Regulatory Risk: Is the Subject Still Relevant or Do Markets Govern?

Regulatory Risk: Economic Principles and Applications to Natural Gas Pipelines and Other Industries, by A. Lawrence Kolbe, William B. Tye and, Stewart C. Myers. Boston: Kluwer Academic Publishers, 1993. 345 pages. Messrs. Kolbe, Tye, and Myers are highly skilled and thoughtful economists. Their thoroughness, analytical abilities, and appreciation for economic subtleties are well demonstrated in Regulatory Risk: Economic Principles and Applications to Natural Gas Pipelines and Other Industries. The authors present a lengthy and detailed argument that in setting rates of return, regulators must specifically recognize the risk of potential disallowances on the grounds that costs have been imprudently incurred or assets have turned out not to be used and useful. In the context of the arcane world of regulated rate-of-return analysis, the work is professional, well documented, and quite systematic, particularly in regard to natural gas pipelines

Siting Transmission Lines in a Changed Milieu: Evolving Notions of the Public Interest In Balancing State and Regional Considerations

This Article discusses how state public utility law presents a barrier to the siting of new high voltage transmission lines to serve renewable resources, and how states could approach its evolution in order to preserve a role for state regulators in a new energy economy in which renewable energy will play a significant role. The traditional approach to determining the public interest in siting transmission lines is well on its way to obsolescence. Two developments over the past fifteen years have begun to challenge this paradigm. First, policies at the federal level and in many states have encouraged increased competition in generation, contributing to de-monopolization of the bulk power side of the industry. Second, the increased emphasis on environmental, energy independence, and other public policy objectives, has resulted in a dramatically increased demand for renewable energy, particularly given heightened attention to climate change. Given that wind power -- the most economically viable renewable resource on a bulk power basis -- is feasible predominantly in locations far removed from, load centers, the demand for new multistate transmission facilities has been brought clearly into focus. After an introduction in Part I, Part II describes the existing arrangements in several resource rich Western states for siting new transmission lines, and the coexistence of those arrangements with a conventional understanding of the public interest in determining need and addressing environmental concerns under traditional state transmission siting laws. Part III discusses transmission issues related to the competitive wholesale market and increased attention to climate change and highlights how federal law has expanded to accommodate some of these concerns. Part IV emphasizes the need for a new definition of the public interest which might better reflect these new market circumstances and opportunities, and highlights the two main barriers to this: 1) legislative and/or regulatory inertia and 2) an outdated cost-allocation model. The public interest under most state siting statutes is sufficiently capacious to give regulators some flexibility to evolve, but in other instances legislative action may be needed. In addition, the state cost-of-service ratemaking model must evolve to a more regional approach to allocating the costs of new transmission

Platelet-mimetic strategies for modulating the wound environment and inflammatory responses

Platelets closely interface with the immune system to fight pathogens, target wound sites, and regulate tissue repair. Natural platelet levels within the body can be depleted for a variety of reasons, including excessive bleeding following traumatic injury, or diseases such as cancer and bacterial or viral infections. Platelet transfusions are commonly used to improve platelet count and hemostatic function in these cases, but transfusions can be complicated by the contamination risks and short storage life of donated platelets. Lyophilized platelets that can be freeze-dried and stored for longer periods of time and synthetic platelet-mimetic technologies that can enhance or replace the functions of natural platelets, while minimizing adverse immune responses have been explored as alternatives to transfusion. Synthetic platelets typically comprise nanoparticles surface-decorated with peptides or ligands to recreate specific biological characteristics of platelets, including targeting of wound and disease sites and facilitating platelet aggregation. Recent efforts in synthetic platelet design have additionally focused on matching platelet shape and mechanics to recreate the marginalization and clot contraction capabilities of natural platelets. The ability to specifically tune the properties of synthetic platelet-mimetic materials has shown utility in a variety of applications including hemostasis, drug delivery, and targeted delivery of cancer therapeutics

Biomaterials for treating sepsis-induced thromboinflammation

Sepsis is a common and life-threatening disorder with an alarmingly high mortality rate. Unfortunately, this rate has not decreased significantly over the last decade and the number of septic cases is increasing each year. Despite sepsis affecting millions of people annually, there is still not an established standard of care. The development of a therapy that targets the thromboinflammation characteristic of sepsis is imperative. Until recently, research has focused on uncovering individual pathways to target. As more of the pathophysiology of sepsis has become understood and more biomarkers uncovered, the interplay between endothelial cells, platelets, and leukocytes has emerged as a critical event. Therefore, a multi-targeted approach is clearly required for designing an effective treatment for sepsis. The versatility of biomaterials offers a promising solution in that they can be designed to target and affect multiple pathways and systems and safely inhibit excessive inflammation while maintaining hemostasis. Already, studies have demonstrated the ability of biomaterials to target different processes and stages in sepsis-induced inflammation and coagulopathy. Moreover, some biomaterials offer inherent anti-inflammatory and hemostatic qualities. This review aims to discuss the most recent advancements in biomaterial development designed to address inflammation, coagulopathy, and thromboinflammation

