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Between 2010 and 2050, the number of people living in the world’s urban areas is expected to grow by 80 percent – from 3.5 billion to 6.3 billion. This growth will pose great challenges for urban mobility – for the networks of transportation facilities and services that maintain the flow of people and commerce into, out of and within the world’s cities.

Addressing the challenge of urban mobility is essential – for maintaining cities’ historic role as the world’s principal sources of innovation and economic growth, for improving the quality of life in urban areas and for mitigating the impact of climate change. It will require creative applications of new technologies, changes in the way transportation services are organized and delivered, and innovations in urban planning and design.

This report examines several aspects of the challenge of urban mobility in the twenty-first century – the growth of the world’s urban population, and changes in the characteristics of that population; emerging patterns of urban mobility; and changes in technology design and connectivity.

Objective. The Medicare and Premier Inc. Hospital Quality Incentive Demonstration (HQID), a hospital-based pay-for-performance program, changed its incentive design from one rewarding only high performance (Phase 1) to another rewarding high performance, moderate performance, and improvement (Phase 2). We tested whetherthis design change reduced the gap in incentive payments among hospitals treating patients across the gradient of socioeconomic disadvantage.

Data. To estimate incentive payments in both phases, we used data from the Premier Inc. website and from Medicare Provider Analysis and Review Files.We used data from the American Hospital Association Annual Survey and Centers for Medicare and Medicaid Services Impact File to identify hospital characteristics.

Study Design. Hospitals were divided into quartiles based on their Disproportionate Share Index (DSH) , from lowest disadvantage (Quartile 1) to highest disadvantage (Quartile 4). In both phases of the HQID, we tested for differences across the DSH quartiles for three outcomes: (1) receipt of any incentive payments; (2) total incentive payments; and (3) incentive payments per discharge. For each of the study outcomes,we performed a hospital-level difference-in-differences analysis to test whether the gap between Quartile 1 and the other quartiles decreased from Phase 1 to Phase 2.

Principal Findings. In Phase 1, there were significant gaps across the DSH quartiles for the receipt of any payment and for payment per discharge. In Phase 2, the gap was not significant for the receipt of any payment, but remained significant for payment perdischarge. For the receipt of any incentive payment, difference-in-difference estimates showed significant reductions in the gap between Quartile 1 and the other quartiles (Quartile 2, 17.5 percentage points [p < .05]; Quartile 3, 18.1 percentage points [p < .01]; Quartile 4, 28.3 percentage points [p < .01]). For payments per discharge, the gap was also signi_cantly reduced between Quartile 1 and the other quartiles (Quartile 2, $14.92 per discharge [p < .10]; Quartile 3, $17.34 per discharge [p < .05]; Quartile 4, $21.31 per discharge [p < .01]). There were no significant reductions in the gap for total payments.

Conclusions. The design change in the HQID reduced the disparity in the receipt of any incentive payment and for incentive payments per discharge between hospitals caring for the most and least socioeconomically disadvantaged patient populations. 

Medicare’s flagship hospital pay-for-performance program, the Premier Hospital Quality Incentive Demonstration, began in 2003 but changed its incentive design in late 2006. The goals were to encourage greater quality improvement, particularly among lower-performing hospitals. However, we found no evidence that the change achieved these goals. Although the program changes were intended to provide strong incentives for improvement to the lowest-performing hospitals, we found that in practice the new incentive design resulted in the strongest incentives for hospitals that had already achieved quality performance ratings just above the median for the entire group of participating hospitals. Yet during the course of the program, these hospitals improved no more than others. Our findings raise questions about whether pay-for-performance strategies that reward improvement can generate greater improvement among lower performing providers. They also cast some doubt on the extent to which hospitals respond to the specific structure of economic incentives in pay-for-performance programs.

Objective:To determine clinical characteristics, demographics and short-term outcomes of neonates diagnosed with fetomaternal haemorrhage (FMH).

Design:The authors analysed the Nationwide Inpatient Sample, 1993 to 2008. Singleton births diagnosed with FMH were identified by International Classification of Diseases (ICD-9) code 762.3. Descriptive, univariate and multivariable regression analyses were performed to determine the national annual incidence of FMH over time as well as demographics and clinical characteristics of neonates with FMH.ResultsFMH was identified in 12 116 singleton births. Newborns with FMH required high intensity of care: 26.3% received mechanical ventilation, 22.4% received blood product transfusion and 27.8% underwent central line placement. Preterm birth (OR 3.7), placental abruption (OR 9.8) and umbilical cord anomaly (OR 11.4) were risk factors for FMH. Higher patient income was associated with increased likelihood of FMH diagnosis (OR 1.2), and Whites were more likely to be diagnosed than ethnic minorities (OR 1.9). There was reduced frequency of diagnosis in the Southern USA (OR 0.8 vs the Northeastern USA).

Conclusions: Diagnosis of FMH is associated with significant morbidity as well as regional, socioeconomic and racial disparity. Further study is needed to distinguish between diagnostic coding bias and true epidemiology of the disease. This is the first report of socioeconomic and racial/ethnic disparities in FMH, which may represent disparities in detection that require national attention. 

OBJECTIVE:

To determine clinical characteristics, demographics and short-term outcomes of neonates diagnosed with fetomaternal haemorrhage (FMH).

DESIGN:

The authors analysed the Nationwide Inpatient Sample, 1993 to 2008. Singleton births diagnosed with FMH were identified by International Classification of Diseases (ICD-9) code 762.3. Descriptive, univariate and multivariable regression analyses were performed to determine the national annual incidence of FMH over time as well as demographics and clinical characteristics of neonates with FMH.

RESULTS:

FMH was identified in 12 116 singleton births. Newborns with FMH required high intensity of care: 26.3% received mechanical ventilation, 22.4% received blood product transfusion and 27.8% underwent central line placement. Preterm birth (OR 3.7), placental abruption (OR 9.8) and umbilical cord anomaly (OR 11.4) were risk factors for FMH. Higher patient income was associated with increased likelihood of FMH diagnosis (OR 1.2), and Whites were more likely to be diagnosed than ethnic minorities (OR 1.9). There was reduced frequency of diagnosis in the Southern USA (OR 0.8 vs the Northeastern USA).

CONCLUSIONS:

Diagnosis of FMH is associated with significant morbidity as well as regional, socioeconomic and racial disparity. Further study is needed to distinguish between diagnostic coding bias and true epidemiology of the disease. This is the first report of socioeconomic and racial/ethnic disparities in FMH, which may represent disparities in detection that require national attention.

Objectives:

To examine the associations of antibiotic exposures during the first 2 years of life and the development of body mass over the first 7 years of life.

Design:

Longitudinal birth cohort study.

Subjects:
A total of 11 532 children born at 2500 g in the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based study of children born in Avon, UK in 1991–1992.

Measurements:

Exposures to antibiotics during three different early-life time windows (

Results:

Antibiotic exposure during the earliest time window (

Conclusions:

Exposure to antibiotics during the first 6 months of life is associated with consistent increases in body mass from 10 to 38 months. Exposures later in infancy (6–14 months, 15–23 months) are not consistently associated with increased body mass. Although effects of early exposures are modest at the individual level, they could have substantial consequences for population health. Given the prevalence of antibiotic exposures in infants, and in light of the growing concerns about childhood obesity, further studies are needed to isolate effects and define life-course implications for body mass and cardiovascular risks.

Context  Bisphenol A (BPA), a manufactured chemical, is found in canned food, polycarbonate-bottled liquids, and other consumer products. In adults, elevated urinary BPA concentrations are associated with obesity and incident coronary artery disease. BPA exposure is plausibly linked to childhood obesity, but evidence is lacking to date.

Objective  To examine associations between urinary BPA concentration and body mass outcomes in children.

Design, Setting, and Participants  Cross-sectional analysis of a nationally representative subsample of 2838 participants aged 6 through 19 years randomly selected for measurement of urinary BPA concentration in the 2003-2008 National Health and Nutrition Examination Surveys.

Main Outcome Measures  Body mass index (BMI), converted to sex- and age-standardized z scores and used to classify participants as overweight (BMI ≥85th percentile for age/sex) or obese (BMI ≥95th percentile).

Results  Median urinary BPA concentration was 2.8 ng/mL (interquartile range, 1.5-5.6). Of the participants, 1047 (34.1% [SE, 1.5%]) were overweight and 590 (17.8% [SE, 1.3%]) were obese. Controlling for race/ethnicity, age, caregiver education, poverty to income ratio, sex, serum cotinine level, caloric intake, television watching, and urinary creatinine level, children in the lowest urinary BPA quartile had a lower estimated prevalence of obesity (10.3% [95% CI, 7.5%-13.1%]) than those in quartiles 2 (20.1% [95% CI, 14.5%-25.6%]), 3 (19.0% [95% CI, 13.7%-24.2%]), and 4 (22.3% [95% CI, 16.6%-27.9%]). Similar patterns of association were found in multivariable analyses examining the association between quartiled urinary BPA concentration and BMI z score and in analyses that examined the logarithm of urinary BPA concentration and the prevalence of obesity. Obesity was not associated with exposure to other environmental phenols commonly used in other consumer products, such as sunscreens and soaps. In stratified analysis, significant associations between urinary BPA concentrations and obesity were found among whites (P < .001) but not among blacks or Hispanics.

