Evaluating the federal role in financing health-related research

This paper considers the appropriate role for government in the support of scientific and technological progress in health care; the information the federal government needs to make well-informed decisions about its role; and the ways that federal policy toward research and development should respond to scientific advances, technology trends, and changes in the political and social environment. The principal justification for government support of research rests upon economic characteristics that lead private markets to provide inappropriate levels of research support or to supply inappropriate quantities of the products that result from research. The federal government has two basic tools for dealing with these problems: direct subsidies for research and strengthened property rights that can increase the revenues that companies receive for the products that result from research. In the coming years, the delivery system for health care will continue to undergo dramatic changes, new research opportunities will emerge at a rapid pace, and the pressure to limit discretionary federal spending will intensify. These forces make it increasingly important to improve the measurement of the costs and benefits of research and to recognize the tradeoffs among alternative policies for promoting innovation in health care.

Efficacia della formazione alla salute e sicurezza sul lavoro: fattori di successo e criticità

Background: sulla base delle evidenze emerse dalle rassegne sistematiche in materia (Johnstone, 1994; Cohen et al.,1998; Robson et al., 2012; Burke et al., 2006; Ricci et al., 2015) si è ipotizzato che la formazione alla salute e sicurezza sul lavoro sia maggiormente efficace quando non è presentata come obbligatoria e venga articolata su più livelli di apprendimento, attraverso metodologie adeguate per ogni livello, con docenti che abbiano caratteristiche corrispondenti allo specifico obiettivo di apprendimento e la cui durata sia parametrata all’obiettivo stesso. Obiettivo di questa ricerca è valutare se esista e quanto sia intensa la relazione causale tra la formazione alla sicurezza sul lavoro e i suoi effetti sul miglioramento delle conoscenze, degli atteggiamenti, dei comportamenti, degli esiti per la salute, del clima di sicurezza aziendale, del controllo comportamentale percepito dai lavoratori, delle condizioni operative e procedure interne, oltre l’eventuale effetto di moderazione determinato da caratteristiche socio-demografiche dei partecipanti e dal gradimento della formazione. Metodo: la variabile indipendente è costituita dell’intervento formativo erogato, articolato in tre condizioni: formazione obbligatoria, formazione non obbligatoria, gruppo di controllo: sono stati posti a confronto due interventi di pari durata (16 settimane, per 10h complessive), realizzati con identiche modalità (step1 audio-visivo; step2 affiancamento su lavoro da parte del preposto; step3 discussione di auto-casi), ma differenziati rispetto all’essere presentati uno come formazione obbligatoria, l’altro come non obbligatoria. I due gruppi sono anche stati confrontati con un gruppo di controllo per il quale la formazione è prevista successivamente. I partecipanti sono stati assegnati in modo casuale al gruppo con obbligo formativo, senza obbligo formativo, di controllo. Sono stati presi come indicatori (variabili dipendenti) per valutare l’effetto della formazione: I livello – conoscenze: riconoscimento o produzione di un maggior numero di risposte corrette. II livello – atteggiamenti e credenze: maggiore propensione a mettere in atto comportamenti auto ed etero protettivi. III livello – comportamenti: comportamenti osservati più adeguati per la tutela della salute propria e altrui. IV livello – salute: maggior grado di benessere bio-psico-sociale auto-riferito. Le misure di esito consistono nella variazione tra la rilevazione iniziale e ogni rilevazione successiva, sulla base delle diverse misure registrate per ognuno dei quattro livelli dell’intervento formativo. Lo stesso confronto del tempo è stato realizzato per le misure del clima di sicurezza aziendale, del controllo comportamentale percepito dai lavoratori, delle condizioni operative e procedure interne, oltre l’eventuale effetto di moderazione determinato da caratteristiche socio-demografiche dei partecipanti e dal gradimento della formazione, quest’ultimo misurato solo immediatamente al termine dell’intervento. Risultati: le condizioni di intervento non differiscono in termini di efficacia, la formazione determina infatti gli stessi risultati per i partecipanti del gruppo obbligo formativo e di quello non obbligo, con una significativa differenza post-intervento rispetto al gruppo di controllo. La formazione ha un effetto forte nel miglioramento delle conoscenze che solo parzialmente decade nel tempo, ma comunque mantenendo un livello maggiore rispetto ai valori iniziali. In relazione al miglioramento di atteggiamenti e comportamenti sicuri nel lavoro al Videoterminale, l’effetto della formazione è modesto: per gli atteggiamenti si registra solo un miglioramento verso l’applicazione delle procedure come utili realmente e non come mero adempimento, ma tale effetto decade entro quattro mesi riportando i partecipanti su valori iniziali; i comportamenti invece migliorano nel tempo, ma con deboli differenze tra partecipanti alla formazione e gruppo di controllo, tuttavia tale miglioramento non decade in seguito. Non si registrano invece effetti della formazione nella direzione attesa in termini di esiti per la salute, per il miglioramento del clima di sicurezza e come maggior controllo comportamentale percepito, non risultano nemmeno dati evidenti di moderazione degli effetti dovuti a caratteristiche socio-demografiche dei partecipanti. Inoltre emerge che il gradimento per la formazione è correlato con migliori atteggiamenti (strumento audio-visivo), il miglioramento del clima di sicurezza e un maggior controllo comportamentale percepito (studio di auto-casi), ovvero gli step che hanno visto l’intervento di formatori qualificati. Infine, la formazione ha determinato migliori condizioni operative e l’adeguamento delle procedure interne. Conclusioni: la presente ricerca ci consente di affermare che la formazione erogata è stata efficace, oltre che molto gradita dai partecipanti, in particolare quando il formatore è qualificato per questa attività (step1 e 3). L’apprendimento prodotto è tanto più stabile nel tempo quanto più i contenuti sono in stretta relazione con l’esperienza lavorativa quotidiana dei partecipanti, mentre negli altri casi il decremento degli effetti è alquanto rapido, di conseguenza ribadiamo la necessità di erogare la formazione con continuità nel tempo. E’ risultato comunque modesto l’effetto della formazione per migliorare gli atteggiamenti e i comportamenti nel lavoro al VDT, ma, al di là di alcuni limiti metodologici, sono obiettivi ambiziosi che richiedono più tempo di quanto abbiamo potuto disporre in questa occasione e il cui conseguimento risente molto delle prassi reali adottate nel contesto lavorativo dopo il termine della formazione. Le evidenze finora prodotte non hanno poi chiarito in modo definitivo se attraverso la formazione si possano determinare effetti significativi nel miglioramento di esiti per la salute, anche eventualmente attraverso interventi di supporto individuale. Inoltre l’assenza di differenze significative negli effetti tra i partecipanti assegnati alla condizione di obbligo e quelli di non obbligo, eccezion fatta in direzione opposta alle attese per la misura del danno da lavoro, suggeriscono che nell’erogare la formazione, occorre sottolineare in misura molto rilevante l’importanza dell’intervento che viene realizzato, anche qualora esistesse una prescrizione normativa cogente. Infine, la ricerca ci ha fornito anche indicazioni metodologiche e misure valide che invitano ad estendere questa formazione, e la sua valutazione di efficacia, a diversi comparti economici e svariate mansioni. Nel fare questo è possibile fare riferimento, e testare nuovamente, un modello che indica la corretta percezione del rischio (conoscenza) come fattore necessario, ma non sufficiente per ottenere, con la mediazione di atteggiamenti favorevoli allo specifico comportamento, azioni sicure, attraverso le quali si rinforza l’atteggiamento e migliorano le conoscenze. La formazione, per raggiungere i propri obiettivi, deve tuttavia agire anche sui meccanismi di conformismo sociale favorevoli alla safety, questi originano da conoscenze e azioni sicure e reciprocamente le rinforzano.

