United States General Accounting Office Research Articles

Weak State as a Security Threat: Study Case of El Salvador (2014-2019)

Weak State as a Security Threat: Study Case of El Salvador (2014-2019)

Cross design analysis of randomized and observational data \u2013 application to continuation rates for a contraceptive intra uterine device containing Levonorgestrel in adolescents and adults

BackgroundTo combine results from a randomized controlled study (RCT) and an observational study (OS) to evaluate discontinuation rate of a levonorgestrel-containing intrauterine contraceptive device (LNG IUD) in a real-life setting.MethodsWe included 253 parous and nulliparous women aged 21–40 years from our own phase II RCT. A total of 1607 women of all ages (including adolescents, < 20 years) were recruited from an OS. We applied the cross design synthesis (CDS) method recommended by the United States General Accounting Office. This method combines the different strengths of RCTs and OSs into one single estimate.ResultsCombined continuation rates for parous vs nulliparous women could be estimated more precisely as well as overall continuation rates after one (86.6%) and two years (78.5%), irrespective of age and parity.ConclusionCross design synthesis allowed more precise estimation of continuation rates of an intrauterine device.

Supporting Librarians in Making the Business Case for OER

ABSTRACTCollege textbook costs increased at three times the rate of inflation between 2002 and 2012 (United States General Accounting Office [GAO], 2013). One solution to high textbook costs is Open Educational Resources (OER) and institutional librarians, because of their reach throughout the institution and particular skillsets, are keenly positioned to make the business case for OER and become leaders of the OER movement. This article discusses the issues most relevant to OER adoption and provides an environmental scan of OER resources currently available to institutions, faculty, and students.

More than the Human Appendix: Fed Capital and Central Bank Financial Independence

In 2002 in reviewing the role of the Federal Reserve System (FED) the United States General Accounting Office declared that We found no widely accepted, analytically based criteria to show whether a central bank needs capital as a cushion against losses or how the level of such an account should be determined; the FED capital has become somewhat like the human appendix, an organ whose function is no longer understood (Stella 2009). Is it still true? These short notes address the issue, using a Q&A exposition and taking the occasion the fact that the U.S. Government Accountability Office (GAO), has been asked by members of the Congress to study the implications of a recent dividend rate change for Federal Reserve Bank stock and the implications of modifying or eliminating the existing requirement that all member banks purchase stock issued by their respective Federal Reserve Bank.

A Culturally Responsive, Transnational Middle Grades Teacher Education Program in American Samoa

