Juita-Elena (Wie) Yusuf

An update on out-of-hospital airway management practices in the United States

OBJECTIVE We characterized out-of-hospital airway management interventions, outcomes, and complications using the 2012 NEMSIS Public-Release Research Data Set containing almost 20 million Emergency Medical Services activations from 40 states and two territories. We compared the outcomes with a previous study that used 2008 NEMSIS data containing 16 states with 4 million EMS activations. METHODS Patients who received airway management interventions including endotracheal intubation (ETI), alternate airways (Combitube, Laryngeal Mask Airway (LMA), King LT, Esophageal-Obturator Airway (EOA)), and cricothyroidotomy (needle and surgical) were identified. Using descriptive statistics, airway management success and complications were examined in the full cohort and key subsets including cardiac arrest, non-arrest medical, non-arrest injury, children<10 years, children 10-19 years, rapid sequence intubation (RSI), population setting, U.S. census region, and U.S. census division. RESULTS Among 19,831,189 EMS activations, there were 74,993 ETIs, 21,990 alternate airways, and 1332 cricothyroidotomies. ETI success rates were: overall 63,956/74,993 (85.3%; 95% CI: 85.0-85.5), cardiac arrest 33,558/39,270 (85.5%), non-arrest medical 12,215/13,611 (89.7%), non-arrest injury (90.1%), children <10 years 2069/2468 (83.8%), children 10-19 years 1647/1900 (86.7%), adults >19 years 58,965/69,144 (85.3%), and rapid sequence intubation 5265/5658 (93.1%). Major complications included bleeding 677 (4.4 per 1000 interventions), vomiting 1221 (8 per 1000 interventions), esophageal intubation immediately detected 874 (5.7 per 1000 interventions), and esophageal intubations other 219 (1.4 per 1000 interventions). CONCLUSIONS Low out-of-hospital ETI and alternate airway success rates were observed. These data may guide national efforts to improve out-of-hospital airway management quality leading efforts to better educate providers on ETI.

For the People: Popular Financial Reporting Practices of Local Governments

Popular financial reports are reports distributed to citizens and other interested parties who lack a background in formal government financial reporting but who desire an overview of the governments financial status and activities. This paper examines the current state of local government popular financial reporting in the U.S. The results of a survey of large cities and counties indicate that 75 percent of these local governments have issued popular financial reports and that the types of reports and methods of distribution vary. Many of the reasons for providing popular reports relate to providing information and improving transparency and accountability by providing more user friendly financial reports. This paper concludes with a discussion on popular financial reporting in the context of government transparency and accountability, and offers a research agenda for continued study of the topic.

Paying for Locally Owned Roads: A Crisis in Local Government Highway Finance

The past two decades have witnessed substantial changes in the dynamics of state—local relationships for highway funding. We argue that four factors have produced a funding crisis for local governments: an increase in developed land and locally owned roads; a rise in construction and maintenance costs; devolution of highway financing responsibility from the states to localities with a reduction in intergovernmental transfers; and more wear and tear on roads due to increased vehicle miles traveled. Local governments can delay maintenance and build fewer new facilities, but eventually many will seek new sources of revenues to fund their growing responsibilities. We identify several potential financing mechanisms: impact fees and smart growth policies; local option transportation taxes; nontraditional taxes and fees such as transportation utility fees and land taxes; and low-cost debt financing from state infrastructure banks. We discuss challenges faced by local governments in continuing to meet their responsibilities and financing needs.

An Empirical Examination of the Statutory Characteristics and Effects of Highway and Transportation Commissions on DOT Capital Management Capacity

A majority of the states have created, by statute, some type of external body (such as a board or commissions) to oversee their departments of transportation (DOTs). The focus of this research is on two types of commissions: highway-only commissions and multimodal transportation commissions. We review the authorizing statutes that establish these boards and commissions to identify their statutorily defined membership characteristics and roles. We then empirically estimate the possible contribution of commissionsstatutory characteristics to a measure of DOT capital and infrastructure management capacity taken from the Government Performance Project. The findings suggest that commissions are designed to promote the general interest in the efficient allocation of transportation resources. They also suggest that large commissions may improve management capacity by fostering more open discussion. There were no significant differences between highway-only and multimodal transportation commissions.

