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Coronavirus disease 2019 (COVID-19) vaccine trials provide valuable insight into the safety and efficacy of vaccines, with individually randomized, placebo-controlled trials being the gold standard in trial design. However, a myriad of variables must be considered as clinical trial data are interpreted and used to guide policy decisions. These variables include factors such as the characteristics of the study population and circulating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains, the force of infection, the definition and ascertainment of endpoints, the timing of vaccine efficacy assessment, and the potential for performance bias. In this Viewpoints article, we discuss critical variables to consider when comparing efficacy measurements across current and future COVID-19 vaccine trials.

The Bill & Melinda Gates Foundation supported respiratory syncytial virus (RSV) mortality surveillance studies in several low- and middle-income countries to address the striking gap in community mortality burden data from these geographies. The compelling findings generated from these studies reveal a high unmeasured burden of community RSV mortality, particularly among infants aged

It is generally agreed that striking a balance between resuming economic and social activities and keeping the effective reproductive number (R0) below 1 using nonpharmaceutical interventions is an important goal until and even after effective vaccines become available. Therefore, the need remains to understand how the virus is transmitted in order to identify high-risk environments and activities that disproportionately contribute to its spread so that effective preventative measures could be put in place. Contact tracing and household studies, in particular, provide robust evidence about the parameters of transmission. In this Viewpoint, we discuss the available evidence from large-scale, well-conducted contact-tracing studies from across the world and argue that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission dynamics should inform policy decisions about mitigation strategies for targeted interventions according to the needs of the society by directing attention to the settings, activities, and socioeconomic factors associated with the highest risks of transmission.

Testing representative populations to determine the prevalence or the percentage of the population with active severe acute respiratory syndrome coronavirus 2 infection and/or antibodies to infection is being recommended as essential for making public policy decisions to ease restrictions or to continue enforcing national, state, and local government rules to shelter in place. However, all laboratory tests are imperfect and have estimates of sensitivity and specificity less than 100%—in some cases, considerably less than 100%. That error will lead to biased prevalence estimates. If the true prevalence is low, possibly in the range of 1%–5%, then testing error will lead to a constant background of bias that most likely will be larger, and possibly much larger, than the true prevalence itself. As a result, what is needed is a method for adjusting prevalence estimates for testing error. Methods are outlined in this article for adjusting prevalence estimates for testing error both prospectively in studies being planned and retrospectively in studies that have been conducted. If used, these methods also would help harmonize study results within countries and worldwide. Adjustment can lead to more accurate prevalence estimates and to better policy decisions. However, adjustment will not improve the accuracy of an individual test.

Starting and stopping preventive chemotherapy (PC) for soil-transmitted helminthiasis is typically based on the prevalence of infection as measured by Kato-Katz (KK) fecal smears. Kato-Katz-based egg counts can vary highly over repeated stool samples and smears. Consequentially, the sensitivity of KK-based surveys depends on the number of stool samples per person and the number of smears per sample. Given finite resources, collecting multiple samples and/or smears means screening fewer individuals, thereby lowering the statistical precision of prevalence estimates. Using population-level data from various epidemiological settings, we assessed the performance of different sampling schemes executed within the confines of the same budget. We recommend the use of single-slide KK for determining prevalence of moderate-to-heavy intensity infection and policy decisions for starting and continuing PC; more sensitive sampling schemes may be required for policy decisions involving stopping PC. Our findings highlight that guidelines should include specific guidance on sampling schemes.

While tensions may lie between science and policy, we argue that dissemination and public engagement are key in alleviating those perceived tensions. Science being valued by society results in fact-based policy-making being demanded by constituents. Constituents’ demands will yield representatives who are familiar with the scientific process and research to inform policy decisions.

