bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Municipal Mergers on Local Public Expenditures in Finland
Authors: Moisio Antti , Uusitalo Roope
Published: May 2024

This article examines the effects on expenditure of municipal mergers that took place in Finland between 1970 and 1981. We collected data on pairs of municipalities that merged after 1970, and matched these with the similar municipal pairs that remained independent using characteristics from the years immediately before the merger. We compared the changes in per capita spending after the merger in the municipalities that merged to the municipalities that remained independent over the same time period. Our results indicate that municipal mergers did not lead to lower per capita spending. In most spending categories, the per capita expenditure increased more in the merged municipalities than in the comparison group. Only in the category of general administration did the per capita spending decrease; however this decrease was far smaller than the increase in spending in other categories. For the first years of the mergers, the spending increases may be explained by transitional costs, such as acquisition of new technology, renovation of existing facilities and upward harmonization of wages and salaries. Nevertheless, it is striking to find that even ten years after amalgamation, spending was still higher in the merged municipalities compared to similar municipalities that chose to stay independent.
Analyzing Electoral Timing and Outcomes through Georgia's Special Purpose Local Option Sales Taxes
Authors: Collins Courtney A. , Dove John A.
Published: May 2024

A large body of literature has attempted to understand how the timing of popular referenda may impact the electoral outcomes that emerge. This current work adds to that literature by exploring the adoption of both educational and special purpose local option sales taxes (known as (E)SPLOSTs) by counties within the state of Georgia between 1985 and 2009. The study analyzes how much the timing of an election, (whether it is a ballot measure placed during a special, general, or primary election), actually impacts the approval rate of such a measure, the probability that it passes, and overall voter turnout. Our evidence suggests that holding a special election for (E)SPLOST measures significantly increases approval rates and the probability that the measure passes, and decreases voter turnout, especially relative to other types of elections. These results are robust to a number of specifications, and may be suggestive of the importance of agenda control in manipulating the median voter and electoral outcomes broadly.
Property Tax Stability: A Tax System Model of Base and Revenue Dynamics through the Great Recession and Beyond
Authors: Mikesell John L. , Liu Cheol
Published: May 2024

American local government property tax collections have remained surprisingly stable during the Great Recession of 2007 – 2009 and its aftermath, even as the value of housing, a major component of that tax base, has fallen precipitously. This puzzle can be understood within the context of the overall property tax system, a system differing from that used for other major taxes in that it is taxpayer passive and administered with significant lags and budget adjustments. Behavior of the finances of cities with populations over 150,000 over the 1999–2011 period is examined within the Slemrod tax system concept, particularly employing a three component model of property tax assessing, taxing, and collecting. The model reported in this paper breaks new theoretical ground by linking the three elements of the property tax system, highlighting the structural uniqueness of the property tax, utilizing actual tax base data, and, by using data that extends through 2011, providing a more complete investigation of how lags shaped the system response to the housing market collapse. Each element contributes to the stability pattern, although recent behavior of the delinquency rate (the third component) found in this article suggests some future interruption of the prior stability.
Performance-Based Budgeting (PBB), Allocative Efficiency, and Budget Changes: The Case of the U. S. Department of Commerce
Authors: Ryu Jay Eungha
Published: May 2024

Although some studies reported that Performance-based budgeting (PBB) initiatives improved productivity of governmental functions, one issue has remained an open question regarding PBB implementation: the so-called allocative efficiency. A paucity of studies presented the evidence that PBB initiatives enhanced allocative efficiency of governmental programs, but their findings were primarily based on anecdotal stories or self-reported surveys. This study attempted to fill the gap in the literature by analyzing real budget dollars. Empirical findings using budget data for the U. S. Department of Commerce (DOC) during the 8 years of the George W. Bush administration do not show that PBB systems enhanced allocative efficiency. Organizational politics might hurdle successful implementation of PBB systems. Proof of causal links between performance evaluation scores of certain programs and their resource allocations is another huge challenge for PBB initiatives.
Through the Complexity of Brankruptcy in Local Governments
Authors: Scorsone Eric , Padovani Emanuele
Published: May 2024

Local governments’ fiscal distress is a complex and multidimensional process. The causes behind jurisdictions that fall into bankruptcy are varied and no simple linear relationship exists. Given the complex nature behind municipal bankruptcy, it is natural to ask questions about the policy rationale that underlines the bankruptcy process. Bankruptcy in local governments remains under the spotlight of practitioners and academics and this special issue contributes to the discussion.
The Financial Crisis in Harrisburg, Pennsylvania
Authors: Beckett-Camarata Jane , Grizzle Cleopatra
Published: May 2024

This article provides a comprehensive analysis of the Harrisburg, PA fiscal crisis and subsequent bankruptcy filing. While the “money burning” incinerator in Harrisburg was a major contributing factor to its overall financial crisis, there were other contributing factors. These include a mixture of political expediency, financial chicanery and malfeasance by public officials, demographic changes, economic decline of the city and the national economic environment during the Great Recession. The paper concludes by focusing on the lessons to be learned from the mistakes made by city officials and offers policy recommendations for other state and local governments to avoid future fiscal crises of this magnitude.
Government Layers and Fiscal Transfers— A Quasi-Experiment of Fiscal Reform in China
Authors: Guo Hai (David)
Published: May 2024

