Unintended Impact Research Articles

Unintended workplace safety consequences of minimum wages

We investigate the unintended impact of minimum wage increases on workplace safety. Using establishment-level data from the United States and a cohort-based stacked difference-in-differences design, we find that large increases in minimum wages have significant adverse effects on workplace safety. Our findings indicate that, on average, a large minimum wage increase results in a 4.6 percent increase in the total case rate. Event study estimates show that this adverse effect persists in the medium run. Furthermore, we find a more salient effect for firms more likely to be financially constrained or subject to a higher labor market rigidity in firing workers. We provide suggestive evidence that small minimum wage increases might reduce injury rates, highlighting the potential heterogeneity in the impact of minimum wage changes. We do not find evidence that capital-labor substitution could be behind the findings.

Cutting-Edge Approach to Targeted Therapy: Repositioning of Old Drugs in Combination with Standard Clinical Chemotherapeutics Potentiates a Propitious Novel Targeted Therapy for Human Pancreatic Cancer

Metastatic pancreatic cancer leads to a fatal outcome, with a median progression-free survival of approximately six months when utilizing the most successful combination of chemotherapeutic regimens. When drug resistance develops, it facilitates an increase in primary tumor growth and new and growing metastases. Patients inevitably and quickly succumb to their disease and die. Notably, chemotherapy has an unintended impact on the development of drug resistance through the enhancement of EMT development and the enrichment of cancer stem cells (CSC). Recent report discovered that neuraminidase-1 (Neu-1) regulates EMT induction, angiogenesis, and cellular proliferation by the activation of several receptor tyrosine kinases. Here, the continual therapeutic inhibition of Neu-1 through intravenous administration of oseltamivir phosphate (OP) and aspirin (ASA) alongside GEM treatment significantly inhibits tumor progression, crucial compensatory signaling pathways, EMT program, CSC, and metastasis progression in a preclinical RAG2xCy double mutant BALB/c mouse model of human PANC-1 pancreatic cancer. The tumorigenic and metastatic potential of the xenotumors from the animals treated with the experimental protocols were significantly ablated when transferred into the mammary fat pads of NSG (NOD SCID gamma) branded mice. Keywords: pancreatic cancer; chemoresistance; drug repurposing; EMT.

One Livelihood Risk Factor Too Many? How Unintended Impacts of Conservation Contribute to Food Insecurity in Kavango Zambezi, Southern Africa

Kavango Zambezi (KAZA) is the world’s largest terrestrial Transfrontier Conservation Area (TFCA), covering vast regions of Angola, Botswana, Namibia, Zambia and Zimbabwe. Elephants and other species traverse KAZA across national borders through both protected and inhabited landscapes along wildlife migration corridors. Zimbabwe’s Simangani ward is located within such a corridor. As in most rural areas of KAZA, subsistence farming constitutes the predominant livelihood strategy in Simangani. Research across KAZA has mostly focused either on climate- or wildlife-induced impacts on farming communities. This paper combines findings from in-depth, qualitative fieldwork with quantitative livelihood survey data and provides a detailed assessment from a farming-household perspective of on-farm and off-farm income sources, which are mobilised in order to mitigate grain harvest shortfalls resulting from climatic fluctuations and wildlife depredation. This study concludes that drought and other stressors have a considerably higher impact on food insecurity than unintended conservation impacts. However, it also confirms that the impacts of crop raiding and livestock depredation caused by wildlife do indeed trigger additional food security risk factors for farming households whose livelihoods are already under pressure.

