Related Policy Changes Research Articles

A consequence analysis study of natural gas consumption in a developing country: Case of India

Natural gas, as the cleanest burning of the fossil fuels is expected to play a significant role in India's future energy mix. This paper presents a modelling approach to quantify the economic and environmental impacts of natural gas utilisation by various sectors in India while the production of domestically sourced natural gas is in decline. One of the most important sectors is the use of natural gas for cooking where the benefits are also evaluated. The long-term impacts of a reducing domestic gas supply is assessed by using the resource-substitution methodology along with a dynamic resource-depletion indicator that is based on decision-making viewpoints. The results show that the replacement of domestic gas with black coal resulted in an increase under the climate change category by 162%, 202% and 234% for the individualist, hierarchist and egalitarian viewpoints, respectively. The paper highlights the prospects for natural gas in India and shows that the growing demand for gas can be met through imports, but it has associated economic and environmental impacts. Further, the paper presents suitable recommendations including policy-related changes such as carbon pricing and subsidy provision schemes to ensure that the growth of the Indian gas market is sustainable.

Toward a More Strategic National Stockpile

The COVID-19 pandemic has uncovered major deficiencies in the United States’ approach to stockpiling for emergencies. States, cities and hospitals across the country had inadequate stores of critical medical items on hand when the pandemic reached US soil, and the federal government’s Strategic National Stockpile proved far too small to fill this inventory gap. As nationwide shortages worsened, many state governments began bidding against each other to procure scarce medical supplies — a distribution approach that inherently disadvantaged low-income and minority communities and left countless health care professionals and staff ill-equipped to protect themselves against a potentially deadly virus. These failings have generated an unprecedented push to reform the nation’s stockpiling policy structure. This Article uses a simple stockpiling cost-benefit model to highlight shortcomings in the existing US stockpiling policy regime and to identify specific new policy strategies capable of addressing them. Among other things, US stockpiling policies need to better account for important differences in the rotatability of supplies and should more aggressively incentivize private stockpiling of the most rotatable emergency items. Reshaping commandeering laws and price-gouging restrictions could also do much to strengthen private incentives to stockpile and could even help to clarify how states and the federal government share responsibilities in the nation’s stockpiling effort. Additional federal support is likewise needed to incentivize the build-out and maintenance of domestic supply chains for the least-rotatable emergency goods. These reforms and certain related policy changes could help to ensure that the nation is far better equipped to respond the next time disaster strikes.

Characterization of initial North American pediatric surgical response to the COVID-19 pandemic

IntroductionThe impact of COVID-19 pandemic on pediatric surgical care systems is unknown. We present an initial evaluation of self-reported pediatric surgical policy changes from hospitals across North America. MethodsOn March 30, 2020, an online open access, data gathering spreadsheet was made available to pediatric surgeons through the American Pediatric Surgical Association (APSA) website, which captured information surrounding COVID-19 related policy changes. Responses from the first month of the pandemic were collected. Open-ended responses were evaluated and categorized into themes and descriptive statistics were performed to identify areas of consensus. ResultsResponses from 38 hospitals were evaluated. Policy changes relating to three domains of program structure and care processes were identified: internal structure, clinical workflow, and COVID-19 safety/prevention. Interhospital consensus was high for reducing in-hospital staffing, limiting clinical fellow exposure, implementing telehealth for conducting outpatient clinical visits, and using universal precautions for trauma. Heterogeneity in practices existed for scheduling procedures, implementing testing protocols, and regulating use of personal protective equipment. ConclusionsThe COVID-19 pandemic has induced significant upheaval in the usual processes of pediatric surgical care. While policies evolve, additional research is needed to determine the effect of these changes on patient and healthcare delivery outcomes. Level of evidenceIII

Factors Influencing Salt-Reducing Behavior in Young Adults: a Pilot Cross-Sectional Study from Kazakhstan

