Analysis of local government contracting decisions typically focuses on transactions costs related to service characteristics, especially asset specificity and difficulty of contract management. This ...analysis expands the focus to include market characteristics (competition), citizen characteristics (public interest in the service delivery process), and place characteristics (metro status and public management) and finds these are the more important factors. A 2007 survey of US city managers' rankings of 67 services by transactions costs, competition, and citizen interest is combined with a 2007 national survey of city managers' sourcing decisions (direct public, intergovernment cooperation, for-profit and nonprofit contracting). Multinomial logit models of service delivery sourcing choice find that metro status and competition are key explanatory variables. Intergovernmental cooperation represents an important public market alternative when contract management is difficult and competition is low. For profit contracting is less common when citizen interest is high and competition is low. Governments with professional managers appear more effective in addressing these broader transactions costs of citizen interests, political and labor opposition, and market management.
Introduction High school students’ electronic cigarette (e-cigarette) use rose rapidly in 2014, to levels higher than cigarette smoking, which declined significantly. This study assesses how ...frequency of e-cigarette use is associated with students’ smoking status. Methods Using Monitoring the Future data in 2015, this study evaluated the association between students’ smoking and frequency of 30-day e-cigarette use in 2014, focusing on high school seniors. Previous research has considered only whether e-cigarettes were used at all during the past month. Results Non-smokers were far less likely than smokers to have used an e-cigarette ( p <0.001). E-cigarette use frequency rose with the amount of ever smoking ( p <0.001). However, among current smokers, there was no difference in e-cigarette use by very light smokers (<1 cigarette/day); light smokers (1–5 cigarettes/day); and heavy smokers (≥1/2 pack/day) ( p =0.99). Because most students have never smoked, never smokers constituted 25% of all seniors who used an e-cigarette. Among tenth- and eighth-graders, 43% and 48% of past-month e-cigarette users had never smoked. Conclusions Non-smoking high school students are highly unlikely to use e-cigarettes; among those who do, most used them only on 1–2 of the past 30 days. By contrast, current smokers are likely to use e-cigarettes and on many more days. It is unclear whether students’ e-cigarette use represents short-term experimentation or future sustained use, and whether it will eventually increase or decrease youth smoking and nicotine addiction. More sophisticated research methods, employing better data, will be essential to unravel the mystery that is the e-cigarette phenomenon.
Pulmonary aspiration of gastric contents during the perioperative period in infants and children may be associated with postoperative mortality or pulmonary morbidity. There has not been a recent ...determination of the frequency of this event and its outcomes in infants and children.
The authors prospectively identified all cases of pulmonary aspiration of gastric contents during the perioperative courses of 56,138 consecutive patients younger than 18 yr of age who underwent 63,180 general anesthetics for procedures performed in all surgical specialties from July 1985 through June 1997 at the Mayo Clinic.
Pulmonary aspiration occurred in 24 patients (1: 2,632 anesthetics; 0.04%). Children undergoing emergency procedures had a greater frequency of pulmonary aspiration compared to those undergoing elective procedures (1:373 vs. 1:4,544, P < 0.001). Fifteen of the 24 children who aspirated gastric contents did not develop respiratory symptoms within 2 h of aspiration, and none of these 15 developed pulmonary sequelae. Five of these nine children who aspirated and in whom respiratory symptoms developed within 2 h subsequently had pulmonary complications treated with respiratory support (P < 0.003). Three children were treated with mechanical ventilation for more than 48 h, but no child died of sequelae of pulmonary aspiration.
In this study population, the frequency of perioperative pulmonary aspiration in children was quite low. Serious respiratory morbidity was rare, and there were no associated deaths. Infants and children with clinically apparent pulmonary aspiration in whom symptoms did not develop within 2 h did not have respiratory sequelae.