Educators in American Samoa learn about teaching young adolescents through a transnational master's degree program.This article describes the development and implementation of a transnational middle level teacher education program, specifically based on the educative needs of young adolescent students and their teachers in American Samoa. For more than 30 years, the University of Hawai'i has partnered with the American Samoa Department of Education to provide undergraduate degrees in elementary education to a total of 647 graduates. While elementary education in American Samoa encompasses kindergarten through eighth grade, professional development needs specific to middle grades teachers have not been adequately addressed through these programs. In 2009, the University of Hawai'i Manoa pioneered a graduatelevel middle level teacher education program in American Samoa, the first program of its kind to focus on young adolescents' learning needs in this Pacific island territory. The 2011 Middle Level Master of Education degree (MLMED) cohort was the first group of inservice teachers ever to receive specialized middle grades teacher training in American Samoa.ContextAmerican Samoa is the center of Polynesia and is home to 65,000 people. Although modern ways have influenced the culture, the traditional Samoan way of life, centered on family and religion, is still predominant in the islands. On Flag Day, April 17, 2011, American Samoa celebrated 111 years of association with the United States. American Samoa has a unique political status as an unorganized and unincorporated United States Territory. As U.S. nationals, American Samoans cannot vote in national elections in the United States and have no representation in the final approval of legislation by Congress (United States General Accounting Office, 1997, p. 9). American Samoan nationals enjoy the privilege of non-restrictive travel to and from the United States and receive the following protections under the law:It shall be the policy of the Government of American Samoa to protect persons of Samoan ancestry against alienation of their lands and the destruction of the Samoans' way of life and language, contrary to their best interests. Such legislation as may be necessary may be enacted to protect the lands, customs, culture, and traditional Samoan family organization of persons of Samoan ancestry. (Government of American Samoa, 1966, Article 1, Sec. 3)The American Samoan education system has been influenced by the United States and tied to an American philosophy of education for more than 100 years. While missionaries began working in American Samoa in 1830, the first public school was established there in 1904, with U.S. Naval wives and officers serving as teachers (Sutherland, 1941). The first students to attend the American public schools were of the Navy officers and part-Samoan children (Allen, 1962, p. 176). The school system in American Samoa evolved through the 20th century and was influenced over the years by the U.S. Navy, the Barstow Foundation for American Samoa, and the U.S. Department of the Interior (see, e.g., Allen, 1962; Pirie, 1976; Reid, 1986; Schramm, Nelson, & Betham, 1981; Sutherland, 1941).American Samoa's young adolescents riskYoung adolescents in American Samoa can be labeled at in terms of academic performance in school and risk behaviors. On the 2002 National Assessment of Educational Progress (NAEP), 87% of American Samoan eighth graders in public schools scored or below a level in reading (Jerry & Lutkus, 2003), and assessments of American Samoan eighth graders in mathematics and science indicated that 93% and 95% of these students, respectively, lacked basic skills in these subjects (Hunkin-Finau, 2006). To put these results in perspective, 26% of 8th graders nationwide scored or below level in reading. Moreover, American Samoa had the largest percentage of eighth graders or below a basic level in reading, followed by the District of Colombia (52%), the U. …

Status of Women in Cardiovascular Clinical Trials

Cardiovascular disease (CVD) is the most common cause of death in American women and accounts for a full one-third of all deaths.1 Although the common perception may be that CVD affects mainly men, there is equal prevalence of this disease between the genders by the age of 40, and by the age of 60 more women than men are affected. More women than men have died from CVD causes on a yearly basis since the mid 1980s, and whereas the CVD mortality has steadily declined in men over the past 30 years, it has remained steady in women until very recently when CVD mortality was noted to decrease for both genders.2 See accompanying article on page 277 The impact of cardiovascular disease (CVD) on the health status of American women is gaining more recognition and has become the focus of public education efforts such as the “Go Red for Women” campaign sponsored by the American Heart Association and the “Red Dress” project sponsored by the Department of Health and Human Services, the National Institutes of Health (NIH), and the National Heart Lung and Blood Institute (NHLBI). These programs are, in part, a response to the increasing awareness of cardiovascular disease as a major source of morbidity and mortality in U.S. women. The importance of CVD as a major source of mortality in women was recognized early on by federally funded institutes including the Public Health Service Task Force, which brought attention to concerns about the health information available to women and the historical lack of research focus on women’s health in its 1985 Report of the Public Health Service Task Force on Women’s Health Issues .3 In response to this report, the National Institutes of Health adopted a policy for the inclusion of women in clinical research …

Medical Malpractice and the Chest Physician

The US malpractice system is based on tort law, which holds physicians responsible for not harming patients intentionally or through negligence. Malpractice claims are brought against physicians from most medical disciplines in proportion to their numbers in practice and to the frequency with which they perform procedures. Claims against chest physicians most commonly allege injuries caused by the following: (1) errors in diagnosis, (2) improper performance of procedures, (3) failure to supervise or monitor care, (4) medication errors, and (5) failure to recognize the complications of treatment. Most of these injuries occur in hospitals, and many of the injured patients die. The social goals of the medical malpractice system include the following: (1) compensating patients injured through negligence, (2) exacting corrective justice, and (3) deterring unsafe practices by creating an economic incentive to take greater precautions. Some patients injured through negligence are compensated, but most are not. Claims are brought against some negligent physicians but also some who are not negligent, and being negligent does not guarantee that a claim will be brought. The deterrent effect of medical malpractice is unproven, and the malpractice system may prompt defensive medicine and increase health-care costs. And by stressing individual accountability, it conflicts with a systems-oriented approach to reducing medical errors.