Introduction:In Kazakhstan, a post-Soviet country in Central Asia, salt intake is estimated as high, potentially contributing to the morbidity and mortality from cardiovascular diseases. The aim of this study was to explore salt intake in residents of the capital of Kazakhstan, Nur-Sultan.Methods:An online cross-sectional survey of knowledge, attitudes, and behaviors on salt intake among young adult residents of the capital city of Kazakhstan was conducted (n = 237). Bivariate and multivariate linear regression analyses were performed.Results:Although 95% (n=225) reported knowledge on the adverse health effects of high salt intake, older respondents were more aware of its association with high blood pressure (p = 0.007), heart disease (p = 0.037), and heart attack (p = 0.002). Only one-third (n=79) correctly identified the recommended level of daily salt intake. Females reported more awareness of Kazakhstani people consuming salt more than recommended (p = 0.0027) and that processed products constituted the major source of salt in diet (p = 0.007). General dietary concern (p < 0.001), high self-assessmen of salt intake (p < 0.001), and older age (p = 0.012) were found to be adjusted predictors of salt-reducing behavior.Conclusions:Lack of reported knowledge on salt-health relationship is of concern, especially among young males. A greater dietary concern and individual awareness of the excessive salt consumption is likely to assist in reducing salt intake. Further studies are required to validate the findings of this pilot study on a bigger population level in order to provide a basis for future salt related interventions and policy changes in Kazakhstan.

Impact of COVID-19 related policy changes on filling of opioid and benzodiazepine medications.

BackgroundHealthcare access has changed drastically during the COVID-19 pandemic. Elective medical procedures, including routine office visits, were restricted raising concerns regarding opioid and benzodiazepine provider and prescription availability.ObjectiveTo examine how the cancelation of elective medical procedures due to COVID-19 impacted the dispensing of opioid and benzodiazepine prescriptions in Texas.MethodsInterrupted time series analyses were preformed to examine changes in prescription trends for opioids and benzodiazepines before and after the restriction on elective medical procedures. Samples of patients who filled an opioid or benzodiazepine prescription from January 5, 2020 to May 12, 2020 were identified from the Texas Prescription Monitoring Program. Elective medical procedures were restricted starting March 23, 2020 indicating the beginning of the intervention period.ResultsRestricting elective procedures was associated with a significant decrease in the number of patients (β = −6029, 95%CI = −8810.40, −3246.72) and prescribers (β = −2784, 95%CI = −3671.09, −1896.19) filling and writing opioid prescriptions, respectively. Also, the number of patients filling benzodiazepine prescriptions decreased significantly (β = −1982, 95%CI = −3712.43, −252.14) as did the number of prescribers (β = −708.62, 95%CI = −1190.54, −226.71).ConclusionRestricting elective procedures resulted in a large care gap for patients taking opioid or benzodiazepine prescriptions.

Outpatient Otolaryngology in the Era of COVID-19: A Data-Driven Analysis of Practice Patterns.

IntroductionCoronavirus disease 2019 (COVID-19) has induced a prioritization of acute care and telehealth, affecting the quantity of patients seen and the modality of their care.Study DesignRetrospective review.SettingSingle-institution study conducted within the Division of Otolaryngology at the Yale School of Medicine.Subjects and MethodsData on all outpatient appointments within the Division of Otolaryngology were obtained from administrative records of billing and scheduling from March 16 to April 10, 2020. For comparison, a corresponding period from 2019 was also utilized.ResultsOf 5913 scheduled visits, 3665 (62.0%) were seen between March 18 and April 12, 2019, in comparison with 649 of 5044 (12.9%) during the corresponding COVID-19–affected period. The majority of completed visits performed in weeks 1 and 2 were in person, while the majority in weeks 3 and 4 were via telehealth. Among subspecialties, a larger proportion of completed visits in 2020 were performed by pediatric and head and neck oncology otolaryngologists as compared with general/specialty otolaryngologists (P < .001). Older adults (≥65 years) were less likely to have telehealth visits than younger adults (18-64 years; 45.6% vs 59.6%, P = .003).ConclusionsA major decrease in the completion rates of scheduled visits was seen in the COVID-19–affected period, though this was not proportional among subspecialties. An associated increase in telehealth visits was observed. After COVID-19–related hospital policy changes, approximately 2 weeks passed before telehealth visits surpassed in-person visits, though this was not true among older adults.