In the past two decades, China has undertaken a fiscal reform called province-managing-county reform, which aims to improve fiscal administrative efficiency by flattening government layers. This reform provides a quasi-experiment setting to examine how the reduction of government layers affect the composition of fiscal transfer at county-level governments in China. Using a panel data of 108 counties in Henan Province from 2000 to 2007, the paper exploits difference-in-differences approach to conduct the empirical analysis. The results show that the decrease of the proportion of tax rebates and the increase of equalizing transfers are greater in reformed counties than those in non-reformed counties. As the tax rebates exhibit an anti-equalization effect, the tradeoff between these two categories of fiscal transfers suggests that the PMC reform helps improve the equalization effects of fiscal transfers among county governments.
Indonesia's Fiscal Decentralization and its Effect on Provincial Public Finances
Authors: Seifert Jan , Li Hui
Published: May 2024

Recent studies of fiscal policy in Indonesia have looked at overall fiscal performance or the effect of decentralization on local governments but neglected the specific situation of provincial governments. In this paper we analyze the provinces’ position in the Indonesian fiscal framework after decentralization and discuss their fiscal autonomy as a separate level of government. We conduct this analysis by looking at five parameters: 1) fiscal health, 2) revenue and expenditure stability, 3) effectiveness in budget management, 4) fiscal independence, and 5) fiscal disparity. Almost 15 years into decentralization provinces show overall healthy fiscal positions with regular surpluses. However, we also find that revenue and expenditure vary strongly across years, provinces do a poor job in implementing planned budgets, they rely on the central government for more than half their revenues and there are great fiscal disparities across the provinces. We conclude by suggesting a number of measures provincial and national policymakers can take to improve the situation.
Frozen in Time: The Much Needed Reform of Expenditures Assignments in China
Authors: Liu Yongzheng , Martinez-Vazquez Jorge , Qiao Baoyun
Published: May 2024

China has been carrying out significant fiscal reforms on intergovernmental fiscal relations for over three decades. However, these reforms have largely concentrated on the revenue side of the budget, and generally have not been coordinated with an explicit strategy for the reform of functional expenditure assignments. Currently, there is large consensus that the weaknesses with the current assignment of expenditure responsibilities have become one of the most serious obstructions—if not the most serious—to the further improvement of China fiscal system. In this paper, we provide a comprehensive review of the actual practice with expenditure assignment among different levels of government in China over the past decades. We highlight the most important issues surrounding the current system qualitatively and quantitatively, and provide a road map and practical recommendations for its future reform.
Selective Enforcement and Rent Extraction
Authors: Cartwright Alexander C.
Published: May 2024

This paper argues that government inaction can be a tool for extracting rents. Politicians can harness government's power to selectively enforce laws and threaten enforcement in exchange for compliance with their demands. Selective enforcement is an attractive rent extraction method for lawmakers because it increases the credibility of their threats, allows them economize on the legislative process, minimizes the amount of voters their actions might offend, and allows them to capitalize on the economies of scale and scope the state's coercive power creates in an environment with selective enforcement. This mechanism suggests that zoning laws are ripe for selective enforcement, and provides a case study to support the thesis that observed selective enforcement in zoning is often rent extraction.
Reforming Canada's Retirement Savings System – Solutions for a Non-Existent Problem?
Authors: Jog Vijay , Lee Ian
Published: May 2024

During the past five years in Canada, issues concerning the adequacy of the Canadian retirement system has been debated with increasing intensity amongst politicians, economists, academics, policy analysts, think tanks and unions. This paper contributes to this important theoretical and public policy debate by reviewing and analysing existing research and presenting and reviewing additional empirical evidence. The central issue in this debate is whether or not Canadians are saving and investing enough through government, employer and private savings to provide an adequate income in retirement. And if a retirement income adequacy problem does exist, is it a universal problem for most Canadians or does it only affect some income groups or age cohorts? The third major question concerns the appropriate policy response. The paper also reviews and questions whether the current and proposed policies properly address the challenge and provides some recommendations.

The paper shows that the larger part of this debate actually hinges on assumptions surrounding savings and the definition of savings. Those who claim that Canada faces a national pension and savings crisis only consider government and private savings pension plans whose assets are approximately only one third of total household wealth in Canada. However, this narrow definition of savings exclude all savings and investments held outside of recognized pension plans and thus exclude investments in stocks, bonds etc. as well as private homes and secondary residences which can provide for an important source of retirement income. However, there are a small number of Canadians that are or will be below the poverty line and this calls for a targeted policy response rather than an across the board reform of the Canada Pension Plan or provincial programs such as the newly proposed Ontario Retirement Pension Plan (ORPP) which may actually be viewed as a payroll tax. Based on the evidence and analysis, the paper concludes that most Canadians do not face an inadequate income during retirement and no new government policy response is needed.
Sub-Provincial Fiscal Conditions in China: Local Fiscal Autonomy and Inter-Jurisdictional Disparities
Authors: Zhang Ping , Ren Qiang
Published: May 2024

