Oversight Committee Research Articles

Abstract 4135444: Sex Disparities in Enrollment of Cardiovascular Trials: A Meta-Analysis of ClinicalTrials.gov Listings

Background: Despite increasing recognition of sex differences in the burden of cardiovascular (CV) diseases, women have historically been underrepresented in clinical trials. Aims: The study aimed to systematically quantify the extent of sex disparity in the enrollment of CV trials and explore the annual enrollment trends of women in CV trials. Methods: The analysis included studies that: (1) were registered in ClinicalTrials.gov up to February 2024; (2) were randomized trials involving ≥1 intervention; (3) investigated ≥1 CV condition, as determined by Medical Subject Heading descriptors. The exclusion criteria were: (1) studies without available enrollment information; (2) studies exclusively enrolling men or women; and (3) studies with ≤100 participants. We computed enrollment disparity difference (EDD), defined as the difference between the proportion of women in trial participants and the proportion of women with CV diseases in the general population, based on the Global Burden of Disease estimates matched by country/geographic region and enrollment period. Random-effects meta-analysis was performed to summarize the overall enrollment disparity. Subgroup analysis by trial characteristics was conducted. Meta-regression was used to assess the association of enrollment disparity with the start year of the trials. Results: A total of 1,687 CV trials were identified from 484,781 studies. Among 2,198,317 trial participants for whom sex was reported, 819,570 (37.3%) were women. EDD in CV trials was -0.105 (95% CI, -0.113 to -0.097), indicating that women were under-enrolled by 10.5% (Figure 1). Except for valvular heart disease trials, disparities were evident across other CV disease trials, with the most remarkable under-enrollment of women in peripheral artery disease trials (-0.302 [95% CI, -0.324 to -0.279]). Disparities were more prominent in trials with larger sample sizes, longer study durations, device or procedural interventions, and data monitoring committee oversight (p<0.001 for subgroup differences; Figure 2). There was a significant yet modest improvement in the representation of women over time (increase of 0.0028 [95% CI, 0.0011 to 0.0045] in EDD per start year of trials; p=0.001; Figure 3). Conclusion: Women remain substantially underrepresented in CV trials, particularly in peripheral artery disease trials. The findings underscore the imperative for interventions to mitigate sex inequity in the enrollment of CV trials.

Navigating the ethical and governance challenges of ai deployment in AML practices within the financial industry

The rapid deployment of Artificial Intelligence (AI) in Anti-Money Laundering (AML) practices within the financial industry presents significant ethical and governance challenges that must be navigated effectively. As financial institutions increasingly adopt AI technologies to enhance their AML efforts, concerns regarding data privacy, algorithmic bias, and transparency emerge. This review explores the ethical implications of AI in AML and offers governance strategies to mitigate risks while ensuring compliance with regulatory frameworks. One of the primary ethical challenges in deploying AI for AML is the potential for algorithmic bias. AI systems trained on historical data may inadvertently perpetuate existing biases, leading to discriminatory practices in transaction monitoring and customer profiling. This raises serious concerns about fairness and equity in the financial sector. Addressing algorithmic bias requires the implementation of rigorous testing and validation processes to ensure AI systems function impartially across diverse populations. Data privacy is another critical issue. The extensive data collection required for effective AML monitoring raises questions about the protection of sensitive customer information. Financial institutions must establish robust data governance frameworks that prioritize privacy and comply with regulations such as the General Data Protection Regulation (GDPR). Ensuring transparency in how data is used and providing clear communication to customers about data practices is essential for building trust. Effective governance frameworks are crucial in navigating these ethical challenges. Financial institutions should adopt a multi-disciplinary approach that includes ethical guidelines, compliance measures, and risk management strategies. Establishing oversight committees can help ensure that AI deployment aligns with ethical standards and regulatory requirements. Furthermore, ongoing training for employees on the ethical use of AI in AML can foster a culture of responsibility and accountability. This review highlights the need for a balanced approach to AI deployment in AML, emphasizing the importance of ethical considerations and governance structures. As the financial industry continues to evolve, addressing these challenges will be essential for maintaining trust, ensuring compliance, and leveraging AI’s potential to enhance AML practices effectively.

