A review of the Malaria Chemoprophylaxis Compliance Program at ExxonMobil Corporation

ExxonMobil, a Fortune 500 oil and gas corporation, has a global workforce with employees assigned to projects in areas at risk for infectious diseases, particularly malaria. As such, the corporation has put in place a program to protect the health of workers and ensure their safety in malaria endemic zones. This program is called the Malaria Control Program (MCP). One component of this program is the more specific Malaria Chemoprophylaxis Compliance Program (MCCP), in which employees enroll following consent to random drug testing for compliance with the company's chemoprophylaxis requirements. Each year, data is gathered on the number of employees working in these locations and are selected randomly and tested for chemoprophylaxis compliance. The selection strives to test each eligible worker once per year. Test results that come back positive for the chemoprophylaxis drug are considered "detects" and tests that are negative for the drug and therefore show the worker is non-compliant at risk for severe malaria infection are considered "non-detect". ^ The current practice report used aggregate data to calculate statistics on test results to reflect compliance among both employees and contractors in various malaria-endemic areas. This aggregate, non-individualized data has been compiled and reflects the effectiveness and reach of ExxonMobil's Malaria Chemoprophylaxis Compliance Program. In order to assess compliance, information on the number of non-detect test results was compared to the number of tests completed per year. The data shows that over time, non-detect results have declined in both employee and contractor populations, and vary somewhat by location due to size and scope of the MCCP implemented in-country. Although the data indicate a positive trend for the corporation, some recommendations have been made for future implementation of the program.^

Adaptação cultural e validação da Compliance with Standard Precautions Scale (CSPS) para enfermeiros brasileiros

Introdução: As precauções-padrão (PP) constituem um conjunto de medidas que têm como finalidade minimizar o risco de transmissão ocupacional de patógenos, sendo indispensável sua utilização por profissionais de saúde, sobretudo pelos enfermeiros. No entanto, a não adesão às PP constitui problemática amplamente discutida em todo o mundo. Embora haja diversos estudos brasileiros que visem avaliar a adesão às PP , ainda tem-se observado grande fragilidade no processo de construção e de validação dos instrumentos utilizados para avaliação deste construto. Objetivo: Realizar a adaptação cultural e validação da Compliance with Standard Precautions Scale (CSPS) para enfermeiros brasileiros. Metodologia: Trata-se de um estudo metodológico para a adaptação e validação da CSPS. Essa escala é composta por 20 itens com quatro opções de respostas, e destina-se a avaliar a adesão às PP. O processo de adaptação consistiu em Tradução, Consenso entre Juízes, Retrotradução e Validação Semântica. A primeira etapa foi a tradução do idioma original para o português do Brasil. Após foi realizado um comitê composto por sete juízes, a versão de consenso obtida na etapa anterior foi traduzida novamente para o idioma de origem. Foram avaliadas as propriedades psicométricas do instrumento, considerando-se as validades de face e de conteúdo, a validade de construto e a confiabilidade. A versão para o Português do Brasil da CSPS (CSPS-PB) foi aplicada em uma amostra de 300 enfermeiros que atuam na assistência a pacientes em um hospital localizado na cidade de São Paulo/SP. A confiabilidade foi avaliada por meio da consistência interna (alfa de Cronbach) e teste reteste (coeficiente de correlação intraclasse - ICC). Para a validação de construto, foi utilizada a comparação entre grupos diferentes, análise fatorial exploratória e análise fatorial confirmatória, segundo o Modelo de Equações Estruturais (SEM). Utilizou-se o software IBM® SPSS, 19.0. Para a análise fatorial confirmatória foi utilizado o módulo específico Analysis of Moment Structures (IBM® SPSS AMOS). Para a análise paralela utilizou-se o programa RanEigen Syntax. O nível de significância adotado foi ? = 0,05. Todos os aspectos éticos foram contemplados. Resultados: A tradução realizada por tradutores juramentados garantiu qualidade a esse processo. A validação de face e de conteúdo possibilitou a realização de modificações pertinentes e imperativas a fim de atender aos critérios de equivalências conceituais, idiomáticas, culturais e semânticas. Obteve-se ?=0,61 na avaliação da consistência interna, indicando confiabilidade satisfatória. O ICC indicou uma correlação de 0,87 quase perfeita para o teste reteste duas semanas após a primeira abordagem, conferindo estabilidade satisfatória. A validade de construto mostrou que a CSPS-PB foi capaz de discriminar as médias de adesão às PP entre grupos distintos referente à idade (F=5,15 p<=0,01), ao tempo de experiência clínica (F = 8,9 p<= 0,000) e a ter recebido treinamento (t = 2,48 p<=0,01). Na análise fatorial confirmatória, o modelo foi subidentificado. A análise fatorial exploratória indicou que todos os itens apresentaram cargas fatoriais adequadas (>=0,30), sendo identificados quatro fatores pela análise paralela. O total de variância explicada foi de 35,48%. Conclusão: A CSPS-PB, trata-se de um instrumento adequado, confiável e válido para medir a adesão às PP entre enfermeiros brasileiros