Conclusions  Urinary BPA concentration was significantly associated with obesity in this cross-sectional study of children and adolescents. Explanations of the association cannot rule out the possibility that obese children ingest food with higher BPA content or have greater adipose stores of BPA.

CONTEXT:

Bisphenol A (BPA), a manufactured chemical, is found in canned food, polycarbonate-bottled liquids, and other consumer products. In adults, elevated urinary BPA concentrations are associated with obesity and incident coronary artery disease. BPA exposure is plausibly linked to childhood obesity, but evidence is lacking to date.

OBJECTIVE:

To examine associations between urinary BPA concentration and body mass outcomes in children.

DESIGN, SETTING, AND PARTICIPANTS:

Cross-sectional analysis of a nationally representative subsample of 2838 participants aged 6 through 19 years randomly selected for measurement of urinary BPA concentration in the 2003-2008 National Health and Nutrition Examination Surveys.

MAIN OUTCOME MEASURES:

Body mass index (BMI), converted to sex- and age-standardized z scores and used to classify participants as overweight (BMI ≥85th percentile for age/sex) or obese (BMI ≥95th percentile).

RESULTS:

Median urinary BPA concentration was 2.8 ng/mL (interquartile range, 1.5-5.6). Of the participants, 1047 (34.1% [SE, 1.5%]) were overweight and 590 (17.8% [SE, 1.3%]) were obese. Controlling for race/ethnicity, age, caregiver education, poverty to income ratio, sex, serum cotinine level, caloric intake, television watching, and urinary creatinine level, children in the lowest urinary BPA quartile had a lower estimated prevalence of obesity (10.3% [95% CI, 7.5%-13.1%]) than those in quartiles 2 (20.1% [95% CI, 14.5%-25.6%]), 3 (19.0% [95% CI, 13.7%-24.2%]), and 4 (22.3% [95% CI, 16.6%-27.9%]). Similar patterns of association were found in multivariable analyses examining the association between quartiled urinary BPA concentration and BMI z score and in analyses that examined the logarithm of urinary BPA concentration and the prevalence of obesity. Obesity was not associated with exposure to other environmental phenols commonly used in other consumer products, such as sunscreens and soaps. In stratified analysis, significant associations between urinary BPA concentrations and obesity were found among whites (P < .001) but not among blacks or Hispanics.

CONCLUSIONS:

Urinary BPA concentration was significantly associated with obesity in this cross-sectional study of children and adolescents. Explanations of the association cannot rule out the possibility that obese children ingest food with higher BPA content or have greater adipose stores of BPA.

Background: In the United States, registered nurses [RNs] are trained through one of three educational pathways: a diploma course; an associate's degree, or a baccalaureate degree in nursing (the BSN). A national consensus has emerged that the proportion of RNs that are baccalaureate-trained should be substantially increased. Yet achieving that goal may be difficult in areas where college graduates are unlikely to reside.

Objectives: To determine whether the level of training of the hospital registered nurse [RN] workforce varies geographically, along with the education of the local general workforce.

Research design: Cross sectional, ecological study.

Subjects: Hospital nurses who participated in the National Sample Survey of Registered Nurses [NSSRN] in 2004 (n = 16,567).

Measures. Registered Nurse training was measured as Diploma, Associates degree, or Baccalaureate degree or above. County-level general workforce quality was assessed as the adult college graduation rate. Counties were divided into US population quartiles, with the highest quartile (Q4) having more than 29.3% college graduates, and the lowest quartile (Q1) having fewer than 16.93% college graduates.

Results: Hospital RNs have a higher level of training in counties where the general population is better
educated. For example, in Q4, 55.2% of hospital RNs are baccalaureate-trained, in Q3, 50.2%; in Q2,45.2%; and in Q1, 34.9% (p < .001 for all pairwise comparisons). The association between RN training and general workforce education is found in cities, towns and rural areas.

Conclusions: Nationwide, there are substantial geographic variations in the training of hospital RNs. Educational segregation (the tendency for educated people to cluster geographically) may make it more difficult to achieve a BSN-rich nursing workforce in some areas of the US. Further work is needed to assess whether educational segregation similarly influences the distribution of other health care professionals, and whether it leads to variations in the local quality of care.

The Irvine Minnesota Inventory (IMI) was designed to measure environmental features that may be associated with physical activity and particularly walking. This study assesses how well the IMI predicts physical activity and walking behavior and develops shortened, validated audit tools. A version of the IMI was used in the Twin Cities Walking Study, a research project measuring how density, street pattern, mixed use, pedestrian infrastructure, and a variety of social and economic factors affect walking. Both bivariate and multivariate analyses were used to assess the predictive value of the IMI. We find that while this inventory provides reliable measurement of urban design features, only some of these features present associations with increased or decreased walking. This article presents two versions of shortened scales—a prudent scale, requiring association with two separate measures of a physical activity or walking behavior, and a moderate scale, requiring association with one measure of physical activity or walking. The shortened scales provide built environment audit instruments that have been tested both for inter-rater reliability and for associations with physical activity and walking. The results are also useful in showing which built environment variables are more reliably associated with walking for travel—characteristics of the sidewalk infrastructure, street crossings and traffic speeds, and land use are more strongly associated with walking for travel, while factors that measure aesthetics are typically less strongly associated with walking for travel.

Objective:Obesity is an enormous public health problem and children have been particularly highlighted for intervention. Of notable concern is the fast-food consumption of children. However, we know very little about how children or their parents make fast-food choices, including how they respond to mandatory calorie labeling. We examined children's and adolescents' fast-food choice and the influence of calorie labels in low-income communities in New York City (NYC) and in a comparison city (Newark, NJ).
Design:Natural experiment: Survey and receipt data were collected from low-income areas in NYC, and Newark, NJ (as a comparison city), before and after mandatory labeling began in NYC. Study restaurants included four of the largest chains located in NYC and Newark: McDonald's, Burger King, Wendy's and Kentucky Fried Chicken.Subjects:A total of 349 children and adolescents aged 1-17 years who visited the restaurants with their parents (69%) or alone (31%) before or after labeling was introduced. In total, 90% were from racial or ethnic minority groups.
Results:We found no statistically significant differences in calories purchased before and after labeling; many adolescents reported noticing calorie labels after their introduction (57% in NYC) and a few considered the information when ordering (9%). Approximately 35% of adolescents ate fast food six or more times per week and 72% of adolescents reported that taste was the most important factor in their meal selection. Adolescents in our sample reported that parents have some influence on their meal selection.
Conclusions:Adolescents in low-income communities notice calorie information at similar rates as adults, although they report being slightly less responsive to it than adults. We did not find evidence that labeling influenced adolescent food choice or parental food choices for children in this population.

Objective To examine variations in health service expenditures and social services expenditures across Organisation for Economic Co-operation and Development (OECD) countries and assess their association with five population-level health outcomes.

Design A pooled, cross-sectional analysis using data from the 2009 release of the OECD Health Data 2009 Statistics and Indicators and OECD Social Expenditure Database.

Setting OECD countries (n=30) from 1995 to 2005.

Main outcomes Life expectancy at birth, infant mortality, low birth weight, maternal mortality and potential years of life lost.

Results Health services expenditures adjusted for gross domestic product (GDP) per capita were significantly associated with better health outcomes in only two of five health indicators; social services expenditures adjusted for GDP were significantly associated with better health outcomes in three of five indicators. The ratio of social expenditures to health expenditures was significantly associated with better outcomes in infant mortality, life expectancy and increased potential life years lost, after adjusting for the level of health expenditures and GDP.

Conclusion Attention to broader domains of social policy may be helpful in accomplishing improvements in health envisioned by advocates of healthcare reform.

This study contributes to ongoing scholarship at the nexus of translational research, education reform, and the developmental and prevention sciences. It reports 2-year experimental impacts of a universal, integrated school-based intervention in social-emotional learning and literacy development on children’s social-emotional, behavioral, and academic functioning. The study employed a school-randomized, experimental design with 1,184 children in 18 elementary schools. Children in the intervention schools showed improvements across several domains: self-reports of hostile attributional bias, aggressive interpersonal negotiation strategies, and depression, and teacher reports of attention skills, and aggressive and socially competent behavior. In addition, there were effects of the intervention on children’s math and reading achievement for those identified by teachers at baseline at highest behavioral risk. These findings are interpreted in light of developmental cascades theory and lend support to the value of universal, integrated interventions in the elementary school period for promoting children’s social-emotional and academic skills.

Faulty and dysfunctional incentive systems have long interested, and frustrated, managers and organizational scholars alike. In this analysis, we pick up where Kerr (1975) left off and advance an explanation for why bad incentive systems are so prevalent in organizations. We propose that one contributing factor lies in the psychology of people who occupy managerial roles. Although designing effective incentive systems is a challenge wrought with perils for anyone, we believe the psychological consequences and correlates of higher rank within organizations make the challenge more severe for managers. Patterns of promotion and hiring typically yield managers that are more competent than their employees, and ascending to management positions increases individuals' workload and power. In turn, these factors make managers more egocentrically anchored and cognitively abstract, while also reducing their available cognitive capacity for any given task, all of which we argue limits their ability to design effective incentives for employees. Thus, ironically, those with the power to design incentives may be those least able to effectively do so. We discuss four specific types of bad incentive systems that can arise from these psychological tendencies in managers: those that over-emphasize compensation, generate weak motivation, offer perverse motivation, or are misaligned with organizational culture.

