategic Planning, Roadmap Implementation Subcommittee, chair, 2020–21; Committee on Divisional Activities, 2017–18; Committee on Meetings and Expositions, member, 2011–16, chair, 2013–15; Committee on Committees, 2008–10; Committee on Local Section Activities, 2002–07, chair, 2005–07, committee associate, 2000–01; Committee on Planning, 2005–07. Service in ACS offices: Coastal

Management of Patients with Advanced Prostate Cancer: Report from the Advanced Prostate Cancer Consensus Conference 2021

BackgroundInnovations in treatments, imaging, and molecular characterisation in advanced prostate cancer have improved outcomes, but various areas of management still lack high-level evidence to inform clinical practice. The 2021 Advanced Prostate Cancer Consensus Conference (APCCC) addressed some of these questions to supplement guidelines that are based on level 1 evidence. ObjectiveTo present the voting results from APCCC 2021. Design, setting, and participantsThe experts identified three major areas of controversy related to management of advanced prostate cancer: newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC), the use of prostate-specific membrane antigen ligands in diagnostics and therapy, and molecular characterisation of tissue and blood. A panel of 86 international prostate cancer experts developed the programme and the consensus questions. Outcome measurements and statistical analysisThe panel voted publicly but anonymously on 107 pre-defined questions, which were developed by both voting and non-voting panel members prior to the conference following a modified Delphi process. Results and limitationsThe voting reflected the opinions of panellists and did not incorporate a standard literature review or formal meta-analysis. The answer options for the consensus questions received varying degrees of support from panellists, as reflected in this article and the detailed voting results reported in the Supplementary material. ConclusionsThese voting results from a panel of experts in advanced prostate cancer can help clinicians and patients to navigate controversial areas of management for which high-level evidence is scant. However, diagnostic and treatment decisions should always be individualised according to patient characteristics, such as the extent and location of disease, prior treatment(s), comorbidities, patient preferences, and treatment recommendations, and should also incorporate current and emerging clinical evidence and logistic and economic constraints. Enrolment in clinical trials should be strongly encouraged. Importantly, APCCC 2021 once again identified salient questions that merit evaluation in specifically designed trials. Patient summaryThe Advanced Prostate Cancer Consensus Conference is a forum for discussing current diagnosis and treatment options for patients with advanced prostate cancer. An expert panel votes on predefined questions focused on the most clinically relevant areas for treatment of advanced prostate cancer for which there are gaps in knowledge. The voting results provide a practical guide to help clinicians in discussing treatment options with patients as part of shared decision-making.

Анализ некоторых избирательных законов: ущемление демократии или гарантия стабильности конституционного строя?

The purpose of the paper is to analyze the competition of principles of electoral process democratic nature, on the one hand, and the principles of constitutional order stability, on the other hand. The authors consider several significant changes in Federal law “On basic protections of electoral rights and the right to participate in a referendum of citizens of the Russian Federation” of the 12th of July, 2002 No. 67-FZ, including the latest changes dated the 14th of March, 2022. Nearly before each election of federal importance, the amendments are being made to federal law No. 67; therefore, electoral law becomes an elastic policy instrument. About three hundred amendments have been introduced for two decades of this federal law action. The paper analyzes several most significant changes in the RF electoral legislation for the last decade, which most notably influenced the current appearance of the direct democracy in Russia: the election pledge abolition, mass reduction of the institution of direct election of heads of local self-government, the abolition of the institution of non-voting members of the electoral commissions (in electoral commissions of under-regional level), the reduction of powers of non-voting members of the electoral commissions in the RF Central Election Commission and election commissions of the constituent entities of the Russian Federation; the introduction of electronic voting in the election of all levels and types throughout the Russian Federation. The paper considers the consequences of these electoral laws for the principles of democracy and competing principles of constitutional order stability. The authors conclude on the priority of the principles of the constitutional order stability over the principles of democracy of the electoral process, although this priority has certain specific historical reasons, as well as the limits.

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(119–122) Proposals to amend Articles 51 and 56 and Division III, to allow the rejection of culturally offensive and inappropriate names

(119–122) Proposals to amend Articles 51 and 56 and Division <scp>III</scp>, to allow the rejection of culturally offensive and inappropriate names

Chemists elected to the National Academy of Sciences for 2021

The National Academy of Sciences (NAS) has elected 120 new members and 30 international members. This brings the total active membership to 2,461 and the number of international members—who are nonvoting members and have citizenship outside the US—to 511. Election to the NAS, which is more than 150 years old, recognizes scientists and engineers for their distinguished and continuing achievements in original research and is considered one of the highest scientific honors bestowed in the US. More women were elected to the academy this year than in any previous year. Of the newly elected members, 20 are either members of the American Chemical Society or work in areas related to the chemical sciences. The US chemists newly elected to the NAS are Anna C. Balazs , University of Pittsburgh; Donna G. Blackmond , Scripps Research, California; C. Jeffrey Brinker , Sandia National Laboratories and the University of New Mexico; Ta

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Lexicon for renal mass terms at CT and MRI: a consensus of the society of abdominal radiology disease-focused panel on renal cell carcinoma.