O uso de medidas antidumping como mecanismo de barreira à entrada no mercado brasileiro

As medidas antidumping são uma exceção ao livre comércio e como tal deveriam ser usadas com restrição. No entanto, desde o GATT 1947 há preocupação com o uso abusivo de tais medidas, podendo ser o mecanismo utilizado não apenas para possibilitar a recuperação da indústria doméstica prejudicada pelas importações objeto de dumping, objetivo do Acordo Antidumping (AAD), mas com o fim de proteger a indústria nacional da concorrência estrangeira. Desta forma, o objetivo do presente trabalho é apresentar as principais características do AAD firmado ao final da Rodada Uruguai que culminou na constituição da Organização Mundial do Comércio (OMC), incluindo seus antecedentes históricos e a possibilidade de aplicação discricionária, demonstrando como uma norma surgida no plano internacional em decorrência de um acordo multilateral vem sendo utilizada pelo Brasil, com a finalidade de se demonstrar a possibilidade de uso das medidas antidumping como barreira à entrada no mercado brasileiro. Confirmada a possibilidade de uso abusivo desse instrumento de defesa comercial, ainda que no plano teórico, uma vez que não é possível analisar os efeitos reais das medidas aplicadas, serão apresentadas as formas de contrabalanço ao protecionismo atualmente existentes no próprio AAD e sua incorporação e utilização pelo Brasil bem como a possibilidade de questionamento de tais medidas como práticas anticompetitivas com fundamento na legislação antitruste perante as autoridades de defesa da concorrência. Serão ainda analisadas outras possibilidades de contrabalanço ao uso exacerbado das medidas antidumping em debate e viabilidade das mesmas no cenário atual em que se verifica, de um lado, o aumento de uso de tais medidas pelos países Membros da OMC, destacando-se o Brasil e, de outro lado, impasse nas negociações multilaterais, cabendo aos Membros tomarem decisões unilaterais sobre a aplicação de tais medidas, seu grau de intensidade e forma de aplicação a depender da proteção que se pretende garantir à indústria nacional.