Twenty years’ follow-up on elder people’s health and quality of life

With a brief overview on changes of elderly people and related socio-economic and policy changes during the last two decades in China, this review introduces the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The review also tracks follow-up survey waves that came after the initial CLHLS and the evolution of CLHLS questionnaire design over this 20 year period. The CLHLS database contains approximately 130 thousand records of surviving and deceased elderly people aged 65 and above. There is information on the demographics of the elderly population, as well as information on health status, the cognitive abilities of the elderly, their lifestyles, their ability to perform daily activities, and self-assessments of the elderly. There is also information on elderly care providers and family members. The review introduces the sampling design used by CLHLS, lists core information collected by the survey, and identifies major items added to follow-up surveys, including to the 2018 survey. It summarizes how CLHLS data is used and related publications.

Depression and Aggressive Behaviour in Continuing Care: How Cognitive Impairment Might Not Explain the Whole Story

Context: There is currently little research examining the relationship between depression and aggressive behaviour among individuals receiving long-term care. Previous research has focused on older adults with neurocognitive disorders (e.g., Alzheimer’s). These studies have found a positive association between aggressive behaviour and depression and are additionally associated with cognitive impairment in older adults. Objectives: The current study aims to better understand the relationship between aggressive behaviour and depression amongst older adults with and without cognitive impairment, as previous studies have not yet examined how these relationships may differ across levels of cognitive functioning. Methods: Data from the Continuing Care Reporting System administered by the Canadian Institute for Health Information was used. At the time of analysis, data for individuals receiving continuing care was available across seven Canadian provinces and one territory. Findings: Data from 2,682,612 individuals were extracted (Mage = 80.42, SD = 11.5). A positive relationship between aggressive behaviour and depressive symptoms was found for those with and without cognitive impairment. There was no evidence of a mediating effect of cognitive impairment on aggressive behaviour. Individuals with symptoms of depression demonstrated more aggressive behaviours. Limitations: A limitation of the current work is the cross-sectional nature of the data examined. This restricts the ability to determine causation, and the questions of “Do depressive symptoms predict aggressive behaviour?” or “Are aggressive behaviours early symptoms of depression?” remain. Implications: These findings indicate that, independent of cognition, those with depressive symptoms are more likely to exhibit aggressive behaviour. Recommendations on identification and treatment of depression in this population are discussed and related policy changes are considered.

MULTI-LEVEL PERSPECTIVE TO FACILITATE SUSTAINABLE TRANSITIONS — A PATHWAY FOR GERMAN OEMS TOWARDS ELECTRIC VEHICLES

Sustainable transitions within industrial branches are a complex problem since they involve emerging technologies, as well as cultural, market and policy-related changes. Recent studies emphasise the need for analytical approaches that not only do justice to this complexity by reflecting relevant trends and determinants, but also reveal insights that are intuitive enough to be implemented without major effort. Aiming at addressing this trade-off, we pursue a strategic analytical procedure that links external factors from multi-level perspective and internal, company-specific dynamic capabilities. We draw on expert interviews and subsequent qualitative analytical evaluation to obtain insights regarding individual motives, visions and boundary conditions of actors from the German automotive industry. Our contribution is both conceptually and practically important, as it unveils manifestations of significant dynamic capabilities and provides recommendations for change managers and policy makers leading to successful, sustainable transition in the automotive industry.

Art and Blockchain

Blockchain technology, while commonly associated with cryptocurrencies, stands to bring radical structural change to the arts and creative industries. This paper presents a history, primer, and taxonomy of blockchain use cases in the arts and then explores the implications of blockchain in three regards: the blurring of the for-profit / nonprofit distinction, changes in the ownership structure of art, and potential for new structures of public and private support and related policy changes. These developments raise important questions of governance of a technology which requires expertise in cryptography, coding, and securities law for implementation. Ultimately, blockchain holds the potential to tip the role of the arts toward democratic availability through collective ownership structures or toward further commodification of cultural assets.