State Infrastructure Banks and Intergovernmental Subsidies for Local Transportation Investment

This study reviews State Infrastructure Banks (SIBs) as an innovative financing mechanism for federal and state governments to support transportation financing for local governments, and determines the cost savings realized by local governments from receiving SIB loans rather than financing through the municipal bond market. The study finds that SIBs provide a mechanism through which local governments receive subsidized loans for their transportation investments. With the Ohio SIB, localities realized average borrowing cost savings between 34 and 184 basis points. Under the worst- and best-case scenarios, 83 and 98 percent of projects, respectively, benefited from lower borrowing costs.

Impact of start-up support through guided preparation

Purpose - – The purpose of this paper is to examine if and how entrepreneurial assistance programs, through guided preparation, affect start-up success. Design/methodology/approach - –This study uses Heckmans two-stage sample selection model to predict the effect of contact and interactions with entrepreneurial support programs on start-up outcomes while taking into account the entrepreneurs self-selection into obtaining support from these programs. Findings - – The results indicate that, after controlling for individual characteristics, activities undertaken during the start-up process, organizational characteristics and external factors, guided preparation contributes to a greater likelihood of achieving positive start-up outcome. This finding holds even after controlling for the entrepreneurs self-selection into contacting and using outside assistance. Research limitations/implications - – Results suggest that self-selection bias remains a concern when studying the impact of assistance programs on start-up outcomes. Future research should make sure to address self-selection in their analysis. Practical implications - – The studys results have implications for the design of start-up programs. It highlights the importance of delivery structures that are fluid, flexible, interactive, experiential, and tailored to the individual entrepreneurs needs. Originality/value - – This study focusses on assistance programs broadly defined (includes many different types of programs) and provides an empirical analysis that addresses self-selection.

Improving Revenue Adequacy by Indexing the Gas Tax to Indicators of Need A Simulation Analysis

The current crisis in highway finance in the United States is mostly driven by greater vehicle fuel efficiency, substantial rises in construction costs and automobile use, and fixed per gallon fuel tax rates that do not increase with inflation. These factors give rise to questions about the adequacy of the gasoline tax (or gas tax) structure to generate sufficient revenue. We argue that the public will be more willing to increase the gas tax if it is restructured to be directly connected to measures of need and is adjusted upward in small, regular increments. We examine how state variable-rate fuel taxes, by incrementally adjusting the gas tax rate on a regular basis, would affect gas tax revenues. This is done by simulating gas tax revenues given different adjustment formulas for the gas tax rate (based on changes in construction costs, general inflation, and improvements in fuel efficiency), and comparing gas tax revenues to determine revenue-generating capacity of variable-rate approaches.

The Crisis in State Highway Finances: Its Roots, Current Effects, and Some Possible Remedies

This paper focuses on the American states and the sources of the expanding structural imbalance between their highway-related revenues on the one hand and expenditures for transportation infrastructure needs on the other. The paper describes the roots of the funding problem over recent decades, looks at some of the responses taken at the state and federal level, and discusses their inherent limitations as solutions to this funding crisis. The paper also presents several policy recommendations for increasing revenues. We demonstrate that a variable rate gas tax indexed to the construction cost index and improvements in automobile fuel efficiency and a tax on large commercial trucks based on equivalent standard axle loads (an esal-mile tax) would more effectively fund the state highway system and reduce the need for more spending on maintenance and new facilities.

THE ENTREPRENEUR-INVESTOR CHARISMATIC RELATIONSHIP: A DRAMATURGICAL APPROACH

This paper presents a dramaturgical approach to understanding the entrepreneur-investor charismatic relationship in the context of the entrepreneurs business plan presentation to outside investors. This approach highlights how entrepreneurs can behave in the presence of investors and how impression management tools can be utilized to develop a successful business plan presentation. Business plan presentations by winners of the 2008 Moot Corp Competition are used to illustrate the charismatic relationship and the impression management techniques that can be used by entrepreneurs in their efforts to project charisma.

An Information Model to Present Proposals to Increase Taxes: Two Examples in the Context of American Values

This article offers an information model for educating the public on the rationale for a tax increase. It argues that citizens exposed to two types of information—a need narrative and an anchor value—are more willing to support a tax increase. The applicability of the model is illustrated with two examples in which the model was used to structure the presentation of information. In both situations, exposure to the specific types of information suggested by the model is associated with support for a tax increase. The conclusion relates the model to the findings of previous research on the attributes of successful referenda campaigns for tax increases.