Suivi longitudinal de la densité osseuse et du statut en vitamine D chez des enfants prépubères avec une allergie au lait de vache non résolue

Problématique : L'allergie au lait de vache (ALV) est reconnue comme une condition transitoire qui disparaît chez la majorité des enfants avant l’âge de 3-5 ans, mais des données récentes révèlent une persistance de l’ALV. Les enfants souffrant d’une ALV sont à risque d’apports insuffisants en calcium et en vitamine D, deux nutriments impliqués dans la santé osseuse. Une première étude transversale portant sur la santé osseuse d’enfants prépubères ALV a observé que la densité osseuse (DMO) lombaire était significativement inférieure à celle d’enfants sans allergie au lait de vache (SALV). Objectifs : Sur la base de ces résultats, nous désirons documenter l’évolution longitudinale de la santé osseuse, du statut en vitamine D, des apports en calcium et en vitamine D et de l’adhérence à la supplémentation des enfants ALV (n=36) et de comparer ces données aux enfants SALV (n=19). Résultats : Le gain annualisé de la DMO lombaire est similaire entre les enfants ALV et SALV. Bien qu’il n’y ait pas de différence significative entre les deux groupes, la DMO lombaire des enfants ALV demeure cependant inférieure à celle des témoins. Qui plus est, le score-Z de la DMO du corps entier tend à être inférieur chez les enfants-cas comparé aux témoins. Au suivi, la concentration de 25OHD et le taux d’insuffisance en vitamine D sont similaires entre les deux groupes tout comme les apports en calcium et en vitamine D. Davantage d’enfants ALV prennent un supplément de calcium au suivi comparativement au temps initial (42% vs. 49%, p<0,05), mais le taux d’adhérence à la supplémentation a diminué à 4 jours/semaine. Conclusion : Une évaluation plus précoce ainsi qu’une prise en charge de la santé osseuse des enfants ALV pourraient être indiquées afin de modifier l’évolution naturelle de leur santé osseuse. Les résultats justifient aussi le suivi étroit des apports en calcium et vitamine D par une nutritionniste et la nécessité d'intégrer la supplémentation dans le plan de traitement de ces enfants et d’assurer une surveillance de l’adhérence à la supplémentation.

Compliance program reference : OTC drug monograph implementation (compliance program #7361.003).

"September, 1985."

Survey of non-destructive tire inspection techniques. Preliminary memorandum.

National Highway Traffic Safety Administration, Washington, D.C.