A acção de condenação à prática de acto devido : conhecimento e prova dos pressupostos de facto do acto

A acção de condenação à prática de acto devido corresponde à concretização, com o Código de Processo nos Tribunais Administrativos, do princípio da tutela jurisdicional efectiva previsto no art. 268º/4 da Constituição da República Portuguesa, assegurando aos particulares a obtenção de uma pronúncia condenatória na prática do acto administrativo que tenha sido recusado ou omitido. Esta pronúncia sofre as limitações decorrentes do princípio da separação de poderes, entre o Administrativo e o Judicial, nos termos expressos no art. 71º/2 do Código de Processo, que determina que quando a emissão do acto pretendido envolva a formulação de valorações próprias do exercício da função administrativa (…) o tribunal não pode determinar o conteúdo do acto a praticar, mas deve explicitar as vinculações a observar (…) na emissão do acto devido. À limitação enunciada acresce outra, sem reflexo no texto do Código mas que se impõe por via do mesmo princípio, e que respeita aos poderes do tribunal no conhecimento e determinação dos pressupostos do acto devido, nos casos em que estes são questionados em juízo. A determinação dos pressupostos de facto do acto devido pelo tribunal está limitada pela natureza da actividade instrutória procedimental, pelo (in)cumprimento do ónus da prova no procedimento pelo interessado, nos casos limitados em que este tem relevância e pelo princípio da decisão prévia administrativa, nos termos do qual é à Administração que compete o conhecimento e decisão das pretensões que lhe são dirigidas e cuja competência que lhe foi determinada pela lei. Os limites enunciados não prejudicam a sindicabilidade, pelos tribunais, dos actos de recolha e valoração das provas pela Administração, que, nos casos em que configurem espaços de margem de livre decisão administrativa, são sindicáveis nos termos em que pode ser controlada a actividade autodeterminada da Administração, sem qualquer limitação quanto aos meios de prova.

Discretion and Accountability: The ESMA Judgment and the Meroni Doctrine. Bruges European Economic Research (BEER) Papers 30/2014

This paper assesses the effectiveness of the Meroni doctrine in the light of the recent judgment in the ESMA case. The first part explains in detail the problem of delegation of powers in the EU from the perspective of the principal-agent theory and complements it with the analysis of the trade-off between different levels of independence and accountability of agencies. A simple economic model is developed to illustrated the relationship between the independence and accountability of an agency. It shows that it is the accountability mechanism that induces the agent to act, rather than the extent of his independence. The paper also explains the inter-temporal interactions between the principal and the agent on the basis of the incentives in place for the different players. The second part is devoted to analysis of the functioning of ESMA in the context of its delegated powers. After the presentation of main aspects of the regulatory framework establishing ESMA, the paper continuous with an analysis and interpretation of the discretionary powers of ESMA. The rather rigid position of the Court of Justice in relation to the Meroni doctrine seems to be unsuitable to delegation of complex regulatory tasks. This is particularly evident in the case of financial markets. Finally, the judgment does not examine in any detail whether and how the principals - i.e. the EU and Member States - are best able to evaluate the quality of ESMA decisions and regulations and whether there are different but more effective accountability mechanisms.

Earnings management in response to the introduction of the Australian gold tax

Earnings from gold mining in Australia remained tax-exempt for almost seven decades until January 1, 1991. In the early 1980s, rapid economic prosperity induced by escalated gold prices brought the Australian gold-mining industry under intense political scrutiny. Using a variant of the modified Jones model, this paper provides evidence of significant downward earnings management by Australian gold-mining firms, which is consistent with their attempts to mitigate political costs during the period from June 1985 to May 1988. In contrast, test of earnings management over a similar period in a control sample of Canadian gold-mining firms produced insignificant results. Further, empirical results are robust to several sensitivity tests performed. During the period from June 1988 to December 1990, the Australian firms were found to have engaged in economic earnings management. This is consistent with the sample firms' incentive of maximizing economic earnings immediately prior to the introduction of income tax on gold mining. The findings of this study help to understand the impact of earnings management on the efficient resource allocation in an economy. They also contribute toward understanding the linkage between regulation of accounting for special purposes and general-purpose financial. reporting.