Public views on open data health research in Switzerland: Implications for research and policy

Abstract Background The increasing volume of publicly available data offers health researchers opportunities to explore public sentiment through open data research on issues such as vaccination hesitancy and fake news propagation. To ensure ethical conduct and maintain public trust, assessing public perceptions of open data research in healthcare is crucial. Methods We conducted 10 focus groups across the German, French, and Italian-speaking regions of Switzerland. We presented participants with real-world examples of open data research in healthcare and guided discussions using a semi-structured format. The topic areas were: (1) using Twitter data to assess public opinion on gene-editing technology, (2) assessment of health policy documents, (3) using Twitter data to predict individual health status and (4) using YouTube data to assess public sentiment on health policies. We assessed our findings using a thematic analysis approach. Results Gathering insights from 75 citizens, four major themes emerged: (1) Expectations towards actors and open data research, such as using research findings for societal benefit, and ensuring transparency in data use through informed consent; (2) Supportive measures including communication strategies to raise awareness and inform the public about the use of publicly available data for health research; (3) Concerns about data reuse for purposes beyond the study’s objectives, especially for financial gain, and about data validity and privacy, particularly for sensitive health data; and (4) Mitigative measures to minimize harm, such as through the involvement of external oversight committees. Conclusions Our findings indicate public support for open data research in healthcare, provided that specific expectations are met. Developing a guiding framework for legitimate open data research in healthcare is a valuable next step, with a focus on enhancing public awareness through communication campaigns and providing oversight measures to foster public trust. Key messages • Open data research in healthcare relies on public data use without explicit consent, which can disconnect the research community from society. • We found that public support for open data research in healthcare is generally present, however it is also conditional on communication and policy efforts addressing their concerns.

07 Partnering with patients with living and lived experience of eating disorders to improve inpatient care on an acute paediatric medicine unit

Abstract Background Since the COVID-19 pandemic, hospitals nationally are seeing a growing number of adolescent patients with eating disorders requiring acute medical stabilization, which is often a time of crisis in the trajectory of this ego-syntonic disorder. The complexity of these admissions often lead to safety events for patients and moral distress for clinicians. Medical admissions can also be an opportunity to engage youth and families. Patient partners are a pillar in healthcare quality improvement, but historically we have not engaged adolescent patient partners in improving acute eating disorder treatment. We gathered the experience of patients and families with living and lived experience of eating disorder treatment to improve their quality of care in an acute paediatric medicine unit. Objectives We aimed to describe the experience of patients and families with living and lived experience of eating disorder treatment, specifically acute medical stabilization, through a quality improvement patient engagement project. Design/Methods We used a mixed-methods design of semi-structured interviews and a focus group with adolescents with eating disorders and their caregivers in an acute medical unit at a tertiary paediatric hospital in British Columbia. We employed opportunity sampling by distributing recruitment flyers through patient experience councils, outpatient clinics, other non-acute units, and to all patients admitted with a medically unstable eating disorder at our hospital during the study period. The interviews consisted of open-ended questions, yes/no questions, and Likert scales related to four categories: admission process, inpatient experience, team communication, and discharge process. Two reviewers analyzed the qualitative data using thematic analysis, and the quantitative data was analyzed descriptively. Quality improvement projects are exempt from Research Ethics Board approval. However, we utilized the "A Project Ethics Community Consensus Initiative" (ARECCI) Ethics Guideline and Screening Tool and presented our proposal at the hospital's quality improvement and research oversight committees. Results We completed 8 interviews with patients with current living experience admitted to our acute medical unit. We also completed 1 interview with a patient with past lived experience and 1 focus group with patients and caregivers. Primary themes identified included uncertainty about their overall treatment journey and stress due to the sudden new expectations on the inpatient unit, such as activity restriction, meal plans by the hospital, and bathroom access after meal times. Patients identified the importance of relational care, inclusion in treatment planning, acknowledgement of the demanding nature of eating disorders, and individualized care. Due to variability in training, resource allocation, and gaps in communication, these patient-identified priorities are not always met. While 100% of participants stated they understood the reasons and goals for admission, participants averaged 3.7 on a 1 (lowest) to 5 (highest) Likert scale when asked to rate their satisfaction with the information they received. Five out of eight adolescents felt that there was consistency in communication within the team. Conclusion We demonstrate the complex needs of patients with eating disorders who require acute medical stabilization. Targeted knowledge mobilization initiatives through admission orientation documents and family-centered rounds could better meet those needs. We are currently developing an admission pamphlet and journal for patients admitted with a new eating disorder to our medical unit. Patient partners exhibited a high willingness to participate in our study and readily acknowledged the importance their contributions could hold for other patients.

