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Appreciating how government budgeting systems and policies vary is best understood by comparing and analyzing the political cultural, historic, economic, and institutional contexts in which they are formulated, adopted, and executed. This book argues that even similar-appearing institutions and budgetary procedures may very well differ in practice due to the influence of a government’s political cultural and historical experiences.
The great budgetary transformation of central Eastern Europe and the former Soviet Union demonstrates the critical importance of economic context, political culture, history, and institutions in the recreation of public financial management systems. Since the collapse of the USSR, countries in this region have served as fiscal laboratories that experiment with budgetary reforms. This includes countries like Hungary and Poland that joined the European Union.
This chapter examines budgeting in the United States, its budgetary institutions, culture, and policies, from the founding of the republic in the 1700s through the Trump administration. The US Constitution is the world’s oldest functioning government document, and its budgetary rules reflect the country’s ongoing debate about fiscal federalism, and how the federal goverment should manage its fiscal and macroeconomic policies.
Latin America has stignificantly improved its budgetary effectiveness during the past thirty years, despite a widespread variation in political, demographic, and income levels. Bureaucratic authoritarian regimes have evolved into contribute to public finance stabilization. Significant problems remain in the financing of such basic services as education and health care. Expenditure control weakenesses remain at the managerial and operational levels of government.
Every government engages in budgeting and public financial management to run the affairs of state. Effective budgeting empowers states to prioritize policies, allocate resources, and discipline bureaucracies, and it contributes to efficacious fiscal and macroeconomic policies. Budgeting can be transparent, participatory, and promote democratic decision-making, or it can be opaque, hierarchical, and encourage authoritarian rule. This book compares budgetary systems around the world by examining the economic, political, cultural, and institutional contexts in which they are formulated, adopted, and executed. The second edition has been updated with new data to offer a more expansive set of national case studies, with examples of budgeting in China, India, Indonesia, Iraq, and Nigeria. Chapters also discuss Brexit and the European Union's struggle to require balances budgets during the Euro Debt Crisis. Additionally, the authors provide a deeper analysis of developments in US budgetary policies from the Revolutionary War through the Trump presidency.
Though geographically diverse, China, Indonesia, Nigeria, and Iraq share some interesting commonalities. All have been heavily influenced by external, primarily European, budgetary models and practices. After the 1949 Revolution, China turned to the Soviet Union for five-year planning and budgetary models and guidelines. Iraq, a former British colony also turned to the Soviet Union for guidance during the Cold War, and more recently its budgetary processes have been influenced by the American occupation. Like Iraq, Nigeria was a British colony, and Indonesia a former Dutch colony, and both these countries were influenced by their colonial histories.
The EU member states engage in budgeting through a set of supranational fiscal procedures outlined in EU treaties and supporting legislation. The EU itself is a suprnational government with its own budget and budgetary institutions, procedures, and programs. It enforces these macrobudgetary rules that significantly constrain the policy decisions of the individual member states.
This chapter examines the budgetary behavior of the former countries of the British Empire, now known as Commonwealth countries. Orginally created by the 1931 Statute of Westminister that recast the British Empire as a “Commonwealth of nations,” the modern Commonwealth consists of a fifty-four-country network of disparate people created in 1949. The chapter in particular examines the budgetary practices of the United Kingdom and India.
All governments have budgets. Budgeting is a core state function. Effective budgeting empowers the state to prioritize policies, allocate resources, and discipline the bureaucracy. Proficient budgeting contributes to efficient fiscal and macroeconomic policies. This book offers a comparative framework that identifies eight categores called cultural clusters that help identify the budgetary institutions and policies adopted by different governments.
