More than five decades have passed since Charles Tiebout wrote his seminal 1956 paper, often cited as the classic apologetic for locally based systems of metropolitan governance. This essay traces ...the impact of Tiebout's work and subsequent scholarship in public choice, identifying important lessons and lingering issues. Although public choice has demonstrated that polycentric systems are adept and flexible in producing and providing municipal services and a variety of interlocal agreements, the presence of municipal boundaries gives rise to a host of spillover problems, such as urban sprawl and segregation. These spillovers are particularly nefarious because, unlike the natural cooperation that seems to occur in service provision, municipalities tend to assert narrow self-interest in the face of these types of externalities. The essay proposes that, commensurate with the growing salience of equity among the pillars of public administration, interjurisdictional spillovers and their attendant equity impacts will be the central challenge for thinkers studying metropolitan governance in the 21st century.
Local administrative professionals typically are accountable to multiple stakeholders, including other governmental units, special interests in the business and nonprofit sectors, and citizens. How ...are these accountability relationships ordered? What is the position of citizens in that hierarchy, particularly the influence of citizen participation? Focusing on patterns of hearing participation and citizen impact on budgeting decisions for the Community Development Block Grant program, this statistical analysis employs ordered pro bit regression. The authors find that communities in which grant administrators feel most accountable to citizens for grant performance have higher degrees of citizen participation in hearings and higher levels of perceived citizen impact on budgetary processes. This relationship holds even in the presence of simultaneity between bureaucratic accountability to citizens and citizen participation. The findings point to the importance of instilling a public service ethic among government employees that places a high value on engaging as well as listening to citizens.
Following failed auctions for sewer debt in April 2008, major bond rating companies downgraded Jefferson County, Alabama's bond rating to D (default) triggering massive mandatory payments by the ...county to its creditors. At the time of writing, the county teeters on the brink of actual default and bankruptcy, unable to pay service on its $3.3 billion sewer debt portfolio. If the county defaults, it will be the largest municipal bankruptcy in United States history, eclipsing Orange County, California's 1994 default. The intriguingly complex tale of the Jefferson County debt crisis is recounted here by identifying and examining failures of transparency and accountability by local bureaucratic and political actors, private financial institutions, as well as the larger regulatory framework governing public finance. Enhanced regulation of local government and the financial sector plus greater local government capacity to close accountability gaps and thus prevent future crises of similar scale in this or other jurisdictions are recommended.
Aims
The duration of type 2 diabetes mellitus (T2DM) is an important determinant of diabetes severity. The EMPA‐HEART CardioLink‐6 trial reported significant left ventricular (LV) mass indexed to ...body surface area (LVMi) regression in patients treated with the sodium‐glucose cotransporter 2 inhibitor (SGLT2i) empagliflozin for 6 months. This exploratory sub‐analysis of the same trial investigated the association between T2DM duration and LVMi regression.
Methods and results
A total of 97 individuals with T2DM and coronary artery disease (CAD) were randomly assigned to receive empagliflozin 10 mg daily or placebo. LVMi was measured at the baseline and 6 month visit using cardiac magnetic resonance imaging. The study population was divided into those with a baseline T2DM duration <10 years (n = 40) or ≥10 years (n = 57). A linear model adjusting for baseline values in each of the subgroups (ANCOVA) was used to assess the treatment effect of 6 month change in LVMi, LV end systolic volume indexed to body surface area, LV end diastolic volume indexed to body surface area and LV ejection fraction. Patients in the T2DM duration <10 years group (38 males 95.0%, median age 63 IQR: 55 years to 70 years) had a median T2DM duration of 4 years (IQR: 2.0 years to 7.0 years). Those in the T2DM duration ≥10 years group (52 males 91.2%, median age 65 IQR: 57 years to 71 years) had a median duration of 15 years (IQR: 12 years to 20 years). There was no significant difference in baseline LVMi according to T2DM duration (median 62 g/m2 IQR: 53.1 g/m2 to 70.0 g/m2 for T2DM duration <10 years; median 57.5 g/m2 IQR: 52.1 g/m2 to 66.2 g/m2 for T2DM duration ≥10 years; P = 0.11). Empagliflozin was associated with reductions in LVMi irrespective of duration of T2DM above and below 10 years (T2DM duration <10 years group, mean adjusted difference −2.90 g/m2 95% CI: −6.64 g/m2 to 0.84 g/m2; T2DM duration ≥10 years group, mean adjusted difference −3.69 g/m2 95% CI: −0.14 g/m2 to −7.24 g/m2; Pinteraction = 0.07).
Conclusions
In the EMPA‐HEART CardioLink‐6 trial, empagliflozin treatment was associated with reductions in LVMi in people with T2DM and CAD irrespective of the duration of diabetes assessed categorically above and below 10 years.
Aims
The neutrophil‐to‐lymphocyte ratio (NLR) is a marker of systemic inflammation and plays a critical role in the assessment and prognosis in patients with heart failure. The EMPA‐HEART ...CardioLink‐6 trial demonstrated that patients with type 2 diabetes (T2D) and coronary artery disease (CAD) treated with a sodium–glucose transport protein 2 inhibitor for 6 months experienced regression in left ventricular mass. Given this, we evaluated the relationship of baseline NLR and cardiac reverse remodelling in the entire cohort of this trial.