Author(s): Fowler, Christie D; Gipson, Cassandra D; Kleykamp, Bethea A; Rupprecht, Laura E; Harrell, Paul T; Rees, Vaughan W; Gould, Thomas J; Oliver, Jason; Bagdas, Deniz; Damaj, M Imad; Schmidt, Heath D; Duncan, Alexander; De Biasi, Mariella; Basic Science Network (BSN) of the Society for Research on Nicotine and Tobacco (SRNT) | Abstract: IntroductionScientific discoveries over the past few decades have provided significant insight into the abuse liability and negative health consequences associated with tobacco and nicotine-containing products. While many of these advances have led to the development of policies and laws that regulate access to and formulations of these products, further research is critical to guide future regulatory efforts, especially as novel nicotine-containing products are introduced and selectively marketed to vulnerable populations.DiscussionIn this narrative review, we provide an overview of the scientific findings that have impacted regulatory policy and discuss considerations for further translation of science into policy decisions. We propose that open, bidirectional communication between scientists and policy makers is essential to develop transformative preventive- and intervention-focused policies and programs to reduce appeal, abuse liability, and toxicity of the products.ConclusionsThrough these types of interactions, collaborative efforts to inform and modify policy have the potential to significantly decrease the use of tobacco and alternative nicotine products and thus enhance health outcomes for individuals.ImplicationsThis work addresses current topics in the nicotine and tobacco research field to emphasize the importance of basic science research and provide examples of how it can be utilized to inform public policy. In addition to relaying current thoughts on the topic from experts in the field, the article encourages continued efforts and communication between basic scientists and policy officials.

I use the introduction of mayoral term limits in Portugal to identify how an exogenous variation in eligibility for office affects policy decisions. Relying on a quasi-experimental difference-in-differences approach, I find that term-limited incumbents pursue more conservative fiscal policies than those who are eligible for re-election. Heterogeneous effects show that the treatment effects primarily reflect the behaviour of right-leaning, term-limited incumbents. Results are in line with a model in which right-leaning officeholders try to maintain a good reputation by pleasing an electorate prone to redistribution while they are eligible, but adopt policies closer to their true preferences when term-limited.

This article discusses the case of the Allied Democratic Forces (ADF) rebel group in the Democratic Republic of Congo (DRC). It shows how a variety of actors that have opposed the ADF group have framed the rebels to achieve a range of political and economic objectives, or in response to organizational and individual limitations. The DRC and Ugandan governments have each framed ADF in pursuit of regional, international and national goals separate from their stated desires to eliminate the armed group. The UN stabilization mission in Congo's (MONUSCO) understanding of the ADF was influenced by organizational limitations and the shortcomings of individual analysts, producing flawed assessments and ineffective policy decisions. Indeed, the many 'faces' of ADF tell us more about the ADF's adversaries than they do about the rebels themselves. The article shows how the policies towards the ADF may not be directly related to defeating a rebel threat, but rather enable the framers (e.g. DRC and Ugandan governments) to pursue various political and economic objectives, or lead the framers to pursue misguided operational plans (e.g. MONUSCO). In doing so, the article highlights more broadly the importance of the production of knowledge on conflicts and rebel groups: the way in which a rebel group is instrumentalized, or in which organizational structure impact on the understanding of the rebel group, are crucial not only in understanding the context, but also in understanding the interventions on the ground. [ABSTRACT FROM AUTHOR]

Performance-based promotion schemes in administrative hierarchies have limitations. Chinese provincial leaders, despite facing strong career concerns, make different policy decisions depending on their career backgrounds. Provincial party secretaries who have risen from low to high positions within the province they govern (“locals”) spend a higher share of budgetary resources on education and health care and invest less in construction infrastructure than party secretaries who have made their most significant career advancements in other provinces (“outsiders”). Identification comes from variation in central leadership and term limits. As the promotion mechanism rewards infrastructure investments, locals are less likely to be promoted at the end of the term. We explore various mechanisms and provide evidence that the difference between locals and outsiders is not driven by knowledge or experience. Several pieces of evidence suggest that locals cater to low-level provincial elites, who helped them rise to power. Thus, local career trajectories limit the power of career concerns by fostering competing allegiances.

Electronic nicotine delivery systems (ENDS), commonly known as electronic cigarettes (or e-cigarettes), are widely available in the USA, yet almost entirely unregulated on a national level. Researchers are currently gathering data to understand the individual and public health effects of ENDS, as well as the role that ENDS may play in tobacco treatment. Given these uncertainties, regulatory efforts should be aimed at understanding and minimizing any potential harms of ENDS. The Society of Behavioral Medicine (SBM) supports stronger regulation of ENDS, incorporation of ENDS into clean air policies, and special consideration of safety standards to protect vulnerable populations. SBM also supports research on ENDS to guide policy decisions.