The effect of innate compliance on the performance of a counterpulsation device

Cardiovascular disease (CVD) continues to be one of the top causes of mortality in the world. World Heart Organization (WHO) reported that in 2004, CVD contributed to almost 30% of death from estimated worldwide death figures of 58 million[1]. Heart failure treatment varies from lifestyle adjustment to heart transplantation; its aims are to reduce HF symptoms, prolong patient survival and minimize risk [2]. One alternative available in the market for HF treatment is Left Ventricular Assist Device (LVAD). Chronic Intermittent Mechanical Support (CIMS) device is a novel (LVAD) heart failure treatment using counterpulsation similar to Intra Aortic Balloon Pumps (IABP). However, the implantation site of the CIMS balloon is in the ascending aorta just distal to aortic valve contrasted with IABP in the descending aorta. Counterpulsation coupled with implantation close to the aortic valve enables comparable flow augmentation with reduced balloon volume. Two prototypes of the CIMS balloon were constructed using rapid prototyping: the straight-body model is a cylindrical tube with a silicone membrane lining with zero expansive compliance. The compliant-body model had a bulging structure that allowed the membrane to expand under native systolic pressure increasing the device’s static compliance to 1.5 mL/mmHg. This study examined the effect of device compliance and vascular compliance on counterpulsating flow augmentation. Both prototypes were tested on a two-element Windkessel model human mock circulatory loop (MCL). The devices were placed just distal to aortic valve and left coronary artery. The MCL mimicked HF with cardiac output of 3 L/min, left ventricular pressure of 85/15 mmHg, aortic pressure of 70/50 mmHg and left coronary artery flow rate of 66 mL/min. The mean arterial pressure (MAP) was calculated to be 57 mmHg. Arterial compliance was set to be1.25 mL/mmHg and 2.5 mL/mmHg. Inflation of the balloon was triggered at the dicrotic notch while deflation was at minimum aortic pressure prior to systole. Important haemodynamics parameters such as left ventricular pressure (LVP), aortic pressure (AoP), cardiac output (CO), left coronary artery flowrate (QcorMean), and dP (Peak aortic diastolic augmentation pressure – AoPmax ) were simultaneously recorded for both non-assisted mode and assisted mode. ANOVA was used to analyse the effect of both factors (balloon and arterial compliance) to flow augmentation. The results showed that for cardiac output and left coronary artery flowrate, there were significant difference between balloon and arterial compliance at p < 0.001. Cardiac output recorded maximum output at 18% for compliant body and stiff arterial compliance. Left coronary artery flowrate also recorded around 20% increase due to compliant body and stiffer arterial compliance. Resistance to blood ejection recorded highest difference for combination of straight body and stiffer arterial compliance. From these results it is clear that both balloon and arterial compliance are statistically significant factors for flow augmentation on peripheral artery and reduction of resistance. Although the result for resistance reduction was different from flow augmentation, these results serves as an important aspect which will influence the future design of the CIMS balloon and its control strategy. References: 1. Mathers C, Boerma T, Fat DM. The Global Burden of disease:2004 update. Geneva: World Heatlh Organization; 2008. 2. Jessup M, Brozena S. Heart Failure. N Engl J Med 2003;348:2007-18.

Measuring the assessment and counselling provided with the supply of non-prescription asthma reliever medication: a simulated patient study

BACKGROUND: Over one quarter of asthma reliever medications are provided without prescription by community pharmacies in Australia. Evidence that community pharmacies provide these medications with sufficient patient assessment and medication counseling to ensure compliance with the government's Quality Use of Medicines principles is currently lacking. OBJECTIVE: To assess current practice when asthma reliever medication is provided in the community pharmacy setting and to identify factors that correlate with assessment of asthma control. METHODS: Researchers posing as patients visited a sample of Perth metropolitan community pharmacies in May 2007. During the visit, the simulated patient enacted a standardized scenario of someone with moderately controlled asthma who wished to purchase a salbutamol (albuterol) inhaler without prescription. Results of the encounter were recorded immediately after the visit. Regression analysis was performed, with medication use frequency (a marker of asthma control) as the dependent variable. RESULTS: One hundred sixty community pharmacies in the Perth metropolitan area were visited in May 2007. Pharmacists and/or pharmacy assistants provided some form of assessment in 84% of the visits. Counseling was provided to the simulated patients in 24% of the visits. Only 4 pharmacy staff members asked whether the simulated patient knew how to use the inhaler. Significant correlation was found between assessment and/or counseling of reliever use frequency and 3 independent variables: visit length (p < 0.001), number of assessment questions asked (p < 0.001), and the simulated patient who conducted the visit (p < 0.02). CONCLUSIONS: Both patient assessment and medication counseling were suboptimal compared with recommended practice when nonprescription asthma reliever medication was supplied in the community pharmacy setting. Pharmacy and pharmacist demographic variables do not appear to affect assessment of asthma control. This research indicates the need for substantial improvements in practice in order to provide reliever medication in line with Quality Use of Medication principles of ensuring safe and effective use of medication.

