Policy Changes Research Articles

In Support of Overdose Prevention Centers: Position Statement of AMERSA, Inc (Association for Multidisciplinary Education and Research in Substance Use and Addiction).

Given increasing rates of fatal overdoses in the United States and the rapidly changing drug supply, overdose prevention centers (OPCs; also known as safe consumption sites) have been identified as a vital, evidence-based strategy that provide people who use drugs (PWUD) the opportunity to use drugs safely and receive immediate, life-saving overdose support from trained personnel. In addition to providing a safe, supervised space to use drugs, OPCs can house further essential harm reduction drop-in services such as sterile supplies, social services, and medical care. There are established national and international data demonstrating the lifesaving services provided by OPCs, inspiring a groundswell of advocacy efforts to expand these programs in the United States. Thus, the Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) endorses OPCs, in addition to other harm reduction strategies that protect PWUD. Ultimately, it is imperative to increase access to OPCs across the United States and support key policy changes at the local, state, and federal levels that would facilitate urgent expansion.

Impact of COVID-19 on road crashes in Thailand

The main goal of this study is to investigate the impact of COVID-19 on road crashes in Thailand using time series and interrupted time series analysis. To achieve the goal, road crash data from the Department of Highway (DOH), which includes total crashes, single vehicle crashes, fatalities, fatal crashes, speeding crashes, and drunk driving crashes, was obtained to conduct Seasonal Autoregressive Integrated Moving Average (SARIMA) time series models and Interrupted Time Series (ITS) models. SARIMA models were applied to forecast the number of crashes in the absence of COVID-19 then compare them to the observed values to identify the difference. The impact of a policy change aimed at addressing the spread of COVID-19 was assessed using ITS models on a time series accident dataset. The goal was to ascertain if the intervention had a meaningful and causative impact on the outcome. The result showed that the first wave of COVID-19 caused a significant reduction in all road crash indicators instead of skyrocketing to a peak. After releasing the lockdown measures from the first wave of spreading, an increase was found in all of the crash indicators as well. However, the third wave of COVID-19, which lasted longest for nearly 7 months, also caused a decrease in the number of crashes, but not as much as the first wave of the outbreak. Moreover, the result from the interrupted time series also revealed that curfews and the closure of entertainment places are associated with a significant decrease in the number of speeding crashes and drunk driving crashes from 10 p.m. to 4 a.m., respectively. It can be observed that the COVID-19 countermeasures, such as curfews and bans on the sales of alcoholic beverages, led to a drop in the number of speeding and drunk driving crashes.

"Infertility Isn't a Choice!": Conversations on Twitter about the Financial Burden of Oncofertility Care.

This study aimed to evaluate how the adolescent and young adult (AYA) cancer community utilized Twitter to discuss the financial challenges of oncofertility care and to advocate for change. Tweets related to oncofertility and finances (n = 166), collected over a 12-week time period encompassing AYA Cancer Awareness Week, were thematically analyzed. Conversations highlighted how the high cost of care contributed to already high emotional and social distress. Proposed actions included providing timely information more equitably, improving access to financial support, and continued advocacy of policy changes to improve access to oncofertility care. Future research can explore the potential impact on policy change and clinical care.

Changes in Donor Utilization and Outcomes for Patients Bridged With Durable Left Ventricular Assist Device.

We studied the impact of the 2018 heart allocation policy change on donor characteristics and posttransplant outcomes of left ventricular assist device (LVAD)-bridged heart transplant (HT) recipients. Left ventricular assist device-bridged adult HT recipients from October 2014 to October 2022 in the United Network for Organ Sharing database were categorized into old allocation policy (OAP) and new allocation policy (NAP) cohorts. Baseline characteristics, posttransplant outcomes, and subgroup analyses of unstable and stable LVAD-bridged recipients were assessed. The study included 7,384 HT recipients; 4,345 (58.8%) were transplanted in the OAP era and 3,039 (41.2%) in the NAP era. Old allocation policy recipients were most frequently status 1A at transplantation (71.1%), whereas NAP recipients were most frequently status 3 (40.0%), and status 4 (31.9%). Median donor sequence number (DSN) was higher in the NAP versus OAP era (9 vs. 3, p < 0.001). On multivariable analysis, NAP recipients had 20% higher 1 year mortality compared to OAP (adjusted hazard ratio [aHR] = 1.20 [95% confidence interval {CI}: 1.04-1.40], p = 0.01). Status 1 or 2 recipients had 28% higher 1 year mortality compared to status 1A (aHR = 1.28 [95% CI: 1.01-1.63], p = 0.04). Status 1 and 2 LVAD-supported recipients had higher mortality following the 2018 allocation change, indicating the need for closer surveillance of LVAD-bridged patients who may decompensate on the waitlist.