Role Reversals in the Life-Course: A Systematic Review

In this manuscript, we systematically review the literature on role reversals in the life-course. The term “role reversals” in this context means changes between the roles of offender and victim (and vice versa) over time. The majority of the literature focuses on the complex relationship between victim and offender in violent situations. The phrases “violence begets violence” or the “transgenerational transmission of violence” center on the relationship between early childhood victimization and future adult offending. The topics of study vary in terms of subject matter, but the general assumption is that in a culture of violence, victims become offenders and offenders become victims. The role reversals literature establishes such a relationship, but as Widom (1988, 1989b, 1996) and others point out (United States General Accounting Office, 1996) there are methodological shortcomings with the research—thus the findings should be viewed as inconclusive. In this paper, we review the role reversals literature published since 1989, providing summary information about the research, and analyzing it from a methodological perspective. There are several variables of interest that must be present in order for a study to be deemed “sound” in its methodology. These are (1) a valid research design that employs a control group, (2) use of a data collection technique that does not rely on retrospective self-reports, (3) uniformity in the definition of the victimization/offense studied, and (4) the avoidance of cross-sectional designs. With these criteria, we find that only two studies can be described as having methodological rigor. The other studies reviewed all have some deficiencies—making the studies less than sound and thus calling into question the findings.

Chemical or Biological Terrorist Attacks: An Analysis of the Preparedness of Hospitals for Managing Victims Affected by Chemical or Biological Weapons of Mass Destruction

The possibility of a terrorist attack employing the use of chemical or biological weapons of mass destruction (WMD) on American soil is no longer an empty threat, it has become a reality. A WMD is defined as any weapon with the capacity to inflict death and destruction on such a massive scale that its very presence in the hands of hostile forces is a grievous threat. Events of the past few years including the bombing of the World Trade Center in 1993, the Murrah Federal Building in Oklahoma City in 1995 and the use of planes as guided missiles directed into the Pentagon and New York's Twin Towers in 2001 (9/11) and the tragic incidents involving twentythree people who were infected and five who died as a result of contact with anthrax-laced mail in the Fall of 2001, have well established that the United States can be attacked by both domestic and international terrorists without warning or provocation. In light of these actions, hospitals have been working vigorously to ensure that they would be "ready" in the event of another terrorist attack to provide appropriate medical care to victims. However, according to a recent United States General Accounting Office (GAO) nationwide survey, our nation's hospitals still are not prepared to manage mass causalities resulting from chemical or biological WMD. Therefore, there is a clear need for information about current hospital preparedness in order to provide a foundation for systematic planning and broader discussions about relative cost, probable effectiveness, environmental impact and overall societal priorities. Hence, the aim of this research was to examine the current preparedness of hospitals in the State of Mississippi to manage victims of terrorist attacks involving chemical or biological WMD. All acute care hospitals in the State were selected for inclusion in this study. Both quantitative and qualitative methods were utilized for data collection and analysis. Six hypotheses were tested. Using a questionnaire survey, the availability of functional preparedness plans, specific preparedness education/training, decontamination facilities, surge capacity, pharmaceutical supplies, and laboratory diagnostic capabilities of hospitals were examined. The findings revealed that a majority (89.2%) of hospitals in the State of Mississippi have documented preparedness plans, provided specific preparedness education/training (89.2%), have dedicated facilities for decontamination (75.7%), and pharmaceutical plans and supplies (56.8%) for the treatment of victims in the event of a disaster involving chemical or biological WMD. However, over half (59.5%) of the hospitals could not increase surge capacity (supplies, equipment, staff, patient beds, etc.) and lack appropriate laboratory diagnostic services (91.9%) capable of analyzing and identifying WMD. In general, hospitals in the State of Mississippi, like a number of hospitals throughout the United States, are still not adequately prepared to manage victims of terrorist attacks involving chemical or biological WMD which consequently may result in the loss of hundreds or even thousands of lives. Therefore, hospitals continue to require substantial resources at the local, State, and national levels in order to be "truly" prepared.