The purpose of this effort has been to foster a dialogue among peers at transportation and planning agencies about their experiences with promoting public transit and, in particular, the challenges they face related to bus rapid transit (BRT) projects, as well as the solutions that they have developed in response. Agencies from dozens of large cities around the United States participated at three (3) peer-to-peer exchanges in New York City, Los Angeles, and Cleveland. The facilitated discussions were structure to address the unique barriers to BRT implementation on the streets of dense and/or highly congested large urban centers. Three major themes were the focus of the workshops: Network, Route and Street Design, Traffic Operations, and BRT as a Driver of Economic Development; Building Political, Interagency and Stakeholder Support. The results of the workshops make clear that better public transportation in general and BRT in particular can be cost-effective and useful tools for improving transportation, the environment and for restoring the livability of America‘s large cities.

Objective. To test the effect of Massachusetts Medicaid's (MassHealth) hospital-based pay-for-performance (P4P) program, implemented in 2008, on quality of care for pneumonia and surgical infection prevention (SIP). Data. Hospital Compare process of care quality data from 2004 to 2009 for acute care hospitals in Massachusetts (N=62) and other states (N=3,676) and American Hospital Association data on hospital characteristics from 2005. Study Design. Panel data models with hospital fixed effects and hospital-specific trends are estimated to test the effect of P4P on composite quality for pneumonia and SIP. This base model is extended to control for the completeness of measure reporting. Further sensitivity checks include estimation with propensity-score matched control hospitals, excluding hospitals in other P4P programs, varying the time period during which the program was assumed to have an effect, and testing the program effect across hospital characteristics. Principal Findings. Estimates from our preferred specification, including hospital fixed effects, trends, and the control for measure completeness, indicate small and nonsignificant program effects for pneumonia (-0.67 percentage points, p>.10) and SIP (-0.12 percentage points, p>.10). Sensitivity checks indicate a similar pattern of findings across specifications. Conclusions. Despite offering substantial financial incentives, the MassHealth P4P program did not improve quality in the first years of implementation.

This study capitalizes on recent advances in the reliable and valid measurement of classroom-level social processes known to influence children's social–emotional and academic development and addresses a number of limitations in our current understanding of teacher- and intervention-related impacts on elementary school classroom processes. A cluster randomized controlled trial design was employed to (a) examine whether teacher social–emotional functioning forecasts differences in the quality of 3rd-grade classrooms, (b) test the experimental impact of a school-based social–emotional learning and literacy intervention on the quality of classroom processes controlling for teacher social–emotional functioning, and (c) examine whether intervention impacts on classroom quality are moderated by these teacher-related factors. Results indicated (a) positive effects of teachers' perceived emotional ability on classroom quality; (b) positive effects of the 4Rs Program on overall classroom quality, net of teacher social–emotional functioning indicators; and (c) intervention effects that are robust to differences in these teacher factors. These findings support and extend recent research examining intervention-induced changes in classroom-level social processes fundamental to positive youth development.

We examine the diffusion of sustainable planning and design concepts into neighbourhood development projects, based on findings of a survey of planners in all 180 cities of five Southern California counties. Sustainable neighbourhood development has particular significance in Southern California owing to the regions’s rapid growth. We compare ‘typical’ and ‘innovative’ neighbourhood developments to determine whether sustainable planning and design concepts are being incorporated in these projects. Although planners agree that ‘innovative’ projects are more likely than ‘typical’ projects to incorporate sustainable planning and design concepts, sustainability is not a high priority even in innovative neighbourhood projects. Our respondents identified significant barriers to and limited opportunities for encouraging sustainable neighbourhood development. These trends in planning and design appear likely to continue unless strong policy and other mechanisms are adopted to encourage sustainable neighbourhood development. The paper concludes with recommendations to promote more sustainable neighbourhood development.

BACKGROUND:

Tetraethyl lead was phased out of gasoline in Uganda in 2005. Recent mitigation of an important source of lead exposure suggests examination and re-evaluation of the prevalence of childhood lead poisoning in this country. Ongoing concerns persist about exposure from the Kiteezi landfill in Kampala, the country's capital.

OBJECTIVES:

We determined blood lead distributions among Kampala schoolchildren and identified risk factors for elevated blood lead levels (EBLLs; >or= 10 microg/dL). Analytical approach: Using a stratified, cross-sectional design, we obtained blood samples, questionnaire data, and soil and dust samples from the homes and schools of 163 4- to 8-year-old children representing communities with different risks of exposure.

RESULTS:

The mean blood lead level (BLL) was 7.15 microg/dL; 20.5% of the children were found to have EBLL. Multivariable analysis found participants whose families owned fewer household items, ate canned food, or used the community water supply as their primary water source to have higher BLLs and likelihood of EBLLs. Distance < 0.5 mi from the landfill was the factor most strongly associated with increments in BLL (5.51 microg/dL, p < 0.0001) and likelihood of EBLL (OR = 4.71, p = 0.0093). Dust/soil lead was not significantly predictive of BLL/EBLL.

CONCLUSIONS:

Lead poisoning remains highly prevalent among school-age children in Kampala. Confirmatory studies are needed, but further efforts are indicated to limit lead exposure from the landfill, whether through water contamination or through another mechanism. Although African nations are to be lauded for the removal of lead from gasoline, this study serves as a reminder that other sources of exposure to this potent neurotoxicant merit ongoing attention.

This paper investigates the causal effect of pedestrian environments on walking behavior and focuses on the issue of research design. The paper differentiates between two types of research designs:treatment-based and traveler-based. The first approach emphasizes the variation of the treatment (pedestrian environments), and generally compares distinct neighborhoods, such as urban vs. suburban or transit-oriented vs. auto-dependent. The second approach emphasizes the homogeneity of subject (pedestrians), and aims at the same pedestrian under different environments normally due to home relocation, or the improvement of pedestrian environments.

This paper presents a third method, following a traveler-based research design while providing the pedestrian multiple walking paths with different pedestrian environments.

At the turn of the twenty-first century, with the amount of money emigrants sent home soaring to new highs, governments around the world began searching for ways to capitalize on emigration for economic growth, and they looked to nations that already had policies in place. Morocco and Mexico featured prominently as sources of "best practices" in this area, with tailor-made financial instruments that brought migrants into the banking system, captured remittances for national development projects, fostered partnerships with emigrants for infrastructure design and provision, hosted transnational forums for development planning, and emboldened cross-border political lobbies.

In Creative State, Natasha Iskander chronicles how these innovative policies emerged and evolved over forty years. She reveals that the Moroccan and Mexican policies emulated as models of excellence were not initially devised to link emigration to development, but rather were deployed to strengthen both governments' domestic hold on power. The process of policy design, however, was so iterative and improvisational that neither the governments nor their migrant constituencies ever predicted, much less intended, the ways the new initiatives would gradually but fundamentally redefine nationhood, development, and citizenship. Morocco's and Mexico's experiences with migration and development policy demonstrate that far from being a prosaic institution resistant to change, the state can be a remarkable site of creativity, an essential but often overlooked component of good governance.

Objective: To report experimental impacts of a universal, integrated school-based intervention in social–emotional learning and literacy development on change over 1 school year in 3rd-grade children's social–emotional, behavioral, and academic outcomes. Method: This study employed a school-randomized, experimental design and included 942 3rd-grade children (49% boys; 45.6% Hispanic/Latino, 41.1% Black/African American, 4.7% non-Hispanic White, and 8.6% other racial/ethnic groups, including Asian, Pacific Islander, Native American) in 18 New York City public elementary schools. Data on children's social–cognitive processes (e.g., hostile attribution biases), behavioral symptomatology (e.g., conduct problems), and literacy skills and academic achievement (e.g., reading achievement) were collected in the fall and spring of 1 school year. Results: There were main effects of the 4Rs Program after 1 year on only 2 of the 13 outcomes examined. These include children's self-reports of hostile attributional biases (Cohen's d = 0.20) and depression ( d = 0.24). As expected based on program and developmental theory, there were impacts of the intervention for those children identified by teachers at baseline with the highest levels of aggression ( d = 0.32–0.59) on 4 other outcomes: children's self-reports of aggressive fantasies, teacher reports of academic skills, reading achievement scaled scores, and children's attendance. Conclusions: This report of effects of the 4Rs intervention on individual children across domains of functioning after 1 school year represents an important first step in establishing a better understanding of what is achievable by a schoolwide intervention such as the 4Rs in its earliest stages of unfolding. The first-year impacts, combined with our knowledge of sustained and expanded effects after a second year, provide evidence that this intervention may be initiating positive developmental cascades both in the general population of students and among those at highest behavioral risk.

High-speed rail lines have been built and proposed in numerous countries throughout the world. The advantages of such lines are a higher quality of service than competing modes (air, bus, auto, conventional rail), potentially faster point-to-point times depending on specifiÂc locations, faster
loading and unloading times, higher safety than some modes, and lower labor costs. The disadvantage primarily lies in higher fixed costs, potentially higher energy costs than some competing modes, and higher noise externalities. Whether the net benefiÂts outweigh the net costs is an empirical question that awaits determination based on location specifiÂc factors, project costs, local demand, and network effects (depending on what else in the network exists). The optimal network design problem is hard (in the mathematical sense of hard, meaning optimal solutions are hard to fiÂnd because of the combinatorics of the possible different network configurations), so heuristics and human judgment are used to design networks.