Enhancing renewable energy certificate transactions through reinforcement learning and smart contracts integration

Given the complexity of issuing, verifying, and trading green power certificates in China, along with the challenges posed by policy changes, ensuring that China’s green certificate market trading system receives proper mechanisms and technical support is crucial. This study presents a green power certificate trading (GC-TS) architecture based on an equilibrium strategy, which enhances the quoting efficiency and multi-party collaboration capability of green certificate trading by introducing Q-learning, smart contracts, and effectively integrating a multi-agent trading Nash strategy. Firstly, we integrate green certificate trading with electricity and carbon asset trading, constructing pricing strategies for the green certificate, carbon, and electricity trading markets; secondly, we design a certificate-electricity-carbon efficiency model based on ensuring the consistency of green certificates, green electricity, and carbon markets; then, to achieve diversified green certificate trading, we establish a multi-agent reinforcement learning game equilibrium model. Additionally, we propose an integrated Nash Q-learning offer with a smart contract dynamic trading joint clearing mechanism. Experiments show that trading prices have increased by 20%, and the transaction success rate by 30 times, with an analysis of trading performance from groups of 3, 5, 7, and 9 trading agents exhibiting high consistency and redundancy. Compared with models integrating smart contracts, it possesses a higher convergence efficiency of trading quotes.

A virtuous cycle? Migrant integration policies, attitudes toward immigration, and populist radical right voting in Europe

Are citizens less likely to support populist radical right parties (PRRPs) in countries with more inclusive migrant integration policies? Studies show that integration policies foster positive attitudes toward migrants, which, in turn, are associated with a lower likelihood of supporting PRRPs. However, the impact of integration policies on PRRP voting has not been assessed yet on a cross-country level—neither direct nor dependent on (anti)immigration attitudes. Using data from the European Social Survey 2016 and the Migrant Integration Policy Index (MIPEX) from 2011 and 2015 for 15 EU member states, we show that more inclusive integration policies are associated with a lower likelihood to support PRRPs. We also find a moderating effect of these policies on the impact of attitudes toward migrants on PRRP voting. However, the effect of migration policy change seems to be more context dependent.

Application of fuzzy Delphi technique to identify analytical lenses for determining the preparation of free and open source software projects for user experience maturity

User eXperience (UX) significantly influences the success of free and open source software (FOSS) projects and is measured using UX capability maturity models (UXCMMs). Every organization desires higher levels of UX maturity; however, it requires upfront preparations and process quality control.Harmonizing processes and analytical lenses for determining preparation for UX maturity are still challenging, and studies to create them are limited. The analysis is ad hoc and based on the actors’ will and experiences. This study proposes and validates analytical lenses.Findings show that UX experts agreed that the lenses could be used with a consensus percentage of 81 %, the threshold value (d) = 0.112, and crisp values greater than α-cut = 0.5. On validation, 47.57 % of stakeholders agreed, and 52.43 % strongly agreed they were relevant. Results help evaluate the status quo and change culture and policies toward ideal preparation. Two areas are suggested for future research.

Climate change, vulnerability and well-being in the Pacific region

The Pacific region has experienced vast adverse effects from climate change impacting the peoples’ livelihoods both in these nations’ urban and rural areas. Countries association between socio-economic performance and livelihoods have been adversity impacted by climatic hazards and vulnerabilities on nations’ economic performance impacting the societal outcomes. An assessment of the Pacific’s climate change, vulnerability and well-being is presented in general and a case study of Fiji in particular. The Pacific islands require resources invested in environmental education, and climate change and trade policy linkages to benefit the islands, future returns to individuals and higher levels of satisfied basic needs to reduce vulnerabilities.