Bank response to policy-related changes in capital requirements

We estimate how banks respond to regulatory capital requirements. We use a novel measure called capital surplus/shortfall, which we construct from notifications on regulatory capital requirements sent to Slovenian banks over the period 2009–2015. Capital surplus/shortfall is more relevant than capital adequacy ratio (CAR). It conveys more information about future lending because it is a forward-looking measure of bank capitalization. Our paper carries policy implications for supervisors in countries with a distressed banking sector. Using this measure we show that the same firm has on average a 3.54 p.p. lower loan growth when the loan is obtained through a bank with 1 p.p. higher capital shortfall. Finally, we show that in response to an increase in capital requirements banks engage in risk-taking behaviour.

Structural Factors and Policy Change as Related to the Quality of Early Childhood Education and Care for 3–4 Year Olds in the UK

In many developed countries it is now the norm for preschool children to spend time outside the home in early childhood education and care (ECEC). Research indicates that attending ECEC can promote longer-term positive life outcomes, which is more likely when the ECEC is of higher quality. In a UK Study of 600 ECEC group settings for 3-4 year olds, staff qualifications were predictive of quality at private (for profit) settings. For voluntary (not for profit) settings, which were more homogenous in staff qualifications, having a staff training plan and a better staff to child ratio were found to be significant predictors of quality. However, state funded nursery classes / schools, which tend to have less favourable staff to child ratios than private and voluntary settings, also tended to have higher process quality ratings, where the presence of more highly qualified staff apparently allowed quality to be maintained with a larger number of children per staff member. A comparison of equivalent quality data from separate UK studies, conducted before and after a period of substantial policy change in relation to ECEC quality, indicated that policy change may have powerful effects in improving ECEC quality with implications for long-term child, and potentially adult, well-being.

Multi-dimensional leaders’ roles and responsibilities: Dynamics, constraints and policy change in a UAE juvenile correctional educational center

This case study explores how educational leaders in a UAE juvenile correctional educational center perceive their multi-dimensional responsibilities and roles. The dynamics of leaders’ responsibilities and roles, as well as the constraints they face, are conceptualized within the paradigms of functionalism, conflict theory, and postmodernism. To track views from different perspectives, data regarding leader and faculty perceptions were gathered through individual and focus group semi-structured interviews. The findings have implications for educational improvements and policy change in relation to the UAE’s juvenile centers and other similar correctional contexts.

Family Justice, “Asian Values” and the Politics of Ambivalence in Singapore

Abstract In recent years, Singapore made significant reforms towards the establishment of a dedicated family justice system, setting up the Family Justice Courts and enacting new laws to better manage the divorce process and the protection of children. Related policy changes have also been implemented to provide and support families that were previously considered non-traditional and even deviant. Rhetorically, the state, led by the long-ruling People’s Action Party, continues to champion the modern nuclear family with heterosexual marriage at its core as the normal “traditional” form of the family and the bedrock of conservative “Asian values” defining society and politics in Singapore. However, what the judiciary espouse as the new family justice paradigm and the related family justice practices, together with the shifts in social policy towards different family types, are changing the texture of the dominant conservatism rallied by “Asian values” discourse. This article locates and analyses the incipient paradigm shift in the rising pluralism of family forms and the influence of international legal developments in protecting the rights of the child and interventionist family law. By attempting to bridge the Weberian chasm of doing sociology as a vocation and doing politics as a vocation (as an opposition Member of Parliament), I show that the family justice paradigm has opened up the discursive field on the family and produce the politics of ambivalence caught between family justice and Asian family values. I argue for a relational family justice paradigm as a way to move beyond the politics of ambivalence.

Cesarean Delivery Rates and Costs of Childbirth in a State Medicaid Program After Implementation of a Blended Payment Policy.