Objective
To determine whether a diabetes case management telemedicine intervention reduced healthcare expenditures, as measured by Medicare claims, and to assess the costs of developing and implementing the telemedicine intervention.
Design
We studied 1665 participants in the Informatics for Diabetes Education and Telemedicine (IDEATel), a randomized controlled trial comparing telemedicine case management of diabetes to usual care. Participants were aged 55 years or older, and resided in federally designated medically underserved areas of New York State.
Measurements
We analyzed Medicare claims payments for each participant for up to 60 study months from date of randomization, until their death, or until December 31, 2006 (whichever happened first). We also analyzed study expenditures for the telemedicine intervention over six budget years (February 28, 2000- February 27, 2006).
Results
Mean annual Medicare payments (SE) were similar in the usual care and telemedicine groups, $9040 ($386) and $9669 ($443) per participant, respectively (p>0.05). Sensitivity analyses, including stratification by censored status, adjustment by enrollment site, and semi-parametric weighting by probability of dropping-out, rendered similar results. Over six budget years 28 821 participant/months of telemedicine intervention were delivered, at an estimated cost of $622 per participant/month.
Conclusion
Telemedicine case management was not associated with a reduction in Medicare claims in this medically underserved population. The cost of implementing the telemedicine intervention was high, largely representing special purpose hardware and software costs required at the time. Lower implementation costs will need to be achieved using lower cost technology in order for telemedicine case management to be more widely used.

Patients with frequent hospitalizations generate a disproportionate share of hospital visits and costs. Accurate determination of patients who might benefit from interventions is challenging: most patients with frequent admissions in 1 year would not continue to have them in the next. Our objective was to employ a validated regression algorithm to case-find Medicaid patients at high-risk for hospitalization in the next 12 months and identify intervention-amenable characteristics to reduce hospitalization risk. We obtained encounter data for 36,457 Medicaid patients with any visit to an urban public hospital from 2001 to 2006 and generated an algorithm-based score for hospitalization risk in the subsequent 12 months for each patient (0 = lowest, 100 = highest). To determine medical and social contributors to the current admission, we conducted in-depth interviews with high-risk hospitalized patients (scores >50) and analyzed associated Medicaid claims data. An algorithm-based risk score >50 was attained in 2,618 (7.2%) patients. The algorithm’s positive predictive value was equal to 0.67. During the study period, 139 high-risk patients were admitted: 60 met inclusion criteria and 50 were interviewed. Fifty-six percent cited the Emergency Department as their usual source of care or had none. Sixty-eight percent had >1 chronic medical conditions, and 42% were admitted for conditions related to substance use. Sixty percent were homeless or precariously housed. Mean Medicaid expenditures for the interviewed patients were $39,188 and $84,040 per patient for the years immediately prior to and following study participation, respectively. Findings including high rates of substance use, homelessness, social isolation, and lack of a medical home will inform the design of interventions to improve community-based care and reduce hospitalizations and associated costs.

There is a lack of consensus as to whether the relationship between the built environment and travel is causal and, if it is, the extent of this causality. This problem is largely caused by inappropriate research designs adopted in many studies. This paper proposes a new method (based on path choice) to investigate the causal effect of the pedestrian environment on the utility of walking. Specifically, the paper examines how the pedestrian environment affects subway commuters' egress path choice from a station to their workplaces in downtown Boston. The path-based measure is sensitive enough to capture minor differences in the environment experienced by pedestrians. More importantly, path
choice is less likely to correlate with job and housing location choices, and therefore largely avoids the self-selection problem. The results suggest that the pedestrian environment can significantly affect a person's walking experience and the utility of walking along a path.

Background: Care coordination is essential to effective chronic care, but knowledge of processes by which health care professionals coordinate their activities when caring for chronically ill patients is limited. Electronic health records (EHRs) are expected to facilitate coordination of care, but whether they do so completely-and under what conditions-is not well understood.

Objectives: To identify processes by which providers worked together to provide care using an EHR and to examine factors supporting coordination of care.

Design: Qualitative multiple case study in 4 sites with diverse care delivery models, using semi-structured in-person interviews with 46 physicians and staff and telephone interviews with 65 adult patients with diabetes.

Setting: Four Kaiser Permanente medical centers.

Results: Across all care models, physicians and staff acted sequentially as loosely coupled links in a chain, relying on EHR-enabled informational continuity to coordinate care. Of providers, 94% were highly satisfied with the availability of patient information, and 89% of patients were satisfied or very satisfied with the coordination of their care. However, 6 of 65 patients described experiences of uncoordinated care, and 5 of 12 primary care providers identified coordination issues. These pertained to unreconciled differences of opinion, conflicting role expectations, and discipline-specific views of patient needs.

Conclusions: Diabetes care can be coordinated across providers, but some coordination issues persist despite the informational continuity provided by an EHR. Multidisciplinary care teams should be alert to potential coordination challenges, and possible solutions should be explored, including longitudinal care planning with structured communications at key points in care.

Wiki Government shows how to bring innovation to government. In explaining how to enhance political institutions with the power of networks, it offers a fundamental rethinking of democracy in the digital age. Collaborative democracy-government of the people, by the people, for the people-is an old dream. Today, Wiki Government shows how technology can make that dream a reality. In this thought-provoking book, Beth Simone Noveck illustrates how collaborative democracy strengthens public decisionmaking by connecting the power of the many to the work of the few. Equally important, she provides a step-by-step demonstration of how collaborative democracy can be designed, opening policymaking to greater participation. "Wiki Government" tells the story behind one of the most dramatic public sector innovations in recent years - inviting the public to participate in the patent examination process. Patent examiners usually work in secret, cut off from essential information and racing against the clock to master arcane technical claims. The Peer-to-Patent project radically transformed this process by allowing anyone with Internet access to collaborate with the agency in reviewing patent applications. "Wiki Government" describes how a far-flung team of technologists, lawyers, and policymakers pried open a tradition-bound agency's doors. Noveck explains how she brought both fiercely competitive companies and risk-averse bureaucrats on board. She discusses the design challenges the team faced in creating software to distill online collaboration into useful expertise, not just rants or raves. And she explains how law, policy, and technology can be revamped to help government work in more open and participatory ways in a wide range of policy arenas, including education and the environment.

Purpose – Recent years have witnessed a national policy shift towards involving state and local police in enforcing US federal immigration laws. Critics argue that involving local police in enforcing immigration law will decrease Latino(a) and immigrant residents' willingness to report crime and their cooperation with the police, and will also increase racial profiling and negatively impact documented and undocumented residents. This paper aims to examine Latino(a) residents' perceptions of the police before and after an extended local controversy about involving police in enforcing immigration laws in Costa Mesa, California.

Design/methodology/approach – The paper reports findings of a before-and-after study in the Westside area of the City of Costa Mesa, California. Methods include Spanish and English language telephone surveys of Latino(a) and non-Latino(a) residents in the Westside (n=169 respondents before and n=91 respondents after), conducted in 2002 and in 2007.

Findings – In survey responses, Latino(a) residents report that they are more likely to be stopped by the police in 2007 compared to 2002. Latino(a) respondents also have more negative perceptions of the police, find the police less helpful, feel less accepted in the community, and say that they are less likely to report crimes after the controversy, compared to before.

Originality/value – The findings show the importance of policies that encourage cooperation with and trust of the police. These results can help inform cities about the potential impacts of involving local police in immigration enforcement.

This article uses the evaluation of the Robert Wood Johnson Foundation’s (RWJF) Urban Health Initiative (UHI), a 10-year effort to improve health and safety outcomes in distressed cities, to demonstrate the strength of an evaluation design that integrates theory of change and quasiexperimental
approaches, including the use of comparison cities. This paper focuses on the later stages of implementation and, especially, our methods for estimating program impacts. While the theory of change was used to make preliminary identification of intended outcomes, we used the sites’ plans and early implementation to refine this list and revisit our strategy for estimating impacts. Using our integrated design, differences between program and comparison cities are considered impacts only if they were predicted by program theory, local plans for action, and early implementation. We find small, measurable changes in areas of greatest programmatic effort. We discuss the importance of the integrated design in identifying impacts.

Research on urban design and walking often emphasizes macro-scale features of the physical environment, such as block length and number of intersections, that can be measured remotely using GIS and or aerial photographs. In contrast, urban designers emphasize the importance of micro-scale features in individuals' use and experience of neighbourhood environments. This paper moves beyond examining correlations of individual built environment features and walking, to begin to test proposals about which composite characteristics of the built environment (safety, comfort, etc.) may have the greatest impact on walking. Several urban design characteristics of 11 neighbourhoods throughout California were observed. Self-report, adult walking data on the number and types of walking trips were obtained from surveys administered to parents of 3rd–5th graders. Urban design features related to both accessibility and safety are associated with the amount of walking that adults do in their neighbourhoods. Grouping related urban design variables into indices provides some clarity as to how the built environment may impact walking. Safety emerges as the most important built environment characteristic (of those tested), related to both destination and recreational walking.

