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US Experience (us + experience)

Distribution by Scientific Domains

Medical Sciences	40%
Humanities and Social Sciences	30%

Selected Abstracts

Plebiscites, Fiscal Policy and the Poor: Learning from US Experience with Direct Democracy

DEVELOPMENT POLICY REVIEW, Issue 5 2005
Arthur A. Goldsmith
Many countries are contemplating direct political participation as a way of giving marginalised people more say in national fiscal policies. The United States is a natural laboratory for studying how large-scale direct democracy actually works in this regard. Every state allows voters to decide certain ballot questions about how to raise and spend public revenue. The 100-year record shows, however, that state-wide plebiscites fail to produce uniformly equitable or financially sustainable government budgets, or to mobilise low-income groups to defend their economic interests. When called upon to make decisions about state government spending, the electorate is apt to disregard any hardship for poor people. Traditional political parties and advocacy organisations are usually a more promising avenue for promoting anti-poverty budgets. [source]

Warnings on alcohol containers and advertisements: International experience and evidence on effects

DRUG AND ALCOHOL REVIEW, Issue 4 2009
CLAIRE WILKINSON
Abstract Issues. In light of possible introduction of alcohol warning labels in Australia and New Zealand, this paper discusses the international experience with and evidence of effects of alcohol warning labels. Approach. The report describes international experience with providing information and warnings concerning the promotion or sale of alcoholic beverages, and considers the evidence on the effects of such information and warnings. The experience with and evaluations of the effects of tobacco warning labels are also considered. Key Findings. The most methodologically sound evaluations of alcohol warning labels are based on the US experience. Although these evaluations find little evidence that the introduction of the warning label in the USA had an impact on drinking behaviour, there is evidence that they led to an increase in awareness of the message they contained. In contrast, evaluations of tobacco warning labels find clear evidence of effects on behaviour. Implications. There is a need and opportunity for a rigorous evaluation of the impacts of introducing alcohol warning labels to add to the published work on their effectiveness. The experience with tobacco labels might guide the way for more effective alcohol warning labels. Conclusion. Alcohol warning labels are an increasingly popular alcohol policy initiative. It is clear that warning labels can be ineffective, but the tobacco experience suggests that effective warning labels are possible. Any introduction of alcohol warning labels should be evaluated in terms of effects on attitudes and behaviour.[Wilkinson C, Room R. Warnings on alcohol containers and advertisements: International experience and evidence on effects. Drug Alcohol Rev 2009;28:426,435] [source]

What are the policy lessons of National Alcohol Prohibition in the United States, 1920,1933?

ADDICTION, Issue 7 2010
Wayne Hall
ABSTRACT National alcohol prohibition in the United States between 1920 and 1933 is believed widely to have been a misguided and failed social experiment that made alcohol problems worse by encouraging drinkers to switch to spirits and created a large black market for alcohol supplied by organized crime. The standard view of alcohol prohibition provides policy lessons that are invoked routinely in policy debates about alcohol and other drugs. The alcohol industry invokes it routinely when resisting proposals to reduce the availability of alcohol, increase its price or regulate alcohol advertising and promotion. Advocates of cannabis law reform invoke it frequently in support of their cause. This paper aims: (i) to provide an account of alcohol prohibition that is more accurate than the standard account because it is informed by historical and econometric analyses; (ii) to describe the policy debates in the 1920s and 1930s about the effectiveness of national prohibition; and (iii) to reflect on any relevance that the US experience with alcohol prohibition has for contemporary policies towards alcohol. It is incorrect to claim that the US experience of National Prohibition indicates that prohibition as a means of regulating alcohol is always doomed to failure. Subsequent experience shows that partial prohibitions can produce substantial public health benefits at an acceptable social cost, in the absence of substantial enforcement. [source]

A new role for MSY in single-species and ecosystem approaches to fisheries stock assessment and management