There is substantial variation in the radiologic terms used to characterize renal masses, leading to ambiguity and inconsistency in clinical radiology reports and research studies. The purpose of this study was to develop a standardized lexicon to describe renal masses at CT and MRI. This multi-institutional, prospective, quality improvement project was exempt from IRB oversight. Thirteen radiologists belonging to the Society of Abdominal Radiology (SAR) disease-focused panel on renal cell carcinoma representing nine academic institutions participated in a modified Delphi process to create a lexicon of terms used to describe imaging features of renal masses at CT and MRI. In the first round, members voted on terms to be included and proposed definitions; subsequent voting rounds and a teleconference established consensus. One non-voting member developed the questionnaire and consolidated responses. Consensus was defined as ≥ 80% agreement. Of 37 proposed terms, 6 had consensus to be excluded. Consensus for inclusion was reached for 30 of 31 terms (13/14 basic imaging terms, 8/8 CT terms, 6/6 MRI terms and 3/3 miscellaneous terms). Despite substantial initial disagreement about definitions of 'renal mass,' 'necrosis,' 'fat,' and 'restricted diffusion' in the first round, consensus for all was eventually reached. Disagreement remained for the definition of 'solid mass.' A modified Delphi method produced a lexicon of preferred terms and definitions to be used in the description of renal masses at CT and MRI. This lexicon should improve clarity and consistency of radiology reports and research related to renal masses.

Management of Patients with Advanced Prostate Cancer: Report of the Advanced Prostate Cancer Consensus Conference 2019

BackgroundInnovations in treatments, imaging, and molecular characterisation in advanced prostate cancer have improved outcomes, but there are still many aspects of management that lack high-level evidence to inform clinical practice. The Advanced Prostate Cancer Consensus Conference (APCCC) 2019 addressed some of these topics to supplement guidelines that are based on level 1 evidence. ObjectiveTo present the results from the APCCC 2019. Design, setting, and participantsSimilar to prior conferences, experts identified 10 important areas of controversy regarding the management of advanced prostate cancer: locally advanced disease, biochemical recurrence after local therapy, treating the primary tumour in the metastatic setting, metastatic hormone-sensitive/naïve prostate cancer, nonmetastatic castration-resistant prostate cancer, metastatic castration-resistant prostate cancer, bone health and bone metastases, molecular characterisation of tissue and blood, inter- and intrapatient heterogeneity, and adverse effects of hormonal therapy and their management. A panel of 72 international prostate cancer experts developed the programme and the consensus questions. Outcome measurements and statistical analysisThe panel voted publicly but anonymously on 123 predefined questions, which were developed by both voting and nonvoting panel members prior to the conference following a modified Delphi process. Results and limitationsPanellists voted based on their opinions rather than a standard literature review or formal meta-analysis. The answer options for the consensus questions had varying degrees of support by the panel, as reflected in this article and the detailed voting results reported in the Supplementary material. ConclusionsThese voting results from a panel of prostate cancer experts can help clinicians and patients navigate controversial areas of advanced prostate management for which high-level evidence is sparse. However, diagnostic and treatment decisions should always be individualised based on patient-specific factors, such as disease extent and location, prior lines of therapy, comorbidities, and treatment preferences, together with current and emerging clinical evidence and logistic and economic constraints. Clinical trial enrolment for men with advanced prostate cancer should be strongly encouraged. Importantly, APCCC 2019 once again identified important questions that merit assessment in specifically designed trials. Patient summaryThe Advanced Prostate Cancer Consensus Conference provides a forum to discuss and debate current diagnostic and treatment options for patients with advanced prostate cancer. The conference, which has been held three times since 2015, aims to share the knowledge of world experts in prostate cancer management with health care providers worldwide. At the end of the conference, an expert panel discusses and votes on predefined consensus questions that target the most clinically relevant areas of advanced prostate cancer treatment. The results of the voting provide a practical guide to help clinicians discuss therapeutic options with patients as part of shared and multidisciplinary decision making.

Restoring the Promise of Federal Reserve Governance

The US Federal Reserve System (Fed) is famous for its organizational complexity. Overlooked in debates about the costs and benefits of this complexity for the Fed’s legitimacy, independence, and accountability is the congressional vision of what the Fed should be. The central bank is governed by a highly accountable seven-person Board of Governors to manage the rest of the system. Time and experience have eroded this authority as a matter of practice but not as a matter of law. The Fed governors are supposed to supervise the system, a legal aspiration that has increasingly been enervated by institutional drift. Using empirical and historical tools, this paper discusses the erosion of the Board of Governors over the Fed’s century-long history, including the substantial reduction in real compensation for the governors, their diminished participation in Federal Open Market Committee (FOMC) meetings, and the increased vacancies that recently have been driven by the political process. To address these problems, the paper suggests reforms across three divides: cultural, regulatory, and legislative. Remedies include changing norms of FOMC meeting participation to place nonvoting members of the FOMC as “observers”; clarifying the role of the Fed’s Board of Governors in supervising the Federal Reserve Banks, particularly with respect to the presidential search process; increasing attention to vacancies and promoting bipartisan interest in credible candidates; and increasing governor salaries to match those of their colleagues at the 12 Federal Reserve Banks, consistent with legislative intent from 1913.

Modeling voting dynamics in a two-party system

The 2016 U.S. presidential primary election, characterized by unexpected results, provides an interesting context to study how citizens are influenced in deciding whether to vote and whom to support. Our aim is to determine which of those changes in voting behavior have the largest impact on the election outcome. We address this question by developing a class of models driven either by the effect of mass media or by social interaction among voters and non-voting members of two parties. The dynamics are modeled using four compartments with a transition matrix describing the evolution of a discrete-time Markov chain. Each model is studied and fit to poll data from the 2012 and 2016 U.S. presidential elections using numerical methods. A comparison across elections indicates that the social influence of each group changes from one election to another, but response to media is similar in both cases.

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