Improving referral of patients to hospice through community physician outreach

Many patients are not referred to a hospice until the very end of the terminal phase of their disease process. Unfortunately, referrals that come late in the course of the illness may hinder optimal symptom management and also may preclude the hospice from meeting the psychosocial and spiritual needs of patients and their families. Indeed, late referrals have been associated with lower satisfaction with hospice care.1 Hospice of St. Mary’s County, a department of St. Mary’s Hospital in Leonardtown, Maryland is the sole provider of hospice care for a rural county with a population of approximately 93,000. In 2003 our agency implemented the National Hospice and Palliative Care Organization’s Family Evaluation of Hospice Care (FEHC) survey, an after-death survey designed for use in evaluation of quality of care. Families were mailed the survey 1 to 3 months following the death of their loved one. One question on the survey asked families whether they believed their loved one had been referred to hospice too early, at the right time, or too late. Sixteen families were surveyed at our facility. In

Optimizing vaccine availability and utilization: Position statement of the American College of Preventive Medicine

I mmunizations represent a major success in public health and their economic and health benefits have been well documented.1,2 Therefore, it is unfortunate that major shortcomings in the current system threaten a reliable supply of immunizations for the American population. The recent shortage of influenza vaccine was yet another reminder of the continuing need to revamp the nation's vaccine supply. Leading organizations such as the National Vaccine Advisory Committee (NVAC),3 the United States General Accounting Office (GAO),4 and the Institute of Medicine (IOM; http://www.nap.edu/books/0309089794/html)5 have dedicated considerable resources to studying this issue. Target areas that have surfaced as important points of intervention have focused on the production, supply, and financing of vaccines. These issues will also resonate in terms of future vaccine development against bioterrorism agents. A cohesive approach to the efficient manufacture and use of these vaccines is of growing concern. Under-utilization of existing vaccines is a related concern, especially in terms of manufacturing efficiency, and in terms of optimizing the utilization of vaccines by at-risk groups during periods of shortages. All of these issues are important components of the vaccine discussion and deserve further attention.