Nearly half of US births are financed by Medicaid, and one-third of births occur by cesarean delivery, at double the cost of vaginal delivery. With the goal of reducing unnecessary cesarean use and improving value, in 2009 Minnesota's Medicaid program introduced a blended payment rate for uncomplicated births (ie, a single facility or professional services payment regardless of delivery mode). We evaluated the effect of the blended payment policy on cesarean use and costs for Medicaid fee-for-service births. We identified births in Medicaid Analytic Extract files from 3 years before and after the 2009 payment change in Minnesota and in 6 control states. We used a quarterly interrupted time series approach to assess policy-related changes in study outcomes, comparing Minnesota to control states. Outcomes included cesarean delivery, childbirth hospitalization costs, and maternal morbidity. Minnesota's prepolicy cesarean rate (22.8%) decreased 0.27 percentage points per quarter after the policy for a total decrease of 3.24 percentage points, compared with control states (P=0.01). The cost of childbirth hospitalizations in Minnesota dropped by $425.80 at the time of the policy. Postpolicy, childbirth hospitalization costs continued to decrease in Minnesota relative to prepolicy by $95.04 per quarter, and declined more than control states (P<0.001). There were no significant policy effects on maternal morbidity. Implementation of a single, blended payment to facilities and clinicians for uncomplicated births mitigated trends toward greater use of cesarean and rising costs of childbirth hospitalization, without adverse effects on maternal morbidity.

Understanding factors influencing the detection of mercury policies in modelled Laurentian Great Lakes wet deposition.

We used chemical transport modelling to better understand the extent to which policy-related anthropogenic mercury emissions changes (a policy signal) can be statistically detected in wet deposition measurements in the Great Lakes region on the subdecadal scale, given sources of noise. In our modelling experiment, we consider hypothetical regional (North American) and global (rest of the world) policy changes, consistent with existing policy efforts (Δglobal = -18%; Δregional = -30%) that divide an eight-year period. The magnitude of statistically significant (p < 0.1) pre- and post-policy period wet deposition differences, holding all else constant except for the policy change, ranges from -0.3 to -2.0% for the regional policy and -0.8 to -2.7% for the global policy. We then introduce sources of noise-trends and variability in factors that are exogenous to the policy action-and evaluate the extent to which the policy signals can still be detected. For instance, technology-related variability in emissions magnitude and speciation can shift the magnitude of differences between periods, in some cases dampening the policy effect. We have found that the interannual variability in meteorology has the largest effect of the sources of noise considered, driving deposition differences between periods to ±20%, exceeding the magnitude of the policy signal. However, our simulations suggest that gaseous elemental mercury concentration may be more robust to this meteorological variability in this region, and a stronger indicator of local/regional emissions changes. These results highlight the potential challenges of detecting statistically significant policy-related changes in Great Lakes wet deposition within the subdecadal scale.

The impact of a physician detailing and sampling program for generic atorvastatin: an interrupted time series analysis

BackgroundIn 2011, Manitoba implemented a province-wide program of physician detailing and free sampling for generic atorvastatin to increase use of this generic statin. We examined the impact of this unique combined program of detailing and sampling for generic atorvastatin on the use and cost of statin medicines, market share of generic atorvastatin, the choice of starting statin for new users, and switching from a branded statin to generic atorvastatin.MethodsWe conducted a retrospective study of Manitoba insurance claims data for all continuously enrolled patients who filled one or more prescriptions for a statin between 2008 and 2013. Data were linked to physician-level data on the number of detailing visits and sample provision. We used interrupted time series analyses to assess policy-related changes in the use and cost of statin medicines, market share of generic atorvastatin, the choice of starting statin for new users, and switching from a branded statin to generic atorvastatin.ResultsThe detailing program reached 31% (651/2103) of physicians who prescribed a statin during the study period. Collectively, these physicians prescribed 61% of statins dispensed in the province. Free sample cards were provided to 61% (394/651) of the detailed physicians. The program did not change the level or trend in the overall statin use rate and the total cost of statins or increase the number of patients switching from another branded statin to generic atorvastatin. We found the program had a small impact on atorvastatin’s market share of new prescriptions, with a level increase of 2.6%.ConclusionsThough physician detailers were skilled at targeting high-prescribing physicians, a combined program of detailing visits and sample provision for generic atorvastatin did not lower overall statin costs or lead to switching from branded statins to the generic. The preceding introduction of generic atorvastatin appeared sufficient to modify prescribing patterns and decrease costs.