Financial Resource Availability and Implementation of Child Protection and Safeguarding Programs in Kwale County, Kenya

The Kenya child protection data on Kwale County revealed an increase of child negligence cases from 49.6% in 2020-2021 to 61.7% in 2022-2023. This has led to the establishment of various child protection and safeguarding programs to curb child protection and safeguarding menace in the county. Despite this effort, implementing such child protection and safeguarding programs has experienced problems. Thus the purpose of this study was to establish the influence of financial resource availability in the implementation of Child Protection and Safeguarding Programs in Kwale County, Kenya .The research was grounded in complexity theory and implementation theory. A descriptive research approach was employed to accurately depict the target population, which included key program personnel such as social workers, government officials, and child/probation officers involved in child protection programs in Kwale County. The sampling frame encompassed personnel from 11 NGOs, 2 government agencies, and 3 rescue centers currently implementing child protection programs in the county. Proportionate and simple random sampling were used for the NGOs and CBOs, while census sampling was employed for the government agencies and rescue centers. Of the 141 selected participants for the sample, 132 responded to the open and closed-ended questionnaires. Quantitative data was analyzed using SPSS, including descriptive statistics (frequencies, percentages, means, and standard deviations) and inferential statistics (correlation and multiple linear regression).Correlation analysis revealed that a financial resource availability showed a correlation of (r=0.859, p=0.000). Multiple linear regression indicated financial resource availability had a significant positive impact (B=0.351, p=0.00).To enhance child protection programs in Kwale County, the study recommends that organizations diversify funding sources, Implement clear reporting mechanisms and independent oversight committees can enhance transparency and accountability. Long-term financial planning, including emergency funds and scenario planning, along with stakeholder engagement, will help create a stable financial environment for implementing child protection and safeguarding programs in Kwale County.

Balancing National Security and Privacy: Examining the Use of Commercially Available Information in OSINT Practices

Open source intelligence (OSINT) researchers utilize specialized tools to access vast amounts of data from multiple sources simultaneously. These tools, equipped with (paid) modules, allow users to tap into aggregated data sets containing commercially available information, such as location data from mobile phone users. The utilization of commercially available information from OSINT tools by intelligence and security services impacts fundamental rights and freedoms; more specifically, the right to personal data protection. Drawing from prior experience working on this topic within a Dutch oversight committee on the intelligence and security services and international developments in OSINT practice, insights are provided on this new OSINT practice and the responses of oversight authorities. Rather than advocating for a categorical ban, a more refined approach to process commercially available information from OSINT tools is suggested. Building on the work of a Dutch oversight authority and the work of the U.S. Office of the Director of National Intelligence, four recommendations are provided to intelligence and security services to responsibly handle commercially available information in OSINT practices.