Quality still doesn't pay in heart failure management

Virtually every contemporary discussion of heart failure starts with an obligatory citation of statistics that make 3 basic points: First, the disease is quite prevalent in North America and Europe. Second, in aggregate, heart failure is one of the most expensive of diseases, with much of the expense concentrated in the elderly population (eg, >65 years). And finally, both the prevalence and associated expense are expected to increase dramatically in the next 25 years. In part, the coming epidemic of heart failure is being created by our partial therapeutic victories of the past 25 years. We are much better than we used to be at keeping patients with coronary disease alive, but we do less well at keeping them healthy and fully functional. As Lewis Thomas pointed out more than 30 years ago, such “halfway technologies” are usually enormously expensive. In heart failure, much of the expense is attributable to the need for hospitalizations for episodes of decompensation. These “failures” of outpatient care may relate in part to the deficiencies of our current therapeutic tools. In particular, we still have no practical way to replace dead heart muscle. However, a growing body of evidence suggests that a significant portion of these decompensations can be attributed to our failure to aggressively apply in practice what we know. For example, we know from large well-done clinical trials that angiotensinconverting enzyme (ACE) inhibitors and -blockers can both improve survival and reduce the need for hospitalizations in heart failure patients. As highlighted in a recent report from the Institute of Medicine, however, these life-saving therapies remain significantly underused in clinical practice. The gap between what we know and what we do in heart failure management has been described as a “quality chasm.” One important set of strategies designed to bridge gaps in the quality of conventional medical care consists of process of care interventions broadly referred to as “disease management.” These programs contain a variable mix of patient education, optimization of congestive heart failure (CHF) therapies, interventions to improve compliance, and early problem solving to prevent the need for subsequent hospital-based care. Some programs consist of a nurse calling a patient over the phone, whereas others involve a team of specialists providing support to the patient at the direction of a designated coordinator. Some programs begin during a hospitalization for heart failure, whereas others are initiated in the outpatient setting. The overarching concept is to provide a means to identify vulnerable patients who are getting into trouble early and to provide preemptive problem solving so that need for hospitalization can be avoided. A meta-analysis of 11 randomized trials of disease management programs published through 1999 found a significant 23% decrease in hospitalization rate for the multidisciplinary form of disease management, but no effect of the telephone based type. In this issue of the Journal, McDonald and Ledwidge propose that disease management strategies should be extended to the inpatient phase of care for CHF. In particular, the authors recommend a structured program involving care by a cardiologist, use of proven medical therapies in proper dosage, education of the patient and family by a specialist heart failure nurse, and use of explicit criteria to assess discharge readiness. In a preliminary report of a randomized trial of this multidisciplinary program, with 70 patients enrolled there were no rehospitalizations out to 1 month for the new program or for conventional care. In contrast, the hospitalization From the Duke University Medical Center, Durham, North Carolina, and Outcomes Research and Assessment Group, Duke Clinical Research Institute, Durham, North Carolina. Reprint requests: Daniel B. Mark, MD, MPH, Professor of Medicine, Duke Clinical Research Institute, 2400 Pratt Avenue, Room 0311, Durham, NC 27705. © 2003 Elsevier Inc. All rights reserved. 1071-9164/03/0904-0004$30.00/0 doi:10.1054/jcaf.2003.52 Journal of Cardiac Failure Vol. 9 No. 4 2003

Gaps between the rich and the poor: The widening differences in wealth, life expectancy, public health infrastructure and perception of threats, and the consequences for global security

Gaps between the rich and the poor: The widening differences in wealth, life expectancy, public health infrastructure and perception of threats, and the consequences for global security

Can Labeled Single-Use Devices Be Reused? An Old Question in the New Era

REPROCESSING and reuse of medical single-use devices (SUDs) such as catheters and guide wires are gaining popularity as a result of the escalating cost of health care. A recent survey revealed that approximately 20%–30% of hospitals in the United States reprocess SUDs (1). The figures are likely underestimated because hospitals tend not to report their use of reprocessed SUDs. According to the United States General Accounting Office, substantial cost savings can be achieved by reprocessing SUDs because the cost of in-house reprocessing can be less than 10% of the cost of a new device and the cost of third-party reprocessing is approximately 50% of the cost of a new device (1). The legitimate questions here are: 1. Is it safe and economically sound to use reprocessed SUDs? 2. Are reprocessed SUDs as good as the original devices in terms of chemical and physical characteristics? 3. How should reprocessing be regulated to ensure public health? The answers to these questions depend on to whom they are addressed. Most of the opposition against reprocessing of SUDs comes from the original equipment manufacturers (OEMs), whereas the medical community is generally supportive of reprocessing (2). Commentary in the English literature on this subject is relatively sparse. Despite extensive debate in cardiologic publications, there is little pertinent information in interventional journals. Therefore, we are providing our colleagues with insight into the historic and current status of the reprocessing and reuse of SUDs. This commentary is not intended to represent our endorsement or opposition to the practice of reprocessing SUDs.

