Browsing by Subject "Compliance"
- Results Per Page
- Sort Options
Item Open Access Case management of patients with Type 2 diabetes mellitus: a cross-sectional survey in Chongqing, China.(BMC Health Serv Res, 2017-02-11) He, Miao; Gao, Jiaqi; Liu, Weiwei; Tang, Xiaojun; Tang, Shenglan; Long, QianBACKGROUND: Type 2 diabetes mellitus has been identified as one of the priority diseases and included in the essential public health service package in China. This study investigated the frequency of follow-up visits and contents of care for case management of patients with Type 2 diabetes in Chongqing located in the western China, in terms of the regional practice guideline; and analyzed factors associated with the use of care. METHODS: A cross-sectional survey was conducted with patients diagnosed with Type 2 diabetes in two areas in Chongqing. Total 502 participants (out of 664 people eligible) completed the interview. The outcome measures included at least four follow-up visits in a year, annual HbA1c test, blood lipid test and diabetic screening for nephropathy and eyes. Logistic regression analysis was applied to examine the association between participants' demographic and socio-economic characteristics and outcome measures. RESULTS: Over the one-year study period, 65% of participants had four or more follow-up visits. In light of the recommended tests, the proportions of having HbA1c test, blood lipid test and screening for nephropathy and eyes annually were 8, 54, 45 and 44%, respectively. After adjusting for study sites, age, sex, education, type of residence, level of income, the patients who were covered by Urban Employee Basic Medical Insurance, were enrolled in the targeted disease reimbursement program, and lived with diabetes more than five years were more likely to have regular follow-up visits and the recommended tests. CONCLUSIONS: Case management for patients with Type 2 diabetes mellitus was not effectively implemented in terms of frequency of follow-up visits and recommended tests over one-year period, as indicated in the regional practice guideline.Item Open Access Compliance of First-Line Anti-Hypertensive Medications in Elderly Tibetan Semi-Nomadic Pastoralists(2012) Lam, Christopher ThyThe burden of hypertension and subsequent in Tibet is quite profound and disproportionate when compared to other Chinese populations. Thus, there has a recent impetus to focus on low-cost sustainable health interventions to ameliorate this tremendous burden. Factors of compliance of first-line low dose hypertensive medications are not known in semi-nomadic Tibetan herdsmen at high altitude.
A retrospective analysis of a de-identified database for a single blinded equal allocation randomized control trial for a dietary reduced sodium salt substitute completed in 2009 using STATA 11.2 (STATA INC. College Station, TX) and logistic regression was performed. Patients were recruited from two townships at 4300 m altitude and northwest of Lhasa, the regional capital. Eligibility criteria included: age 40 years and older, with hypertension (≥ 140mmHg / ≥ 90 mmHg) , enrollment in salt substitute trial, and prescription of hypertensive medication. Primary outcome was compliance to medication at three and six months of follow-up. Factor variables included and adjusted for included: sex, age, blood pressure, township, class of medication, and trial arm assignment.
The overall rate of non-compliance was 33.0% (38/115) after three months and 12.9% (28/217) after six months. After three months follow-up patients with Stage I and Stage II hypertension were at an adjusted odds ratio of 0.03(95%CI: 0.002-0.70) and 0.13(95%CI: 0.012-1.37) times lower odds of non-compliance when compared patients with only isolated systolic hypertension, (p=0.028 and 0.089, respectively). Furthermore, at six months of follow-up patients prescribed combination pharmacologic therapy had an adjusted odds ratios of 0.20 (95%CI: 0.05-0.81) times lower odds than those patients on diuretic only, p =0.023.
Item Open Access Evaluating Compliance and Enforcement Mechanisms of Regional Fishery Management Organizations(2022-04-22) Barkley, CardenEstablished by international agreements or treaties, Regional Fisheries Management Organizations (RFMOs) manage fisheries on the high seas, or ocean areas beyond national jurisdiction. Countries interested in joining an RFMO for access to highly migratory species such as tuna are subject to legally binding conservation management measures (CMMs) and convention mandates created by the organization. Historically, the overall effectiveness of RFMOs for protecting valuable high seas fisheries and their ecosystems has been called into question and there has been a recent push from consumers for increased seafood traceability. This project critically evaluates compliance and enforcement of CMMs and is a component of a larger comprehensive performance review of the current seventeen global RFMOs by an interdisciplinary team of researchers at Duke, NYU, and the Stockholm Resilience Centre led by Duke Marine Lab PhD student Gabrielle Carmine. In this evaluation, RFMOs were scored using a set of ten different criteria to assess existing compliance mechanisms and understand existing levels of transparency within high seas fisheries management.Item Open Access 'It is So Ordered'? The Judicial Enforcement of Land Restitution Rulings and the Politics of Compliance in Colombia (2011-2021)(2022) Montoya, Ana MaríaThis dissertation explains how land courts enforce their rulings in Colombia’s ongoing land restitution program, and, in turn, why politicians and bureaucrats comply with these judicial decisions protecting property rights, while others do not. Our current understanding of enforcement is mostly derived from analyses focused on the political actors involved and the electoral incentives following a rational choice approach. Instead, the argument developed here proposes that to explain variation in compliance with judicial decisions, it is necessary to jointly examine the interaction between different levels of state capacity and the political will to comply with those decisions.