Democratic foreign policy choices are a function of expected international outcomes and the preferences, power, and information of domestic actors. Studies of domestic political competition and international crisis bargaining have argued that an opposition's policy positions send credible signals of the government's intentions to adversarial target states. This paper contends that while opposition behavior may send informative signals, it can also directly constrain the policy options of the government. We relax previous assumptions that the opposition cannot directly prevent war or influence the outcomes of war (Schultz 2001). Instead, we assume that the opposition controls some political resources and attempts to influence the government's policy decisions in a way that advances its own partisan interests. To empirically demonstrate the theoretical differences in our model in comparison with previous domestic opposition models, we examine the case of the Quasi-War of 1798 between the United States and France.

Scrutinizing and questioning contentious and failed policy decisions should result in discussing ‘ifs, buts, and maybes’, particularly when there are policy alternatives. This article scrutinizes and questions the British decision to reject Armenian proposals to form a legion of Armenian volunteers in 1914 and 1915, especially since in late 1916 the French, with British approval, established an Armenian legion (until 1919 called the Legion d'Orient); and because the first proposals for a legion were connected to British considerations, also overlooked, to land a force at Alexandretta. Nothing of substance has been published on the initial proposals to form an Armenian legion, and on its connection to the Armenian genocide and the proposed British landing at Alexandretta. By focusing on why the British rejected the proposal to form an Armenian legion and the implications, if any, for the Armenian genocide and the Allied discussions on where to attack the Ottoman empire during the first four months of 1915, this article offers important new insights into why the British and French failed to do anything to prevent the Armenian genocide, and got it wrong with their decision to land forces at Gallipoli in April 1915 instead of at Alexandretta. Imperialism lies at the heart of the explanation.

European self-regulation to ensure children's safety on social networking sites requires that providers ensure children are old enough to use the sites, aware of safety messages, empowered by privacy settings, discouraged from disclosing personal information, and supported by easy to use reporting mechanisms. This article assesses the regulatory framework with findings from a survey of over 25000 9- to 16-year-olds from 25 European countries. These reveal many underage children users, and many who lack the digital skills to use social networking sites safely. Despite concerns that children defy parental mediation, many comply with parental rules regarding social networking. The implications of the findings are related to policy decisions on lower age limits and self-regulation of social networking sites.

This study compares two frequently used operationalizations of understanding: factual knowledge and perceived familiarity. The authors argue that these measurements--which have been used interchangeably in past research--are conceptually distinct and should be treated as such. Using hierarchical linear ordinary least squares regression, this study provides evidence that factual knowledge and perceived familiarity are only slightly correlated and are influenced differently by predicting variables, such as media use and cognitive processing variables. As a result, the use of these measures may result in different assessments of the levels of public understanding, which has important implications for future policy decisions. Copyright The Author 2012. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com, Oxford University Press.

Background: Nutrition labels are a potentially valuable tool to assist consumers in making healthy food choices. Front-of-pack labels are a relatively new format and are now widely used across many European countries, but it is unclear which of the many formats in use are best understood by consumers. It is also unclear whether the existence of multiple formats impedes understanding and use. This article addresses this question with findings from a study commissioned by the UK Food Standards Agency to provide evidence to inform policy decisions in this area. Methods: In-depth qualitative interviews were used to explore consumers’ decision-making processes when using two different front-of-pack label formats to judge the relative healthiness of a pair of products. Participants were presented with product pairs differently labelled and a series of structured prompts were used to access their internal dialogues and to identify any difficulties encountered. Results: The interviews revealed that making product comparisons using different label formats was challenging for participants and particularly for those product pairs where there was not an obvious answer. When the label formats on the product pairs lacked a common element, such as text, this also caused difficulties and misinterpretation. The comparisons also took time and effort that would be a deterrent in real-life situations. Conclusions: These findings indicate that the existence of multiple front-of-pack label formats in the marketplace may impede consumer comprehension and discourage use. They suggest that a single format may encourage consumers to use front-of-pack labels in making healthy food choices.