‘Anti-aging’ medicine: does it exist? A critical discussion of ‘anti-aging health products’

‘Anti-aging’ medicine has become a popular topic, in the lay press, the (semi-) scientific literature and the Internet. 1 1 Searching with anti-aging medicine yielded 139,000 hits in Google.com; please also visit www.quackwatch.com In almost all instances, claims of drugs, health supplements and other types of intervention are not based on any evidence supported by sound scientific knowledge. Specifically, the aging process itself, in contrast to age-related diseases, has so far neither been fully understood, nor significantly influenced in higher species, notably humans. In addition to the ill-defined effects, claims of anti-aging medicine also pose a considerable economic burden on the usually poorly informed older segment of the population. The present paper is based on a recent report by the United States General Accounting Office (GAO) on the questionable and even harmful effects of anti-aging health products for seniors.

Academic pediatric departments, government agencies, and children with special health care needs

Academic pediatric departments, government agencies, and children with special health care needs

Arizona's Cancer Clinical Trials Law: Flawed Process, Flawed Product

For cancer patients, participation in a clinical trial is more attractive than receiving standard therapies, which may be limited in effectiveness. Lately, however, this choice has been complicated by the fact that insurers explicitly refuse to reimburse for expenses incurred as part of a clinical trial. In the pre-managed care era, procedures were routinely covered by a combination of sources: the administrative and agent costs of clinical trials were borne by the pharmaceutical industry or the government (through the National Institutes of Health or the Veterans Administration), and other costs were unwittingly absorbed by patients' third-party insurers.[1] As managed care review brought this expenditure to light, insurers began to deny reimbursement for or experimental regimens, on the grounds that covering unproven services was outside the intended use of the pooled funds for which managed care insurers were responsible. Clinical researchers at first responded to this refusal by persuading insurers to cover investigational treatments on a case-by-case basis, or by camouflaging a patient's research participation so as to slip the claims through the increasingly vigilant payment systems.[2] In spite of increases in government funding for clinical research, an ongoing conflict evolved among doctors, patients, and insurers over the question of whether insurers should reimburse for investigational procedures. Some patients have gone to court when faced with the prospect of paying for an investigational intervention themselves, or when they were unable to pay for an therapy that they saw as a last chance treatment. But attempts to resolve this controversy in the courts have resulted in such varied and at times illogical outcomes that no consistent legal direction has emerged.[3] In response, researchers and patients have taken the problem to Congress and to state legislatures. Thus Arizona's Cancer Clinical Trials legislation. In April 2000, the governor of Arizona signed into law a bill requiring insurers to provide coverage for some costs associated with their enrollees' participation in cancer clinical trials. The bill was modeled on legislation already enacted in Georgia, Maryland, and Rhode Island, among other states, and was developed in the same year as similar legislation in Illinois and Louisiana.[4] In Arizona, the legislation had been sharply contested since its inception, and it remained controversial at the time it was signed into law. Predictably, oncologists at academic medical centers, cancer patients, and their advocates were the most vocal supporters of the bill, while third party payers, including Medicaid medical administrators, were opposed to it. Problems with the Law The Cancer Clinical Trials bill was supposed to respond to the fact that cancer clinical trials are underenrolled.[5] Most people from both sides of the debate agreed that only 3 percent of cancer patients currently enroll in clinical trials, while up to 20 percent may be eligible. The hypothesis behind the legislation was that patients do not participate in clinical trials because they would have to pay for it themselves, since most managed care insurers explicitly refuse to reimburse their enrollees for any interventions. The trouble with this hypothesis is that it is flatly contradicted by the best evidence available. According to a study by the United States General Accounting Office, insurers tend to make case-by-case exceptions to their general policy not to cover interventions.[6] The finding was corroborated by lobbyists for managed care organizations during public hearings on the Arizona bill, as well as by research oncologists in a study at the University of Arizona's Medical Center.[7] The GAO study concluded that many factors, in addition to insurance coverage practices, can influence patient participation in clinical trials. …

Medication Errors and Adverse Drug Events in Nursing Homes: Problems, Causes, Regulations, and Proposed Solutions