Based on this interaction, I propose a typology of patterns of compliance. On one hand, two ideal types, full and noncompliance, are observed when politicians are either committed to comply with those decisions in municipalities with higher state capacity where infrastructural conditions, as other presence of state institutions, allowed to fully comply with rulings protecting property rights; whereas noncompliance occurs when low state capacity conditions become the perfect excuse for those politicians who do not have any willingness to comply. On the other hand, they differ from patterns of partial compliance where external constraints condition the relative strength either of the levels of state capacity or the political will of elected officials. I expect that under high state capacity, low compliance will occur when politicians without political will, will lack the incentives to fully comply and will partly comply with judicial decisions as they are pressured by societal groups, namely, groups in favor of the victims. Finally, medium compliance will result when politicians, with political will, face constraints under low state capacity contexts that impede the full compliance with judicial decisions in favor of victims’ property rights.
In the first part, I further developed the mechanisms that explain the relevance of the interaction between state capacity and political will to explain both enforcement and compliance with judicial decisions. Chapter 1 offers an alternative conceptualization and measure of state capacity by bringing a neglected dimension of it: the legal capacity. I argued that the role of legal capacity, -observed as the presence of judges, attorneys, inspectors, watchdog agencies-, is a crucial constrain to politicians’ noncompliance. Chapter 2 instead puts politics front and center. Using a regression discontinuity design in close mayoral elections, the chapter causally identifies the role of political will in the implementation of the land restitution rulings.
After testing the empirical implications of the macro-level theory of compliance, the second part of the dissertation focuses on how land restitution judges achieve compliance with their rulings. Leveraging the institutional innovation by which land restitution courts preserve the competence over their rulings, I explain the effect of the oversight mechanisms on the compliance with these decisions. By exploiting the random assignment of cases to judges, I find that a ruling is more likely to be comply with if the case was assigned to a judge who is more active in taking post-rulings actions to ensure enforcement.
The final chapter assesses this gap between the legal definition of property rights and their actual enforcement on the ground at the household level. By using a conjoint experiment embedded in a rural household survey, I find strong support for the strength of prior property rights before the dispossession, and to lesser extent, the individual’s expectation of enforcement matter when deciding to bring a case.
To empirical evaluate this enforcement gap, I wield a broad variety of empirical tools, including computational methods to build original datasets, experimental and quasi-experimental research designs, original surveys, extensive fieldwork, and a close collaboration with state agencies over compliance outcomes.
Item Open Access North Carolina Stormwater Compliance Evaluation for the 20 Coastal Counties(2014-04-24) Bishop, Rachael; Chen, Szu-Ying; Santoni, AmandaStormwater is one of the largest sources of pollutants in the United States and contributes sediment, heavy metals, oil, pesticides, fertilizers, bacteria, and other contaminants to coastal waters. Water quality is critical to coastal areas for commercial fishery health and recreational activities. To minimize the introduction of water quality pollutants, North Carolina implemented the State Stormwater Program (SSP) for post construction stormwater management. A study in 2005 identified low compliance rates with the SSP (30.7%) and a follow-up in 2009 found that only 20% of noncompliant sites had rectified their violations. There are currently no studies documenting recent compliance rates with the SSP. This study addressed three objectives: (1) Update the compliance study to include recent trends in compliance and reasons for violations (2) Determine the perceptions of the strengths and opportunities for improvement, and (3) Conduct a program analysis of the SSP. These objectives were achieved by analyzing compliance data from the Division of Energy, Mineral, and Land Resources, conducting interviews with a small sample of entities that interact with the SSP, and reviewing applicable compliance literature. The results of our study show potential areas for improvement and were used to make policy recommendations for North Carolina to increase compliance with these regulations. Our results indicate that compared to the 2005 estimate, compliance in 2012 increased to 50%, and was lower in coastal counties than noncoastal counties. In total there were 2,838 compliance inspections between 2008 and 2012. Yearly inspections increased between 2008 and 2010, but decreased sharply in 2011 and remained low in 2012. The majority of violations were due to reporting and maintenance issues. Interview respondents indicated that the main impediments to compliance are maintenance and education, and that compliance could be improved through increased maintenance checks and public outreach efforts. The program analysis showed that while the stormwater program generally has clear regulations, it could benefit from increased visibility of the regulating agency, engagement, as well as education. Potential avenues for improvement are discussed, and are considered within the context of our findings.Item Open Access Reminders, Refugees, and Ramadan: Characterizing Missed Immunization Appointments among Palestinian Refugees in Jordan(2015) Schermerhorn, Jordan TaylorThere are currently over two million Palestinian refugees residing in Jordan, 370,000 of whom reside in refugee camps. Due to conflict-affiliated disease outbreaks among children in the region, the UN Relief and Works Agency for Palestine Refugees (UNRWA) has identified incomplete vaccination as a critical public health issue and has invested in the development and implementation of a text message reminder service for preventing loss-to-follow-up. Childhood immunization rates in UNRWA catchment regions are generally high, yet little is known about risk factors for missed appointments, which impose a substantial administrative burden due to the need to contact patients for rescheduling. Stronger user characterization is necessary for improved targeting and minimized cost as we develop a more robust SMS system capable of scaling across all health facilities.