While most studies conclude that China is fiscally much decentralized based on the sub-national percentages of expenditure, the within province perspective lacks due attention. This paper reveals that within provinces, the local fiscal capacity and autonomy of districts, especially counties, are still far from sufficient. Additionally, regional (eastern, interior, and western) and urban-rural (districts vs. counties) differences symbolize the fiscal conditions of China. As the two most important types of local governments, this paper highlights the different fiscal scenarios of districts and counties and the different effects of intergovernmental grants. Since most inter-governmental grants go to counties, even though inter-jurisdictional disparities within provinces in own revenue before the transfers were higher for counties than for districts, after the transfers, the disparities in public expenditures were lower due to the equalization effects of intergovernmental grants. The large amount of intergovernmental grants dramatically eliminates the big district-county disparities that previously existed in the interior and western regions, bringing the average public expenditures for the localities to almost the same level. In the eastern region, the heterogeneity of own revenue in counties contribute more to the local expenditure variation than the interior and western regions, where the intergovernmental transfers effectively decrease the large local disparities among counties and between districts and counties. Finally, while the intergovernmental grants are effective in reducing the fiscal disparities within provinces, the large inter-province/region heterogeneities due to the level of economic development still dominate the fiscal scenario. Recent developments indicate that to a large extent, the above trends still exist and will continue over a long run.
The Effects of Double Tax Treaties for Developing Countries. A Case Study of Austria's Double Tax Treaty Network
Authors: Braun Julia , Fuentes Daniel
Published: May 2024

To what degree developing countries gain from signing double tax treaties is being hotly debated. in this paper, we analyze Austrian tax treaty policy. We find that developing countries are likely to expect both positive and negative impacts from signing a double tax treaty (DTT) with Austria. On the one hand, the results of our econometric analysis suggest that middle-income countries signing a DTT with Austria may expect an increased number of foreign direct investment projects from Austrian companies. On the other hand, an overview of the institutional background shows that the signatory states may suffer from limited withholding taxation rights established in DTTs for the source country, which could lead to reduced tax revenues in developing countries. the paper also discusses policy options for developing countries.
Why Do Per-Household Expenditures Differ between Municipalities?
Authors: Kushner Joseph , Ogwang Tomson
Published: May 2024

The purpose of this paper is to identify the factors that account for variation in per-household expenditures between municipalities. Using multiple regression techniques, we find that it is advantageous for a community to have growth and a high percent of non-residential to residential assessment. We also find that larger sized municipalities have higher per-household expenditures. However, the impact of size on the various categories is mixed with some being subject to economies of scale whereas others are subject to diseconomies. Thus, there is a potential for municipalities to lower their expenditures by growth, by increasing commercial and industrial assessment and by consolidating with other municipalities those services that are subject to economies of scale. Since 80% of expenditures in Ontario are financed by local revenues such as taxes and user fees, the determinants of expenditures should give an indication as to why these local revenue sources differ between municipalities.
An Empirical Analysis of the Determinants of per Capita Municipal Expenditure in South Australian Local Government
Authors: Tran Carolyn-Dung Thi Thanh , Dollery Brian , López Gemma Pérez
Published: May 2024

The inability of a range of public policies aimed at improving the financial sustainability and performance of local government has given rise to renewed interest in the determinants of local government expenditure. This paper seeks to add to the empirical literature on local government expenditure by not only investigating its determinants, especially the impact of ‘external’ non-discretionary factors on expenditure, but also whether expenditure varies systematically between different types of local authorities. Situating our analysis in the institutional context of South Australian (SA) local government and using 2015/2016 data for the 68 SA local councils, we investigate these two questions. We find that systematic differences exist between the four classes of council in our study and that non-discretionary environmental factors exert a significant effect on municipal expenditure.
Changes in the Benefits of the Taxable Value Cap When Property Values are Decreasing: Evidence from Michigan
Authors: Hodge Timothy R. , Ballard Charles L. , Skidmore Mark
Published: May 2024

We evaluate the changes in the benefits of the taxable value cap in the property tax in Michigan, stemming from decreases in real-estate values. We find a substantial increase in the dispersion of benefits. Comparing results for 2012 with results for 2008, we find that the tax savings for long-time homeowners were reduced in areas with low and medium rates of population growth, but that the benefits increased by 60% in high-growth areas. We also find that, in areas that experienced greater price appreciation before Michigan's housing-price decline than depreciation during the decline, long-time homeowners experienced reductions in their effective property-tax rates of 1.08 mills for each year of ownership. However, long-time homeowners in areas with pre-crisis appreciation that was substantially smaller than the subsequent depreciation actually experienced higher effective tax rates, relative to new homeowners. Finally, we explore the non-linearity of our results, comparing “older” and “newer” homeowners (i.e., those purchasing their property before or during the housing-market decline). the benefits nearly double for long-time homeowners with the exclusion of newer homeowners, with newer homeowners contributing to the higher effective tax rates. These findings are the result of inaccurate assessments, particularly overassessments, experienced by those purchasing their property during the housing-market decline.
Combining Optimal Tax Evasion with the Policy Objectives of Equity/Efficiency
Authors: Dalamagas Basil , Leventides John , Tantos Stefanos
Published: May 2024