The Institute of Medicine (IOM) report To Err is Human: Building a Safer Health System has focused national attention on quality of care and the prevalence of medical errors in the healthcare system. According to the report, medical errors are responsible for a large number of deaths and additional morbidity in healthcare facilities and increased cost to the healthcare system. 1 Kohn LT Corrigan JM Donaldson MS To Err is Human: Building a Safer Health System. The Institute of Medicine National Academy Press, Washington, DC1999 Google Scholar A large proportion of medical errors are medication-related. 2 Leape LL Brennan TA Laird N et al. The nature of adverse events in hospitalized patients: Results of the Harvard medical practice study II. N Engl J Med. 1991; 324: 377-384 Crossref PubMed Scopus (2855) Google Scholar Medication-related errors and other adverse drug reactions are known collectively as adverse drug events (ADEs), defined as “any injury resulting from the medical use of a drug.” 3 Bates DW Spell N Cullen DJ et al. The costs of adverse drug events in hospitalized patients. JAMA. 1997; 277: 307-311 Crossref PubMed Google Scholar , 4 Gurwitz JH Field TS Avorn J et al. Incidence and preventability of adverse drug events in nursing homes. Am J Med. 2000; 109: 87-94 Abstract Full Text Full Text PDF PubMed Scopus (526) Google Scholar ADEs occur across the entire healthcare delivery system and are most common in older people, particularly those in hospitals and nursing homes. 5 Rothschild JN Bates DW Leape LL Preventable medical injuries in older patients. Arch Intern Med. 2000; 160: 2717-2728 Crossref PubMed Scopus (220) Google Scholar , 6 Gurwitz JH Sanchez-Cross T Eckler MA Matulis J The epidemiology of adverse and unexpected events in the long-term care setting. J Am Geriatr Soc. 1994; 42: 33-38 Crossref PubMed Scopus (74) Google Scholar ADEs are the adverse events most common in hospitalized patients 2 Leape LL Brennan TA Laird N et al. The nature of adverse events in hospitalized patients: Results of the Harvard medical practice study II. N Engl J Med. 1991; 324: 377-384 Crossref PubMed Scopus (2855) Google Scholar and the second most common adverse event in nursing home residents. 6 Gurwitz JH Sanchez-Cross T Eckler MA Matulis J The epidemiology of adverse and unexpected events in the long-term care setting. J Am Geriatr Soc. 1994; 42: 33-38 Crossref PubMed Scopus (74) Google Scholar In a report to Congress published in January 2000, 7 United States General Accounting Office. Adverse drug events. The magnitude of health risk is uncertain because of limited incidence data. Report to congressional requesters. GAO/HEHS-00–21. Washington, DC, January 2000. Google Scholar the United States General Accounting Office (GAO) reviewed available studies and concluded that the magnitude of health risk, as well as the cost, is uncertain because of limited incidence data and the difficulty inherent in recognition and identification of ADEs. However, studies reviewed in the report showed a rate of 0.56 ADEs per 100 patients admitted to hospitals in Colorado and Utah and 0.72 in New York. 8 Brennan TA Leape LL Laird NM et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard medical practice study I. New Engl J Med. 1991; 324: 370-376 Crossref PubMed Scopus (3435) Google Scholar , 9 Thomas EJ Studdert DM Burstin HR et al. Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care. 2000; 38: 261-271 Crossref PubMed Scopus (1241) Google Scholar In nursing homes, two studies reported an incidence of 0.44 to 0.71 per patient month. 10 Gerety MB Cornell JE Plichta DT Eimer M Adverse events related to drugs and drug withdrawal in nursing home residents. J Am Geriatr Soc. 1993; 41: 1326-1332 Crossref PubMed Scopus (84) Google Scholar , 11 Cooper JW Drug-related problems in a geriatric long term care facility. J Am Geriatr Soc. 1986; 37: 323-326 Google Scholar Another study in 332 nursing home residents showed an incidence of 134 ADEs per 100 admissions. 12 Cooper JW Probable adverse drug reactions in rural geriatric nursing home population: A four year study. J Am Geriatr Soc. 1996; 44: 194-197 PubMed Google Scholar A recently published study conducted in 18 Massachusetts nursing homes 4 Gurwitz JH Field TS Avorn J et al. Incidence and preventability of adverse drug events in nursing homes. Am J Med. 2000; 109: 87-94 Abstract Full Text Full Text PDF PubMed Scopus (526) Google Scholar found an incidence of 1.89 ADEs per 100 resident/months and potential ADEs in an additional 0.65 per 100 resident/months.