An Overview of the Roles and Functions of Selected Financial Role Players to Protect Financial Stability and Promote Market Integrity in South Africa

The South African Reserve Bank (SARB) and other financial role players such as the Prudential Authority (PA), the Financial Sector Conduct Authority (FSCA), the National Credit Regulator (NCR), the Financial Intelligence Centre (FIC), the Financial Stability Oversight Committee (FSOC), the Financial Sector Contingency Forum (FSCF), the Financial Sector Council of Regulators (FSCR) and the Financial Sector Inter-Ministerial Council (FSIC) play a significant role in the protection and promotion of financial stability and market integrity in South Africa. The SARB has the primary financial stability mandate, whilst the FSCA was established to primarily promote market integrity and enhance market efficiency through protecting and promoting the fair treatment of financial customers and promoting financial literacy programs. As technology advances and new players enter the market, traditional financial institutions are faced with increased competition and the need to adapt and innovate to stay relevant. In this regard, regulatory frameworks and the functions of regulatory bodies should be constantly reviewed to conform to financial technology (fintech) developments and safeguard consumer interests. This article examines the roles and functions of the aforementioned financial role players as regulated by the Financial Sector Regulation Act (FSR Act) and other relevant financial sector laws. This is done to evaluate the effectiveness of their roles and functions to protect and promote financial stability and market integrity in line with fintech and Artificial Intelligence (AI) developments. The paper also evaluates the importance of cooperation and collaboration between the financial role players to fulfil their roles and functions.

Police Misconduct Investigation Processes: Police Officer Perceptions of Fundamental Fairness

Police misconduct has historically garnered much research attention. Internal affairs (IA) processes exist within police departments to investigate such cases of misconduct. Yet, sworn officers may distrust IA processes, potentially hampering its effectiveness and its amenability for reform. The purpose of this study was to examine police officers’ perceptions of the IA process in its current state and their amenability to various types of IA reforms (e.g., civilian oversight committees, independent investigators). We collected survey data from a sample of 115 police officers from various police departments in New Jersey, USA. The results indicated that police officers vary in their perceptions of IA processes, such as the fairness of IA processes, their amenability to reforming IA systems, and what reforms were perceivably appropriate. Findings also indicated greater amenability for revisions to the current IA process, primarily among lower-ranking police officers and Black officers. Implications for policy and practice are discussed.

The effects and potential benefits of audit committee oversight in a strategic setting

AbstractSince the passage of the Sarbanes‐Oxley Act of 2002, many notable frauds have been tied to ineffective audit committee (AC) oversight. As a result, AC oversight is of continuing interest, and regulators continue to debate this issue, garnering a growing body of research focused on the role played by the AC. But little theoretical research exists to guide analytical and empirical researchers investigating AC oversight. The purpose of this study is to provide theoretical guidance by examining AC oversight in a strategic setting. We focus on the AC's role in overseeing internal controls (ICs) and the impact of whether the AC relies on management in designing the controls. We characterize how the nature of control risk changes and how IC strength is associated with the amount of managerial fraud, expected probability of fraud detection (which, on average, equates to audit effort), and audit quality (assessed as 1 − audit risk) across two settings defined by the degree of AC oversight. As one example that highlights the need for theoretical guidance, we consider the literature's presumption that IC strength is negatively associated with audit effort. We find that this association may be positive or negative as IC changes, where the association varies with the degree of direct AC oversight and the change in payoff parameters.

Impact of IFRS 9 Implementation and Audit Committee Effectiveness on Earnings Management in The Indonesian Banking Sector

Background- The implementation of IFRS 9, utilizing the Expected Credit Loss (ECL) method, along with effective oversight from the audit committee, can be a relevant strategy to anticipate earnings management practices. Purpose- to examine the impact of IFRS 9 implementation and audit committee supervision on restricting managerial discretion in loan loss provisions. Design/methodology/approach- This study will use a quantitative analysis method using secondary data from an annual report. The sampling method used in this study was purposive sampling, which resulted in selecting 42 banks listed on the Indonesian Stock Exchange from 2017 to 2022. This study uses the data panel analysis method with the STATA analysis tool. Findings- This research found that the implementation of IFRS 9 and audit committees had an impact on increasing bank managerial discretion. This explains that the implementation of IFRS 9 and the audit committee have not been able to limit managerial discretion, which may be due to the influence of unstable economic conditions due to the pandemic and countercyclical policy to anticipate the impact of the pandemic. Research limitation- The potential impact of the COVID-19 pandemic on research outcomes related to managerial discretion and the effectiveness of audit committee oversight. Originality/Value- To enhance the literature related to the trends of the impact of PSAK implementation in Indonesia on earnings management more comprehensively by extending the research period and contributing to the literature by employing multiple criteria to identify the quality of oversight provided by the audit committee.

