How Credible Is the Evidence,and Does It Matter? An Analysis of the Program Assessment Rating Tool

This research empirically assesses the quality of evidence that agencies provided to the Office of Management and Budget in the application of the Program Assessment Rating Tool (PART), introduced in 2002 to more rigorously, systematically, and transparently assess public program effectiveness and hold agencies accountable for results by tying them to the executive budget formulation process and program funding. Evidence submitted by 95 programs administered by the U.S. Department of Health and Human Services for the PART assessment is analyzed using measures that capture the quality of evidence and methods used by programs and information on characteristics of agencies that might relate to program results and government funding decisions. The study finds that of those programs offering some evidence, most was internal and qualitative, and about half did not assess how their performance compared to other government or private programs with similar objectives. Programs were least likely to provide externally generated evidence of their performance relative to long‐term and annual performance goals. Importantly, overall PART and results scores were (statistically) significantly lower for programs that failed to provide quantitative evidence and did not use long‐term measures, baseline measures or targets, or independent evaluations. Although the PART program results ratings and overall PART scores had no discernible consequences for program funding over time, the PART assessments appeared to take seriously the evaluation of evidence quality, a positive step forward in recent efforts to base policy decisions on more rigorous evidence.     

Biology,Ideology, and Epistemology: How Do We Know Political Attitudes Are Inherited and Why Should We Care?

Evidence that political attitudes and behavior are in part biologically and even genetically instantiated is much discussed in political science of late. Yet the classic twin design, a primary source of evidence on this matter, has been criticized for being biased toward finding genetic influence. In this article, we employ a new data source to test empirically the alternative, exclusively environmental, explanations for ideological similarities between twins. We find little support for these explanations and argue that even if we treat them as wholly correct, they provide reasons for political science to pay more rather than less attention to the biological basis of attitudes and behaviors. Our analysis suggests that the mainstream socialization paradigm for explaining attitudes and behaviors is not necessarily incorrect but is substantively incomplete.     

The Relationship Between Traumatization and Pain: What is the Role of Emotion?

The role of emotion in the relationship between traumatic experiences and physical pain was examined via path modeling by using a sample of hospital outpatients (N = 138). Most of the participants reported being traumatized (77%) and experiencing chronic pain (69%). Trauma survivors and nontraumatized individuals did not differ significantly on mean symptom scale scores (i.e., depression, anxiety, anger, dissociation, somatization and pain). However, a moderate effect size was found for dissociation. There were also significant associations found between trauma levels and levels of adult symptomatology. Interestingly, sexual abuse was less highly correlated with symptomatology than other types of traumatization, such as neglect. None of the three proposed path models describing the relationship between trauma, pain, and emotion fit the data successfully. Implications are discussed.     

Effect of wrist restraint on maximal exercise capacity in healthy volunteers

Each year, reports occur of deaths in individuals, while struggling against physical restraint. The mechanism of these deaths remains unclear. This study aimed to determine the effect of wrist restraint on cardiorespiratory function during maximal exercise. Twelve healthy volunteers underwent 3 incremental maximal exercise tests on a cycle ergometer. In a randomized order, they exercised while unrestrained, with the wrists tied in front of the body or wrists tied behind the back. The primary outcome measures were the number of minutes exercised in each position and heart rate and whole blood lactate level for each stage and on reaching maximum exercise capacity. The mean exercise duration was 19 minutes 6 seconds unrestrained (95% confidence interval [CI] 16 minutes 52 seconds to 20 minutes 57 seconds), 18 minutes 51 seconds (95% CI 17 minutes 51 seconds to 20 minutes 50 seconds) with arms restrained in front and 16 minutes 51 seconds (95% CI 14 minutes 6 seconds to 19 minutes 20 seconds) with the arms restrained behind the body (P = 0.16). There was no significant difference in heart rate or lactate measurements. It is probable that other factors make a more important contribution than wrist restraint behind the body to cardiorespiratory compromise in a struggling and fatigued individual.     