The equity/efficiency tradeoff is a fairly extensive topic in economic literature. A large body of work has concentrated efforts on a variety of relevant issues, such as the determining factors of equity and efficiency and the potentially damaging economic consequences in terms of government failure in choosing the proper mix of fiscal objectives. However, no attempt has been made so far to use adjustments in tax rates in order to define an optimal equity/efficiency level that could be combined with the government's aim of playing a more prominent role in promoting the optimal fiscal policy objectives. in the present study, we find that changes in direct/indirect tax rates are capable of affecting not only the optimal level of evasion but also the optimal policy goals of equity/efficiency. To this end, a theoretical optimization model is constructed, the first-order conditions are properly manipulated and simulations are conducted to determine optimal evasionand optimal allocation of resources to the fiscal objectives of equity and/or efficiency. the model is empirically tested by employing data from 35 countries over the period 2007–2015.
Do We Really Need Another Municipal Fiscal Health Analysis? Assessing the Effectiveness of Fiscal Health Systems
Authors: McDonald Bruce D. , Maher Craig S.
Published: May 2024

One of the difficulties faced in the effective and efficient management of public organizations is the understanding of when the organization is showing symptoms of financial distress. Administrators and researchers alike have typically relied upon financial condition systems such as Brown's (1993) 10-point test and Wang, Dennis, and Tu's (2007) financial condition index (FCI). the evidence is mounting that these systems are ineffective at predicting fiscally distressed communities; however, previous studies are limited to either case studies or entities in a few states. in an attempt to generalize over a longer period of time and across more states, this analysis utilizes a sample of 150 municipalities for the period of 1977 to 2012. the authors test the efficacy of the measurement approaches with a series of rare event history analyses (EHA) that captures their utility in predicting municipal bankruptcy or state takeover of financial operations. the findings are consistent with previous studies - financial condition systems do not predict fiscally distressed communities. Measures of fiscal reserves and long-term liabilities were more effective at predicting distress, suggesting that scholars should continue to work on the refinement of measures rather than systems of fiscal condition as predictors of fiscal distress.
Anchoring Votes: School District Performance Ratings and Bond Referenda
Authors: Jones Peter A. , Greer Robert , Reitano Vincent
Published: May 2024

School district performance ratings are presented on intuitive grading scales. These ratings are widely publicized by local news outlets and can potentially influence voter behavior. Based on behavioral research applied to the local public finance context, we hypothesize that voters will anchor their votes in initial performance ratings even if the performance rating subsequently changes. This article investigates this hypothesis with a panel of all Texas school district bond referenda from 1998 to 2015. Estimates of probit models with careful consideration of selection bias provide support for our anchoring hypothesis. Evidence of anchoring votes, however, is nuanced and varies across two different Texas school district rating systems.
Getting Mileage Fees Right: What Does the U.S. Public Think?
Authors: Agrawal Asha Weinstein , Nixon Hilary
Published: May 2024

The United States faces a critical policy dilemma with respect to transportation funding: how to fund roads, highways, and public transportation into the future given the dwindling productivity of fuel taxes. This paper explores survey data that shed light on public opinion about one promising replacement for fuel taxes, so-called “mileage fees.” We analyzed 14 years of national survey data from U.S. adults to provide policymakers and researchers with evidence to answer three questions. First, what percent of Americans support the concept of mileage fees and has that support changed over time? Second, does support for mileage fees vary substantially by personal characteristics such as income or annual mileage driven? And third, are some mileage fee design choices more popular with the public than others?
Occupational Therapists’ Perspectives and Role With Illness-Induced Trauma From Medical Conditions
Authors: Beyers Camryn N. , Weaver Jennifer A. , Huyber Carly M. , Currin-McCulloch Jennifer , Schmid Arlene A.
Published: May 2024

Illness-induced trauma (IIT) might cause a disruption in an individual’s occupational performance. To examine occupational therapy practitioners’ (OTPs) perspectives and role in addressing IIT. In this descriptive mixed-methods design, 24 OTPs completed an online survey and 10 OTPs participated in a semi-structured 1:1 interview. Survey questions asked about knowledge regarding IIT. Interviews addressed incorporation of IIT knowledge and trauma-informed care (TIC) into practice. Quantitative results showed most OTPs (64%) did not receive TIC training and believed training was inadequate. Qualitative results indicated three major themes: “Impact on Rehabilitation,” “Variety of OT Approaches for IIT,” and “Barriers to Providing Trauma-Informed Care.” Although OTPs report inconsistencies with incorporating TIC into practice, there are similarities with foundational OT skills and TIC. Findings suggest OTPs utilize a TIC approach to support clients with IIT to process and re-engage in meaningful occupations.
Comparison of aspiration catheter performance using adaptive pulsatile aspiration in an in vitro thrombectomy model
Authors: Silva Michael A , Sanikommu Sai , Bartkevitch Rodrigues Pedro , Hanser Manning , Ortiz Ryan , Gamez Victor , Starke Robert M
Published: May 2024

Objective

Aspiration with a pump or syringe is a mainstay of mechanical thrombectomy (MT) for acute ischemic stroke (AIS), but this technology has seen minimal evolution. Non-continuous adaptive pulsatile aspiration (APA) has been proposed as a potential alternative to standard continuous aspiration as a means of improving revascularization efficiency.