Behind the scenes of research ethics committee oversight: a qualitative research study with committee chairs in the Middle East and North Africa region

BackgroundResearch cites shortcomings and challenges facing research ethics committees in many regions across the world including Arab countries. This paper presents findings from qualitative in-depth interviews with research ethics committee (REC) chairs to explore their views on the challenges they face in their work with the oversight of research involving human populations.MethodsVirtual in-depth interviews were conducted with chairs (n = 11) from both biomedical and/or social-behavioral research ethics committees in six countries, transcribed, coded and subject to thematic analysis for recurring themes.ResultsTwo sets of recurring themes impede the work of the committees and pose concerns for the quality of the research applications: (1) procedures and committee level challenges such as heavy workload, variations in member qualification, impeding bureaucratic procedures, member overwork, and intersecting socio-cultural values in the review process; (2) inconsistencies in the researchers’ competence in both applied research ethics and research methodology as revealed by their applications.ConclusionsNarratives of REC chairs are important to shed light on experiences and issues that are not captured in surveys, adding to the body of knowledge with implications for the region, and low- and middle-income countries (LMICs) in other parts of the world. International research collaborations could benefit from the findings.

Health screening clinic to reduce absenteeism and presenteeism among NHS Staff: eTHOS a pilot RCT.

Staff sickness absenteeism and presenteeism (attending work while unwell) incur high costs to the NHS, are associated with adverse patient outcomes and have been exacerbated by the COVID-19 pandemic. The main causes are mental and musculoskeletal ill health with cardiovascular risk factors common. To undertake a feasibility study to inform the design of a definitive randomised controlled trial of the effectiveness and cost effectiveness of a health screening clinic in reducing absenteeism and presenteeism amongst the National Health Service staff. Individually randomised controlled pilot trial of the staff health screening clinic compared with usual care, including qualitative process evaluation. Four United Kingdom National Health Service hospitals from two urban and one rural Trust. Hospital employees who had not previously attended a pilot health screening clinic at Queen Elizabeth Hospital Birmingham. Nurse-led staff health screening clinic with assessment for musculoskeletal health (STarT musculoskeletal; STarT Back), mental health (patient health questionnaire-9; generalised anxiety disorder questionnaire-7) and cardiovascular health (NHS health check if aged ≥ 40, lifestyle check if < 40 years). Screen positives were given advice and/or referral to services according to UK guidelines. The three coprimary outcomes were recruitment, referrals and attendance at referred services. These formed stop/go criteria when considered together. If any of these values fell into the 'amber' zone, then the trial would require modifications to proceed to full trial. If all were 'red', then the trial would be considered unfeasible. Secondary outcomes collected to inform the design of the definitive randomised controlled trial included: generalisability, screening results, individual referrals required/attended, health behaviours, acceptability/feasibility of processes, indication of contamination and costs. Outcomes related to the definitive trial included self-reported and employee records of absenteeism with reasons. Process evaluation included interviews with participants, intervention delivery staff and service providers. Descriptive statistics were presented and framework analysis conducted for qualitative data. Due to the COVID-19 pandemic, outcomes were captured up to 6 months only. Three hundred and fourteen participants were consented (236 randomised), the majority within 4 months. The recruitment rate of 314/3788 (8.3%) invited was lower than anticipated (meeting red for this criteria), but screening identified that 57/118 (48.3%) randomised were eligible for referral to either general practitioner (81%), mental health (18%) and/or physiotherapy services (30%) (green). Early trial closure precluded determination of attendance at referrals, but 31.6% of those eligible reported intending to attend (amber). Fifty-one of the 80 (63.75%) planned qualitative interviews were conducted. Quantitative and qualitative data from the process evaluation indicated that the electronic database-driven screening intervention and data collection were efficient, promoting good fidelity, although needing more personalisation at times. Recruitment and delivery of the full trial would benefit from a longer development period to better understand local context, develop effective strategies for engaging with underserved groups, provide longer training and better integration with referral services. Delivery of the pilot was limited by the impact of COVID-19 with staff redeployment, COVID-research prioritisation and reduced availability of community and in-house referral services. While recruitment was rapid, it did not fully represent ethnic minority groups and truncated follow-up due to funding limitations prevented full assessment of attendance at recommended services and secondary outcomes. There is both a clinical need (evidenced by 48% screened eligible for a referral) and perceived benefit (data from the qualitative interviews) for this National Health Service staff health screening clinic. The three stop/go criteria were red, green and amber; therefore, the Trial Oversight Committee recommended that a full-scale trial should proceed, but with modifications to adapt to local context and adopt processes to engage better with underserved communities. This trial is registered as ISRCTN10237475. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/42/42) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 23. See the NIHR Funding and Awards website for further award information.