Does the Statutory Regulation of Advance Decision-Making Provide Adequate Respect for Patient Autonomy?

This paper considers advance decision-making in the context of healthcare. The common law recognition of advance decisions is contrasted with new statutory provision. This paper will examine the Mental Capacity Act 2005 framework for advance decisions and lasting powers of attorney. The ‚best interests’ test and substituted judgment as criteria for proxy decision-making are compared by application to a case example. The paper examines the statutory safeguards in respect of refusals of ‚life-sustaining treatment’ and postulates that these safeguards may render respect for autonomous advance decision-making difficult to achieve in practice.     

Integrated Deliberation: Reconciling Civil Society's Dual Role in Deliberative Democracy

Among the growing literature on deliberative democracy there are two diverging streams of thought, each implying a different role for civil society. Micro deliberative theorists, with their focus on the procedural conditions for structured fora, encourage civil society to engage in collaborative practices, usually with the state. In contrast, macro deliberative democrats, who are interested in the messy and informal deliberation in the public sphere, advocate that civil society should work discursively outside and against the state. This article explores some of the implications of these conflicting roles, taking into account two observations from deliberative practice: first, that all micro deliberative fora are surrounded and impacted by their macro discursive context, and second, that some actors in civil society are more willing and capable of deliberating than others. To conceive of deliberative democracy as an entirely micro or macro enterprise is not only unrealistic, but potentially exclusive. The article advocates for a more viable and inclusive deliberative theory; one that integrates all kinds of deliberation from the micro to the macro. To this end, public deliberation is best conceptualised as an activity occurring in a range of discursive spheres that collectively engage a diversity of civil society actors.     

Dimensions of publicness and performance in substance abuse treatment organizations.

Changes in funding, clientele, and treatment practices of public and privately owned substance abuse treatment programs, compelled in part by increased cost containment pressures, have prompted researchers' investigations of the implications of organizational form for treatment programs. These studies primarily probe associations between ownership status, patient characteristics, and services delivered and do not empirically link organizational form or structure to treatment outcomes. Data from the National Treatment Improvement Evaluation Study (NTIES) were used to study the relationship of ownership and other dimensions of publicness identified in the public management literature to patient outcomes, controlling for patient characteristics, treatment experiences, and other program characteristics. A few effects of organizational form and structure on substance abuse treatment outcomes are statistically significant (primarily improved social functioning), although the specific contributions of measures of ownership and publicness to explaining program-level variation are generally small.     

Limits to Hegemonic Influence in the Organization of American States

Although powerful states have the ability to dominate the international system to achieve their policy preferences, such dominance has limits in the Organization of American States. Even though the United States, its most powerful member state, has considerable influence over OAS actions, institutional factors also affect decisionmaking and produce more varied outcomes than one might anticipate. Adapting three different perspectives from organizational sociology, this study constructs an analytical framework to explore the impact of structural, normative, internal relational, and environmental factors on the level of U.S. influence in the OAS. Four hypotheses are tested on 30 cases of regional conflict management from 1948 to 2002. The organizational variables also reveal incentives for the United States to act multilaterally rather than unilaterally in most instances in the post-Cold War era.     

KEEPING SODA IN SNAP: Understanding the Other Iron Triangle

Participants in SNAP have always been allowed to use their taxpayer-funded benefit to purchase Sugar Sweetened Beverages (SSBs). Despite an acute public health crisis surrounding the consumption of unhealthy products including SSBs, especially among the low-income citizens who also qualify for SNAP benefits, this policy has yet to be changed. Interviews with policy participants in Washington, D.C., reveal that change is being blocked by a culture of “personal responsibility” in America, plus three specific political forces: corporate lobbying primarily by the beverage and food retail industries; a desire by liberals to defend SNAP as income support for the poor even if nutrition outcomes are sub-optimal; and institutional inertia within the Department of Agriculture and the agricultural committees of Congress. In the 2018 farm bill debate, this “iron triangle” of bipartisan resistance to change was strong enough to block even a pilot study of SSB restrictions in SNAP.