Methods

Using a pathophysiological flow bench model with a synthetic clot, we performed in vitro thrombectomies using the ALGO® Von Vascular, Inc. (Sunrise, FL) APA pump. A total of 25 FDA-approved aspiration catheters were tested, representing inner diameters (ID) from 0.035 in. to 0.088 in. The pump was used in 30 trials with each catheter to remove a simulated M1 occlusion. Revascularization, clot ingestion, time to clot removal, and distal embolization were measured.

Results

Among catheters tested using APA, first-pass TICI 3 revascularization was achieved in 100% of the 750 thrombectomy trials using 25 different catheters. There were no distal emboli detected in any trial run. Complete clot ingestion into the pump collection chamber was achieved in 87% to 100% of trials (overall 95%) with clot in the remaining trials corking within the catheter and removed from the model. Time from clot contact to clot removal ranged from 11 s to 90 s (mean 22.6 s, SD 16.8 s), which was negatively correlated with catheter ID ( p = 0.007).

Conclusion

APA via the Von Vascular, Inc. ALGO® pump achieved a high success rate in an in vitro MT model. All catheters tested with the pump achieved complete reperfusion in all trials, and complete clot ingestion into the pump was seen in a majority of trials. The promising in vitro performance of APA using multiple catheters warrants future in vivo investigation.
Applying GRADE-CERQual to Interpretive Review Findings: Reflections From a Cochrane meta-ethnography on Childhood Vaccination Acceptance
Authors: Cooper Sara , Leon Natalie , Schmidt Bey-Marrie , Swartz Alison , Wiysonge Charles S. , Colvin Christopher J.
Published: May 2024

GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) was developed to support the use of evidence from qualitative reviews within policy- and decision-making. To date, the approach has been applied predominantly to aggregative synthesis methodologies and descriptive review findings. GRADE-CERQual guidance recommends the approach be tested on more diverse review methodologies and outputs to support its evolution. This paper contributes to this evolution by reflecting on our experiences of applying GRADE-CERQual to findings that emerged from a recent Cochrane meta-ethnography on childhood vaccination. Specifically, we describe the similarities and differences, challenges and dilemmas we experienced applying the approach to more interpretive versus more descriptive review findings. We found that we were able to apply the core criteria and principles of GRADE-CERQual in ways that were congruent with the methodologies and epistemologies of a meta-ethnography and its findings. We also found that the practical application processes were similar across review finding types. The main differences related to the level of demand placed on the evidence and the level of complexity involved with the decisions. Compared to more descriptive findings, more interpretive findings required evidence that was richer, thicker, more contextually situated and methodologically stronger for us to have the same level of confidence in them. Making the assessments for these findings also involved more complicated forms of judgement. We provide practical examples to illustrate these complexities and how we approached them, which others applying GRADE-CERQual to more interpretive review findings could draw upon. We also highlight areas requiring further discussion, in the hope that this will offer a platform for engagement and the potential future refinement of the approach. Ultimately, this could enhance the usability of GRADE-CERQual for a larger range of qualitative review findings and in turn expand the kinds of knowledges that count within decision-making.
Temporal pattern in foraging behaviour of Vanellus malabaricus in relation to different seasons and habitats
Authors: Prateek  , Mishra Himanshu , Kumar Vikas , Kumar Ashish
Published: May 2024

This study monitored the temporal pattern of the diurnal foraging behaviour of yellow-wattled lapwing Vanellus malabaricus Boddaert, 1783 (Charadriiformes: Charadriidae) in different seasons (breeding and non-breeding) and habitats (uncultivated, cultivated, ponds and rivers). The focal observation method was employed to investigate the foraging behaviours of yellow-wattled lapwings. Foraging techniques showed non-significant (p = 0.85) variation in different habitat types; however, walk-halt pecking (WHP) was observed to be the most commonly utilized foraging technique across all habitats. Furthermore, foraging success varied significantly in seasons (p <0.05) as well as in habitat types (p <0.05). Due to the availability of ample food items, foraging success reached its peak in uncultivated habitats. We documented considerably high feeding rates in the uncultivated habitat in the breeding season due to the high prey abundance. Additionally, seasons and habitat both greatly affected the rate of walking. Uncultivated habitat represented the highest value of % successful attempts while the lowest value of % successful attempts was recorded in river habitat. Moreover, the % successful attempts were significant (p <0.05) in the breading season as compared to the non-breeding season. Finally, we found substantial (p <0.05) changes in temporal pattern with regard to daily foraging behaviour. The behaviours appear to be bimodal, with morning and evening types for both seasons and habitat types.
Illustrating Tomorrow: The Role of Comics in Engaging Research Participants in Disruptive Futures Research
Authors: MacGeorge Richard B.
Published: May 2024