Work-Family Policy for Fathers in Dutch Municipalities: A Vignette Experiment on Contexts for Parental Leave Among Male Civil Servants

The European Union Work-Life Balance Directive aims to promote a better work-care balance by introducing extensive parental leave. However, a change in policy does not necessarily mean behavioral change. Starting from the idea of gendered organizations and gendered policies within local government a conceptual model is developed to investigate under which organizational circumstances male civil servants in Dutch municipalities are willing to take parental leave. With a vignette experiment ( N = 572) among civil servants in the summer of 2021, the organizational characteristics that affect employees’ decisions on the potential use of parental leave are investigated. Adverse career consequences have the largest influence, followed by managerial support and coworker support. Furthermore, the larger the work ambition is, the more negative the effect of career consequences is for using parental leave. That adverse career consequences hardly had an effect among male civil servants with low work ambition shows that the relationship to parental leave uptake is nuanced. The results of this study underscore the importance of contexts in implementing policy goals and achieving greater gender equality in local government.

Brain Drain: A Cross-Sectional Study Evaluating Migration Intentions of Neurosurgery Trainees in Pakistan

Abstract Background Pakistan has a significant proportion of medical graduates who intend to leave the country for better opportunities abroad, leading to a brain drain. However, the push and pull factors within neurosurgery remain unexplored, emphasizing the need for evaluation to enact policy changes. Materials and Methods We conducted a nationwide survey across 22 College of Physicians and Surgeons of Pakistan accredited neurosurgery training centers in all provinces of Pakistan. SPSS version 26 and STATA 15 were used for data analysis. Results We collected responses from 120 neurosurgery trainees across Pakistan. Trainees were categorized into two groups: those intending to leave (64%) and those intending to stay (36%) in Pakistan. A significant association was observed between the availability of fellowship training in the residents' hospital and the decision to leave or remain in Pakistan (p = 0.034). About 67.5% of our respondents did not have any publication, and among the intention to leave group, a greater percentage had academic involvement, when compared with the stay group. A significant association (p = 0.012) was also observed between the decision to leave or remain in Pakistan and the number of publications in nonindexed journals. Conclusion There remains a need for improvement in the standard of training provided by neurosurgery programs across the country. Our study found that disparities in research and academic exposure, as well as the lack of fellowship opportunities, may serve as stimuli for residents to leave Pakistan.

Association of geographical disparities and segregation in regional treatment facilities for Black patients with aneurysmal subarachnoid hemorrhage in the United States

Background and objectivesThis study investigates geographic disparities in aneurysmal subarachnoid hemorrhage (aSAH) care for Black patients and aims to explore the association with segregation in treatment facilities. Understanding these dynamics can guide efforts to improve healthcare outcomes for marginalized populations.MethodsThis cohort study evaluated regional differences in segregation for Black patients with aSAH and the association with geographic variations in disparities from 2016 to 2020. The National Inpatient Sample (NIS) database was queried for admission data on aSAH. Black patients were compared to White patients. Segregation in treatment facilities was calculated using the dissimilarity (D) index. Using multivariable logistic regression models, the regional disparities in aSAH treatment, functional outcomes, mortality, and end-of-life care between Black and White patients and the association of geographical segregation in treatment facilities was assessed.Results142,285 Black and White patients were diagnosed with aSAH from 2016 to 2020. The Pacific division (D index = 0.55) had the greatest degree of segregation in treatment facilities, while the South Atlantic (D index = 0.39) had the lowest. Compared to lower segregation, regions with higher levels of segregation (global F test p &amp;lt; 0.001) were associated a lower likelihood of mortality (OR 0.91, 95% CI 0.82–1.00, p = 0.044 vs. OR 0.75, 95% CI 0.68–0.83, p &amp;lt; 0. 001) (p = 0.049), greater likelihood of tracheostomy tube placement (OR 1.45, 95% CI 1.22–1.73, p &amp;lt; 0.001 vs. OR 1.87, 95% CI 1.59–2.21, p &amp;lt; 0.001) (p &amp;lt; 0. 001), and lower likelihood of receiving palliative care (OR 0.88, 95% CI 0.76–0.93, p &amp;lt; 0.001 vs. OR 0.67, 95% CI 0.59–0.77, p &amp;lt; 0.001) (p = 0.029).ConclusionThis study demonstrates regional differences in disparities for Black patients with aSAH, particularly in end-of-life care, with varying levels of segregation in regional treatment facilities playing an associated role. The findings underscore the need for targeted interventions and policy changes to address systemic healthcare inequities, reduce segregation, and ensure equitable access to high-quality care for all patients.