This mixed-methods study prospectively recorded 6 months of immunization history among a cohort of children born in June 2014 at Taybeh Health Center in Amman. Demographic information was collected at the time of birth, and caregivers of cohort members were invited to participate in interviews that assessed immunization knowledge, preferences, decision-making, and experience with the SMS reminder system. Patients were more likely to significantly delay appointments during the Ramadan holiday and for doses further from the child date of birth. Future policies that might bridge these gaps include targeting pre-appointment SMS reminders to high-risk patients, implementing holiday shifts in clinic hours, and regularly updating patient contact information.
Item Open Access Revoked, Restructured or Retained: Examining the effect of external shifts on norm compliance(2010) VanHo, Valerie Kay FrancesIn this work, I use case study analysis to examine the response by states to exogenous shifts in international norms. Specifically, I examine the behavior of states when unforeseen technological advances make the norm previously established between states insufficient to ensure the security needs that were the onus for creating the original norm. I argue that altering the specific clauses of the norm to honor the intention of the norm maintains the habit of compliance and international credibility of the norm, yielding a greater level of acceptance and rate of compliance than if the norm is either discarded and a new norm is sought or if the norm retains in place without being renegotiated.
Item Open Access Start Right - Environmentall Compliance Strategies for Start-Ups(2024-04-12) Fanslau, TaushaWith the passage of the Infrastructure Investment and Jobs Act (IIJA), the Inflation Reduction Act (IRA), and Creating Helpful Incentives to Produce Semiconductors (CHIPS), construction of manufacturing facilities has more than doubled since late 2021. As companies rush to find a site to build these facilities, it is important to consider the environmental responsibilities associated with a new build. Often, companies do not have internal environmental staff at this phase. The cost of noncompliance can be high. The Environmental Plan Guide (EPG) assists companies during each phase of a construction project in performing due diligence and meeting environmental responsibilities while addressing compliance with common environmental issues and a focus on federal regulations. The EPG describes the topic, how to screen for applicability, what steps to take if it applies, and an estimate of how long compliance activities will take. Each topic also includes links to get more information.Item Open Access U.S. Carbon Offset Policy: Risks, Uncertainties and What We Can Learn from Current Financial Markets(2009-04-24T17:56:22Z) Abramson, AlanClimate change has become an increasingly important topic of political discussion and public concern. Although the United States has not signed the Kyoto Protocol, some individuals, companies, municipalities, states and regions have made either voluntary or regulatory efforts to reduce their greenhouse gas (GHG) emissions. Many observers believe the U.S. will institute a national carbon policy sometime during the current administration. Most public policy experts believe a cap-and-trade program will be part of any U.S. climate change policy. A trading program will presumably include both carbon allowances and carbon offsets. This Masters Project investigates what lessons policymakers can learn about regulation, oversight and transparency from the recent credit and financial market crisis. The research and analysis will suggest how policymakers can apply these lessons to help build the nascent carbon offset market into a robust, trusted, viable and liquid financial market over the long term. The research method included conducting twenty-nine interviews with specific questions for each group of participants. Ten financial market respondents, eleven carbon market respondents, five NGO respondents and three public policy experts were interviewed. A thorough literature review of current environmental commodity markets was conducted, too. The results address three distinct areas. First, what went wrong in the financial markets is scrutinized. Specific findings suggest too much complexity, too much leverage, and an overall lack of transparency caused most problems. Second, how the carbon market, in general, can avoid these problems is revealed. A consensus advocates utilizing a central clearinghouse with margin requirements for market participants while limiting the number of derivative products to the simplest of futures and options. Finally, explicit guidance for the offset market is given. This market must reduce the number of standards and registries. Furthermore, the conflict of interest inherent in the current verification and validation model for offset approval needs to be eliminated.