Methods and results
A total of 97 individuals were randomized to receive empagliflozin (10 mg/day) or placebo for 6 months. The primary outcome of the trial was change in left ventricular mass indexed to body surface area (LVMi) from baseline to 6 months as measured by cardiac magnetic resonance imaging. In our analysis, the cohort was stratified above and below an NLR level of 2. To assess the treatment effect on the 6 month change in NLR, we used a linear model adjusting for baseline differences in NLR analysis of covariance (ANCOVA) that included an interaction term between the baseline NLR and treatment. To assess the treatment effect on the 6 month change in LVMi in each of the subgroups divided by baseline NLR, we used an ANCOVA adjusting for baseline differences in LVMi that included an interaction term between the subgroups and treatment. The results of the regression models were summarized as adjusted differences with two‐sided 95% confidence intervals (CIs). Patients who exhibited an elevated baseline NLR demonstrated higher LVMi and left ventricular end‐diastolic volume indexed to body surface area than those with a lower NLR. In patients with an NLR < 2 and NLR ≥ 2, the adjusted difference in LVMi between the empagliflozin‐ and placebo‐treated patients was −2.98 g/m2 (95% CI: −6.18 to 0.22 g/m2) (P value = 0.067) and −4.43 g/m2 (95% CI: −8.50 to −1.11 g/m2), respectively (Pinteraction = 0.60).
Conclusions
Empagliflozin treatment is associated with consistent reductions in LVMi in patients with T2D and CAD independent of baseline NLR.
Amidst a crisis shortage of foster homes in the child welfare system, a number of innovative faith-based collaborations aimed at recruiting foster parents have recently emerged. It has been suggested ...that these collaborations offer a unique opportunity to recruit committed and altruistic parents as caregivers, providing much needed capacity to an overloaded child welfare system. This paper uses data from the National Survey of Current and Former Foster Parents to examine the associations between religious motivations for fostering, altruism and various measures of foster home utilization and longevity. The empirical results demonstrate that religiously motivated foster parents are more likely to have altruistic reasons for fostering, and scored higher than the non-religiously motivated group on an index of altruism. A separate empirical analysis shows that the interaction of high levels of altruism and religious motivation is associated with higher foster home utilization. No association was found between religious altruism and the parent’s expressed intent to continue providing foster care. The implications of these findings for current faith-based collaboration in the child welfare arena are discussed.
ABSTRACT
We examine poverty's effect in two ways. First, we study the relationship between poverty and capacity for innovation in the U.S. states; second, we study the combined effects of poverty and ...innovation capacity on U.S. state economic output and employment. Because many of the relationships among poverty, innovation capacity and economic performance are simultaneous, we employ the Arellano Bond Difference GMM estimator to estimate various models using panel data (1980–1999). The findings reveal a negative indirect effect of socio‐economic need (poverty) on human and U.S. state and local financial innovation capacity, though there is no empirical link between poverty and federal financial capacity. We find no statistically significant evidence of the contemporaneous effect of poverty on state economic performance, holding innovation capacity constant. This suggests that poverty primarily affects state economic performance indirectly through reduction of innovation capacity. Overall, our findings suggest that U.S. officials ought to be concerned about the role poverty plays in diminishing their state economies' capacity to innovate.
This article combines the neighborhood effects and spatial mismatch frameworks into a single model explaining how geographic factors contribute to unemployment. Using National Longitudinal Survey of ...Youth (1979) data, I estimate a two-step model that separately models the effects of segregation and spatial mismatch. The first model predicts educational attainment as a function of exposure to residential segregation as a youth. The second model predicts unemployment probability as an adult as a function of educational attainment and spatial mismatch. The empirical results show that segregation does have discernable effects on educational attainment for blacks, but not for whites. I also find that spatial mismatch affects unemployment probability for blacks, but such an effect is hardly present for whites. A partial equilibrium analysis using predictions from the models shows that large changes in either segregation levels or the central city/suburban distribution of the black population would yield only moderate decreases in unemployment probability for the black population overall. Yet despite small predicted effects, these results should be viewed with caution because the general equilibrium effects of a large scale movement of blacks and whites across metropolitan space are largely impossible to predict with current data.
Using a mixed method approach, this article investigates growth management policy in the American states, presenting an event history analysis of state growth management policy adoptions, ...supplemented by a case study of growth management's evolution in the state of Maryland. Empirical results from the event history analysis suggest that growth pressures, the countervailing forces of state environmentalism and building interests, stronger gubernatorial powers, and citizen liberalism are all important factors associated with state adoptions of growth management. The Maryland case triangulates and contextualizes these key empirical findings, demonstrating the importance of those variables in a state-specific context. Beyond triangulating the empirical results, Maryland's legislative history with growth management highlights the importance of civic engagement as a means to both formulate and build sustained support for state growth management policy, even in the face of significant opposition from development interests.
Objective. This article comments on the findings of Romero and Liserio's "Saving Open Spaces." Their primary claim is that open-space ballots are not related in any way to actual land-use patterns. ...Methods. First, I present a number of methodological problems with their approach and demonstrate a sample selection bias using their original data. Second, I present some alternate models using data from 350 municipalities in the greater Philadelphia area. Results. I demonstrate that the sample selection bias in Romero and Liserio's model is so acute that all their parameter estimates are joindy zero. With other data, I find that sprawl votes are related to land-use patterns using a number of different measures. Conclusions. I conclude that open-space votes are related to land-use patterns and that this may be explained as a rational response to sprawl by community planning bureaucracies.
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