Introduction: Hemorrhage is the primary cause of death in 39% of trauma patients. In prehospital trauma management, there is debate over pursuing a ‘scoop-and-run’ approach versus early intravenous (IV) fluid therapy. We evaluated the literature regarding the effect of prehospital IV fluid therapy on mortality in adult trauma patients. Methods: A librarian-assisted search was conducted in PubMed, Medline and Embase. The population was adults with blunt and/or penetrating trauma. The intervention was total prehospital IV fluid volume 0-500 mL, and the control was prehospital fluid volume >500 mL. The outcome of interest was in-hospital mortality. Randomized controlled trials (RCTs), cohort and case-matched studies were included. Two reviewers used the Cochrane Risk of Bias (RoB) and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tools to evaluate biases, and kappa was calculated for inter-rater agreement. A summary relative risk (RR) of in-hospital mortality was calculated and heterogeneity (I2) analysis performed using RevMan 5 software. Results: Four RCT's and eleven observational studies were identified, with n = 15,448 patients. Two RCTs and four observational studies were excluded due to non-English language, and the location or volume of IV fluid administered, leaving eight studies with n = 4,568 patients. Inter-rater agreement was high with the ROBINS-I (unweighted κ=0.8841) and RoB tool (unweighted κ=0.8276). Two studies found decreased mortality, one found increased mortality, and five found no significant relationship to mortality with 0-500 mL prehospital IV fluid. The summary relative risk of mortality with 0-500 mL IV fluid compared to >500 mL IV fluid was not significant (RR = 0.98 [0.87, 1.11]). The heterogeneity for all studies was high (I2 = 84%), but was low (I2 = 0%) with removal of two studies. Conclusion: The majority of studies did not find a relationship between the volume of prehospital IV fluids and in-hospital mortality. Study heterogeneity was low except for two studies: this may be explained by mortality only being recorded at emergency department discharge in one study, and the high rate of penetrating gunshot and stabbing wounds in the other. There is a paucity of high-quality RCTs on the topic, and many studies are at significant risk of bias. Further research is needed to delineate the best approach to IV fluid therapy in adult trauma patients.
Innovation Concept: Dizziness is an increasingly common presenting complaint in the emergency department (ED), accounting for >2% of visits annually or almost 30% of visits in patients aged over 65. Approximately half of all cases of dizziness in older adults are caused by benign paroxysmal positional vertigo (BPPV). The use of computerized tomography (CT) to rule out serious but rare underlying central nervous system (CNS) causes in patients with dizziness in the ED is increasing despite guidelines supporting the use of clinical exam maneuvers such as the Dix-Hallpike test and therapeutic canalith repositioning maneuvers. Evidence indicates that these clinical tools are underutilized due to clinician discomfort or lack of understanding in performing and interpreting the maneuvers, supporting brief and accessible clinical resources that incorporate video examples to address this. Methods: Through an iterative process the authors have developed a smartphone app that is designed to facilitate the clinical diagnosis of BPPV and provide treatment maneuvers where appropriate. The app is being tested by clinicians practicing emergency medicine or primary care in Northern Ontario. Curriculum, Tool, or Material: The BPPV Tool is designed as a step-wise guide to diagnose BPPV. Clinicians will be prompted to perform specific exam maneuvers based on clinical findings, and can follow short example videos or written directions. Potentially precipitated nystagmus is described along with example videos. Provocative tests include the Dix-Hallpike and Supine Roll. If appropriate, the clinician will be prompted to perform therapeutic repositioning maneuvers such as the Epley or Gufoni, with associated sample videos, descriptions, and billing information where available. If at any point a clinician's exam findings are not in keeping with a diagnosis of BPPV, they will be alerted to this and stop progressing through the app. Conclusion: The BPPV Tool is an accessible and easily disseminated smartphone app designed to improve clinician comfort in reliably diagnosing BPPV. Diagnosing this common condition clinically is supported in the literature and can reduce the number of unnecessary CT scans performed, which would reduce healthcare costs and ED length of stay for these visits, and could reduce the number of patient transfers from peripheral sites for imaging.
On the 1st of August 2010 guidelines aimed at ensuring the safe supply of over-the -counter codeine containing medicinal products came to force in Ireland.
The study aimed to examine the frequency of use as well as reasons for the use of non-prescription codeine containing medicines in an Irish psychiatric population before and after the introduction of regulations on the supply of codeine containing medicines.
Self administered questionnaires were designed and administered to patients before and after the introduction of guidelines regulating the sale of non-prescribed codeine containing medicines in Ireland. The results were compiled and analysed using descriptive statistics and chi-square test.
Significantly more patients reported that they often or regularly used codeine containing medicines before the introduction of the regulation compared to the period after that(33.3% vs. 17.4%, x2 = 6.354, p = 0.01). Significantly more patients also reported that others had expressed concerns about the frequency with which they used codeine containing medicines before the introduction of the regulation compared to the period after the introduction of the regulation (15.5% vs. 4.8%, x2 = 7.29, p = 0.03). Finally, significantly more patients stated that they would use codeine containing medicines either for the ‘feel good’ effect or to curb cravings before the introduction of the regulation than after the introduction of the regulation (15.9% vs. 1.9%, p = 0.00).
Tight regulations on the supply of non-prescription codeine containing medicines have the potential to reduce the abuse of such medicine among psychiatric patients in general.