A Wide-Field CCD Survey for Centaurs and Kuiper Belt Objects

A modified Baker-Nunn camera was used to conduct a wide-field survey of 1428 square degrees of sky near the ecliptic in search of bright Kuiper Belt objects and Centaurs. This area is an order of magnitude larger than any previously published CCD survey for Centaurs and Kuiper Belt Objects. No new objects brighter than red magnitude m=18.8 and moving at a rate 1"/hr to 20"/hr were discovered, although one previously discovered Centaur 1997 CU26 Chariklo was serendipitously detected. The parameters of the survey were characterized using both visual and automated techniques. From this survey the empirical projected surface density of Centaurs was found to be SigmaCentaur(m<18.8)=7.8(+16.0 -6.6)x10^-4 per square degree and we found a projected surface density 3sigma upper confidence limit for Kuiper Belt objects of SigmaKBO(m< 18.8)<4.1x10^-3 per square degree. We discuss the current state of the cumulative luminosity functions of both Centaurs and Kuiper Belt objects. Through a Monte Carlo simulation we show that the size distribution of Centaurs is consistent with a q=4 differential power law, similar to the size distribution of the parent Kuiper Belt Objects. The Centaur population is of order 10^7 (radius > 1 km) assuming a geometric albedo of 0.04. About 100 Centaurs are larger than 50 km in radius, of which only 4 are presently known. The current total mass of the Centaurs is 10^-4 Earth Masses. No dust clouds were detected resulting from Kuiper Belt object collisions, placing a 3sigma upper limit <600 collisionally produced clouds of m<18.8 per year.Comment: 13 pages, 5 figures, Accepted for Publication in A

A briefing for mental health professionals : why asking about abuse matters to service users (REVA project, briefing 3)

There are high prevalence rates of violent and abusive experience in both the childhoods and adult lives of mental health service users. Histories of childhood sexual and physical abuse amongst women service users are particularly well documented. Although many of the samples in studies are small, figures of over 50% are not unusual (Palmer et al, 1992; Bryer et al, 1987; Walker and James, 1992; Wurr and Partridge, 1996). In secure settings this figure is even higher (Bland et al, 1999). Studies of severe domestic violence among psychiatric in-patients report lifetime prevalence ranging from 30% to 60% (Golding, 1999; Howard et al. 2010). The REVA study, on which this briefing is based, has also found that people who suffer violence and abuse are much more likely to have a mental disorder, self-harm or attempt suicide than those with little or no experience of this kind (Scott et al, 2013). Given the prevalence of experiences of abuse among users of adult mental health services it is vitally important that these experiences are identified to ensure appropriate diagnosis, support and referral. Since 2003 it has been Department of Health policy that all adult service users should be asked about experiences of violence and abuse in mental health assessments. Yet actually disclosing experiences of violence and abuse can be very difficult. Survivors can feel a deep sense of shame and responsibility for the abuse they have experienced – feelings that are often strategically encouraged by their abusers (Clark and Quadara, 2010). These feelings can be compounded by unhelpful responses from professionals when they try to disclose (Imkaanetal, 2014). And survivors consistently say that disclosure has to be ‘at the right time for them’, which may be immediately or many years after the abuse (McNaughton Nicholls, 2012). In this briefing paper we present findings from research funded by the Department of Health Policy Research Programme on responding effectively to the needs of survivors of violence and abuse: the REVA study. The study included specifically asking survivors of violence and abuse about their views on routine enquiry, their experiences of disclosing abuse and their recommendations for how staff should ask clients about abuse

Guidance for Trust managers : implementing and sustaining routine enquiry about violence and abuse in mental health services (REVA project, briefing 2)

Since 2003 it has been Department of Health policy that all adult service users should be asked about experiences of violence and abuse in mental health assessments. However, by 2006 it was apparent that mental health provider trusts were not generally implementing the policy and a two-year initiative was launched to pilot an approach to introducing routine enquiry and embedding it in clinical practice. The pilot involved a total of 15 trusts and its evaluation identified key lessons for effective implementation of routine enquiry in all trusts. In 2012 the Department of Health funded follow-up research on responding effectively to the needs of survivors of violence and abuse to include case-studies of four of the original pilot trusts to implement routine enquiry (the REVA study). This guidance is based on findings from this study

Implementation of a novel antimicrobial stewardship strategy for rural facilities utilising telehealth

