Connecting Tax Time to Financial Security: Designing Public Policy with Evidence from the Field

The ability to accumulate and access savings is a fundamental determinant of economic security for many families, especially those with low incomes and limited resources. Since every family's circumstance is different, so too are their savings needs, which can range both in time horizon and flexibility of purpose. Current federal policy favors longer-term, targeted purposes, such as savings for retirement, leaving a void in policy supports for households whose savings needs are more immediate. This impedes a household's ability to build up a stock of flexible use savings that are accessible to buffer against financial shocks or to invest in ways that may improve their future, roles that serve as the underpinning for economic mobility. Policy solutions to fill this gap need to address both the lack of resources that lower-income households can dedicate to saving and the lack of products that facilitate saving for flexible purposes. In response, the Asset Building Program at the New America Foundation has developed a proposal, The Financial Security Credit, which offers lower- and middle-income households the option to open an account and an incentive to save in that account at a moment when they are receiving an influx of resources -- tax time

Boston Hospitality Review: Fall 2012

Lodging Update: Greater Boston by Rachel Rogisnky and Matthew Arrants -- A Sense of Place by Rachel Black -- Hospitality, Tourism, and Politics by Stephen W. Litvin -- Paris in Boston by photo essay by Jack Dzamba -- The Cradle of American Hospitality by Bradford Hudson -- Thompon’s Spa: The Most Famous Lunch Counter in the World by Peter Szende and Heather Rule -- The Restaurant as Hybrid: Lean Manufacturer and Service Provider by Christopher Mulle

Development and pilot of clinical performance indicators for English ambulance services

Introduction: There is a compelling need to develop clinical performance indicators for ambulance services in order to move from indicators based primarily on response times and in light of the changing clinical demands on services. We report on progress on the national pilot of clinical performance indicators for English ambulance services. Method: Clinical performance indicators were developed in five clinical areas: acute myocardial infarction, cardiac arrest, stroke (including transient ischaemic attack), asthma and hypoglycaemia. These were determined on the basis of common acute conditions presenting to ambulance services and in line with a previously published framework. Indicators were piloted by ambulance services in England and results were presented in tables and graphically using funnel (statistical process control) plots. Results: Progress for developing, agreeing and piloting of indicators has been rapid, from initial agreement in May 2007 to completion of the pilot phase by the end of March 2008. The results of benchmarking of indicators are shown. The pilot has informed services in deciding the focus of their improvement programme in 2008 and 2009 and indicators have been adopted for national performance assessment of standards of prehospital care. Conclusion: The pilot will provide the basis for further development of clinical indicators, benchmarking of performance and implementation of specific evidencebased interventions to improve care in areas identified for improvement. A national performance improvement registry will enable evaluation and sharing of effective improvement methods as well as increasing stakeholder and public access to information on the quality of care provided by ambulance services

Projected Impact of Pharmacogenomic Testing on Medications Beyond Antiplatelet Therapy in Percutaneous Coronary Intervention Patients

CYP2C19 genotyping is used to guide antiplatelet therapy after percutaneous coronary intervention (PCI). This study evaluated the potential impact of CYP2C19 and multigene pharmacogenomic (PGx) testing on medications beyond antiplatelet therapy in a real-world cohort of PCI patients that underwent CYP2C19 testing. Multiple medications with actionable PGx recommendations, notably proton pump inhibitors, antidepressants and opioids, were commonly prescribed. Approximately 50% received a CYP2C19 metabolized medication beyond clopidogrel, and 7% met criteria for a CYP2C19 genotype-guided intervention. A simulation analysis projected that 17.5 PGx-guided medication interventions per 100 PCI patients could have been made if multigene PGx results were available. This suggests that CYP2C19 and multigene PGx results could be used to optimize medication prescribing beyond antiplatelet therapy in PCI patients.Doctor of Pharmac

The Epidemiology and Patient Perspectives of Glucocorticoid Use in Rheumatoid Arthritis and Other Inflammatory Diseases