Religious compliance in Islamic financial institutions

The central goal of this research is to explore the approach of the Islamic banking industry in defining and implementing religious compliance at regulatory, institutional, and individual level within the Islamic Banking and Finance (IBF) industry. It also examines the discrepancies, ambiguities and paradoxes that are exhibited in the individual and institutional behaviour in relation to the infusion and enactment of religious exigencies into compliance processes in IBF. Through the combined lenses of institutional work and a sensemaking perspective, this research portrays the practice of infusion of Islamic law in Islamic banks as being ambiguous and drifting down to the institutional and actor levels. In instances of both well-codified and non-codified regulatory frameworks for Shariah compliance, institutional rules ambiguity, rules interpretation and enactment ambiguities were found to be prevalent. The individual IBF professionals performed retrospective and prospective actions to adjust the role and rules boundaries both in the case of a Muslim and a non-Muslim country. The sensitizing concept of religious compliance is the primary theoretical contribution of this research and provides a tool to understand the nature of what constitutes Shariah compliance and the dynamics of its implementation. It helps to explain the empirical consequences of the lack of a clear definition of Shariah compliance in the regulatory frameworks and standards available for the industry. It also addresses the calls to have a clear reference on what constitute Shariah compliance in IBF as proposed in previous studies (Hayat, Butter, & Kock, 2013; Maurer, 2003, 2012; Pitluck, 2012). The methodological and theoretical perspective of this research are unique in the use of multi-level analysis and approaches that blend micro and macro perspectives of the research field, to illuminate and provide a more complete picture of religious compliance infusion and enactment in IBF.

Corporate governance and compliance with International Financial Reporting Standards (IFRSs):evidence from two MENA stock exchanges

This study examines the influence of corporate governance structures on the levels of compliance with IFRSs disclosure requirements by companies listed on the stock exchanges of two leading MENA (Middle East and North Africa) countries, Egypt and Jordan. This study employs a cross-sectional analysis of a sample of non-financial companies listed on the two stock exchanges for the fiscal year 2007. Using an unweighted disclosure index, the study measures the levels of compliance by companies listed on the two stock exchanges investigated.Univariate and multivariate regression analyses are used to estimate the relationships proposed in the hypotheses. In addition, the study uses semi-structured interviews in order to supplement the interpretation of the findings of the quantitative analyses. An innovative theoretical foundation is deployed, in which compliance is interpretable through three lenses - institutional isomorphism theory, secrecy versus transparency (one of Gray’s accounting sub-cultural values), and financial economics theories. The study extends the financial reporting literature, cross-national comparative financial disclosure literature, and the emerging markets disclosure literature by carrying out one of the first comparative studies of the above mentioned stock exchanges. Results provide evidence of a lack of de facto compliance (i.e., actual compliance) with IFRSs disclosure requirements in the scrutinised MENA countries. The impact of corporate governance mechanisms for best practice on enhancing the extent of compliance with mandatory IFRSs is absent in the stock exchanges in question. The limited impact of corporate governance best practice is mainly attributed to the novelty of corporate governance in the region, a finding which lends support to the applicability of the proposed theoretical foundation to the MENA context. Finally, the study provides recommendations for improving de facto compliance with IFRSs disclosure requirements and corporate governance best practice in the MENA region and suggests areas for future research.

Sales tax enforcement: An empirical analysis of compliance enforcement methodologies and pathologies

Most research on tax evasion has focused on the income tax. Sales tax evasion has been largely ignored and dismissed as immaterial. This paper explored the differences between income tax and sales tax evasion and demonstrated that sales tax enforcement is deserving of and requires the use of different tools to achieve compliance. Specifically, the major enforcement problem with sales tax is not evasion: it is theft perpetrated by companies that act as collection agents for the state. Companies engage in a principal-agent relationship with the state and many retain funds collected as an agent of the state for private use. As such, the act of sales tax theft bears more resemblance to embezzlement than to income tax evasion. It has long been assumed that the sales tax is nearly evasion free, and state revenue departments report voluntary compliance in a manner that perpetuates this myth. Current sales tax compliance enforcement methodologies are similar in form to income tax compliance enforcement methodologies and are based largely on trust. The primary focus is on delinquent filers with a very small percentage of businesses subject to audit. As a result, there is a very large group of noncompliant businesses who file on time and fly below the radar while stealing millions of taxpayer dollars. ^ The author utilized a variety of statistical methods with actual field data derived from operations of the Southern Region Criminal Investigations Unit of the Florida Department of Revenue to evaluate current and proposed sales tax compliance enforcement methodologies in a quasi-experimental, time series research design and to set forth a typology of sales tax evaders. This study showed that current estimates of voluntary compliance in sales tax systems are seriously and significantly overstated and that current enforcement methodologies are inadequate to identify the majority of violators and enforce compliance. Sales tax evasion is modeled using the theory of planned behavior and Cressey’s fraud triangle and it is demonstrated that proactive enforcement activities, characterized by substantial contact with non-delinquent taxpayers, results in superior ability to identify noncompliance and provides a structure through which noncompliant businesses can be rehabilitated.^