FISH AND FISHERIES, Issue 1 2001

In 1977, Peter Larkin published his now-famous paper, ,An epitaph for the concept of maximum sustained yield'. Larkin criticized the concept of single-species maximum sustained yield (MSY) for many reasons, including the possibility that it may not guard against recruitment failure, and the impossibility of maximising sustainable yields for all species simultaneously. However, in recent years, there has been a fundamental change in the perception of the fishing mortality associated with MSY (FMSY) as a limit to be avoided rather than a target that can routinely be exceeded. The concept of FMSY as a limit is embodied in several United Nations Food and Agriculture Organization (FAO) agreements and guidelines, and has now been incorporated into the US Magnuson,Stevens Fishery Conservation and Management Act. As a result, the United States now requires the development of overfishing definitions based on biological reference points that treat the FMSY as a limit reference point and must also define a lower limit on biomass below which rebuilding plans with strict time horizons must be developed. This represents a major paradigm shift from the previously mandated (but often unachieved) objective to simply maintain fishing mortalities at levels below those associated with recruitment overfishing. In many cases, it requires substantial reductions in current fishing mortality levels. Therefore, the necessity of the new paradigm is continually questioned. This paper draws on examples from several fisheries, but specifically focuses on the recent US experience illustrating the practical difficulties of reducing fishing mortality to levels below those corresponding to MSY. However, several studies suggest that even more substantial reductions in fishing mortality may be necessary if ecosystem considerations, such as multispecies interactions, maintenance of biodiversity and genetic diversity, and reduction of bycatch and waste, are taken into account. The pros and cons of moving beyond single-species assessment and management are discussed. A US plan for improving stock assessments indicates that even a ,basic' objective such as ,adequate baseline monitoring of all managed species' may be extremely costly. Thus, the suggestion of Larkin (1983, 1997) that the costs of research and management should not exceed 10,20% of the landed value of the catch may preclude comprehensive ecosystem management. More importantly, neither single-species nor ecosystem-based fisheries management is likely to improve appreciably unless levels of fishing capacity are aligned with resource productivity, as is currently being promoted by FAO and several individual nations. [source]

Bedside Ultrasound Diagnosis of Clavicle Fractures in the Pediatric Emergency Department

ACADEMIC EMERGENCY MEDICINE, Issue 7 2010
Keith P. Cross MD
ACADEMIC EMERGENCY MEDICINE 2010; 17:687,693 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, Clavicle fractures are among the most common orthopedic injuries in children. Diagnosis typically involves radiographs, which expose children to radiation and may consume significant time and resources. Our objective was to determine if bedside emergency department (ED) ultrasound (US) is an accurate alternative to radiography. Methods:, This was a prospective study of bedside US for diagnosing clavicle fractures. A convenience sample of children ages 1,18 years with shoulder injuries requiring radiographs was enrolled. Bedside US imaging and an unblinded interpretation were completed by a pediatric emergency physician (EP) prior to radiographs. A second interpreter, a pediatric EP attending physician with extensive US experience, determined a final interpretation of the US images at a later date. This final interpretation was blinded to both clinical and radiography outcomes. The reference standard was an attending radiologist's interpretation of radiographs. The primary outcome was the accuracy of the blinded US interpretation for detecting clavicle fractures compared to the reference standard. Secondary outcome measures included the interrater reliability of the unblinded bedside and the blinded physicians' interpretations and the FACES pain scores (range, 0,5) for US and radiograph imaging. Results:, One-hundred patients were included in the study, of whom 43 had clavicle fractures by radiography. The final US interpretation had 95% sensitivity (95% confidence interval [CI] = 83% to 99%) and 96% specificity (95% CI = 87% to 99%), and overall accuracy was 96%, with 96 congruent readings. Positive and negative predictive values (PPVs and NPVs, respectively) were 95% (95% CI = 83% to 99%) and 96% (95% CI = 87% to 99%), respectively. Interrater reliability (kappa) was 0.74 (95% CI = 0.60 to 0.88). FACES pain scores were available for the 86 subjects who were at least 5 years old. Pain scores were similar during US and radiography. Conclusions:, Compared to radiographs, bedside US can accurately diagnose pediatric clavicle fractures. US causes no more discomfort than radiography when detecting clavicle fractures. Given US's advantage of no radiation, pediatric EPs should consider this application. [source]

Correlation of Optic Nerve Sheath Diameter with Direct Measurement of Intracranial Pressure

ACADEMIC EMERGENCY MEDICINE, Issue 2 2008
Heidi Harbison Kimberly MD
Abstract Background:, Measurements of the optic nerve sheath diameter (ONSD) using bedside ultrasound (US) have been shown to correlate with clinical and radiologic signs and symptoms of increased intracranial pressure (ICP). Objectives:, Previous literature has identified 5 mm as the ONSD measurement above which patients exhibit either clinical or radiologic signs of elevated ICP. The goals of this study were to evaluate the association between ONSD and ICP and to validate the commonly used ONSD threshold of 5 mm using direct measurements of ICP as measured by ventriculostomy. Methods:, A prospective blinded observational study was performed using a convenience sample of adult patients in both the emergency department (ED) and the neurologic intensive care unit (ICU) who had invasive intracranial monitors placed as part of their clinical care. Ocular USs were performed with a 10,5 MHz linear probe. Emergency physicians (EPs) with previous ocular US experience performed ONSD measurements while blinded to the contemporaneous ICP reading obtained directly from invasive monitoring. The association between ONSD and ICP was assessed with the Spearman rank correlation coefficient, and a receiver operator characteristic (ROC) curve was created to determine the optimal ONSD cutoff to detect ICP > 20 cm H2O. Results:, Thirty-eight ocular USs were performed on 15 individual patients. Spearman rank correlation coefficient of ONSD and ICP was 0.59 (p < 0.0005) demonstrating a significant positive correlation. An ROC curve was created to assess the ability of ONSD to distinguish an abnormal ICP greater than 20 cm H2O. The area under the ROC curve was 0.93 (95% confidence interval [CI] = 0.84 to 0.99). Based on inspection of the ROC curve, ONSD > 5 mm performed well to detect ICP > 20 cm H2O with a sensitivity of 88% (95% CI = 47% to 99%) and specificity of 93% (95% CI = 78% to 99%). Conclusions:, Using an ROC curve the authors systematically confirmed the commonly used threshold of ONSD > 5 mm to detect ICP > 20 cm H2O. This study directly correlates ventriculostomy measurements of ICP with US ONSD measurements and provides further support for the use of ONSD measurements as a noninvasive test for elevated ICP. [source]