The overarching theme is to improve understanding of oral glucocorticoid (GC) use, including the benefits and harms of GC treatment in inflammatory rheumatic diseases, with an emphasis on rheumatoid arthritis (RA). The introduction summarises inflammation as a normal physiological process, and its contribution to chronic inflammatory diseases, commonly treated with GCs. It further describes GCs in detail, identifying three key areas where the literature is lacking and/or conflicting that are addressed as the thesis aims. The first section of the thesis explores how GCs are used in RA and the influence of patient and prescriber factors in two large databases in the United Kingdom (UK) and Australia. In Chapter 2, primary care data from clinical practice research datalink (CPRD) demonstrated that half of patients with incident RA received GCs in primary care, with an average GC use of 7.5 mg (prednisolone equivalent daily dose, PEQ) for 25% of the time. GCs were prescribed more commonly in certain high-risk populations. In Chapter 3, data from Australian Rheumatology Association Database (ARAD), found the probability of GC use has decreased over time. In contrast to CPRD, GC use in ARAD RA patients was less likely with increasing age, with older patients being less likely to commence GCs, but also less likely to cease GCs. The second section of the thesis explores the patient perspective of the benefits and harms of GC use, and the need for a patient reported outcome measure (PRO). A crosssectional survey administered to GC users with rheumatic diseases in Australia and United States (US) demonstrated that most patients with rheumatic diseases feel that GCs are effective treatments and that the benefits of GC use, outweigh the harms. Many adverse effects important to patients, cannot be easily measured, such as skin thinning/easy bruising, sleep disturbance, mood disturbance, and change in facial shape. This chapter also discusses the role of Outcome Measures in Rheumatology (OMERACT) in developing a PRO for GC use, describing additional work by the author contributing to both this thesis and the OMERACT GC working group. The final section of the thesis focuses on cataract and glaucoma, as two important potential harms of GC use. Chapter 5 presents a published manuscript reporting the results of a systematic literature review and meta-analysis, concluding that although the current literature suggests a possible association between GC use and the development of cataract, this risk cannot be accurately quantified in RA from the available evidence. In addition, there was insufficient evidence to determine the risk of GC use and the development of glaucoma. To address this gap in the literature, analyses of different models of GC exposure in CPRD were performed to quantify the risk of developing cataracts and glaucoma in RA patients. The results demonstrated that current GC exposure is associated with a twofold increased risk of developing cataracts and 60% increased risk of developing glaucoma in patients with RA. For cataracts, cumulative doses greater than 1000mg PEQ are associated with increased risk, more so at doses above 4000mg PEQ, whereas for glaucoma, the risk is seen only with higher cumulative doses greater than 4000mg. The results of these three sections of work expand current knowledge about GC use, with opportunities for the findings to be directly translated and improve clinical care.Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 201

Do location specific forecasts pose a new challenge for communicating uncertainty?

In the last decade, the growth of local, site-specific weather forecasts delivered by mobile phone or website represents arguably the fastest change in forecast consumption since the beginning of Television weather forecasts 60 years ago. In this study, a street-interception survey of 274 members of the public a clear first preference for narrow weather forecasts above traditional broad weather forecasts is shown for the first time, with a clear bias towards this preference for users under 40. The impact of this change on the understanding of forecast probability and intensity information is explored. While the correct interpretation of the statement ‘There is a 30% chance of rain tomorrow’ is still low in the cohort, in common with previous studies, a clear impact of age and educational attainment on understanding is shown, with those under 40 and educated to degree level or above more likely to correctly interpret it. The interpretation of rainfall intensity descriptors (‘Light’, ‘Moderate’, ‘Heavy’) by the cohort is shown to be significantly different to official and expert assessment of the same descriptors and to have large variance amongst the cohort. However, despite these key uncertainties, members of the cohort generally seem to make appropriate decisions about rainfall forecasts. There is some evidence that the decisions made are different depending on the communication format used, and the cohort expressed a clear preference for tabular over graphical weather forecast presentation

Understanding the Nature of Non-Profit Incubators with Other Sector Incubators in the Founding of Social Change Organisations by Social Entrepreneurs

Incubators have been studied extensively in the private sector, such as those that engage in technological innovation or growing small businesses. The scholarship has not sufficiently explored the efforts of incubators in the nonprofit sector that help create programs supporting, mentoring, and cultivating social entrepreneurs. There are numerous documented cases of nonprofit organizations establishing initiatives that help motivated entrepreneurs achieve social change; but research is lagging in developing a systematic understanding of these effort’s impact, and the factors associated with the success of nonprofit initiatives that support social entrepreneurs. This paper seeks to understand the nature of nonprofit organizations that support and cultivate social entrepreneurs. We rely on a unique data set from survey research on nonprofit initiatives across three U.S. Census Regions. Results indicate that the characteristics of nonprofit organizations vary in their reliance on a variety of revenue resources and governance arrangements, as well as in their diverse policy focus. They also provide an extensive and diverse set of services that supports the ideas and efforts of social entrepreneurs