Building on decades of authoritative scholarship, this completely updated text continues to offer accessible, carefully crafted, and straightforward coverage of the foundations of American politics, as well consistent focus on the achievements of a government by the people

In an increasingly cynical world, GBTP emphasizes that politics matters and encourages, motivates, and even inspires students–with accounts of individual and collective acts of courageousness, intellect, and integrity in the political arena–to be effective and informed citizens.  

With each chapter now framed by nationally-selected learning objectives and chapter mastery self-tests, several compelling new features, and an all new contemporary design, this thoroughly updated Twenty-Third Edition continues in the book’s long tradition for excellence.  As we enter this very complex political era, there is no more reliable or more relevant text to help you advance your students from being simple onlookers to knowledgeable participants in the American political experience.

Segregation: The Rising Costs for America documents how discriminatory practices in the housing markets through most of the past century, and that continue today, have produced extreme levels of residential segregation that result in significant disparities in access to good jobs, quality education, homeownership attainment and asset accumulation between minority and non-minority households.The book also demonstrates how problems facing minority communities are increasingly important to the nations long-term economic vitality and global competitiveness as a whole. Solutions to the challenges facing the nation in creating a more equitable society are not beyond our ability to design or implement, and it is in the interest of all Americans to support programs aimed at creating a more just society.The book is uniquely valuable to students in the social sciences and public policy, as well as to policy makers, and city planners.

This paper investigates the impact of pedestrian environments on walking behavior, and the related choice of travel path for transit riders. Activity logs from trip surveys combined with transit-route and land-use information are used to fit discrete-choice models of how riders choose among multiple paths to downtown destinations. The work illustrates (1) how the quality of pedestrian environments along transit egress paths affects transfers inside a transit system, and (2) how the impedance of transferring affects egress walking path choices. The use of GIS techniques for path-based spatial analysis is key to understanding the impact of pedestrian environments on walking behavior at the street level. The results show that desirable pedestrian environments encourage transit riders to choose paths that are ‘friendlier', even if they involve more walking after leaving transit. Policy implications for land-use planning and transit service planning are discussed.

In this essay, we explore how the Environmental Protection Agency (EPA) might use technology to improve the agency's level of scientific expertise and to obtain useful information sooner to inform EPA policymaking. By creating a self-reinforcing collaboration between government and networked publics, new web-based tools could help produce change within government and without - namely governmental decisions informed by better data obtained through citizen participation and civic action coordinated with governmental priorities. The agency has the opportunity to help break the logjam of environmental policymaking by developing transparent and participatory mechanisms for expert citizen participation. The key insight is not to throw open the floodgates to undifferentiated public input, but to design group-based processes that enable online communities to collaborate on finding and vetting information for agencies.

Objective. To identify strategies that facilitate readiness for local Institutional Review Board (IRB) review, in multicenter studies.

Study Setting. Eleven acute care hospitals, as they applied to participate in a foundation-sponsored quality improvement collaborative.

Study Design. Case series.

Data Collection/Extraction. Participant observation, supplemented with review of written and oral communications.

Principal Findings. Applicant hospitals responded positively to efforts to engage them in early planning for the IRB review process. Strategies that were particularly effective were the provisions of application templates, a modular approach to study description, and reliance on conference calls to collectively engage prospective investigators, local IRB members, and the evaluation/national program office teams. Together, these strategies allowed early identification of problems, clarification of intent, and relatively timely completion of the local IRB review process, once hospitals were selected to participate in the learning collaborative.

Conclusions. Engaging potential collaborators in planning for IRB review may help expedite and facilitate review, without compromising the fairness of the grant-making process or the integrity of human subjects protection.

Urban design is frequently identified as a tool to reduce crime and improve traffic safety in urban neighborhoods. In this “before” and “after” evaluation, we assess a major urban revitalization in the Minnie Street neighborhood in Santa Ana, California, in terms of its impacts on crime and pedestrian safety. Conclusions suggest that urban design can help to improve crime and traffic safety in poor urban neighborhoods but that other factors must also be considered.

PURPOSE:
Focusing on guidelines governing medication use in nursing homes, in this study we explore the ways in which clinical professionals perceive and apply treatment guidelines, and how interprofessional interactions shape the delivery of pharmacotherapies to residents.

DESIGN AND METHODS:
Seventeen semistructured interviews were conducted with physicians, nursing staff, and consultant pharmacists in 4 purposefully selected nursing homes in Michigan.

RESULTS:
Perceptions of guidelines varied by clinical groups, with physicians perceiving them as reference tools, whereas nurses and consultant pharmacists saw them as rules to which clinical practices should adhere. Key external factors including resident and family demands, economic constraints, limited face-to-face contact, and the organizational hierarchy further drove clinical personnel to use guidelines differently and induced interprofessional conflicts. These negative interactions make facility-wide guideline adherence challenging by undermining the regulatory role of consultant pharmacists.

IMPLICATIONS:
This study provides important insight on work-related factors that hinder the implementation of treatment guidelines in nursing homes.

Purpose – The paper explores an emerging challenge for large public-sector bureaucracies: developing information and performance measurement systems that support anti-corruption efforts.
Design – An analytical framework linking functions and contexts of performance measurement to anti-corruption requirements is presented. The framework is used to explore a case study of the World Bank’s ongoing efforts to strengthen anti-corruption information systems in Indonesia.
Findings – A range of organizations are increasingly turning to performance measurement systems to fulfill several functions related to organizational integrity: to hold organization’s accountable for reaching publicly stated standards of fiduciary responsibility and corruption control; to identify vulnerable operational points in multi-faceted public enterprises; and to facilitate organizational learning regarding ‘what works’. Yet corruption is difficult to measure, and corruption vulnerabilities often arise from informal practices, insufficient incentives for enforcement or adherence to standards, and managerial blindspots. Enhanced information systems need to be coupled with effective and multi-directional accountability arrangements in order for performance measurement to contribute effectively to corruption control.
Practical implications – Improved information systems and a reassessment of managerial incentives and attitudes are both essential in order to reduce organizational vulnerability to corruption and to the public backlash that follows in the wake of corruption scandals.
Originality/value – Focus on an emerging area of performance management likely to gain increasing visibility as large bureaucracies attempt to institutionalize public commitments to high anti-corruption standards

Community-Driven Development (CDD) projects have motivated both large amounts of funding from international development agencies and a number of general critiques centering on the potential susceptibility of decentralized projects to local elite capture. Drawing on case analysis and surveys fielded in 250 Indonesian sub-districts, this paper subjects the design logic of a CDD project to close empirical testing. Results suggest that while CDD projects can help create spaces for a broader range of elite and non-elite community leaders to emerge, elite control of project decision-making is pervasive. However, its effects can be influenced by project-initiated accountability arrangements, such as democratic leadership selection.

Purpose: Focusing on guidelines governing medication use in nursing homes, in this study we explore the ways in which clinical professionals perceive and apply treatment guidelines, and how interprofessional interactions shape the delivery of pharmacotherapies to residents.

Design and Methods: Seventeen semistructured interviews were conducted with physicians, nursing staff, and consultant pharmacists in 4 purposefully selected nursing homes in Michigan.

Results: Perceptions of guidelines varied by clinical groups, with physicians perceiving them as reference tools, whereas nurses and consultant pharmacists saw them as rules to which clinical practices should adhere. Key external factors including resident and family demands, economic constraints, limited face-to-face contact, and the organizational hierarchy further drove clinical personnel to use guidelines differently and induced interprofessional conflicts. These negative interactions make facility-wide guideline adherence challenging by undermining the regulatory role of consultant pharmacists.

Implications: This study provides important insight on work-related factors that hinder the implementation of treatment guidelines in nursing homes.

Aims To assess the relative cost-effectiveness of lower versus higher cost prize-based contingency management (CM) treatments for cocaine abuse.

Design Cost-effectiveness analyses based on resource utilization, unit costs and outcomes from a previous CM efficacy trial.

Setting Two community-based treatment centers.

Participants Patients (n = 120) enrolled in out-patient treatment for cocaine abuse.

Intervention Random assignment to one of three 12-week treatment conditions: standard treatment (STD) alone or two variants of STD combined with prize based CM. In CM, drawing for prizes was available to those submitting drug-free urine samples and completing goal-related activities. There were two levels of pay-out (referred to as $80 versus $240) based on the potential value of prizes won.

Measurements Costs per participant associated with counseling utilization, urine and breathalyzer testing, and operation of the prize-drawing procedure were derived from a survey conducted at 16 clinics that had participated in CM studies. The three measures of effectiveness were: (1) longest duration of consecutive abstinence; (2) percentage completing treatment; and (3) percentage of samples drug-free.

Findings The higher magnitude CM produced outcomes at a lower per unit cost than did the lower magnitude prize CM treatment. This was the case for all three outcome measures examined and held across various assumptions in the sensitivity analysis.

Conclusions Cost-effectiveness analyses can inform policy decisions regarding selection of one treatment model over another. Decisions on adoption of new evidence-based treatments would be aided by more information on society's willingness to pay for incremental gains in effectiveness.

Each year the federal individual income tax code provides over $500 billion worth of incentives intended to encourage socially beneficial activities, such as charitable contributions, homeownership, and education. This is an enormous investment, exceeding our budget for national defense and amounting to about 4% of Gross Domestic Product (GDP). The design of these tax incentives is an immensely important policy matter. Yet despite their efficiency rationale, little attention has been paid to the question of what economic efficiency implies about the form these tax incentives should take.