Substantial nitrogen abatement accompanying decarbonization suppresses terrestrial carbon sinks in China

China faces challenges in reaching its carbon neutrality goal by the year 2060 to meet the Paris Agreement and improving air quality simultaneously. Dramatic nitrogen emission reductions will be brought by this ambitious target, yet their impact on the natural ecosystem is not clear. Here, by combining two atmospheric chemistry models and two process-based terrestrial ecosystem models constrained using nationwide measurements, we show that atmospheric nitrogen deposition in China’s terrestrial land will decrease by 44–57% following two emission control scenarios including one aiming at carbon neutrality. They consequently result in a pronounced shrinkage in terrestrial net ecosystem production, by 11–20% depending on models and emission scenarios. Our results indicate that the nitrogen emission reductions accompanying decarbonization would undermine natural carbon sinks and in turn set back progress toward carbon neutrality. This unintended impact calls for great concern about the trade-offs between nitrogen management and carbon neutrality.

Reduced Efficacy of Behavior Therapy Following Initial Multimodal Treatment of ADHD

ABSTRACT Background Evidence-based treatments for childhood attention-deficit/hyperactivity disorder (ADHD) include behavioral treatment and psychostimulants, preferably in combination. Research on the treatment of ADHD underscores a gap in the literature regarding the optimal sequencing of treatments (Pelham et al. 2020). Emerging evidence supports starting with behavioral treatment before psychostimulants, though the mechanisms of this sequencing effect are not entirely understood. Objective This study explores one plausible mechanism – that psychostimulants reduce behaviors targeted by behavioral treatment, thereby reducing opportunities for children to learn and practice self-regulation skills. The article reports post hoc findings from a triple-masked, AB/BA crossover study, conducted in the Summer Treatment Program (STP). Method Two-hundred forty-eight children diagnosed with ADHD; 77% male; 85% Hispanic) were randomized to receive either (a) intensive behavior therapy plus medication (“COMB”) or (b) intensive behavior therapy plus placebo (“BT”) for 3 weeks, then crossed over to the other condition for 3 weeks. Behavior in recreational settings was systematically recorded and analyzed as a function of medication status and order of treatments. Results We found evidence that initial medication reduced the efficacy of subsequent behavior therapy. That is, children exhibited significantly more misbehaviors when unmedicated if they started with combined treatment, then had medication withdrawn, than if they started with behavior therapy alone. Conclusion These findings suggest that starting with a combined treatment approach had an unintended adverse impact on children’s behavioral functioning when medication was withdrawn. The results support current clinical recommendations, which are to start treatment of ADHD with behavior therapy alone and to add medication as necessary.

Mayors’ promotion incentives and subnational-level GDP manipulation

What role do local officials’ incentives play in regional economic growth? How do local officials behave under promotion pressure? This paper studies the unintended impact of mayors’ promotion incentives on regional economic growth and subnational-level GDP manipulation in China. We employ a regression discontinuity design that accounts for age restrictions in deciding promotions for mayors. We find that when GDP performance is prioritized in officials’ promotion evaluations (before 2013), mayors’ promotion incentives significantly increase the statistical GDP growth rate by 3.4 percentage points. However, their effects on nighttime light and other non-manipulable real economic growth indicators are close to zero. This gap can be attributed to GDP manipulation under our empirical framework. The above pattern no longer persists after 2013, when the role of GDP statistics in mayoral promotions was reduced. Our findings indicate that GDP manipulation makes performance-based competition between mayors devolve into a data manipulation game.

Do no harm: the impact of implementing cancer prevention strategies on other preventive health measures

BackgroundTranslational efforts to increase uptake of evidence-based practices typically look at those outcomes in isolation of their impact on other aspects of care delivery. If we are in fact to “do no harm”, we must consider the possible negative impact of improving use of one practice on other quality measures. Alternatively, a focus on one practice could lead to spread of effective strategies to other practices, which would be highly beneficial. We studied the impact of a colorectal cancer (CRC) screening initiative on delivery of other preventive care measures.MethodsWe used an interrupted time series design with implementation year as the interruption point. The initiative was conducted between 2015 and 2020, with three staggered cohorts. Main outcomes were quality measures for colorectal cancer screening, cervical cancer screening, hypertension management, diabetes management, weight screening and follow-up, tobacco use screening and cessation treatment, and depression screening and follow-up.ResultsThe initiative was associated with an increase in CRC screening (OR = 1.67, p ≤ 0.01; average marginal effect = 12.2% points), and did not reduce performance on other quality measures in the year of CRC program implementation or a change in their respective secular trends.ConclusionsThe initiative led to a clinically meaningful increase in CRC screening and was not associated with reductions in delivery of six other preventive services. Quality improvement (QI) initiatives typically approach implementation with an eye towards reducing unintended impact and leveraging existing staff and resources. Implementation research studies may benefit from considering how QI initiatives factor in the local context in implementation efforts.