Family Involvement in the Care of Hospitalized Older Adults: Protocol for a Qualitative Evidence Synthesis.

Older adults are frequently hospitalized. Family involvement during these hospitalizations is incompletely characterized in the literature. This study aimed to better understand how families are involved in the care of hospitalized older adults and develop a conceptual model describing the phenomenon of family involvement in the care of hospitalized older adults. We describe the protocol of a qualitative evidence synthesis (QES), a systematic review of qualitative studies. We chose to focus on qualitative studies given the complexity and multifaceted nature of family involvement in care, a type of topic best understood through qualitative inquiry. The protocol describes our process of developing a research question and eligibility criteria for inclusion in our QES based on the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) tool. It describes the development of our search strategy, which was used to search MEDLINE (via Ovid), Embase (via Elsevier), PsycINFO (via Ovid), and CINAHL Complete (via EBSCO). Title and abstract screening and full-text screening will occur sequentially. Purposive sampling may be used depending on the volume of studies identified as eligible for inclusion during our screening process. Descriptive data regarding included individual studies will be extracted and summarized in tables. The results from included studies will be synthesized using qualitative methods and used to develop a conceptual model. The conceptual model will be presented to community members via engagement panels for further refinement. As of September 2023, we have assembled a multidisciplinary team including physicians, nurses, health services researchers, a librarian, a social worker, and a health economist. We have finalized our search strategy and executed the search, yielding 8862 total citations. We are currently screening titles and abstracts and anticipate that full-text screening, data extraction, quality appraisal, and synthesis will be completed by summer of 2024. Conceptual model development will then take place with community engagement panels. We anticipate submitting our manuscript for publication in the fall of 2024. This paper describes the protocol for a QES of family involvement in the care of hospitalized older adults. We will use identified themes to create a conceptual model to inform further intervention development and policy change. PROSPERO 465617; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023465617. PRR1-10.2196/53255.

Can toll prices changes affect the housing market? The case of the Severn crossing toll removal

PurposeSince 1966, the Severn crossing has been connecting England and Wales. In January 2018, its ownership returned to the UK Government, and this marked the start of a toll-free journey across the two countries and made commuting between the regions more affordable. In this paper, we examine the impact of the toll removal on the property market.Design/methodology/approachWe employ property-level data from the Land Registry and a difference-in-differences (DiD) empirical model for the periods 2016–2018 and 2019–2021 to capture the pre- and post-toll removal dynamics. The DiD estimation allows us to examine the causal relationship between policy changes and property prices.FindingsOur findings suggest that property prices in Newport and Monmouthshire (South East Wales) are positively affected by the policy, which results in a statistically significant increase of 5.8% more than those located in the South West England (Bristol and South Gloucestershire) region in the period 2019–2021. The impact can reach up to 13.1% for properties located in a 10 km radius of the bridge. The results indicate that the toll removal enables the ripple effect across the two markets by reducing commuting costs.Originality/valueThis is the first paper that examines the Severn Crossing case study. Its contribution is significant since we provide empirical evidence on how reduced transportation costs increase property prices in the lowest income region and have the opposite effect on the area with higher incomes and economic activity levels.

Connecting unstably housed veterans living in rural areas to health care: Perspectives from Health Care Navigators.