Context The Centers for Medicare & Medicaid Services (CMS) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) measure and report quality process measures for acute myocardial infarction (AMI), but little is known about how these measures are correlated with each other and the degree to which inferences about a hospital's outcomes can be made from its performance on publicly reported processes.

Objective To determine correlations among AMI core process measures and the degree to which they explain the variation in hospital-specific, risk-standardized, 30-day mortality rates.

Design, Setting, and Participants We assessed hospital performance in the CMS/JCAHO AMI core process measures using 2002-2003 data from 962 hospitals participating in the National Registry of Myocardial Infarction (NRMI) and correlated these measures with each other and with hospital-level, risk-standardized, 30-day mortality rates derived from Medicare claims data.

Main Outcome Measures Hospital performance on AMI core measures; hospital-specific, risk-standardized, 30-day mortality rates for AMI patients aged 66 years or older.

Results We found moderately strong correlations (correlation coefficients ≥0.40; P values <.001) for all pairwise comparisons between beta-blocker use at admission and discharge, aspirin use at admission and discharge, and angiotensin-converting enzyme inhibitor use, and weaker, but statistically significant, correlations between these medication measures and smoking cessation counseling and time to reperfusion therapy measures (correlation coefficients <0.40; P values <.001). Some process measures were significantly correlated with risk-standardized, 30-day mortality rates (P values <.001) but together explained only 6.0% of hospital-level variation in risk-standardized, 30-day mortality rates for patients with AMI.

Conclusions The publicly reported AMI process measures capture a small proportion of the variation in hospitals' risk-standardized short-term mortality rates. Multiple measures that reflect a variety of processes and also outcomes, such as risk-standardized mortality rates, are needed to more fully characterize hospital performance.

Abstract The U.S. faces rising rates of overweight and obesity. Active living-urban planning and design to promote physical activity?has emerged as a strategy to combat growing obesity. The active living movement initially targeted mostly middle-class, suburban communities. In this article, I argue that planning for active living must especially address low-income, Black, and Latino communities, where obesity and related health risks are greatest and resources least available. First I review the problem of obesity and related health conditions among low-income, Black, and Latino populations in the U.S., and identify the role of insufficient physical activity in this problem. I then examine physical environment and other factors that shape opportunities for physical activity in low-income communities and communities of color. Finally, I identify strategies that may help to promote active living in urban settings to better serve these communities. Abstract The U.S. faces rising rates of overweight and obesity. Active living-urban planning and design to promote physical activity?has emerged as a strategy to combat growing obesity. The active living movement initially targeted mostly middle-class, suburban communities. In this article, I argue that planning for active living must especially address low-income, Black, and Latino communities, where obesity and related health risks are greatest and resources least available. First I review the problem of obesity and related health conditions among low-income, Black, and Latino populations in the U.S., and identify the role of insufficient physical activity in this problem. I then examine physical environment and other factors that shape opportunities for physical activity in low-income communities and communities of color. Finally, I identify strategies that may help to promote active living in urban settings to better serve these communities.

Objective: To use publicly available secondary data to assess the impact of Brazil's Family Health Program on state level infant mortality rates (IMR) during the 1990s.

Design: Longitudinal ecological analysis using panel data from secondary sources. Analyses controlled for state level measures of access to clean water and sanitation, average income, women's literacy and fertility, physicians and nurses per 10 000 population, and hospital beds per 1000 population. Additional analyses controlled for immunisation coverage and tested interactions between Family Health Program and proportionate mortality from diarrhoea and acute respiratory infections.

Setting: 13 years (1990-2002) of data from 27 Brazilian states.

Main results: From 1990 to 2002 IMR declined from 49.7 to 28.9 per 1000 live births. During the same period average Family Health Program coverage increased from 0% to 36%. A 10% increase in Family Health Program coverage was associated with a 4.5% decrease in IMR, controlling for all other health determinants (p<0.01). Access to clean water and hospital beds per 1000 were negatively associated with IMR, while female illiteracy, fertility rates, and mean income were positively associated with IMR. Examination of interactions between Family Health Program coverage and diarrhoea deaths suggests the programme may reduce IMR at least partly through reductions in diarrhoea deaths. Interactions with deaths from acute respiratory infections were ambiguous.

Conclusions: The Family Health Program is associated with reduced IMR, suggesting it is an important, although not unique, contributor to declining infant mortality in Brazil. Existing secondary datasets provide an important tool for evaluation of the effectiveness of health services in Brazil.

This essay focuses on the design of insurance products for poor customers. Several promising innovations are described: credit life insurance, health insurance partnerships, and weather insurance. Each was created to serve populations that were previously unserved, and workable institutional solutions are emerging. The next step must be to shift from the question of what creates workable institutions to the question of how to refine designs to best serve low-income populations. In doing so, current approaches must be reassessed in order to most improve clients’ lives and to avoid doing unintended harm.

This paper contributes to the literature on information systems in crisis management by providing an overview of
emerging technologies for sensing and recording sociological data about disasters. These technologies are transforming our capacity to gather data about what happens during disasters, and our ability to reconstruct the social dynamics of affected communities. Our approach takes a broad review of disaster research literature, current research efforts and new reports from recent disasters, especially Hurricane Katrina and the Indian Ocean Tsunami. We forecast that sensor networks will revolutionize conceptual and empirical approaches to research in the social sciences, by providing unprecedented volumes of high-quality data on movements, communication and response activities by both formal and informal actors. We conclude with a set of recommendations to designers of crisis management information systems to design systems that can support social science research, and argue for the inclusion of post-disaster social research as a design consideration in such systems.

The Collaborative raises three areas in which more dialogue would be useful. First, they express a desire for more data about how I was seen by my informants of color. They use that point to raise broader questions about validity: How can I, as a white person, know what is not being said by my informants of color? How can I be sure that my informants were candid with me, given the ‘strong taboos that prohibit revealing oneself . . . to the white world'? Second, they point out that my dissertation research was not emancipatory or mutual: it was a relatively traditional qualitative design, with a clear demarcation between researcher and researched. Finally, they raise the concept of ‘critical humility' and the spirit of inquiry in doing this work. I will address each of these areas in turn.

Implementation of anti-corruption programs is plagued by a paradox: the very actors posited to be the source of the problem are those most critical to implementation success. This paper presents a framework for understanding the large gaps that exist between policy intentions and outcomes in anti-corruption programs. It applies this to ‘grassroots democratization’ as an anti-corruption initiative in Vietnam, a high-profile policy mandating greater transparency in local budget use and participation in decisionmaking. Local leaders in this case face weak incentives for implementation that stem from both poor policy design and local institutional environments. But as with many anti-corruption programs in adverse environments, potential exists for the initiative to
provide tools with which reform-minded leaders and social groups can challenge local governance practices in unanticipated ways.

Senator Bill First, the majority leader, has often invoked the founding fathers to make his case against delaying tactics like the filibuster, especially when such tactics allow a small number of senators to create what he calls "a tyranny of the minority." But he has shown almost no interest in the founders' similar concerns about tactics that accelerate Senate action, even when those tactics enable a handful of senators to effectively deny the chamber the possibility of reading a bill, let alone debate it. There is plenty of minority tyranny, for example, in the conference committees that Congress uses to spur legislative agreement between the two chambers. Such committees clearly bypass the founders' inefficient back-and-forth in which the House and Senate are supposed to trade versions of legislation until they finally reach agreement. These committees have become more powerful over the years, in no small part because Congress stopped instructing them to stay within the four corners of the versions of legislation at issue. In the 2003 conference over President Bush's energy bill, which eventually failed, conferees added $277 million in subsidies for environmentally friendly shopping malls, including one in Shreveport, La., that would have included a Hooters restaurant. As President Ronald Reagan once said, an apple and an orange could go into a conference committee and come out a pear. There is also enormous opportunity for minority tyranny in the writing of omnibus bills, another legislative accelerant the founders might view as a violation of their constitutional design. Employed after the Civil War to handle the onslaught of private pension bills for disabled veterans, omnibus bills were not used for appropriations until 1950. Since then, they have become a commonplace vehicle for packaging everything from spending bills to highway projects. Last year's $388 billion omnibus bill not only ran more than 1,600 double-sided pages and weighed 14 pounds, it arrived on the House and Senate floor only hours ahead of passage. No wonder members missed the provision that allowed Congressional staff members to review the tax returns of individual taxpayers. Although Mr. Frist promised that Congress would work on reforming the use of omnibus bills, filibuster reform has taken precedence.

Mass transit is a critical infrastructure of urban environments worldwide. The public uses it extensively, with roughly 9 billion mass transit trips occurring annually in the United States alone according to the U.S. Department of Transportation data. Its benefits per traveler include lower emissions of air pollutants and energy usage and high speeds and safety records relative to many other common modes of transportation that contribute to human health and safety. However, mass transit is vulnerable to intrusions that compromise its use and the realization of the important benefits it brings. These intrusions pertain to physical conditions, security, external environmental conditions, and equity. The state of the physical condition of transit facilities overall has been summarized in the low ratings the American Society of Civil Engineers gives to mass transit, and the large dollar estimates to maintain existing conditions as well as to bring on new improvements, which are, however, many times lower than investments estimated for roadways. Security has become a growing issue, and numerous incidents point to the potential for threats to security in the US. External environmental conditions, such as unexpected inundations of water and electric power outages also make transit vulnerable. Equity issues pose constraints on the use of transit by those who cannot access it. Transit has shown a remarkable ability to rebound after crises, most notably after the September 11, 2001 attacks on the World Trade Center, due to a combination of design and operational features of the system. These experiences provide important lessons that must be captured to provide proactive approaches to managing and reducing the consequences of external factors that impinge negatively on transit.