Austerity and fiscal crisis make the search for cost‐saving reforms in local government more critical. While cost savings from privatization have frequently proven ephemeral, inter‐municipal ...cooperation has been a relatively understudied reform. We analyse the literature on cost savings under cooperation and find that savings are dependent on (1) the cost structure of public services, particularly those related to scale and density economies and externalities, (2) the structure of local government (size, metropolitan location, powers granted by the nation or regional state), and (3) the governance framework at the local/regional level where cooperation varies from informal to formal. European studies give more emphasis to cost savings, while US studies focus on coordination concerns arising from the higher degree of devolution in the US local government system.
Introduction People with serious mental illness experience substantially reduced life expectancy, likely due in part to their higher smoking rates relative to the general population. However, the ...extent to which smoking affects their life expectancy, independent of mental illness, is unknown. This study quantifies the potential contribution of smoking to reduced life expectancy among individuals with serious psychological distress (SPD), a measure that screens for serious mental illness in national surveys. Methods A cohort of 328,110 U.S. adults was examined using the 1997–2009 National Health Interview Surveys linked to the 2011 National Death Index. Cox models were used to estimate mortality hazard ratios for current smoking, former smoking, and SPD and construct life tables by smoking and SPD status. The smoking-attributable fraction of deaths by SPD status was calculated. Analyses were conducted in 2015. Results Among those with SPD, being a current smoker doubles the risk of death. Current smokers with SPD lose 14.9 years of life relative to never smokers without SPD. Among never smokers, having SPD reduces life expectancy by 5.3 years. Thus, smoking may account for up to two thirds of the difference in life expectancy between smokers with SPD and never smokers without SPD. One third of deaths among those with SPD can be attributed to smoking. Conclusions The life expectancy difference between current smokers with SPD and never smokers without SPD is primarily due to smoking. Aiding individuals with serious mental illness to avoid smoking will translate into sizeable gains in life expectancy.
Rising seawater temperature and ocean acidification threaten the survival of coral reefs. The relationship between coral physiology and its microbiome may reveal why some corals are more resilient to ...these global change conditions. Here, we conducted the first experiment to simultaneously investigate changes in the coral microbiome and coral physiology in response to the dual stress of elevated seawater temperature and ocean acidification expected by the end of this century. Two species of corals, Acropora millepora containing the thermally sensitive endosymbiont C21a and Turbinaria reniformis containing the thermally tolerant endosymbiont Symbiodinium trenchi, were exposed to control (26.5°C and pCO2 of 364 μatm) and treatment (29.0°C and pCO2 of 750 μatm) conditions for 24 days, after which we measured the microbial community composition. These microbial findings were interpreted within the context of previously published physiological measurements from the exact same corals in this study (calcification, organic carbon flux, ratio of photosynthesis to respiration, photosystem II maximal efficiency, total lipids, soluble animal protein, soluble animal carbohydrates, soluble algal protein, soluble algal carbohydrate, biomass, endosymbiotic algal density, and chlorophyll a). Overall, dually stressed A. millepora had reduced microbial diversity, experienced large changes in microbial community composition, and experienced dramatic physiological declines in calcification, photosystem II maximal efficiency, and algal carbohydrates. In contrast, the dually stressed coral T. reniformis experienced a stable and more diverse microbiome community with minimal physiological decline, coupled with very high total energy reserves and particulate organic carbon release rates. Thus, the microbiome changed and microbial diversity decreased in the physiologically sensitive coral with the thermally sensitive endosymbiotic algae but not in the physiologically tolerant coral with the thermally tolerant endosymbiont. Our results confirm recent findings that temperature-stress tolerant corals have a more stable microbiome, and demonstrate for the first time that this is also the case under the dual stresses of ocean warming and acidification. We propose that coral with a stable microbiome are also more physiologically resilient and thus more likely to persist in the future, and shape the coral species diversity of future reef ecosystems.