Internal control reporting by non-accelerated filers

I examine three issues related to internal control reporting by non-accelerated filers. Motivation for the three studies comes from the fact that Section 404 of the Sarbanes-Oxley Act (SOX) continues to be controversial, as evidenced by the permanent exemption from Section 404(b) of SOX granted to non-accelerated filers by the Dodd-Frank Wall Street Reform and Consumer Protection Act of 2010. The Dodd-Frank Act also requires the SEC to study compliance costs associated with smaller accelerated filers. In the first part of my dissertation, I document that the audit fee premium for non-accelerated filers disclosing a material weakness in internal controls (a) is significantly lower than the corresponding premium for accelerated filers, and (b) declines significantly over time. I also find that in the case of accelerated filers remediating clients pay lower fees compared to clients continuing to report internal control problems; however, such differences are not observed in the case of non-accelerated filers. The second essay focuses on audit report lag. The results indicate that presence of material weaknesses are associated with increased audit report lags, for both accelerated and non-accelerated filers. The results also indicate that the decline in report lag following remediation of problems is greater for accelerated filers than for non-accelerated filers. The third essay examines early warnings (pursuant to Section 302 disclosures) for firms that subsequently disclosed internal control problems in their 404 reports. The analyses indicate that non-accelerated firms with shorter CFO tenure, presence of accounting experts on the audit committee, and more frequent audit committee meetings are more likely to provide prior Section 302 warnings. Overall the results suggest that there are differences in internal control reporting between the accelerated and non-accelerated filers. The results provide empirical grounding for the ongoing debate about internal control reporting by non-accelerated filers.

Using food intake records to estimate compliance with the Eatwell plate dietary guidelines

Funded by Scottish Government's Rural and Environment Science and Analytical Services (RESAS) Division Food Standards Agency, UK Biscuit, Cake, Chocolate and Confectionery Association, London, UK

Using food intake records to estimate compliance with the Eatwell plate dietary guidelines

Funded by Scottish Government's Rural and Environment Science and Analytical Services (RESAS) Division Food Standards Agency, UK Biscuit, Cake, Chocolate and Confectionery Association, London, UK

On the Regulation of Small Actors: Three Experimental Essays about Policies based on Voluntary Compliance and Decentralized Monitoring

Monitoring and enforcement are perhaps the biggest challenges in the design and implementation of environmental policies in developing countries where the actions of many small informal actors cause significant impacts on the ecosystem services and where the transaction costs for the state to regulate them could be enormous. This dissertation studies the potential of innovative institutions based on decentralized coordination and enforcement to induce better environmental outcomes. Such policies have in common that the state plays the role of providing the incentives for organization but the process of compliance happens through decentralized agreements, trust building, signaling and monitoring. I draw from the literatures in collective action, common-pool resources, game-theory and non-point source pollution to develop the instruments proposed here. To test the different conditions in which such policies could be implemented I designed two field-experiments that I conducted with small-scale gold miners in the Colombian Pacific and with users and providers of ecosystem services in the states of Veracruz, Quintana Roo and Yucatan in Mexico. This dissertation is organized in three essays.

The first essay, “Collective Incentives for Cleaner Small-Scale Gold Mining on the Frontier: Experimental Tests of Compliance with Group Incentives given Limited State Monitoring”, examines whether collective incentives, i.e. incentives provided to a group conditional on collective compliance, could “outsource” the required local monitoring, i.e. induce group interactions that extend the reach of the state that can observe only aggregate consequences in the context of small-scale gold mining. I employed a framed field-lab experiment in which the miners make decisions regarding mining intensity. The state sets a collective target for an environmental outcome, verifies compliance and provides a group reward for compliance which is split equally among members. Since the target set by the state transforms the situation into a coordination game, outcomes depend on expectations of what others will do. I conducted this experiment with 640 participants in a mining region of the Colombian Pacific and I examine different levels of policy severity and their ordering. The findings of the experiment suggest that such instruments can induce compliance but this regulation involves tradeoffs. For most severe targets – with rewards just above costs – raise gains if successful but can collapse rapidly and completely. In terms of group interactions, better outcomes are found when severity initially is lower suggesting learning.