Opening the door to anti‐system leaders? Anti‐corruption campaigns and the global rise of populism

AbstractAlmost all anti‐corruption drives contain an awareness raising element. However, recent research reveals that anti‐corruption awareness raising messages can backfire by triggering a sense that corruption is too big of a problem to tackle, thus encouraging resignation rather than resistance. We advance this literature by exploring another potential unintended impact. Corruption scandals have played a prominent role in the rise of many populist leaders, who claim to challenge ‘the corrupt status quo’. We test whether anti‐corruption messages that call attention to the problem unintentionally help to foster populist attitudes through an original survey experiment in Albania. Breaking new ground by testing messages based on descriptive (how the world is) and injunctive (how people want it to be) norms, we find that while the latter has no effect, exposure to the former – which is more common in contemporary anti‐corruption campaigns – is associated with greater agreement with populist sentiments and beliefs.

Targeted sanctions, resource substitution, and violence against civilians: Localized evidence from African states

Since the 1990 s, the UN Security Council increased its use of targeted sanctions, yet we know very little about their unintended impact on civilian victimization, especially at the local level. This study argues that imposing sanctions on armed actors may compel them to seize non-sanctioned agricultural resources to replenish lost revenues and use violence to facilitate appropriation. A new dataset on sanctioned group violence in agricultural areas is developed by matching UN sanctions data with information on local attacks on civilians from the UCDP GED and combining these data with a new geographic dataset. Quantitative analyses establish that monthly changes in cash crop productivity affect political violence by sanctioned actors in Africa, while violence by unsanctioned and pre-sanctioned actors is unaffected. A short case study of Somalia validates the hypothesized mechanism by showing that al-Shabaab actively engaged in violence over such substitution dynamics.

‘When my husband died, I collected debt of N20,000……were going to take me to the court, but since the money came, I have cleared my debt and bought cattle’: intended and unintended socioeconomic impact of cash transfer program in Nigeria

‘When my husband died, I collected debt of N20,000……were going to take me to the court, but since the money came, I have cleared my debt and bought cattle’: intended and unintended socioeconomic impact of cash transfer program in Nigeria

Qualitative analysis of UK women's attitudes to calorie-based alcohol marketing and alcohol calorie labelling.

Mandatory standardized nutritional information on alcoholic drinks such as energy, or calorie labelling, is a population-level public health measure aimed at addressing obesity and alcohol consumption. In the UK, such measures are not a statutory requirement, but some alcohol brands do include references to calories on their products and in their marketing materials, as a marketing strategy to encourage sales and consumption. This article presents findings of semi-structured individual (N = 43) and group (N = 9) interviews with 78 women living in the UK that aimed to gain insight into their attitudes towards calorie-based alcohol brand marketing, and alcohol calorie labelling (ACL) as a health policy. Three themes are presented that outline how women rejected calorie marketing and labelling; the potential positive and unintended impact on alcohol consumption and dietary/eating practices; and how views on calorie labelling were intertwined with women's attitudes towards marketing that draws on calorie messaging. A feminist anti-diet discourse, as well as a discourse of pleasure through alcohol consumption, was at play in women's accounts, which may limit the intended aims of ACLs. It is concluded that ACLs should be considered within the wider commercial context of alcohol marketing that draws on calories to promote sales and consumption, consideration of the gendered factors that may lead some to reject ACLs as a health policy, and the potential for unintended consequences.