The implications of US experiences with early childhood interventions for the UK Sure Start Programme

CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 6 2007
R. Gray
Abstract Background, The UK Government introduced a large-scale early childhood intervention programme, Sure Start, in 1999. Sure Start is to be further expanded, to achieve national coverage. US experience is highly relevant for anticipating challenges that this expansion will raise. Methods, This is a focused, narrative review. We examine the impact, funding, quality-improvement and programme objectives of Head Start and Early Head Start programmes. Results, (1) Early childhood interventions can make a significant difference to children's life chances; (2) expansion without adequate funding threatens quality; (3) narrower objectives, which are easier to measure, can crowd out broader objectives, which are difficult to measure; (4) programmes must balance fidelity to the model and flexibility to local conditions; (5) multiple objectives may conflict; and (6) programmes may have differential impacts. We consider the implications of these findings for Sure Start, focusing on funding, quality control and parental involvement. We also consider that the potential Sure Start should offer for tackling health inequalities in early childhood and suggest ways in which this aspect of the Programme could be enhanced. Conclusion, Head Start has been dogged by concerns about quality and effectiveness. Many of these problems stemmed from an over-hasty expansion, which locked the Programme into inadequate funding and uneven project- and staff-quality. These issues have been addressed through large funding increases and more rigorous performance measures. Nevertheless, concerns about the aims of the Programme and the extent of parental involvement in management remain. Current funding for Sure Start appears to be adequate, while systematic evaluation procedures have been built in from its inception. Concerns have been raised about the implications of expansion for funding, quality and for parental involvement in management of local programmes. US experience shows that these are centrally important issues and that, if they are not addressed early on, they can take many years to rectify. [source]

Responsible alcohol service: lessons from evaluations of server training and policing initiatives

DRUG AND ALCOHOL REVIEW, Issue 3 2001
TIM STOCKWELL
Abstract Responsible alcohol service programmes have evolved in many countries alongside a general increase in the availability of alcohol and a greater focus on the prevention of alcohol-related road crashes. They also recognize the reality that a great deal of high-risk drinking and preventable harm occurs in and around licensed premises or as drinkers make their way home. Early US efficacy studies of programmes which trained managers and barstaff to limit customers' levels of intoxication and prevent drink driving showed promise. Studies of effectiveness of these programmes in the wider community, and in the absence of the enforcement of liquor laws, found little benefit. The data will be interpreted as suggesting that, in reality, skills deficits in the serving of alcohol are not a significant problem compared with the motivational issue for a commercial operation of abiding by laws that are rarely enforced and which are perceived as risking the goodwill of their best customers. Australian, UK and US experiences with liquor law enforcement by police will be discussed along with outcomes from the Australian invention of Alcohol Accords, informal agreements between police, licensees and local councils to trade responsibly. It will be concluded that the major task involved in lifting standards of service and preventing harm is to institutionalize legal and regulatory procedures which impact most on licensed premises. A number of strategies are suggested also for creating a political and social climate which supports the responsible service of alcohol and thereby supports the enactment and enforcement of appropriate liquor laws. [source]

Right-lobe living donor liver transplantation

LIVER TRANSPLANTATION, Issue 6B 2000
Amadeo Marcos M.D.
Key Points 1. Living donor liver transplantation (LDLT) is currently performed at about 30 centers in the United States. 2. Careful and critical evaluation of donor and recipient is required for optimal outcome. 3. Right lobe donation is preferred over left lobe donation in adult LDLT. 4. There has been 1 donor death (<0.3%) in the US experiences. Donor biliary complications occur in approximately 4% of the cases. 5. Recipient survival after adult LDLT in the United States is approximately 88%. Hepatic artery thrombosis occurs in 3% and biliary complications in 18%. [source]