The office of UK Minister for Sport was created in 1964 at a junior level in government and has had 14 post-holders up to 2011. In this period, sport has become increasingly politicised. However, decisions to bid for major events such as the 2012 Olympics are made at Cabinet level from which the Minister for Sport is excluded. If Sports Ministers do not get closely involved in high-level sports policy decisions, what do they actually do? This article looks at relevant aspects of government sports policy, the influence that Ministers for Sport may have had on it and the limitations of that influence. It then examines the activities of the Ministers in Parliament, including the proportion of their time actually spent on sport. Finally, it assesses the holders of the office themselves and, in particular, their prospects for promotion in government.

This article examines the following question: How do independent agencies within parliamentary democracies perceive the influence of various political principals and societal stakeholders in their environment on their strategic and policy decisions? This question is examined through an extension of the theory and methodology of Waterman, Rouse, and Wright for 213 Dutch agencies. We find that agencies perceive their parent minister as their primary principals. This implies that the relationship between politicians and agencies in the Netherlands fit the model of dyadic principal agency relationship. By contrast, we find no support for the existence of horizontal network type of relationships between agencies and governmental and nongovernmental stakeholders in their environment. We also find, remarkably, that agency officials in the Netherlands apply the same categories for distinguishing between their principals as the US agency officials in the study of Waterman, Rouse, and Wright. Este articulo examina la siguiente pregunta: En democracias parlamentarias ?como perciben las agencias independientes la influencia tanto de los principales politicos como de las entes sociales de interes dentro de su entorno, sobre sus decisiones estrategicas y politicas? Esta pregunta es examinada en 213 agencias neerlandesas a traves de una extension de la teoria y metodologia empleada por Waterman, Rouse y Wright. Descubrimos que las agencias perciben su ministro matriz como su principal mas importante Esto implica que la relacion entre los politicos y sus agencias en los Paises Bajos cuadran con el modelo de la relacion diadica de principal-agente. Por el contrario, no descubrimos evidencia que existan relaciones horizontales del tipo red entre las agencias y los entes, gubernamentales y no gubernamentales, que tienen algun tipo de interes dentro del entorno de la agencia. Tambien descubrimos, increiblemente, que los funcionarios de las agencias en los Paises Bajos emplean las mismas categorias para distinguir entre sus principales como lo hacen los funcionarios de las entidades estadounidenses en el estudio de Waterman, Rouse y Wright. Translations by Claudia N. Avellaneda, University of North Carolina Charlotte and Nicolai Petrovsky, University of Kentucky

Conservation scientists increasingly recognize the need to incorporate the social sciences into policy decisions. In practice, however, considerable challenges to integrating the social and natural sciences remain. In this article, we review the US Fish and Wildlife Service's (FWS) 2009 decision to remove the northern Rocky Mountain population of gray wolves from the federal list of endangered species. We examine the FWS's arguments concerning the threat posed by humans' attitudes toward wolves in light of the existing social science literature. Our analysis found support for only one of four arguments underlying the FWS's assessment of public attitudes as a potential threat to wolves. Although we found an extensive literature on attitudes toward wolves, the FWS cited just one empirical research article. We conclude that when listing decisions rest on assumptions about society, these assumptions should be evaluated using the best available natural and social science research.

Nonindigenous forest insects and pathogens affect a range of ecosystems, industries, and property owners in the United States. Evaluating temporal patterns in the accumulation of these nonindigenous forest pests can inform regulatory and policy decisions. We compiled a comprehensive species list to assess the accumulation rates of nonindigenous forest insects and pathogens established in the United States. More than 450 nonindigenous insects and at least 16 pathogens have colonized forest and urban trees since European settlement. Approximately 2.5 established nonindigenous forest insects per year were detected in the United States between 1860 and 2006. At least 14% of these insects and all 16 pathogens have caused notable damage to trees. Although sap feeders and foliage feeders dominated the comprehensive list, phloem- and wood-boring insects and foliage feeders were often more damaging than expected. Detections of insects that feed on phloem or wood have increased markedly in recent years.

This study reports results from a 2008 survey of U.S. State agency administrators across all 50 states and 12 different agency types. Agency managers were asked to disclose the extent to which they relied on information from 19 information sources and to weight the value of information from each source. This paper is particularly interested in ascertaining the proportion of agency policies that are based on formal scientific evidence, and the importance of scientific information as a source of influence on agency decisions relative to other potential sources of information. Information is presented by agency type with significant differences across substantive policy areas noted. Using a weighted index approach, we combine the frequency of consultation of an information source with the weight placed on that evidence by the agency administrator in developing programs and practices. Using these weighted scores, we further examine the relationship of these responses to the weight agencies place on information from various sources.