To understand existing care practices and policies, and potential enhancements, to improve the effectiveness of the US Department of Veterans Affairs (VA) Supportive Services for Veteran Families (SSVF) Health Care Navigators (HCN) in linking Veterans experiencing housing instability in rural areas with health care services. We used primary data collected during semistructured interviews with HCNs (n = 21) serving rural areas across the United States during Spring 2022. We applied the Consolidated Framework for Implementation Research (CFIR) 2009 and the Social Ecological Model (SEM) to the collection and analysis of qualitative data to understand how HCNs administer services within SSVF and the larger community. We used rapid qualitative methods to summarize and analyze data. Templated matrix summaries identified facilitators and barriers to linking Veterans with health care services and policy and practice implications. Using CFIR 2009, we identified contextual factors affecting successful implementation of HCN services within SSVF; we offer a crosswalk between CFIR 2009 and the version updated in 2022. Framing facilitators and barriers within the SEM provided insight into whether implementation strategies should be addressed at a community, interpersonal, or intrapersonal level within the SEM. Facilitators included sufficient knowledge, training, and mentorship opportunities for HCNs and their capacity to collaborate within their organization and with other community-based organizations. Barriers included lack of local technology and housing resources, inadequate understanding of Veterans' service eligibilities and pathways to access those services, and deficient collaboration with the VA. Understanding facilitators and barriers experienced by HCN when linking unstably housed Veterans in rural areas with health care services can inform future strategies, including policy changes such as increased training to support HCNs' understanding of eligibility, benefits, and entitlements as well as improving communication and collaboration between VA and community partners.

Teachers’ views on the sustainability of the Incredible Years Teacher Classroom Management programme: a one-year qualitative follow-up study

ABSTRACT The Incredible Years Teacher Classroom Management (TCM) programme is an evidence-based training with documented positive effects on teachers’ classroom management strategies and pupil mental health. However, programme effectiveness alone does not ensure sustainability. This study explored teachers’ views on the sustainability of the TCM programme. One year after attending the TCM training, 25 UK primary schoolteachers participated in three focus groups and ten individual interviews. Data were thematically analysed using the Framework Method. One year after the training, teachers were still using TCM strategies, adapting their use to their new cohort of pupils and still reported positive effects on children, teacher-parent relationships, and themselves. However, some school-level and educational policy changes hindered their intended use of TCM strategies. Teachers had shared the TCM strategies with their colleagues, with mixed responses from the latter. To ensure the sustainability of the programme, teachers endorsed refresher sessions and a whole-school training approach.

Inter-agency coordination and digital platform regulation: lessons from the Whatsapp case in Brazil

ABSTRACT This article examines the drivers and obstacles behind the first large-scale cross-agency coordination in digital platform regulation in Brazil. Drawing on elite semi-structured interviews and document analysis, it investigates how the Brazilian National Data Protection Authority (ANPD) and other federal agencies worked together to scrutinize the legal implications of WhatsApp’s privacy policy and terms of service changes announced in January 2021, including concerns regarding transparency, legitimate interest, and consent. The study reveals that while formal institutional arrangements such as cooperation agreements existed, informal factors like personal relationships played a significant role in facilitating coordination. However, capacity and autonomy issues within the involved bodies hindered more substantive coordination and may explain divergences in the interpretation of data protection legislation. The findings emphasize the importance of enhancing mechanisms for inter-agency coordination in digital platform regulation, especially considering capacity and autonomy issues within and across regulatory ecosystems, offering insights to other jurisdictions, particularly for developing countries facing public governance constraints similar to those experienced in Brazil.

Conflict mitigation as a means of climate change adaptation: Lessons for policy and development practice

In this article, we examine the ways conflict can drive climate change vulnerability and, in turn, argue that conflict mitigation can act as a means of climate change adaptation. We identify three key ways in which conflict mitigation enhances adaptation opportunities: (a) addressing conflict dynamics increases opportunities to address climate risks; (b) grounded analysis of conflict dynamics often reveals high-value opportunities for climate change-oriented programs as well as potential maladaptations to be avoided; and (c) conflict mitigation interventions which rely heavily on governance can be leveraged in climate change adaptation efforts. This has multiple implications for global climate change policy, especially when one considers key climate security outcomes emanating from international policy discussions such as COP 28. We conclude this article by identifying three under-examined—and practical—lines of inquiry that would address key knowledge gaps in how to fortify climate resilience in conflict-affected regions.