A randomized controlled trial to assess sunscreen application and beta carotene supplementation in the prevention of solar keratoses

Background: Solar keratoses (SKs) are among the strongest determinants of skin cancer, but little is known about the success of measures to control these common skin tumors. Objective: To determine whether daily sunscreen application and/or beta carotene supplementation retards the rate of occurrence of SKs in adults in the medium term. Design: Randomized controlled trial conducted between February 1992 and August 1996. Setting: General community of the subtropical township of Nambour, Australia (latitude, 26degrees south). Participants: A total of 1621 adults aged 25 to 74 years. Interventions: Participants were randomized to daily use of sunscreen (application of a high-protection sunscreen to their head, neck, arms, and hands every morning) or application of sunscreen at their usual discretionary rate. They were also randomly assigned to take either one 30-mg tablet of beta carotene or one placebo tablet each day. Main Outcome Measure: Change in the prevalent number of SKs in the intervention group relative to change in the control group. Results: The ratio of SK counts in 1994 relative to 1992 was lower in people randomized to daily sunscreen use (1.20; 95% confidence interval, 1.04-1.39) than in those randomized to discretionary sunscreen use (1.57; 95% confidence interval, 1.35-1.84). This 24% reduction is equivalent to the prevention of an average of I additional SK per person over that time. A reduction in the rate of change of SK prevalence was also seen in the sunscreen intervention group relative to the discretionary sunscreen group between 1994 and 1996, but it was not significant. No effect on the rate of change of prevalent SK counts was seen among those taking beta carotene supplements relative. to those taking placebo tablets. Conclusions: Daily application of sunscreen retarded the rate of SK acquisition among adults in a subtropical environment, while a beta carotene supplementation of 30 mg/d had no influence on the occurrence of SKs.

The current account, fiscal policy, and medium-run income determination

This article presents a new framework for analyzing the simultaneous determination of current account imbalances and the path of national income. Using standard macroeconomic behavioral relationships, it first examines how and why current account deficits matter by investigating links between domestic consumption, government spending, output, saving, investment, interest rates, and capital flows. Central to the model is the distinction between aggregate output and expenditure that enables dissection of the effects of discretionary fiscal change on the current account and national income. The framework yields results relevant to the twin deficits hypothesis that are contrary to those of standard models.

Long-term increase in sunscreen use in an Australian community after a skin cancer prevention trial

Background. Given the public health burden of skin cancer in white populations, an increase in sun protective behavior is needed. In a highrisk community, we assessed long-term Sunscreen use among people who had participated in a randomized trial of daily Sunscreen application for prevention of skin cancer. Methods. In 1992, 1621 residents of the subtropical Australian township of Nambour were randomly allocated to either daily or discretionary sunscreen use until 1996. From 1997 to 2002, we monitored by questionnaires their ongoing sunscreen use. Results. People who had never or irregularly used sunscreen when in summer sun before the trial were more likely (P < 0.0001) to be sustaining regular application especially to their face (20% vs. 11%) and forearms (14% vs. 5%) if they had been allocated to daily, not discretionary, use of sunscreen for 5 years. Conclusions. Regular voluntary sunscreen use for skin cancer prevention can be sustained by sun-sensitive people in the long term. Habit formation appears to be an important goal for sun protection programs among those living, or on vacation, in sunny places. (c) 2005 Elsevier Inc. All rights reserved.

Room to move? Professional discretion at the frontline of welfare-to-work

Outcomes of social policies have always been mediated by the discretionary agency of front-line staff, processes which nevertheless have received insufficient attention in policy evaluation and in the social policy literature more broadly. This article takes the case example or the policy reforms associated with the Australian government's welfare-to-work agenda. Drawing on two discreet research projects undertaken at different points in the policy trajectory, the practices of social workers in Centrelink - the Commonwealth government's primary service delivery agency involved in welfare-to-work - is examined. Centrelink social workers have been and remain one of the core groups of specialist staff since the Department's inception in the late 1940s, working to improve the well being Of people in receipt of income security. Their experiences of the recent past and their expectations of the future of their professional practice as welfare reform becomes more entrenched are canvassed. In summary, the discretionary capacity of the Centrelink social workers to moderate or shape the impact of policy on income security recipients is steadily eroding as this group of professionals is increasingly captured by the emerging practices of workfare.