This paper investigates citations to articles published in the Review of Agricultural Economics and in the American Journal of Agricultural Economics to better understand the impact of articles published in these journals and to evaluate recent policy decisions made by the Agricultural and Applied Economics Association. The biggest factors affecting non-self citations are self-citations and whether the article received at least one citation in the year after publication, suggesting that "advertising" and "signaling" play important roles in the extent to which a paper is cited. Principal papers and commentssreplies are associated with significantly fewer citations for both journals. Copyright 2009 Agricultural and Applied Economics Association

In recent decades, the roles of government have changed greatly and consequently systems of national planning have also changed. Governments still have roles but they must play soft roles and therefore, they need new tools for these new roles. This paper proposes a model to make it possible to establish which actions needs to be planned at the national level (particularly for science and technology development) by compounding three government roles (providing policy intelligence, making policy decisions and policy implementation) with four tools (direct intervention, regulations, offering incentives and promotion). The National Iranian Nanotechnology Initiative is used as a case study. Copyright , Beech Tree Publishing.

Scientists and their professional societies are seeking to increase their influence in shaping policy decisions. A recent call for natural resource professional societies to endorse position statements on economic growth raises questions about how scientific societies can and should effectively contribute to policy development. Taking a stand on policy issues is akin to serving as a policy advocate. We believe that natural resource professionals can most constructively contribute to policy development by conducting rigorous research that is policy relevant and by effectively conveying the results and policy implications of that research to all parties interested in the issue. By actively engaging decisionmakers and providing information on pressing policy issues, professional societies can increase opportunities to be recognized as sources for reliable, unbiased information about natural resources and their management.

The theory of representative bureaucracy suggests that a demographically diverse public sector workforce (passive representation) will lead to policy outcomes that reflect the interests of all groups represented, including historically disadvantaged communities (active representation). Implicit in the passive-active link is the expectation that minority public administrators, in particular, will have similar attitudes to minority citizens on issues of critical import and relevance to those citizens, and those attitudes, in turn, will influence policy decisions. This research examines the attitudes of citizens and administrators on a series of survey items focused on the responsibilities of local government administrators to advocate for the interests of the African-American community. The survey results confirm the hypothesis that African-American citizens and administrators are more likely than white citizens and administrators to support governmental behaviors that specifically target the interests of the African-American community and that African-American citizens and administrators hold markedly different attitudes from white administrators. Most significantly, attitude congruence with the views of African-American citizens by administrators is shown to be a significant predictor of the adoption of an African-American representative administrative role, overwhelming the influence of other variables including race.

In this article, I review and expand upon arguments showing that Freedman's so-called "clinical equipoise" criterion cannot serve as an appropriate guide and justification for the moral legitimacy of carrying out randomized clinical trials. At the same time, I try to explain why this approach has been given so much credence despite compelling arguments against it, including the fact that Freedman's original discussion framed the issues in a misleading way, making certain things invisible: Clinical equipoise is conflated with community equipoise, and several versions of each are also conflated. But a misleading impression is given that, rather than distinct criteria being arbitrarily conflated, a puzzle is solved and a number of features unified. Various issues are pushed under the rug, hiding flaws of the "clinical equipoise" approach and thus deceiving us into thinking that we have a solution when we do not. Particularly significant is the ignoring of the crucial distinction between the individual patient decision and the policy decision.

Background Both the prediction and evaluation of outcomes from health interventions frequently rely on self-report data. As these have the potential to not only influence daily healthcare but also influence large-scale policy decisions, it is imperative that data collected are pertinent to patients, clinicians and other stakeholders. Consequently, researchers have an ethical responsibility to apply only those instruments that generate …

A monetary union is modelled as a technology that makes a surprise policy deviation impossible and requires voluntarily participating countries to follow the same monetary policy. Within a fully dynamic context, we show that such an arrangement may dominate a regime with independent national currencies. Two new results are delivered by the voluntary participation assumption. First, the optimal plan is shown to respond to a country's temptation to leave the union by tilting both current and future policy in its favour. This yields a non-linear rule according to which each country weight in policy decisions is time-varying and depends on its incentive to abandon the union. Second, we show that there might be conditions such that a break-up of the union, as has occurred in some historical episodes, is efficient. The paper thus provides a first formal analysis of the incentives behind the formation, sustainability, and disruption of a monetary union.