A significant portion of healthcare takes place in small hospitals, and many are located in rural and regional areas. Facilities in these regions frequently do not have adequate resources to implement an onsite antimicrobial stewardship programme and there are limited data relating to their implementation and effectiveness. We present an innovative model of providing a specialist telehealth antimicrobial stewardship service utilising a centralised service (Queensland Statewide Antimicrobial Stewardship Program) to a rural Hospital and Health Service. Results of a 2-year post-implementation follow-up showed an improvement in adherence to guidelines [33.7% (95% CI 27.0–40.4%) vs. 54.1% (95% CI 48.7–59.5%)] and appropriateness of antimicrobial prescribing [49.0% (95% CI 42.2–55.9%) vs. 67.5% (95% CI 62.7–72.4%) (P < 0.001). This finding was sustained after adjustment for hospitals, with improvement occurring sequentially across the years for adherence to guidelines [adjusted odds ratio (aOR) = 2.44, 95% CI 1.70–3.51] and appropriateness of prescribing (aOR = 2.48, 95% CI 1.70–3.61). There was a decrease in mean total antibiotic use (DDDs/1000 patient-days) between the years 2016 (52.82, 95% CI 44.09–61.54) and 2018 (39.74, 95% CI 32.76–46.73), however this did not reach statistical significance. Additionally, there was a decrease in mean hospital length of stay (days) from 2016 (3.74, 95% CI 3.08–4.41) to 2018 (2.55, 95% CI 1.98–3.12), although this was not statistically significant. New telehealth-based models of antimicrobial stewardship can be effective in improving prescribing in rural areas. Programmes similar to ours should be considered for rural facilities

A briefing for commissioners : what survivors of violence and abuse say about mental health services (REVA project, briefing 4)

The Department of Health publication, Commissioning services for women and children who have experienced violence or abuse – a guide for health commissioners, clearly acknowledges that ‘victims of violence or abuse tend to use health services more than average’ and that this is ‘despite often finding it hard to access services’ (Golding and Duggal, 2011: 22). The guidance goes on to state that it is precisely because of this that ‘it is in the NHS interest to identify these women and children, provide opportunities for them to disclose, and provide services [..] to help them improve their physical and mental health’ (ibid). The policy that has been implemented to support this process is known as ‘routine enquiry’ (RE). Since 2003 it has been Department of Health policy that all adult service users should be asked about experiences of violence and abuse in mental health assessments. However, asking about experiences of abuse and violence is not enough. To be effective the policy of routine enquiry has to be underpinned by the provision of appropriate and effective services for survivors of abuse. As the commissioning guidance notes, ‘commissioners should be aware of the importance of clear referral pathways, so that health professionals know where and how to refer women and children to local services’. For appropriate services to be available, commissioners also need to be aware of the type of services and care pathways that people who have experienced abuse feel are appropriate to meet their needs. In this briefing we present information drawn from interviews with mental health service users who have experienced domestic and/or sexual violence. This briefing focusses on the links between experience of abuse and mental health and the implications this has for commissioners to create an effective service landscape. The REVA research included the experience of both male and female service users. Useful guidance focussing on commissioning services specifically for women and girls who have survived violence is also available: see Woman’s Aid and Imkaan, 2014 ‘Successful commissioning: a guide to commissioning services that support women and children survivors of violence’, see www.womensaid.org.uk for details

A briefing for service providers and commissioners : measuring outcomes for survivors of violence and abuse (REVA project, briefing 5)

The long-term consequences of violence and abuse can only be addressed if appropriate services for survivors are available. Many such services are located within the voluntary sector, and the fact that they are oversubscribed indicates a high level of demand, but there is limited robust evidence as to whether, how and why they work. Third sector organisations need to demonstrate their effectiveness, particularly in the context of competitive commissioning (Harlock, 2013). However, cuts to already under-resourced services in the violence against women and girls (VAWG) sector have made it difficult for many, especially smaller services, to develop meaningful measurement frameworks or to fully engage in commissioning processes (Callanan et al., 2012; Women’s Aid & Imkaan, 2014). The lack of standardised sector-specific outcome measures also means that services may be required to conduct multiple monitoring exercises for a variety of different funding streams, with none fully reflecting the reality of their work. To address these gaps, one strand of the REVA project has involved developing an outcomes framework to reflect the work of such services more accurately. In doing this, we built upon work underway in the specialist women’s voluntary sector by Women’s Aid, Imkaan, Rape Crisis England and Wales, and consulted with a range of individuals and organisations through the REVA Reference Network. We also drew on tools developed and used within the health and mental health sectors. Our aim was for the measures to be suitable for use in a range of types of services addressing various forms of violence and abuse located in both the voluntary and statutory sectors. The resulting outcomes tool was piloted in seven voluntary sector and NHS settings in 2013-14