Paying clinicians to join clinical trials : a review of guidelines and interview study of trialists

Background: The motivations of clinicians to participate in clinical trials have been little studied. This project explored the potential role of payment for participation in publicly funded clinical trials in the UK. The aims were to review relevant guidelines and to collate and analyse views of clinical trialists on the role of payments and other factors that motivated clinicians to join clinical trials. Methods: Review of guidelines governing payments to clinicians for recruitment to trials. Semistructured interviews with a range of NHS clinical trial leaders, analysed using qualititative methods. Results: While UK guidelines had little to say specifically on payments linked to recruitment, all payments have become highly regulated and increasingly transparent. Interview participants believed that expenses arising from research should be covered. Payments in excess of expenses were seen as likely to increase participation but with the risk of reducing quality. Motivations such as interest in the topic, the scope for patients to benefit and intellectual curiosity were considered more important. Barriers to involvement included bureaucracy and lack of time. Discussion: Limited scope exists for paying clinicians over-and-above the cost of their time to be involved in research. Most trialists favour full payment of all expenses related to research. Conclusion: Payment of clinicians beyond expenses is perceived to be a less important motivating factor than researching important, salient questions, and facilitating research by reducing bureaucracy and delay

The political economy of the disability insurance: theory and evidence of gubernatorial learning

Abstract The dramatic rise in the disability insurance (DI) rolls in the last 20 years has been the subject of much controversy. While the relationship between DI and labor force participation has been the subject of a growing literature, the mechanism of this transition from employment to DI remains unclear. We hypothesize that one mechanism is the state-level administration of the program which creates a classic principal-agent problem. We analyze the conflict of interests for Disability Determination Services agencies between Social Security Administration (SSA) standards and state gubernatorial political interests interacted with the increased demand for disability insurance as an alternative for low-skilled employment during the period of 1982 to 2013. We find evidence that multi-term governors allow a greater fraction of applicants than do first-term governors, but only up to year 2000, when allowance rates started to decrease over time. We develop a model that illustrates how these differences can be due to the type of monitoring conducted by the SSA. We provide additional evidence supporting this hypothesis analyzing how the effects interact with economic and political constraints. JEL codes H55, I18, I38, G22</jats:p

The Control of Methicillin-Resistant Staphylococcus aureus Blood Stream infections in England

Methicillin-resistant Staphylococcus aureus (MRSA) blood stream infection (BSI) is a major healthcare burden in some but not all healthcare settings, and it is associated with 10%–20% mortality. The introduction of mandatory reporting in England of MRSA BSI in 2001 was followed in 2004 by the setting of target reductions for all National Health Service hospitals. The original national target of a 50% reduction in MRSA BSI was considered by many experts to be unattainable, and yet this goal has been far exceeded (∼80% reduction with rates still declining). The transformation from endemic to sporadic MRSA BSI involved the implementation of serial national infection prevention directives, and the deployment of expert improvement teams in organizations failed to meet their improvement trajectory targets. We describe and appraise the components of the major public health infection prevention campaign that yielded major reductions in MRSA infection. There are important lessons and opportunities for other healthcare systems where MRSA infection remains endemic

United Nations Sustainable Development Goals: Promoting health and well-being through physical education partnerships

The United Nations recently approved the Sustainable Development Goals (SDGs) which forms a guideline policy for all nations. While the UN have strongly advised that partnerships are essential for the implementation of these global goals, within local communities there is little evidence of how this is best done or what it looks like in practice. This paper shares a health and wellbeing community initiative that achieves goals three and four of the SDGs, and in doing so models how to implement physical education partnerships as advocated by the UN. The highly successful innovative initiative is “Best Start: A community collaborative approach to lifelong health and wellness” (2011–2014).This paper shares a health and wellbeing partnership, modelling implementation of physical education (PE) advocated by the United Nations (UN). The Sustainable Development Goals (SDGs) exemplifies global efforts towards equality, specifically Goal 3 and 4 address health and wellbeing. The purpose of this paper is to provide insights into cross sector “partnerships”, identified as essential for the implementation of the SDGs. This is significant as the UN acknowledge a present gap of information on partnerships in action and a need for reporting from the ground level. The project “Best Start: A community collaborative approach to lifelong health and wellness”, began as a partnership between a university and nearby schools and quickly grew to involve Australian Registered Training Organisations, the local health industry, Education departments and sport governing bodies. The collaborations involved pre-service teachers teaching Health and PE lessons to children in a disadvantaged socio-economic area, creating valuable learning experiences for stakeholders. Local and global communities were involved in research and reform. The project creatively optimised resources available through state, Australian and international connections. International partnerships enabled identification of unique contextual opportunities. Programme planning was strengthened with data gathered from an England and Wales Ofsted awarded Primary Physical Education course. Various methods, including; semi-structured interviews, reflective journal, observations, document analysis, and Student Evaluation of Teaching Units (SETU) were adopted. SETU is valid and reliable data collected by the university for the purposes of research. The findings support that partnerships enable SDG implementation and the research paper offers direction for localisation

Report of the Commissioner of the General Land Office, 1893

53-2Annual Message to Congress with Documents; Pres. Cleveland. [3197-3218] Pres. Discusses Indian policy; annual report of the Sec. of War (Serials 3198-3206); annual report of the Sec. of Interior (Serials 3209-3215); annual report of the Gen. Land Office (1893-13

Annual Report of the Commissioner of the General Land Office for the Year 1891.

52-1Annual Message to Congress with Documents; Pres. Harrison. [2920-2942] Negotiations with Indians for reduction of their reservations; education of the Indians; Sioux outbreak of 1890; land cessions in Oklahoma Territory; annual report of the Sec. of War (1891-15

Legal themes concerning obesity regulation in the United States: Theory and practice

Despite national health objectives to reduce the incidence of obesity to 15% of the population by 2010, public health data suggest that the incidence of obesity in the United States is actually increasing. The U.S. recognizes that it (like other industrialized countries) faces an epidemic of obesity and related health conditions. How can U.S. jurisdictions (federal, state, and local) and the private sector respond to this epidemic through laws and policies that are directly or indirectly designed to address obesity? This article analyzes the theoretical and practical roles of law as a tool to curb obesity in the U.S. It proffers ten major legal themes to address obesity among the U.S. population, including: (1) use of incentives to encourage healthier behaviors; (2) use of financial disincentives to discourage unhealthy behaviors; (3) requirements to improve food quality, diversity, or availability; (4) compensation for injured persons seeking recourse; (5) restriction of access to unhealthy foods; (6) regulations aimed at influencing consumer choices; (7) control of marketing and advertising; (8) creation of communities that support healthy lifestyles; (9) physical education/fitness requirements; and (10) insurance coverage mandates

Editorial: Disarmament and Development – the International Context

The interconnections between international economic recession, the new Cold War and militarisation in the South provide the context for the articles in the IDS Bulletin 'Disarmament and World Development: Is There a Way Forward', from October 1985. Contributors were asked to reassess four key reports on development, disarmament and security issues. All were undertaken during a period of transition in the global economy and the Cold War (1979–83). Despite differences of emphasis they all advocate an integrated global approach to world economic and military problems, the restructuring of North-South economic relationships, strengthening of detente, and reductions in the allocation of resources for military purposes. But why, then, have they had so little impact on policy and still less on the march of events? Contributors to the Bulletin were also asked to address how disarmament and development could be put back on the international agenda. For instance, is there an adequate political case for linking disarmament to development and does military spending in fact entrench underdevelopment