Experiences of fatherhood in prison: A thematic analysis of differences between fathers in a family approach programme and a comparison group

Various programmes have been implemented in prisons to strengthen parental involvement and parent–child relationships during imprisonment. In-depth insights into such programmes are limited. This qualitative study compared the experiences of two groups of imprisoned fathers in the Netherlands: fathers who participated in a family approach programme ( N = 10) and fathers in a comparison group ( N = 29). Based on a thematic analysis, four key differences were identified between the family approach group and the comparison group. Fathers in the family approach group: (1) described more positive engagement activities in direct father–child interactions, (2) reflected more positively on their fathering role during imprisonment, (3) structurally included participation in the family approach programme in their narratives of how imprisonment affected father–child relationship quality, and (4) more often expressed feelings of uncertainty and caution when discussing family life after imprisonment. The findings of this study are informative for the mechanisms behind prison-based parenting and family relationship programmes and illustrate the potential of these programmes to alleviate the unintended negative impact of imprisonment on parental involvement and family relationships. Based on these findings, recommendations for further research and practice are provided.

Communication in the ICU: An Unintended Nocebo Effect?

To identify medical phrases utilized by the critical care team that may have an unintended impact on the critically ill patient, we administered an anonymous survey to multi-professional critical care team members. We elicited examples of imprecise language that may have a negative emotional impact on the critically ill. Of the 1600 providers surveyed, 265 offered 1379 examples (912 unique) which were clustered into 5 categories. Medical jargon (eg, "riding the vent") was most prevalent (n = 549). There were 217 negative suggestions (eg, "you will feel a stick and a burn"). Hyperboles (eg, "black cloud") were common (n = 198) while homonyms (ie "he fibbed") accounted for 150 examples. Phrases such as "code brown in there" were categorized as metonyms (n = 144). 121 metaphors/similes (eg, "rearranging deck chairs on the Titanic") were provided. Phrases that have the potential to negatively impact critically ill patient perceptions are commonplace in critical care practice. Whether these everyday communication habits lead to an unintended nocebo effect on mental health outcomes of the critically ill deserves further study.

Evidence on the effectiveness of value-based payment schemes implemented in a hospital setting: A systematic review.

Value-based payment is among payment models rewarding health care providers for achieving pre-defined targets of quality or efficiency measures of care. This paper aims to identify the evidence of the effectiveness of value-based payment schemes implemented in hospital settings. A systematic review of databases for studies published from 2000 to 2022 that evaluated VBP programs was conducted. We searched four databases including PubMed, Scopus, Embase, and Web of Sciences in July 2023. Studies were screened and assessed for eligibility. A thematic analysis approach was used to synthesize and summarize the findings. Overall, 29 articles looking into the VBP programs have been included. Most articles describe the effects on the outcome of care (n = 18). The findings of a great deal of evidence in this field show that VBP is not correlated with some outcome measures including hospital-acquired conditions, 30-day mortality, mortality trends, as well as mortality among patients with acute myocardial infarction or heart failure. Only three of 12 studies have revealed a positive relationship between a P4P program and efficiency. Seven studies from the United States (US) found no evidence or mixed findings on the effects of P4P on efficiency. The magnitude of the effects of VBP on healthcare quality, patient experience, and costs has often been small and non-significant. The unintended negative impact of incentives in value-based payment on hospitals should be tackled when adopting policies and decisions.