Background The authors develop projections for global smoking prevalence for the years 2020 and 2030 with and without the implementation, starting in 2010, of the WHO's recommended multipronged ...approach to tobacco control known as the MPOWER policy package. Methods Using data from the WHO's Global InfoBase Database and the WHO's Global Adult Tobacco Survey, the authors construct adult cigarette smoking prevalence time series for 60 countries that account for 90% of the world's smokers and 85% of the world's population. The authors then use a stock/flow model to project those countries' smoking prevalence for the years 2020 and 2030, with and without the implementation of MPOWER. The authors aggregate the results and report regional and global figures. Results The authors estimate global adult cigarette smoking prevalence in 2010 to be 23.7%. If no additional policies are set in place and the initiation and cessation rates existing in 2010 persist, the authors estimate that global prevalence will be 22.7% by 2020 and 22.0% by 2030 (872 million smokers). If MPOWER had been implemented globally starting in 2010 with a 100% price increase for cigarettes, the authors estimate that global cigarette smoking prevalence would be 15.4% in 2020 and 13.2% in 2030 (523 million smokers). Conclusions The estimates indicate the magnitude and trajectory of the global tobacco pandemic and of the impact the authors could expect if evidence-based tobacco control policies were applied immediately and universally throughout the world. As half of lifetime smokers die of tobacco-related diseases, if MPOWER were applied globally, within a few decades, many millions of premature tobacco-related deaths would be avoided.
Social impact bonds (SIBs) attract private investment to social programs by paying a market rate of return if predefined outcome targets are met. SIBs monetize benefits of social interventions and ...tie pay to performance, limiting governmental control once the contract is designed. Despite policy enthusiasm across the globe, SIBs have failed to attract private market investors without substantial additional guarantees. SIBs raise questions about government's ability to ensure broader public values. Using literature on contracting, performance management, and public private partnerships, this exploratory analysis focuses on institutional design, transaction costs, and performance measurement, outlining the opportunities and concerns SIBs present.
Based on several observational studies that have yielded consistent results, the combination of annual magnetic resonance imaging (MRI) plus mammography is now the standard of care for screening ...women with BRCA mutations who decline risk-reducing mastectomy. However, many of these women will develop breast cancer at a young age and, while most of these cancers will be very early stage, oncologists need to be aware of the unique issues faced by women in this age group due to the diagnosis and treatment. Fear of death, loss of fertility, premature menopause, relationship stress, career disruption and financial losses are only some of the problems that are either unique to young women or much more pronounced in this age group. Urgent referral to a fertility specialist of any woman who has not yet completed her family should be made as soon as the possible need for systemic treatment is recognized. The oncologist should also have a low threshold for referring young women to professionals experienced in navigating young women and their families through the psychosocial trauma of a breast cancer diagnosis.
Conscious vision is believed to depend upon an intact primary visual cortex (V1), although injury in early life is often accompanied by the preservation of visual capacity, unlike in adulthood. The ...middle temporal area (MT) receives input from the retinorecipient koniocellular layers of the lateral geniculate nucleus (LGN) and the more recently described medial subdivision of the inferior pulvinar (PIm) of the thalamus, pathways that potentially contribute to preservation of vision after early damage to V1.
We examined the potential of these pathways to the long-term preservation of vision after permanent lesions of primate V1 in early and adult life by using a combination of neural tracing and diffusion MRI. We show that early-life V1 lesions lead to less pruning of the retina-pulvinar-MT pathway than is observed in control or adult lesion animals.
These findings suggest that sustained visual input through the pulvinar to MT following a lesion of V1 in early life has the capacity to afford improved visual outcomes.
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•The pulvinar is responsible for preserved vision following early-life V1 lesions•The retina-pulvinar-MT pathway remains unpruned following early-life lesions of V1•The retina-pulvinar-MT pathway is an alternate pathway for visual information•Retinal input to the LGN degenerates after an early-life V1 lesion
Warner et al. demonstrate in primates how, following early-life lesions of the primary visual cortex (V1), the disynaptic connection from the retina to the middle temporal area via the medial division of the inferior pulvinar is the likely neural substrate that affords the preservation of visual capacity. This phenomenon is often observed in humans.
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