Scholarly Activity During Neonatal-Perinatal Medicine Fellowship.

Objective To describe scholarly activity training during neonatal-perinatal medicine (NPM) fellowship and factors associated with scholarship productivity. Study Design NPM fellowship program directors (FPD) were surveyed between March and October 2019, as part of a larger study of all pediatric subspecialty programs, to define barriers, resources, and productivity for fellow scholarly activity. High productivity was defined as > 75% of fellows in a program in the last 5 years having a manuscript accepted for publication based on fellowship scholarly work. Results Fifty-four percent (54/100) of NPM FPDs completed the survey. Nineteen fellowship programs (35%, 19/54) met the definition for high productivity. High productivity in scholarly activity was associated with a greater likelihood of having funds to conduct scholarship (p=0.011), more protected months dedicated to scholarly activity (p=0.03), and fellow extramural grant applications (submitted or accepted, p=0.047). FPDs of productive programs were less likely to report lack of an adequate core research curriculum (p=0.018), lack of adequate expertise on the fellowship scholarly oversight committee (p=0.048), and lack of sufficient divisional mentorship (p=0.048) as barriers to completion of scholarly activity during fellowship. Conclusions Research funding, protected research time, established research mentors, and a research curriculum are associated with higher scholarly activity productivity among NPM fellowship programs. Further investment in these resources may improve scholarly activity productivity during fellowship training.

Integrating electronic health records (EHRs) to facilitate cancer biomarker testing: Real-world implementation barriers and solutions.

e13649 Background: Effective integration between EHRs and cancer biomarker testing processes is an unmet need across academic and community settings. Despite the benefits of EHR-integrated workflows and the desire for streamlined test results, as supported by a recent ASCO Workforce Survey, many health systems do not currently have this capacity, especially when reference labs are external to the ordering institution. Methods: The Association of Cancer Care Centers (ACCC) convened a live summit on October 4, 2023 to understand facilitators and barriers to integrating biomarker orders and results into the EHR. To capture a comprehensive perspective, ACCC convened 37 oncologists, pathologists, nurse navigators, and administrators from diverse settings using a range of EHRs, patient advocacy groups, and EHR/testing companies. Thematic analysis of the summit transcript and a post-summit assessment was employed to identify common experiences among participants. Results: The key benefits of EHR integration include increased efficiency with test ordering/result retrieval, streamlined communication, and improved clinical decision-making. Factors associated with successful EHR integration include strong clinical champions, creation of a precision medicine oversight committee, buy-in from administrative leadership, IT support to build EHR customizations, support from EHR vendors/reference labs, and coordinated project management. Notable barriers include variations in EHR interoperability, utilization of multiple reference labs, lack of consistent nomenclature, resistance to change, allocation of time for post-integration updates/maintenance, lack of internal IT capabilities/resources, and a need to establish different clinical workflows depending on which clinician places the biomarker order. Conclusions: The rapid expansion of biomarker-driven cancer treatments requires oncologists to have timely access to guideline-concordant clinical information to inform complex clinical decision-making. While EHRs can streamline clinical workflows, these results underscore the need to address operational and human factors to facilitate successful EHR-laboratory integration. Strategies to address barriers and build successful EHR integrations across diverse clinical oncology settings are crucial for optimizing how cancer biomarker tests are ordered, reported and used in clinical practice.