The second essay, “Collective Compliance can be Efficient and Inequitable: Impacts of Leaders among Small-Scale Gold Miners in Colombia”, explores the channels through which communication help groups to coordinate in presence of collective incentives and whether the reached solutions are equitable or not. Also in the context of small-scale gold mining in the Colombian Pacific, I test the effect of communication in compliance with a collective environmental target. The results suggest that communication, as expected, helps to solve coordination challenges but still some groups reach agreements involving unequal outcomes. By examining the agreements that took place in each group, I observe that the main coordination mechanism was the presence of leaders that help other group members to clarify the situation. Interestingly, leaders not only helped groups to reach efficiency but also played a key role in equity by defining how the costs of compliance would be distributed among group members.

The third essay, “Creating Local PES Institutions and Increasing Impacts of PES in Mexico: A real-Time Watershed-Level Framed Field Experiment on Coordination and Conditionality”, considers the creation of a local payments for ecosystem services (PES) mechanism as an assurance game that requires the coordination between two groups of participants: upstream and downstream. Based on this assurance interaction, I explore the effect of allowing peer-sanctions on upstream behavior in the functioning of the mechanism. This field-lab experiment was implemented in three real cases of the Mexican Fondos Concurrentes (matching funds) program in the states of Veracruz, Quintana Roo and Yucatan, where 240 real users and 240 real providers of hydrological services were recruited and interacted with each other in real time. The experimental results suggest that initial trust-game behaviors align with participants’ perceptions and predicts baseline giving in assurance game. For upstream providers, i.e. those who get sanctioned, the threat and the use of sanctions increase contributions. Downstream users contribute less when offered the option to sanction – as if that option signal an uncooperative upstream – then the contributions rise in line with the complementarity in payments of the assurance game.

Imputing accelerometer non-wear time when assessing children's moderate-to-vigorous physical activity

BACKGROUND: Moderate-to-vigorous physical activity (MVPA) is an important determinant of children’s physical health, and is commonly measured using accelerometers. A major limitation of accelerometers is non-wear time, which is the time the participant did not wear their device. Given that non-wear time is traditionally discarded from the dataset prior to estimating MVPA, final estimates of MVPA may be biased. Therefore, alternate approaches should be explored. OBJECTIVES: The objectives of this thesis were to 1) develop and describe an imputation approach that uses the socio-demographic, time, health, and behavioural data from participants to replace non-wear time accelerometer data, 2) determine the extent to which imputation of non-wear time data influences estimates of MVPA, and 3) determine if imputation of non-wear time data influences the associations between MVPA, body mass index (BMI), and systolic blood pressure (SBP). METHODS: Seven days of accelerometer data were collected using Actical accelerometers from 332 children aged 10-13. Three methods for handling missing accelerometer data were compared: 1) the “non-imputed” method wherein non-wear time was deleted from the dataset, 2) imputation dataset I, wherein the imputation of MVPA during non-wear time was based upon socio-demographic factors of the participant (e.g., age), health information (e.g., BMI), and time characteristics of the non-wear period (e.g., season), and 3) imputation dataset II wherein the imputation of MVPA was based upon the same variables as imputation dataset I, plus organized sport information. Associations between MVPA and health outcomes in each method were assessed using linear regression. RESULTS: Non-wear time accounted for 7.5% of epochs during waking hours. The average minutes/day of MVPA was 56.8 (95% CI: 54.2, 59.5) in the non-imputed dataset, 58.4 (95% CI: 55.8, 61.0) in imputed dataset I, and 59.0 (95% CI: 56.3, 61.5) in imputed dataset II. Estimates between datasets were not significantly different. The strength of the relationship between MVPA with BMI and SBP were comparable between all three datasets. CONCLUSION: These findings suggest that studies that achieve high accelerometer compliance with unsystematic patterns of missing data can use the traditional approach of deleting non-wear time from the dataset to obtain MVPA measures without substantial bias.