Employment services in an age of e-government

The increasing use of information and communications technologies among government departments and non-government agencies has fundamentally changed the implementation of employment services policy in Australia. The administrative arrangements for governing unemployment and unemployed people are now constituted by a complex contractual interplay between government departments as ‘purchasers’ and a range of small and large private organizations as ‘providers’. Assessing, tracking and monitoring the activities of unemployed people through the various parts of the employment services system has been made possible by developments in information technology and tailored computer programs. Consequently, the discretionary capacity that is traditionally associated with ‘street-level bureaucracy’ has been partly transformed into more prescriptive forms of ‘screen-level bureaucracy’. The knowledge embedded in these new computer-based technologies is considered superior because it is based on ‘objective calculations’, rather than subjective assessments of individual employees. The relationship between the sociopolitical context of unemployment policy and emerging forms of e-government is explored using illustrative findings from a qualitative pilot study undertaken in two Australian sites. The findings suggest that some of the new technologies in the employment services system are welcomed, while other applications are experienced as contradictory to the aims of delivering a personalized and respectful service.

Multiple paradigms and organisational research: an analysis of work behaviour in the fire service

The thesis examines Kuhn's (1962, 1970) concept of paradigm, assesses how it is employed for mapping intellectual terrain in the social sciences, and evaluates it's use in research based on multiple theory positions. In so doing it rejects both the theses of total paradigm 'incommensurability' (Kuhn, 1962), and also of liberal 'translation' (Popper, 1970), in favour of a middle ground through the 'language-game of everyday life' (Wittgenstein, 1953). The thesis ultimately argues for the possibility of being 'trained-into' new paradigms, given the premise that 'unorganised experience cannot order perception' (Phillips, 1977). In conducting multiple paradigm research the analysis uses the Burrell and Morgan (1979) model for examining the work organisation of a large provincial fire Service. This analysis accounts for firstly, a 'functionalist' assessment of work design, demonstrating inter alia the decrease in reported motivation with length of service; secondly, an 'interpretive' portrayal of the daily accomplishment of task routines, highlighting the discretionary and negotiated nature of the day's events; thirdly, a 'radical humanist' analysis of workplace ideology, demonstrating the hegemonic role of officer training practices; and finally, a 'radical structuralist' description of the labour process, focusing on the establishment of a 'normal working day'. Although the argument is made for the possibility of conducting multiple paradigm research, the conclusion stresses the many institutional pressures serving to offset development.

Which factors drive firm survival within an industry boundary over time?:the UK onshore oil and gas production industry 1984-1999

This thesis looks at the UK onshore oil and gas production industry and follows the history of a population of firms over a fifteen-year period following the industry's renaissance. It examines the linkage between firm survival, selection pressures and adaptation responses at the firm level, especially the role of discretionary adaptation, specifically exploration and exploitation strategies.Taking a Realist approach and using quantitative and qualitative methods for triangulation on a new data base derived from archival data, as well as informant interviews, it tests seven hypotheses' about post-entry survival of firms. The quantitative findings suggest that firm survival within this industry is linked to discretionary adaptation, when measured at the firm level, and to a mixture of selection and adaptation forces when measured for each firm for each individual year. The qualitative research suggests that selection factors dominate. This difference in views is unresolved. However the small, sparse population and the nature of the oil and gas industry compared with other common research contexts such as manufacturing or service firms suggests the results be treated with caution as befits a preliminary investigation. The major findings include limited support for the theory that the external environment is the major determinant of firm survival, though environment components affect firms differentially; resolution of apparent literature differences relating to the sequencing of exploration and exploitation and potential tangible evidence of coevolution. The research also finds that, though selection may be considered important by industry players, discretionary adaptation appears to play the key role, and that the key survival drivers for thispopulation are intra-industry ties, exploitation experience and a learning/experience component. Selection has a place, however, in determining the life-cycle of the firm returning to be a key survival driver at certain ages of the firm inside the industry boundary.

Loan loss provisions, bank valuations and discretion : a comparative study between conventional and Islamic banks

This study investigates the use of reported loan loss provisions (LLP) by investors in their valuations of banks within the Middle East and North Africa region between the years 2006 and 2011. We decompose LLP into discretionary and non-discretionary components to test for differential valuations in the two banking sectors. We use alternative criteria to define the components of LLP in banks: loan quality/size and earnings management/ manipulation incentives. We employ a price-level valuation model estimated using two-stage analyses. We find that LLP has positive value relevance to investors in both banking sectors. Investors in Islamic banks price the discretionary component relatively lower than their conventional counterparts. We attribute this result to differences in product and governance structures as well as to the religious perception of Islamic banking. In both banking sectors, investors construe an increase in the non-discretionary component as irrelevant valuation information. Our results are relevant to bank regulators in showing the signalling effect of LLP to bank value and stability.