The impact of Medicaid expansion on state expenditures through the COVID-19 era.

To investigate the impact of Medicaid expansion on state expenditures through the end of 2022. We used data from the National Association of State Budget Officers (NASBO)'s State Expenditure Report, Kaiser Family Foundation (KFF)'s Medicaid expansion tracker, US Bureau of Labor Statistics data (BLS), US Bureau of Economic Analysis data (BEA), and Pandemic Response Accountability Committee Oversight (PRAC). We investigated spending per capita (by state population) across seven budget categories, including Medicaid spending, and four spending sources. We performed a difference-in-differences (DiD) analysis that compared within-state changes in spending over time in expansion and nonexpansion states to estimate the effect of Medicaid expansion on state budgets. We adjusted for annual state unemployment rate, annual state per capita personal income, and state spending of Coronavirus Relief Funds (CRF) from 2020 to 2022 and included state and year fixed effects. We linked annual state-level data on state-reported fiscal year expenditures from NASBO with state-level characteristics from BLS and BEA data and with CRF state spending from PRAC. Medicaid expansion was associated with an average increase of 21% (95% confidence interval [CI]: 16%-25%) in per capita Medicaid spending after Medicaid expansion among states that expanded prior to 2020. After inclusion of an interaction term to separate between the coronavirus disease (COVID) era (2020-2022) and the prior period following expansion (2015-2019), we found that although Medicaid expansion led to an average increase of 33% (95% CI: 21%-45%) in federal funding of state expenditures in the post-COVID years, it was not significantly associated with increased state spending. There was no evidence of crowding out of other state expenditure categories or a substantial impact on total state spending, even in the COVID-19 era. Increased federal expenditures may have shielded states from substantial budgetary impacts.

The beginning of becoming a human.

According to birth certificates, the life of a child begins once their body comes out of the mother's womb. But when does their organismal life begin? Science holds a palette of answers-depending on how one defines a human life. In 1984, a commission on the regulatory framework for human embryo experimentation opted not to answer this question, instead setting a boundary, 14 days post-fertilization, beyond which any experiments were forbidden. Recently, as the reproductive technologies developed and the demand for experimentation grew stronger, this boundary may be set aside leaving the ultimate decision to local oversight committees. While science has not come closer to setting a zero point for human life, there has been significant progress in our understanding of early mammalian embryogenesis. It has become clear that the 14-day stage does in fact possess features, which make it a foundational time point for a developing human. Importantly, this stage defines the separation of soma from the germline and marks the boundary between rejuvenation and aging. We explore how different levels of life organization emerge during human development and suggest a new meaning for the 14-day stage in organismal life that is grounded in recent mechanistic advances and insights from aging studies.