This study examines the application of comics in futures research to involve stakeholders in infrastructure strategy discussions for disruptive futures. It employs a graphic novel called “Vanishing Point! Our Built World,” which augments generative AI art with human storytelling to transport participants into a speculative 2150 with a solarpunk theme. The narrative applies the concept of future-self continuity and a temporal discontinuity framework to promote visions of sustainability for both humanity and the environment. The research emphasises the ability of comics to foster meaningful discussions on future infrastructure coordination by incorporating Social Construction Theory, Social Construction of Technology Theory, and Actor Network Theory. Comics being adapted into videos and used in workshops highlight their effectiveness in promoting engagement and facilitating semi-structured discussions. This demonstrates comics as a dynamic tool in futures research and participatory methodologies. Relevant themes: Anthropocene, Ecocene and Climate Change/Post-capitalism/Utopias, Eutopias and Dystopias/Solar Punk and its relations/Artificial Intelligence and Automation/Wicked Problems/Futures and Metaphor/Reimagining Futures Tools and Methodologies. Statement acknowledging use of Generative AI Art and copyright ownership: “Vanishing Point! Our Built World” graphic novel artwork was created with Midjourney generative AI. These images were created using the author’s prompts and ideas. The author owns these AI-generated photos and their derivatives. Synthesia was used to create animated films and AI-generated avatars from comic artwork. Statement on the use of Generative AI in the production of this manuscript: Referring to Author Guidelines on Using Generative AI and Large Language Models| Sage Learning Resources (sagepub.com ), this manuscript employed various AI tools to assist with research and writing. ChatGPT4 and its plugin, Scholar AI, helped identify relevant literature in addition to traditional research. Litmaps revealed article linkages, clarifying the research landscape. ChatGPT4 critiqued the manuscript. Quillbot improved the manuscript's clarity and consistency by improving its language.
Improved interpretable machine learning emergency department triage tool addressing class imbalance
Authors: Look Clarisse SJ , Teixayavong Salinelat , Djärv Therese , Ho Andrew FW , Tan Kenneth BK , Ong Marcus EH
Published: May 2024

Objective

The Score for Emergency Risk Prediction (SERP) is a novel mortality risk prediction score which leverages machine learning in supporting triage decisions. In its derivation study, SERP-2d, SERP-7d and SERP-30d demonstrated good predictive performance for 2-day, 7-day and 30-day mortality. However, the dataset used had significant class imbalance. This study aimed to determine if addressing class imbalance can improve SERP's performance, ultimately improving triage accuracy.

Methods

The Singapore General Hospital (SGH) emergency department (ED) dataset was used, which contains 1,833,908 ED records between 2008 and 2020. Records between 2008 and 2017 were randomly split into a training set (80%) and validation set (20%). The 2019 and 2020 records were used as test sets. To address class imbalance, we used random oversampling and random undersampling in the AutoScore-Imbalance framework to develop SERP+-2d, SERP+-7d, and SERP+-30d scores. The performance of SERP+, SERP, and the commonly used triage risk scores was compared.

Results

The developed SERP+ scores had five to six variables. The AUC of SERP+ scores (0.874 to 0.905) was higher than that of the corresponding SERP scores (0.859 to 0.894) on both test sets. This superior performance was statistically significant for SERP+-7d (2019: Z = −5.843, p < 0.001, 2020: Z = −4.548, p < 0.001) and SERP+-30d (2019: Z = −3.063, p = 0.002, 2020: Z = −3.256, p = 0.001). SERP+ outperformed SERP marginally on sensitivity, specificity, balanced accuracy, and positive predictive value measures. Negative predictive value was the same for SERP+ and SERP. Additionally, SERP+ showed better performance compared to the commonly used triage risk scores.

Conclusions

Accounting for class imbalance during training improved score performance for SERP+. Better stratification of even a small number of patients can be meaningful in the context of the ED triage. Our findings reiterate the potential of machine learning-based scores like SERP+ in supporting accurate, data-driven triage decisions at the ED.
The 2023 US National Seismic Hazard Model: Subduction ground-motion models
Authors: Rezaeian Sanaz , Powers Peter M , Altekruse Jason , Ahdi Sean K , Petersen Mark D , Shumway Allison M , Frankel Arthur D , Wirth Erin A , Smith James A , Moschetti Morgan P , Withers Kyle B , Herrick Julie A
Published: May 2024

The US Geological Survey National Seismic Hazard Models (NSHMs) are used to calculate earthquake ground-shaking intensities for design and rehabilitation of structures in the United States. The most recent 2014 and 2018 versions of the NSHM for the conterminous United States included major updates to ground-motion models (GMMs) for active and stable crustal tectonic settings; however, the subduction zone GMMs were largely unchanged. With the recent development of the next generation attenuation-subduction (NGA-Sub) GMMs, and recent progress in the utilization of “M9” Cascadia earthquake simulations, we now have access to improved models of ground shaking in the US subduction zones and the Seattle basin. The new NGA-Sub GMMs support multi-period response spectra calculations. They provide global models and regional terms specific to Cascadia and terms that account for deep-basin effects. This article focuses on the updates to subduction GMMs for implementation in the 2023 NSHM and compares them to the GMMs of previous NSHMs. Individual subduction GMMs, their weighted averages, and their impact on the estimated mean hazard relative to the 2018 NSHM are discussed. The updated logic trees include three of the new NGA-Sub GMMs and retain two older models to represent epistemic uncertainty in both the median and standard deviation of ground-shaking intensities at all periods of interest. Epistemic uncertainty is further represented by a three-point logic tree for the NGA-Sub median models. Finally, in the Seattle region, basin amplification factors are adjusted at long periods based on the state-of-the-art M9 Cascadia earthquake simulations. The new models increase the estimated mean hazard values at short periods and short source-to-site distances for interface earthquakes, but decrease them otherwise, relative to the 2018 NSHM. On softer soils, the new models cause decreases to the estimated mean hazard for long periods in the Puget Lowlands basin but increases within the deep Seattle portion of this basin for short periods relative to the 2018 NSHM.
CAR T cells vs bispecific antibody as third- or later-line large B-cell lymphoma therapy: a meta-analysis
Authors: Kim Jinchul , Cho Jinhyun , Lee Moon Hee , Yoon Sang Eun , Kim Won Seog , Kim Seok Jin
Published: May 2024