We estimated the effectiveness of postexposure smallpox vaccination in preventing or modifying disease in naive and previously vaccinated adults, using the formal Delphi technique. For persons not previously vaccinated, the median effectiveness in preventing disease with vaccination at 0-6 h, 6-24 h, and 1-3 days after exposure was estimated as 93%, 90%, and 80%, respectively, and effectiveness in modifying disease among those who develop illness was estimated as 80%, 80%, and 75%, respectively. Effectiveness was greater for those vaccinated previously. High postexposure vaccination effectiveness for preventing or modifying smallpox is consistent with the limited data available, is biologically plausible, and is similar to that seen for other viral vaccine-preventable diseases. These estimates support the Advisory Committee on Immunization Practices recommendations and provide a key parameter for mathematical models on which policy decisions may be based.

Electoral constituencies recognize favorable policy outcomes in high- turnout jurisdictions (Key 1984 [1949]; Hamilton 1993; Fleck 1999). In the present paper, I evaluate whether underlying institutions might provide a finer explanation of this relationship. To do so, I formally examine variation in telecommunications policy across US states. The resulting evidence is consistent with residential customers recognizing more favorable policy when institutions reduce voting’s resource cost (measured by registration rules) or increase its non-pecuniary benefit (measured by Perot-support). Measures of either force explain significantly more variation in the present data than does a measure of actual participation (i.e., turnout).

William Brock and Steven Durlauf's article nicely summarizes some of the recent research on Bayesian model averaging. They make a number of important points. One is that the empirics of growth face three key problems: model uncertainty, parameter uncertainty, and endogeneity. They argue that theory uncertainty can be dealt with using Bayesian model averaging methods.

During the last decade, thhe European Union intensified its efforts to define its external borders in conjunction with its efforts to evolve into a coherent, frontier-free political territory. European policy-makers slowly shaped new norms and rules pertaining to asylum, with increasingly stronger mechanisms to enforce the policy decisions. In the case of asylum and refugee protection, Europe's efforts are nested in the broad global institutional framework negotiated through and carried out by international organizations. However, these developments raise the specter of deteriorating refugee protection in Europe and beyond. This article reviews the norms and rules on which the post–World War II refugee protection regime rests and then points to the recent developments in refugee protection in Europe, which might undermine the goals of the global refugee protection.

This paper analyses the dynamics of the interactions between scientific and non-scientific considerations in providing scientific advice to policy, focusing on the first scientific committee to advise on BSE (bovine spongiform encephalopathy) policy-making in the UK and the political and social roles it was expected to play, and in practice played, in policy-making. The paper argues that the Committee was both deliberately and inadvertently utilised to provide spurious scientific legitimation for policy decisions which government officials believed ministers, other government departments, the meat industry and the general public might not otherwise accept. It demonstrates how those social roles rendered the spectrum of policy choices available on BSE opaque, allowed officials to undermine the democratic accountability of ministers, and contributed to making a very serious problem considerably worse. Some practical lessons are outlined for the organisation of scientific expertise in political affairs. Copyright , Beech Tree Publishing.

We think of voice as a means of information aggregation within groups operating in a variety of settings. We explore how the characteristics of groups and their leaders influence voice. In relatively homogeneous groups, members farthest away from the leader have the best incentives to provide information, and their voice tends to moderate policy decisions. In large heterogeneous groups where leaders cannot identifY individual members, the possibilities for informational exchange are severely limited, and any communication that exists pushes policies farther to the extreme.

This article addresses the question of why the public provision of objective, nonpartisan policy information has become increasingly conflicted and difficult. The nature of a public-policy information system is first described. An examination of the changing mission of the U.S. Department of Agriculture provides a perspective on the challenges one faces today in providing information and advice for policymakers in agriculture, food, natural resource use, and the environment. Then an attempt is made to identify the many forces influencing today's difficult policy environment. The conclusion presents lessons from experience or principles that need to be observed if a public agency is to be a success over time in providing objective information for policy decisions. The profession's stake in this matter is discussed.