Continued Cartographic Chaos, Or a New Paradigm in Public Land Reconfiguration? The Effect of New Laws Authorizing Limited Sales of Public Land

A recent report by the United States General Accounting Office stated that the federal government's primary means of land reconfiguration, the land exchange, was so fraught with problems that it recommended Congress discontinue all land exchange programs. (1) At least one Congressional Representative, not apt to mince his words, stated that the Bureau of Land Management and the Forest Service, the two principal land management agencies, flat got conducting exchanges. (2) His comments reflect an all too common perception that something is fundamentally wrong with the way the federal government conducts land reconfiguration. Partially in response to such criticism, Congress has passed several pieces of legislation aimed at reforming the land reconfiguration process in recent years. The first was the Southern Nevada Public Land Management Act of 1998. (3) More recently, the Federal Land Transaction Facilitation Act of 2000 was signed into law. (4) Both Acts authorize the sale of land and the retention of the proceeds by the land management agencies in order to purchase private land better suited for conservation and protection. The two Acts differ remarkably in terms of scope and authority. In many ways the sale processes authorized by these Acts appear to solve or avoid many of the problems that have plagued the traditional land exchange process. Therefore, these laws are an important step in the evolution of western land reconfiguration. In other ways, these new laws fail to meet their statutory intent. Part I of this note will examine how the land disposition laws of the nineteenth century resulted in a fragmented pattern of western land ownership. In addition, it will detail how the land exchange process became the solution. Part II will explore some of the problems and criticisms of the land exchange process, which have lead many to claim that the federal government gets snookered conducting land exchanges. Part III will survey the Southern Nevada Public Lands Management Act of 1998 and the Federal Land Transaction Facilitation Act of 2000. This note will compare and contrast the scope and authority of the two laws and point out each Act's relative strengths and weakness. Finally, this note will conclude by submitting that while the two Acts are clearly aimed at encouraging better land management and reconfiguration, only the Southern Nevada Act will ultimately be successful. I. FRAGMENTED WESTERN LAND OWNERSHIP AND THE ROLE OF THE LAND EXCHANGE As of 1998, the federal government owned more then 29 percent of the United States total landmass, some 654 million acres. (5) Often called the public domain or the public lands, most of this land is concentrated in 12 western states. (6) But this represents only a fraction of what the federal government once owned. Beginning in mid-nineteenth century, the official policy of the United States was to dispose of the lands in order to promote settlement and development of the West. To further this policy Congress gave away lands through various provisions such as the Homestead Act of 1862 and the Desert Lands Act of 1877. (7) To increase settlement, Congress encouraged the building of railroads throughout the west by passing the Act of July 1, 1862, which helped finance the Union Pacific and Central Pacific railroads. (8) The Act granted the railroads alternating one square mile sections (640 acres) of lands along the route. (9) All told, the federal government granted over 130 million acres of land to the railroads in this alternating pattern. (10) The railroad grants resulted in the checkerboard problem, a pattern of ownership whereby neither a private owner nor the can gain access to its property without encroaching on the others land. (11) Adding to this intermingled pattern of western land ownership were an array of grants made to the states in order to promote education. …

Evaluating human capital policy in the federal government.

This article describes the consulting role the author, a psycholo8 gist, performs at the United States General Accounting Office (GAO). It explains how GAO responds to information requests from Congress, GAO’s process of evaluating human capital efforts and policies at federal agencies, and the special circumstances of designing studies at GAO. Management challenges and techniques of working in a matrix-management setting are also discussed.