The Resolving Conflict Creatively Program (RCCP) is one of the oldest and largest school-based conflict resolution programs in the United States. Beginning in 1994, we planned and implemented a rigorous scientific evaluation of the RCCP, involving over 350 teachers and 11,000 children from 15 public elementary schools in New York City. In this chapter, we describe the RCCP, explain the rationale for and design of the study, summarize the major results related to the program's impact on children's trajectories of social and emotional learning (SEL) and academic achievement, and discuss the implications of these findings for research, practice, and policy.

Managers of a healthcare organization have numerous demands on their time, their skills, their knowledge, and their budgets. They are responsible for adapting to change, managing their office, making effective decisions, among countless other tasks.

This text�newly revised to include readings, commentary, and cases�offers a bridge from management theory to the actual world of healthcare management.

Throughout its past editions, Health Services Management has featured the best literature on health services management to help readers understand the role of the manager, organizational design and control, the blending of organization and health professionals, change (adaptation), and responsiveness (accountability). This new edition continues that effort, and features new readings.

The cases take place in a variety of organizations, including a faculty practice, a neighborhood health center, a small rural hospital, an HMO, as well as a variety of other settings.

Managers of a healthcare organization have numerous demands on their time, their skills, their knowledge, and their budgets. They are responsible for adapting to change, managing their office, making effective decisions, among countless other tasks. This text-newly revised to include readings, commentary, and cases-offers a bridge from management theory to the actual world of healthcare management that will help your students learn the role of manager in a healthcare organization.

Throughout its past editions, Health Services Management has featured the best literature on health services management to help learners understand the role of the manager, organizational design and control, the blending of organization and health professionals, change (adaptation), and responsiveness (accountability). This new edition continues that effort, and features new readings and classroom-tested cases.

The cases take place in a variety of organizations, including a faculty practice, a neighborhood health center, a small rural hospital, an HMO, as well as a variety of other settings. This book will prepare your future managers for the multitude of healthcare settings they could face in their careers.

The results-oriented management reforms fostered by the New Public Management movement are often argued to emphasize the search for efficiency, quality and other typical market values at the expense of democratic accountability. On the other hand, challenging this view, some authors claim that results-based management reforms have the potential to enhance political accountability and representative democracy. There is however, limited empirical evidence of this relationship. This article uses some of the findings from a comparative study of public management evaluation systems in four Latin American countries to illuminate this relationship in practice. We discuss the fact that, in two of the four countries surveyed, the design features of the new systems were based on the explicit search for increased political accountability and the deepening of democracy. We also discuss the possible causes for the finding that the outcome and performance information generated is not being applied for decision-making purposes yet, as expected.

Study objective: The study tests the extent to which primary care physician supply (office based primary care physicians per 10 000 population) moderates the association between social inequalities and infant mortality and low birth weight throughout the 50 states of the USA.

Design: Pooled cross sectional, time series analysis of secondary data. Analyses controlled for state level education, unemployment, racial/ethnic composition, income inequality, and urban/rural differences. Contemporaneous and time lagged covariates were modelled.

Setting: Eleven years (1985-95) of data from 50 US states (final n = 549 because of one missing data point).

Main results: Primary care was negatively associated with infant mortality and low birth weight in all multivariate models (p<0.0001). The association was consistent in contemporaneous and time lagged models. Although income inequality was positively associated with low birth weight and infant mortality (p<0.0001), the association with infant mortality disappeared with the addition of sociodemographic covariates.

Conclusions: In US states, an increased supply of primary care practitioners-especially in areas with high levels of social disparities-is negatively associated with infant mortality and low birth weight.

Indonesia is currently facing some severe challenges, both in political affairs and in economic management. One of these challenges is the recently enacted decentralization program, now well underway, which promises to have some wide-ranging consequences. This edited volume presents original papers, written by a select group of widely recognized and distinguished scholars, that take a hard, objective look at the many effects of decentralization on economic and political issues in Indonesia. There are many questions about this program: how will it be implemented, is there capacity at the local level to implement its reforms, is there sufficient local political accountability to make it work, and how will the decentralization affect the broader program of economic growth and stabilization? Topics covered include: the historical and political dimensions of decentralization, its macroeconomic effects, its effects on poverty alleviation, the assignment of expenditure and revenue functions across levels of government, the design of transfers, the role of natural resource taxation and the effects of local government borrowing. An authoritative, comprehensive collection, Reforming Intergovernmental Fiscal Relations and the Rebuilding of Indonesia will be of interest to economists and policy makers as well as students of public finance, development, and Asian economics.

New Urbanism is increasingly applied to revitalize diverse urban neighborhoods. New Urbanism relies on an ideal of “community” that makes its suitability for these contexts questionable. This article examines the use of New Urbanism to revitalize neighborhoods with diverse populations, investigating the following concerns: (1) physical changes may not be the best solutions for the social problems that often face such neighborhoods, (2) New Urbanist ideas may have different meanings to different groups of neighborhood residents, (3) New Urbanist neighborhood renovation may displace low-income residents, and (4) New Urbanist participatory design processes may not accommodate diversity. The article presents findings from a case study of the Westside of the city of Costa Mesa, California. Recommendations suggest alternative planning and design strategies to support and reinvigorate diverse, urban neighborhoods.

This article critically reviews published literature on the relationship between income inequality and health outcomes. Studies are systematically assessed in terms of design, data quality, measures, health outcomes, and covariates analyzed. At least 33 studies indicate a significant association between income inequality and health outcomes, while at least 12 studies do not find such an association. Inconsistencies include the following: (1) the model of health determinants is different in nearly every study, (2) income inequality measures and data are inconsistent, (3) studies are performed on different combinations of countries and/or states, (4) the time period in which studies are conducted is not consistent, and (5) health outcome measures differ. The relationship between income inequality and health is unclear. Future studies will require a more comprehensive model of health production that includes health system covariates, sufficient sample size, and adjustment for inconsistencies in income inequality data.

Objective
To assess the contribution of primary care systems to a variety of health outcomes in 18 wealthy Organization for Economic Cooperation and Development (OECD) countries over three decades.

Data Sources/Study Setting
Data were primarily derived from OECD Health Data 2001 and from published literature. The unit of analysis is each of 18 wealthy OECD countries from 1970 to 1998 (total n=504).

Study Design
Pooled, cross-sectional, time-series analysis of secondary data using fixed effects regression.

Data Collection/Extraction Methods
Secondary analysis of public-use datasets. Primary care system characteristics were assessed using a common set of indicators derived from secondary datasets, published literature, technical documents, and consultation with in-country experts.

Principal Findings
The strength of a country's primary care system was negatively associated with (a) all-cause mortality, (b) all-cause premature mortality, and (c) cause-specific premature mortality from asthma and bronchitis, emphysema and pneumonia, cardiovascular disease, and heart disease (p<0.05 in fixed effects, multivariate regression analyses). This relationship was significant, albeit reduced in magnitude, even while controlling for macro-level (GDP per capita, total physicians per one thousand population, percent of elderly) and micro-level (average number of ambulatory care visits, per capita income, alcohol and tobacco consumption) determinants of population health.

Conclusions
(1) Strong primary care system and practice characteristics such as geographic regulation, longitudinality, coordination, and community orientation were associated with improved population health. (2) Despite health reform efforts, few OECD countries have improved essential features of their primary care systems as assessed by the scale used here. (3) The proposed scale can also be used to monitor health reform efforts intended to improve primary care.

Beth Weitzman and Diana Silver from New York University's Center for Health and Public Service Research offer their experience integrating a comparison group design into a theory of change approach.

After the terrorist attacks on the World Trade Center in New York City on September 11, 2001, the ability to rapidly restore transportation, power, water, and environmental services to users was absolutely critical, especially to those involved in the immediate search, rescue, and recovery operations. What better way could infrastructure serve its users-both emergency workers and the general public-than to be able to respond quickly in a crisis? The ability to provide these services required a degree of flexibility, often unanticipated and unplanned, that only became apparent as the response efforts unfolded. The capability of basic infrastructure service providers to respond to public needs for transportation, energy, communication, water, sanitation, and solid waste removal after the September 11th attacks was to a great extent influenced by the flexibility of the initial infrastructure design and management functions to respond to normal system disruptions and to extreme, but not necessarily terrorist-related, events.

Sound budget policy requires a clear understanding of the nature of fiscal problems and creative thinking in the design of solutions. The recent public debate about how to close
New York City's unprecedented budget gap falls short on both counts. The Citizens Budget Commission - a nonprofit, nonpartisan civic organization - has prepared this document to clear up a series of common misunderstandings that hinder the debate and to focus attention on the potential for significant savings by delivering City services more efficiently. The first part of the document identifies ten "myths" about the budget and provides the facts that dispel them. The second part presents five ideas that together
would save the City more than $1 billion annually. The ideas are based on research conducted by the Commission's staff and presented in greater detail in separate reports published by the Commission.