Legislators value both campaign contributions and policy-relevant information interest groups might offer through lobbying. At the same time, there is some evidence that legislators are price setters to the extent that access to an incumbent legislator is conditional in part on making some level of campaign contribution. In this article, I consider a legislator's trade-off between granting access for informational reasons and granting access for contributions. Legislative influence in the model is exclusively through the provision of decision-relevant information, and money is used exclusively to seek access; in particular, groups cannot make contributions in exchange for policy decisions. The focus of the analysis is on the implications of the legislator's price setting on the induced pattern of demand for access and the consequences for the informational quality of subsequent legislative decisions. Moreover, although lobbyists are permitted to choose their informational source strategically, there is no possibility of dissembling when making an argument for one policy decision over another. The analysis yields both empirical predictions on the frequency and character of induced lobbying by different types of agents and provides some qualified support for limiting campaign contributions.

Most graduate programs require students to participate in a course or seminar that allows them to develop skills in scientific presentation. Few programs, however, prepare students to locate, read, analyze, and critique the types and sources of information that so frequently underpin the public debates that precede most policy decisions. Still fewer programs allow students to practice using incomplete or contradictory information to formulate and defend arguments on policy, ethics, or related issues. Increasingly, entomologists find themselves involved in a public arena, using such information to discuss matters that have broad consequences for science and society. Scientists who enter the workplace with debating skills will be more prepared to shape effective policy, prioritize research agendas, defend their discipline against budgetary cutbacks, and/or confront allegations of ethical or other misconduct. This being the case, providing opportunities in graduate education for students to debate timely and important issues will benefit not only the students but also their discipline and society as a whole (Carroll et al. 1993).

Little is known concerning health outcome for patients who survive burn injuries, and how their health outcome compares with that of other medical populations. Such information is important given that the current direction of health care policy decision making is toward outcomes-driven decision models. We compared the health status of 91 patients 1 month after severe burn injury with the published reports of the health status of 39 medical comparison samples, and two reports of health status for the general population. Additionally, we collected longitudinal data on a subsample of our surviving patients with burn injuries at 1 year. Our findings suggest that people who survive a severe burn experience a stable and relatively good health status after their injury compared with other medical samples. However, their health status remains worse than that of the general population over time. Further, people who survive a major burn indicate that the areas of vocational and psychosocial functioning are often the most troublesome for therm.

This paper presents a theoretical framework for understanding the reforms that occurred in the CFA franc zone in the 1980s and 199Os, focusing on public debt and the exchange rate. It analyses the real-side adjustment strategy that was adopted initially. It shows how the debt problem and misdirected policy decisions led to the historical devaluation of January 1994, the first since 1948. Copyright 1997 by Oxford University Press.

Objective: The objective of this study is to quantify the future worldwide economic impact of functional gastrointestinal disease and to describe international differences that might exist between major industrialized countries. Design: This study employs an econometric projection using data from the only known survey of national economic impact of functional gastrointestinal disease. Economic costs from this survey are combined with country specific population estimates, health care spending characteristics, and growth rates to estimate economic impact for major industrial countries. Results: The estimated economic impact of functional gastrointestinal disease for eight major industrial countries is over 41 billion U.S. dollars annually. This estimate includes both direct and indirect costs of disease. Conclusion: The economic impact of functional gastrointestinal disease is large. Economic estimates are useful in policy decision making regarding the allocation of health care resources. Copyright © 1998 Taylor and Francis Ltd.

This article presents a general mathematical model of the diffusion of innovations, which incorporates mass media and interpersonal influence. The model is applied to three classic diffusion data sets: (a) use of hybrid corn, (b) knowledge of Eisenhower's stroke, and (c) doctors’prescription of a new drug. Nonlinear regression is used to estimate the mathematical model. The results show that diffusion of hybrid corn occurred via interpersonal influence, whereas the diffusion of knowledge of Eisenhower's stroke occurred via the mass media. For the diffusion of the new drug, the model shows that doctors who subscribed to few medical journals learned about the drug primarily through interpersonal influence, while doctors who subscribed to many medical journals learned about the drug through both mass media and interpersonal channels. Policy decision-makers can use diffusion models to (a) evaluate the effectiveness of media versus interpersonal campaigns, (b) make comparisons between subgroups, and (c) evaluate the effect of a policy.