This meta-analysis evaluates the efficacy and safety of chimeric antigen receptor (CAR) T-cell therapy and bispecific antibodies for relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL). We searched MEDLINE, Embase, and Cochrane databases until July 2023 for trials assessing CAR T-cell therapies and CD20×CD3 bispecific antibodies as third or subsequent lines in R/R DLBCL. Random-effects models estimated the complete response (CR) rate and secondary outcomes, with meta-regressions adjusting for relevant covariates. Sixteen studies comprising 1347 patients were included in the pooled analysis. The pooled CR rate for bispecific antibodies was 0.36 (95% confidence interval [CI], 0.29-0.43), compared with 0.51 (95% CI, 0.46-0.56) for CAR T-cell therapy (P < .01). This superiority persisted when comparing the CAR T-cell–naive patients within the bispecific antibody group, with a CR rate of 0.37 (95% CI, 0.32-0.43). Multivariable meta-regression also revealed better efficacy of CAR T cells with adjustment for the proportion of double-hit lymphoma. The pooled 1-year progression-free survival rate mirrored these findings (0.32 [95% CI, 0.26-0.38] vs 0.44 [95% CI, 0.41-0.48]; P < .01). For adverse events of grade ≥3, the bispecific antibody had incidences of 0.02 (95% CI, 0.01-0.04) for cytokine release syndrome, 0.01 (95% CI, 0.00-0.01) for neurotoxicity, and 0.10 (95% CI, 0.03-0.16) for infections. The CAR T cell had rates of 0.08 (95% CI, 0.03-0.12), 0.11 (95% CI, 0.06-0.17), and 0.17 (95% CI, 0.11-0.22), respectively, with significant differences observed in the first 2 categories. In summary, CAR T-cell therapy outperformed bispecific antibody in achieving higher CR rates, although with an increase in severe adverse events.
Advances in non-type 2 severe asthma: from molecular insights to novel treatment strategies
Authors: Liu Tao , Woodruff Prescott G. , Zhou Xiaobo
Published: May 2024

Asthma is a prevalent pulmonary disease that affects more than 300 million people worldwide and imposes a substantial economic burden. While medication can effectively control symptoms in some patients, severe asthma attacks, driven by airway inflammation induced by environmental and infectious exposures, continue to be a major cause of asthma-related mortality. Heterogeneous phenotypes of asthma include type 2 (T2) and non-T2 asthma. Non-T2 asthma is often observed in patients with severe and/or steroid-resistant asthma. This review covers the molecular mechanisms, clinical phenotypes, causes and promising treatments of non-T2 severe asthma. Specifically, we discuss the signalling pathways for non-T2 asthma including the activation of inflammasomes, interferon responses and interleukin-17 pathways, and their contributions to the subtypes, progression and severity of non-T2 asthma. Understanding the molecular mechanisms and genetic determinants underlying non-T2 asthma could form the basis for precision medicine in severe asthma treatment.
A randomised trial of oral prednisone for cystic fibrosis pulmonary exacerbation treatment
Authors: Waters Valerie , Shaw Michelle , Perrem Lucy , Quon Bradley S. , Tullis Elizabeth , Solomon Melinda , Rayment Jonathan H. , Lavoie Annick , Tse Sze Man , Daigneault Patrick , Bilodeau Lara , Price April , Nicholson Michael , Chin Melanie , Parkins Michael , McKinney Martha L. , Tam Julian S. , Stanojevic Sanja , Grasemann Hartmut , Ratjen Felix ,   (PIPE Study Investigators)
Published: May 2024

Background

Elevated markers of systemic and pulmonary inflammation are associated with failure to recover lung function following pulmonary exacerbations in people with cystic fibrosis (pwCF). Our aim was to determine whether adjuvant oral prednisone treatment would improve recovery of forced expiratory volume in 1 s (FEV1) % pred in CF pulmonary exacerbations not responding to antibiotic therapy.

Methods

This was a randomised, double-blind, placebo-controlled trial in pwCF treated with intravenous antibiotics for a pulmonary exacerbation. At day 7, those who had not returned to >90% baseline FEV1% pred were randomised to adjuvant prednisone 1 mg·kg−1twice daily (maximum 60 mg·day−1) or placebo for 7 days. The primary outcome was the difference in proportion of subjects who recovered >90% baseline FEV1% pred at day 14 ofi.v.antibiotic therapy.