There is a large conceptual and empirical literature on intergovernmental fiscal transfers.1 Drawing on this work and examples from various countries, we provide in this chapter a broad overview of the theory and practice of intergovernmental transfers, with particular focus on developing countries. We begin with a review of the main objectives of intergovernmental transfers and the criteria used to evaluate them. We then consider the principal types of transfers and the mechanisms used to implement them. Given the common problem of fiscal disparities across subnational jurisdictions and the particular interest of Asian Development Bank in this topic, we also discuss the measurement of redistribution and equalization in theory and practice, one of the most difficult challenges in designing transfers. Finally, we examine the linkages between transfers and other major elements of the intergovernmental fiscal system, an important dimension of fiscal transfer design that often receives inadequate
attention. We conclude with some broad lessons about designing intergovernmental transfer systems in developing countries.

Community interventions are rare in the field of sexually transmitted disease (STD) control and prevention. The goals of the Gonorrhea Community Action Project are to design and implement interventions for the reduction of gonorrhea in high-prevalence areas and to increase the appropriateness and effectiveness of STD care in the participating communities. Key to conducting the formative research and developing the interventions was the creation of a community-academic-health department collaborative partnership. Using a staged model, this article presents a case study of collaboration development in the community of Harlem, New York.

Managers of a healthcare organization have numerous demands on their time, their skills, their knowledge, and their budgets. They are responsible for adapting to change, managing their office, making effective decisions, among countless other tasks.

This book, newly revised to include readings, commentary, and cases, offers a bridge from management theory to the actual world of healthcare management. Throughout its past editions, Health Services Management has featured the best literature on health services management to help readers understand the role of the manager, organizational design and control, the blending of organization and health professionals, change (adaptation), and responsiveness (accountability). This edition continues that effort, and features new readings.

This book of updated cases emphasizes a manager's need for skills in strategy, operations, and relations. To aid both professors and students, the cases are divided into the same categories as are used in Health Services Management: Readings and Commentary, Seventh Edition: role of the manager, control, organizational design, professional integration, adaptation, and accountability. All of the cases have been tested in the classroom.

This paper considers recent thinking on and experience with decentralization and local government reform in developing countries, primarily from the perspective of national policy. The paper begins by reviewing why decentralization has re-emerged as an important development trend and considers whether this is sensible. The third section examines why recent attempts to decentralize have not been particularly successful.  The fourth section selectively summarizes a few experiences from the 1990s in which attempts were made to overcome common obstacles to decentralization. The paper closes with a few modest lessons for the design and implementation of decentralization and local government reform programs.

The dramatic growth in the development and use of information technology (IT) has had an untold impact upon the nature and performance of the fundamental infrastructure systems that support our economy and social environment. The use of IT is no doubt already pervasive in these infrastructure systems from design and planning through operations and maintenance. IT has the potential to address many of the quality issues that infrastructure has faced, by providing detection capability for infrastructure condition, coordination of complex operations, and integration of multi-modal and multi-locational facilities to provide seamless services to consumers. Still to be understood are not only the opportunities IT provides (for example, in terms of improved performance) but also the barriers to its use (for example, in terms of IT and infrastructure compatibility). Moreover, little is known about how IT influences infrastructure and the social systems it supports. This white paper provides a background for the development of a research agenda that addresses both interrelationships between IT and infrastructure and its impacts ranging from infrastructure operations to social systems.

During the past decade, federal housing policy has shifted to recognize a key role for nonprofit housing providers in providing affordable housing. Two federal programs, Low-Income Housing Tax Credit and HOME, are now the primary federal housing production programs, and the legislation governing both programs provides explicit support for nonprofit providers of new housing. This article focuses on these two programs to document the change in emphasis, looking at the extent to which resources flow to nonprofit providers. We explicate the rationale for this shift and speculate on future federal policy toward nonprofits.

We find that both programs channeled sizable shares of their funding to nonprofits throughout the 1990s, in patterns consistent with program design. It is also possible that the scale and form of funding itself has affected the nonprofit sector. Changes in the funding of nonprofits have not been uniform spatially, and the nonprofit sector's share of such funding appears to have leveled off. As currently structured, these programs do little to simplify the complicated financial dealings and multiple sources of funding common among nonprofit housing providers. Shifts in policy priorities and emerging financial stresses may necessitate changes in federal policy toward the nonprofit sector.

How to secure an adequate measure of unity among citizens in a liberal democratic state? Versions of this question formed the brunt of communitarian critiques of liberalism over the past two decades. Most liberal respondents took aim in return at communitarians' own vision of a healthy political society, while others emphasized the shared values or purposes indigenous to the liberal tradition. Yet as the liberal/communitarian debate dissolves into a common center, it appears that this immense body of theoretical exchanges has left the problem of national union no closer to solution. Liberal theorists now affirm this issue's centrality; as Will Kymlicka writes, "[i]dentifying the bases of social unity in multinational states is... one of the most pressing tasks facing liberals today." Meanwhile, communitarians like Michael Sandel have come to acknowledge the importance of a national, not only neighborhood, sense of mutual trust and solidarity. But no coherent principled or practical unionist design has emerged from the two sides' convergence.

Study objectives: The purpose of this study was to confirm the validity of a brief screen for pediatric asthma in schools.

Background: Asthma is the most common chronic disease of childhood, yet the frequency with which this condition is recognized among school-aged children varies widely. Several methods are used to increase the accuracy of detection of asthma, but many are cumbersome and difficult to apply on a large scale.

Design: We elected to validate a five-question instrument, the Brief Pediatric Asthma Screen (BPAS), to screen for the presence of asthma among children attending school in Region 5 of the Chicago school district, where the schools report a 2.7% frequency of asthma. The questionnaire was distributed to the parents of grade-school children at the time of report-card pick-up.

Setting: A clinical assessment was performed on a selected group of children whose parents completed the questionnaire in a school and in a hospital outpatient clinic.

Participants: Of 4,147 questionnaires that we distributed, 1,796 (43%) were returned. We excluded 341 children (19% of the total sample) whose parents reported that they had been diagnosed with asthma. The remaining pool indicated that the children of 183 responders (10%) had symptoms suggestive of asthma, while 1,272 parents (71%) indicated that their children did not have symptoms of asthma.

Measurements and results: We selected 90 of the respondents who did not indicate that their children had a diagnosis of asthma. Of this group, 81 completed the validation, in which their responses suggested symptoms of asthma (n = 34) or no asthma symptoms (n = 47). The children of these respondents were given a blinded clinical evaluation consisting of history, physical examination, and spirometry. The survey demonstrated a sensitivity of 75% and a specificity of 81.2% for the presence of asthma among those who were unaware of the diagnosis.

Conclusions: The BPAS is brief, can be filled out by parents, and appears accurate in detecting asthma.

To develop and validate a measure of contemporary life stressors. STUDY SETTING: Three interview studies: Study 1 (pilot), 32 caregivers receiving case management services for a child with chronic illness; Study 2 (validation), 311 caregivers of children receiving general pediatric care at a university clinic; Study 3 (reliability), 17 caregivers of children with a complex medical diagnosis. STUDY DESIGN: Study 1: item development via discussions with case managers; piloted with caregivers. Study 2 examined psychometric properties of the measure and correlated it with the CES-D, a measure of depressive symptomatology and the PRQ85-Part 2, a measure of perceived social support, to establish its convergent construct validity. Study 3 established the test-retest reliability of the measure over two weeks by correlating two administrations of the index. DATA COLLECTION: Face-to-face interviews in homes (Study 1) or in clinic waiting rooms (Studies 2 and 3) and by telephone (Study 3 retest). PRINCIPAL FINDINGS: The CRISYS is a flexible, multidimensional tool that demonstrates strong face, content, and construct validity, and excellent test-retest reliability. The format is easy to use and well accepted by respondents and is suitable for low-income populations. CONCLUSIONS: Researchers will find the CRISYS useful when evaluating the success of a clinical model or a healthcare system, and the effectiveness of an insurance plan or a government program. Clinicians may also find that the CRISYS is an effective screen for family needs.

The nation continues to experience major problems in the performance of its infrastructure in spite of the considerable investment of resources to expand capacity, increase accessibility, and exploit innovative technologies for infrastructure improvement. Some problems can be solved with incremental changes that retain the current specialized and categorical organization of infrastructure endeavors. Others, however, require a broad, sweeping, interdisciplinary perspective. Problems in this latter group may require the interaction of the sciences with engineering to address a materials problem, to identify statistical trends in performance, or to understand the environmental impacts of the design, construction or operation of a facility.

The impact of training on physicians' commitment to professional values is examined, using a cohort design to assess the evolution of attitudes toward AIDS during residency training. Cohorts of surgeons training in the same six residency programs were followed at key junctures, and their outlooks on three AIDS-related attitudes were examined: willingness to treat people with AIDS (PWAs), concern about exposure to HIV, and perceived benefits of treating AIDS. The findings revealed a consistent, negative impact of training on all three attitudes. Cohort and period (historical) effects were limited: younger cohorts more often viewed treating PWAs as a clinically valuable experience, and greater concern about exposure was evidenced as training progressed. The findings yield new evidence of the importance of residency training to professional socialization. More knowledge of alterable aspects of residency training that play a role is key to assuring that physicians emerge with a dedication to fulfilling their social responsibilities.