The Unintended Impact of the Volcker Rule on Primary Market Bond Pricing: Evidence from the Rule 144A Bond Market

The Unintended Impact of the Volcker Rule on Primary Market Bond Pricing: Evidence from the Rule 144A Bond Market

The Unintended Impacts of the One-child Policy Relaxation in China on Women's Labor Market Outcomes

The Unintended Impacts of the One-child Policy Relaxation in China on Women's Labor Market Outcomes

For Worse or for Better? The Unintended Impacts of an Initial Employment Prohibition on Refugee Health

For Worse or for Better? The Unintended Impacts of an Initial Employment Prohibition on Refugee Health

Revitalizing Mumbai's Housing Landscape: Unraveling the Evolution, Challenges, and Strategies in Urban Renewal of Old and Dilapidated Structures

The research paper delves into Mumbai's urban evolution, narrating its journey from a fishing village to becoming India's second-largest commercial center. The city's growth is dissected, considering historical, geographical, and economic influences, particularly focusing on the dynamic changes in housing typology. A critical aspect explored is the unintended impact of the Rent Control Act, which, by freezing rents since 1940, has resulted in neglected properties, necessitating comprehensive redevelopment strategies. Government interventions, such as the Cluster Approach, Joint Ventures, and targeted policies for Chawls and Gaothans, are analyzed in the context of urban renewal. Public-Private Partnerships, notably with MHADA, emerge as pivotal elements in fostering collaborative models for redevelopment. The study emphasizes Mumbai's adaptive strategies to address housing challenges and stresses the importance of sustainable and resilient policies for the city's housing future. In this context, the research underscores the transformative role of redevelopment in Mumbai's real estate dynamics, driven by a new generation of discerning homebuyers prioritizing quality of life. Key Words: Housing Typology, Chawls, Rent Control Act, Redevelopment Strategies,

Identifying the need to institutionalize digital equity among faculty: the experience of the Kenya Medical Training College

BackgroundThe use of digital tools and applications in health professions education is increasing exponentially, however this has the potential to increase the digital inequities with the resulting effect of vulnerable groups facing an increased risk of digital exclusion. It is therefore important to approach digitalization with contextual determinants of the intended and unintended impact in mind. We present a perspective paper on digital equity, informed by lessons learnt at the Kenya Medical Training College (KMTC).MethodsUsing a case description methodology, we examined routine educational data collected from faculty at KMTC in November 2022. This included quantitative and qualitative data on access, ownership, utilization, confidence and skills to create, share, and exchange knowledge on the institution’s learning management system. We used these factors as the conceptual framework for understanding how faculty adopt digitalization in health professions education.Results306 faculty responded to the survey (response rate 27.8%) of whom 90.8 and 75.2% had personal laptops at home and at work and 75.9% had internet at work. 53.4% (n = 163) knew they had accounts created on the institution’s learning management system (LMS) majority of whom had basic skills and were able to perform skills such as logging in and accessing learning resources. However, a minority had advanced skills needed for teaching and learning in the LMS.ConclusionMedical education institutions in LMICs need to adopt programs to enhance digital literacy and monitoring of access, utilization and self-efficacy across all learner and faculty groups, to ensure that digital technologies reduce rather than exacerbate existing inequities.

Resilience of traditional midwifery in Southern Cameroons: 1922-1961

It is instructive that well organized healthcare systems existed in Africa before contacts with the outside world. During this period, midwifery services were prioritized because societal wellbeing depended on the quality and availability of child and maternity services. The arrival of European colonial imperialists with their assumed superior culture/civilization and their colonial economic agenda caused the introduction of Western biomedicine. This was intended in part to maintain a constant and healthy work force for colonial exploitation. Drawing from the case of Southern Cameroons, this paper sets out to examine the resilience of local midwifery practices in the face of an imposed Western biomedicine. The paper was informed by both primary and secondary sources. Archival information and oral interviews made up the primary sources while books, published articles and dissertations constituted the secondary sources. The discriptive historical approach was employed in the analysis of the work. This study submits that: African women were not passive subjects on issues of their reproductive life but agents that could reject imposed values and stick to their tested practices. The ideological and cultural arrogance that characterized the introduction of Western biomedicine had the unintended impact of galvanizing an unexpected resilience of traditional medical practices. Consequently appreciable change in favor of Western biomedicine was only witnessed in the period after independence.