The rise of China's securitization market

AbstractWe study the development of asset securitization markets in China. We manually collect all asset securitization projects and securities data from 2005 to 2015. Inspection of this sample combined with related policy changes reveals distinct characteristics and some potential problems. At the macro level, asset securitization market in China is policy driven, regulation‐segmented, and highly illiquid. At the micro level, the underlying assets are mainly corporate loans or assets, rather than mortgage or consumption loans as in the US and European markets. State owned commercial banks and enterprises enjoy significantly lower interest rates when issuing securitization bonds. Finally, risk‐isolation and credit enhancing techniques significantly improve the rating of asset‐backed securities.

Industry-Supported Sampling Underpins Temporal Management Policy Change in a Commercial Rock Lobster (Jasus edwardsii) Fishery

A winter fishery closure has existed in the northern zone rock lobster fishery of South Australia since 1966. This study describes the process undertaken to review and ultimately change temporal management policy with the aim of providing greater fishing flexibility to the commercial fishing sector. The work was driven by a research subcommittee (RSC) project team consisting of various stakeholder groups that included commercial fishers, fishery research scientists, resource managers, and conservation representatives. The RSC ultimately reported to the South Australian Rock Lobster Fisheries Management Advisory Committee (RLFMAC), an expertise-based, advisory body to the South Australian Government. To inform management discussions and possible policy change, the RSC proposed monthly sampling surveys during the winter fishery closure to examine key aspects of the catch composition. Sampling was underpinned by strong industry support in terms of survey logistics. Results were reviewed by the RSC and indicated that compared with the regular fishing season, closed season surveys identified (1) low catch rates of undersized lobsters; (2) reduced levels of predation mortality; (3) low contribution of female lobsters to the catch; and (4) negligible impacts on key bycatch species. Based on these findings, the RLFMAC recommended that policy changes in relation to the winter fishing closure could be considered. In June 2016, the Department of Primary Industries and Regions South Australia implemented the removal of the winter closure in an offshore region (>80 m depth) of the fishery resulting in a 12-mo fishing season for this area. The winter closure in the remainder of the fishery can be reconsidered after a 3 y period. This work is an example of industry, science, and Government collaboration to deliver management outcomes from industry-supported research.

HIV Services Provided by STD Programs in State and Local Health Departments - United States, 2013-2014.

The incidence of human immunodeficiency virus (HIV) infection in the United States is higher among persons with other sexually transmitted diseases (STDs), and the incidence of other STDs is increased among persons with HIV infection (1). Because infection with an STD increases the risk for HIV acquisition and transmission (1-4), successfully treating STDs might help reduce the spread of HIV among persons at high risk (1-4). Because health department STD programs provide services to populations who are at risk for HIV, ensuring service integration and coordination could potentially reduce the incidence of STDs and HIV. Program integration refers to the combining of STD and HIV prevention programs through structural, service, or policy-related changes such as combining funding streams, performing STD and HIV case matching, or integrating staff members (5). Some STD programs in U.S. health departments are partially or fully integrated with an HIV program (STD/HIV program), whereas other STD programs are completely separate. To assess the extent of provision of HIV services by state and local health department STD programs, CDC analyzed data from a sample of 311 local health departments and 56 state and directly funded city health departments derived from a national survey of STD programs. CDC found variation in the provision of HIV services by STD programs at the state and local levels. Overall, 73.1% of state health departments and 16.1% of local health departments matched STD case report data with HIV data to analyze possible syndemics (co-occurring epidemics that exacerbate the negative health effects of any of the diseases) and overlaps. Similarly, 94.1% of state health departments and 46.7% of local health departments performed site visits to HIV care providers to provide STD information or public health updates. One fourth of state health departments and 39.4% of local health departments provided HIV testing in nonclinical settings (field testing) for STD contacts, and all of these programs linked HIV cases to care. STD programs are providing some HIV services; however, delivery of certain specific services could be improved.