Results

173 subjects were enrolled, with 76 randomised. 50% of subjects in the prednisone group recovered baseline FEV1on day 14 compared with 39% of subjects in the placebo group (difference of 11%, 95% CI −11–34%; p=0.34). The mean±sdchange in FEV1% pred from day 7 to day 14 was 6.8±8.8% predicted in the prednisone group and 4.6±6.9% predicted in the placebo group (mean difference 2.2% predicted, 95% CI −1.5–5.9%; p=0.24). Time to subsequent exacerbation was not prolonged in prednisone-treated subjects (hazard ratio 0.83, 95% CI 0.45–1.53; p=0.54).

Conclusions

This study failed to detect a difference in FEV1% pred recovery between adjuvant oral prednisone and placebo treatment in pwCF not responding at day 7 ofi.v.antibiotic therapy for pulmonary exacerbations.
Burden of eosinophilic granulomatosis with polyangiitis in Europe
Authors: Jakes Rupert W. , Kwon Namhee , Huynh Lynn , Hwee Jeremiah , Baylis Lee , Alfonso-Cristancho Rafael , Du Shawn , Khanal Anamika , Duh Mei Sheng , Terrier Benjamin
Published: May 2024

Background and aims

Real-world evidence characterising the burden of eosinophilic granulomatosis with polyangiitis (EGPA) in Europe is limited. The aim of this study was to characterise patients in a large European EGPA cohort.

Methods

This retrospective, non-interventional, longitudinal study (GSK ID: 214661) recruited cross-specialty physicians from France, Germany, Italy, Spain and the UK to conduct medical chart reviews for patients with a physician-confirmed diagnosis of EGPA. Patients were ≥12 years of age at diagnosis with ≥1 year of follow-up data from the first clinical visit with the physician (index date). Outcome measures collected from index date to end of follow-up included clinical manifestations and healthcare resource utilisation (HCRU).

Results

In total, 407 patient medical charts were reviewed by 204 physicians; median (interquartile range) duration of follow-up from index date was 2.2 (1.7−3.5) years. Most patients (73.5%) had asthma. Patients underwent multiple diagnostic assessments, and 74.9% received ≥3 different therapies between diagnosis and end of follow-up (98.8% oral corticosteroids, 63.9% immunosuppressive therapies, 45.5% biologics). During follow-up, 84.5% of patients experienced EGPA clinical manifestations; most were considered moderate or severe and commonly affected the lungs (55.8%; including lung infiltrates 25.8% and severe asthma 24.8%), ear, nose and throat (53.3%), and skin (41.8%). HCRU was substantial: 26.0% of patients made emergency department visits, 36.6% were hospitalised and 84.8% had outpatient visits.

Conclusions

These real-world data show that EGPA presents a substantial burden to patients and the healthcare system. Earlier and better differential diagnosis and appropriate treatment may help reduce incidence of clinical manifestations and HCRU.
Polycyclic aromatic hydrocarbon exposure during pregnancy and changes in umbilical renal function
Authors: Hsu Chou-Yi , Liu Cong , Morozova Natalia S. , Hussain Shaik Althaf , Kumar Ashwani , Mohammed Jaafaru Sani , Pramanik Atreyi , Juraev Nizomiddin , Ali Saad Hayif Jasim , Najafi Moslem Lari
Published: May 2024

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous environmental pollutants with significant adverse effects on human health, particularly concerning fetal development during pregnancy. This study investigates the relationship between maternal exposure to particulate matter-bound (PM-bound) PAHs and potential alterations in fetal renal function. A cross-sectional investigation was conducted on 450 mother-pair newborns from June 2019 to August 2021. Exposure to PM-bound PAHs was estimated at the residential address using spatiotemporal models based on data from 30 monitoring stations across the study area. Umbilical cord blood samples were collected post-delivery for biochemical analysis of renal function markers, including creatinine (Cr), blood urea nitrogen (BUN), and estimated glomerular filtration rate (eGFR). Multivariable regression models were used to assess the relationship between exposure to each PAHs compound and fetal renal function. Moreover, the mixture effects of exposure to PAHs on fetal renal function were assessed using quantile g-computation analysis. Increased concentrations of various PAH compounds at the residential address correlated with raised levels of umbilical BUN and Cr, suggesting potential renal impairment. Notably, exposure to certain PAHs compounds demonstrated statistically negative significant associations with eGFR levels. An increment of one quartile in exposure to PAHs mixture was correlated with a rise of 1.08 mg/dL (95% CI 0.04, 2.11, p = 0.04) and 0.02 mg/dL (95% CI − 0.00, 0.05, p = 0.05) increase in BUN and Cr, respectively. Moreover, a one-quartile increase in PAHs mixture exposure was associated with − 1.09 mL/min/1.73 m2 (95% CI − 2.03, − 0.14, p = 0.02) decrease in eGFR. These findings highlight the potential impact of PAH exposure on fetal renal function and underscore the importance of considering environmental exposures in assessing neonatal renal health outcomes.