The Boundary Conditions of Optimal Contracting and Managerial Entrenchment: A Simultaneous Two-Equation Vector Autoregression with Exogenous Variables Approach for Chief Executive Officer Compensation and Firm Performance

We apply the vector autoregression with exogenous variables (VARX) approach to integrate the optimal contracting theory, the managerial entrenchment theory, the principal-agent theory, the contextual criteria theory, and the upper echelon theory. Based on this new approach, we discover two middle ground conditions between the boundary of managerial entrenchment and optimal contracting, where CEO non-entrenchment or entrenchment cannot be explained by the managerial entrenchment theory or optimal contracting theory alone. For example, some CEOs are not entrenched when the agency problem is not mitigated, while others are entrenched when the agency problem is mitigated. The results imply that merely mitigating the agency problem cannot prevent managerial entrenchment. However, not mitigating the agency problem at all leads to managerial entrenchment. We recommend the boards look at other non-financial means and social approaches (e.g., value- and culture-based trainings, performance recognition, goodwill and friendship building events, pay transparency increase, smooth flow of information among stakeholders, value-adding managerial investments, oversight committee) to minimize the impact of managerial entrenchment on both firm performance and CEO compensation. In addition, we recommend the boards take on the approaches unique to their own firms and their CEOs to address managerial entrenchment.

Political parties and parliamentary oversight committee seats: sharing and trading the costs

ABSTRACT Political parties are important actors for making the chain of delegation in parliamentary systems work in practice, but less constructive in securing the corresponding chain of accountability that goes in the opposite direction. This article, however, argues that parliamentary oversight (accountability) conditions improve in institutionalised settings, like in central oversight committees. The article explores political parties’ strategies related to this type of task by investigating who sits in this type of committee. The expectation is that in this setting political parties will share the oversight responsibility, but that smaller parties want to trade the costs because they have fewer resources compared to larger parties. The investigation focuses on the five Nordic national parliaments with strong parties that control elections as well as the committee seat allocation. Overall, the investigation shows that institutionalisation does seem to spur joint responsibility and that larger parties take the load of this type of activity.

Bridging the Divide

The creation of Public Finance Journal (PF) is the culmination of several years of discussion about how best to address the divide between practitioners’ research needs and academic scholarship. PF’s origin is predicated on the expectation that for a professional discipline such as public administration and the subfield of public budgeting and finance, in particular, there needs to be an easily accessible forum for the dissemination of ideas and solutions. This journal would not be possible without the support of the Government Finance Officers Association, the oversight committees, the editorial board, and those helping with the journal’s management. We are excited about the inaugural edition, where we have reviews of three important books, three thought-provoking research articles, and an article that surveys current research needs in the budget and finance field as expressed by faculty and practitioners.

National Unified Renal Translational Research Enterprise: Idiopathic Nephrotic Syndrome (NURTuRE-INS) study.

Idiopathic nephrotic syndrome (INS) is a heterogenous disease and current classification is based on observational responses to therapies or kidney histology. The National Unified Renal Translational Research Enterprise (NURTuRE)-INS cohort aims to facilitate novel ways of stratifying INS patients to improve disease understanding, therapeutics and design of clinical trials. NURTuRE-INS is a prospective cohort study of children and adults with INS in a linked biorepository. All recruits had at least one sampling visit collecting serum, plasma, urine and blood for RNA and DNA extraction, frozen within 2hours of collection. Clinical histology slides and biopsy tissue blocks were also collected. A total of 739 participants were recruited from 23 centres to NURTuRE-INS, half of whom were diagnosed in childhood [n=365 (49%)]. The majority were white [n=525 (71%)] and the median age at recruitment was 32years (interquartile range 12-54). Steroid-sensitive nephrotic syndrome (SSNS) was the most common clinical diagnosis [n=518 (70%)]. Of patients diagnosed in childhood who underwent a kidney biopsy, for SSNS (n=103), 76 demonstrated minimal change disease (MCD), whereas for steroid-resistant nephrotic syndrome (n=80), 21 had MCD. Almost all patients diagnosed in adulthood had a kidney biopsy [n=352 (94%)]; 187 had MCD and 162 had focal segmental glomerulosclerosis. NURTuRE-INS is a prospective cohort study with high-quality biosamples and longitudinal data that will assist research into the mechanistic stratification of INS. Samples and data will be available through a Strategic Access and Oversight Committee.