Characteristics and challenges of companion animal rescue organisations in New Zealand

ABSTRACT Aims To describe the characteristics of companion animal rescue organisations (CARO) in New Zealand; to describe current capacity, resource limitations and challenges of CARO with a particular focus on cats and dogs; and to explore support for creating a national database of CARO in New Zealand. Methods A cross-sectional survey was administered to CARO in New Zealand in May 2022. The survey asked about organisational characteristics, types and numbers of animals cared for, services provided, policies, staffing, funding sources, challenges, and attitudes towards a national database for rescue organisations. Descriptive statistics were provided for all quantitative study variables and free-text comments were analysed for common themes. Results The survey was completed by 106/208 (51%) known CARO distributed across the country. These CARO provided services to an estimated 59,874 homeless animals annually with 86/106 (81%) providing services to cats and/or dogs. Primary services provided by CARO who cared for cats or dogs included rehoming (72/86; 84%) and housing (70/86; 81%) animals. Intake was managed through a combination of strategies. Donations (72/86; 82%) were the main funding source. The 62 registered charities were more likely to report being funded by grants than the 23 non-charities (39/62 (63%) vs. 1/23 (4%); p < 0.001), and non-charities were more likely to self-fund (18/23 (78%) vs. 20/62 (32%); p < 0.001). Nearly half of the CARO that provided workforce information (35/72; 49%) had a workforce of 10 or fewer including volunteers. A total of 5,699 people worked for 86 CARO that care for cats or dogs of whom 4,847 (85%) were part-time volunteers. Of the 72 cat and dog CARO who provided workforce information, 57/72 (79%) relied solely on volunteers. The majority of all 106 CARO respondents (78/106; 73%) indicated they were likely to register on a national database of CARO, subject to addressing concerns about time required and information security. CARO respondents described challenges of insufficient funding, access to veterinary services, and a shortage of volunteers and foster homes, with additional concerns including a lack of public awareness, supportive legislation, and resources. Financial support (90/106; 85%) and policy change (76/106; 72%) were preferred support options. Conclusions This study highlights the significant role played by CARO in New Zealand and the challenges they face, emphasising the need for financial support, legislation, and initiatives extending beyond the rescue sector to reduce the number of animals being surrendered. The findings also suggest a willingness among CARO to participate in a national database.

Research on Corporate Financial Risk Management and Countermeasures

In today's new economic environment, competition among businesses is intensifying, leading to various challenges across industries. Financial risks, in particular, are receiving significant attention due to their potential impact. These risks can stem from market fluctuations, policy changes, or poor management, among other factors. Therefore, it's crucial for businesses to comprehensively consider and effectively manage these risks to ensure long-term stability and growth. Furthermore, controlling financial risks entails multiple measures. Businesses need to establish robust financial management systems, including clear financial goals, standardized financial processes, and well-defined internal control mechanisms. Additionally, they should enhance monitoring and analysis of market and industry dynamics to promptly identify and address potential risks. Moreover, by establishing reasonable financial budgets and funding plans and appropriately allocating financial resources, businesses can mitigate operational risks.

Heterogeneous effects of Medicaid expansion on food security measures

AbstractThe 2014 Affordable Care Act (ACA) included state‐level Medicaid expansion programs, which have been credited with gains in food security for low‐income, able‐bodied, childless adults without dependents (ABAWDs). Yet, ABAWDs represent a diverse cohort who experience disparities along racial and ethnic lines, which could be partly responsible for differences in health‐related outcomes. This study uses data from the Current Population Survey Food Security Supplement to estimate the heterogeneous effect of ACA Medicaid expansion on food security among ABAWDs by race, ethnicity, and income. We find that Medicaid expansion improved food security for households headed by White ABAWDs—particularly those with incomes above 50% of the federal poverty line—but we do not find similarly significant evidence of gains among some historically marginalized populations. We find weak evidence that suggests that households headed by Hispanic ABAWDs may have experienced gains. However, Black‐headed ABAWD households had significantly worse food insecurity relative to the pooled sample of all races and ethnicities. Our results suggest that the relationship between healthcare access and food security is complex and, although spillover effects from a change in healthcare policy can influence food security status, such effects may not be equitably distributed across race, ethnicity, or income.