Data collected through routine surveillance of measles cases will ideally be used to make policy decisions for vaccination programs. Nigeria has recently implemented a passive surveillance system for measles. Results indicate increasing measles cases in Southwest Nigeria but this may or may not indicate a true increase in measles cases. Only very basic assessments of the logistics of the system have been conducted. Further investigations of the quality of the data and performance of reporting sites must be made to determine the reliability of information being generated by the surveillance system before conclusions can be drawn.

To the editor—Borse et al. [1] describe an economic analysis of respiratory syncytial virus (RSV) prophylaxis for infants in Alaska's Yukon-Kuskokwim Delta. The authors should be congratulated for evaluating this important question with a robust analysis. As these infants are almost entirely insured by Medicaid, we wish to clarify the net Medicaid cost of palivizumab. Based on the 2010 average wholesale price (AWP), Alaska Medicaid's published reimbursement rate, and the minimum Medicaid rebate, the authors estimated a cost of $1055 per 50 mg [1]. However, using Alaska Medicaid's reported pre-rebate expenditures for palivizumab and incorporating all components of the Medicaid rebate yields a more accurate estimate, which is substantially lower at $588 per 50 mg [2, 3]. AWP is determined by drug reference companies and does not reflect a price at which manufacturers sell products to wholesalers. The US Office of the Inspector General has described AWP-based reimbursement as “fundamentally flawed” and has recommended payment based on a single national pricing benchmark based on average drug acquisition costs [4]. Given this, a better source is wholesale acquisition cost (WAC), or the list price for a drug sold by a manufacturer to wholesalers. The 2010 WAC for 50 mg of palivizumab was $1074. For Alaska Medicaid specifically, the reported pre-rebate palivizumab expenditure for 2010–2011 was $1082 per 50 mg [2]. Precise estimates of Medicaid rebates for drugs are difficult to calculate because rebate payments are not publicly available. However, they can be estimated based on the two components of the Medicaid rebate [5]. The authors note that the first component is 17.1% of average manufacturer price. However, there is a second consumer price index (CPI)–based component, which effectively precludes drug cost increases in excess of changes in CPI [5]. Based on data from 10 large states, these two rebate components were estimated to result in a 41% reduction in the 2010 palivizumab cost for Medicaid [6]. Other drugs have rebates of similar magnitude; Medicaid rebates recouped 45% of expenditures on 100 brand-name drugs in 2009 [4]. For Alaska Medicaid specifically, the estimated net 2010–2011 cost of palivizumab after rebates is $588 per 50 mg [2, 3]. This cost is considerably lower than the Borse et al. estimate and approaches one of the modeled cost-neutral thresholds of $486 [1]. Lastly, the authors incorrectly state that palivizumab AWP increased by 184% from 2001–2010 (20% annually), referencing Red Book data [7, 8]. Red Book [7, 8] reports a palivizumab AWP increase of 78% from 2001 to 2010, a 7% annual increase. After Medicaid rebates, the net US cost increase was approximately 60% from 2001 to 2010, or 5.5% annually. This increase is lower than the 83% inflation rate for US inpatient hospital services from 2001 to 2010 [9]. Similarly, the cost of an RSV hospitalization among US infants increased by 89% from 2000 to 2009 [10]. In closing, we congratulate the authors on a robust analysis and hope that this additional information regarding the net Medicaid costs of palivizumab will help inform policy decisions and future research regarding RSV prophylaxis in the United States.

This paper illustrates how adding an epidemiologic perspective to medical accession policy development allows the Department of Defense to address unacceptably high rates of premature attrition, lost duty time, avoidable medical care costs, sick leave, disability, and various wasteful, inefficient practices. The Accession Medical Standards Analysis and Research Activity is a major new epidemiologic entity. Historically, military medical accession policy and waiver deliberations were based heavily on expert opinion. A common limitation of expert opinion is that although experience teaches much about individuals with certain conditions who develop problems, it does not teach about individuals with the same conditions who remain well. The Accession Medical Standards Analysis and Research Activity produces the analyses of epidemiologic data necessary for the joint personnel and medical flag-level Department of Defense Accessions Medical Standards Steering Committee to make evidence-based accession policy decisions.