Participatory Budgeting: Could It Diminish Health Disparities in the United States?

Participatory budgeting (PB)—a democratic process where ordinary residents decide directly how to spend part of a public budget—has gained impressive momentum in US municipalities, spreading from one pilot project in Chicago’s 49th ward in 2009 to 50 active PB processes across 14 cities in 2016–2017. Over 93,600 US residents voted in a PB process in 2015–2016, deciding over a total of about $49.5 million and funding 264 projects intended to improve their communities. The vast majority of US PB processes take place in large urban centers (e.g., New York City, Chicago, Seattle, Boston), but PB has also recently spread to some smaller cities and towns [1]. Figure 1 illustrates the growth of PB processes in the USA, and within New York City and Chicago council districts specifically.

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Fig. 1 Participatory budgeting in the USA has grown from 1 process in 2009–2010 to 50 processes in 2016–2017

PB constitutes a rare form of public engagement in that it typically comprises several distinct stages that encourage residents to participate from project idea collection to project implementation (see Fig. 2). The decisive public vote in US PB is practically binding as elected officials commit to implementing the public decision at the outset of the process. Moreover, all current PB processes in the USA have expanded voting rights to residents under 18 years old and to non-citizens. Under President Obama, the White House recognized PB as a model for open governance. Participatory Budgeting Project, a nonprofit organization that advocates for PB, won the 2014 Brown Democracy Medal, which recognizes the best work being done to advance democracy in the USA and internationally.

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Fig. 2 Typical stages of a participatory budgeting process in the USA

PB has been lauded for its potential to energize local democracy, contribute to more equitable public spending and help reduce inequality [2, 3]. Social justice goals have been explicit in US PB from the start. Grassroots advocates, technical assistance providers, and many elected officials who have adopted it emphasize that PB must focus on engaging underrepresented and marginalized communities [2, 4, 5]. PB steering committees have specified equity and inclusiveness goals in PB rule books [6, 7]. The most conclusive research so far on PB’s potential to reduce social inequalities, however, comes from Brazil, where PB started in 1989. In Brazil, PB has been associated with a reduction in extreme poverty, better access to public services, greater spending on sanitation and health services, and, most notably, a reduction in child and infant mortality [8, 9].In this paper, we outline three mechanisms by which PB could affect health disparities in US municipalities: First, by strengthening residents’ psychological empowerment; second, by strengthening civic sector alliances; and third, by (re)distributing resources to areas of greatest need. We summarize the theoretical argument for these impacts, discuss the existent empirical evidence, and highlight promising avenues for further research.     

Antitumor compounds from tunicates

Of the six marine-derived compounds that have reached clinical trials as antitumor agents three-didemnin B, Aplidine, and ecteinascidin 743-are derived from tunicates. Di-demnin B (DB), a cyclic depsipeptide from the compound tunicate Trididemnum solidum, was the first marine-derived compound to enter Phases I and II clinical trials. The Phase II studies, sponsored by the U. S. National Cancer Institute, indicated complete or partial remissions with non-Hodgkins lymphoma, but cardiotoxicity caused didemnin B to be dropped from further study. The closely related dehydrodidemnin B (DDB, Aplidine) was isolated in 1988 from a second colonial tunicate, Aplidium albicans, and spectroscopic studies assigned a structural formula in which a pyruvyl group in DDB replaced the lactyl group in DB and syntheses of DDB have been achieved. Aplidine is more active than DB and lacks DB's cardiotoxicity. It was introduced by PharmaMar into Phase I clinical trials in January 1999. The second family of tunicate-derived antitumor agents are the ecteinascidins (ETs), from the mangrove tunicate Ecteinascidia turbinata. The antitumor extracts of E. turbinata were first described in 1969, but the small amount of ETs in E. turbinata prevented their isolation for over a decade. The structures of ETs have been assigned mainly by spectroscopy. Phase II clinical trials with ET 743 are underway. Future supplies of ET's should be available from aquaculture or synthesis.     

ADMAdda5]-microcystins in Planktothrix agardhii strain PH-123 (cyanobacteria)--importance for monitoring of microcystins in the environment

Two major and two minor microcystins (MCYST) were isolated from a hepatotoxic Danish strain of Planktothrix agardhii (Gomont) Anagnostidis et Komárek by reversed-phase high-performance liquid chromatography. The microcystins were characterized by UV spectroscopy, amino acid analysis, fast atom bombardment mass spectrometry (FABMS), and high-resolution FABMS. The major microcystins were further analysed by collisionally induced tandem electrospray ionization MS. The microcystins were found to be demethylated variants of MCYST-HtyR (homotyrosine-arginine) and MCYST-LR (leucine-arginine). The two major microcystins contained an acetyl-demethyl variant (ADMAdda) of 3-amino-9-acetoxy-2,6,8-trimethyl-10-phenyldeca-4,6-dienoic acid (Adda). This is the first report of [ADMAdda5]-microcystins in Planktothrix. The two [ADMAdda5]-microcystins inhibited protein phosphatase activity but showed low cross-reactivity with antibodies of an enzyme-linked immunosorbent assay (ELISA), emphasizing the potential underestimation of the toxicity of natural blooms dominated by Planktothrix when microcystin content is quantified using only an ELISA.     

Brief Report: Random Number Generation in Autism

This study explored the ability of individuals with autism to generate a unique series of digits. Fourteen low-functioning individuals with autism, 14 intellectually disabled individuals, and 14 postgraduate university students generated a series of pseudo-random digits. Individuals with autism were more likely to repeat previous digits than were either of the control groups. The normal control group, however, was less likely to attempt cycling through all digits before repeating. Accordingly, low-functioning individuals with autism may exhibit a shortfall in response inhibition. This finding supports the executive dysfunction theory of autism.     

Prospective randomized trial comparing the outcome and cost of in vitro fertilization with that of a traditional treatment algorithm as first-line therapy for couples with infertility

OBJECTIVE: To determine whether IVF or a standard infertility treatment algorithm results in better outcome and/or lower cost when used as first-line therapy for couples with infertility. DESIGN: Prospective, randomized clinical study. SETTING: University-affiliated infertility clinic. PATIENT(S): Couples with newly diagnosed infertility and no prior treatment. INTERVENTION(S): Couples were randomized to undergo either IVF (group 1, n = 46) or a standard infertility treatment algorithm (group 2, n = 50) as initial therapy for infertility. MAIN OUTCOME MEASURE(S): Pregnancy rates and costs per couple, per month of treatment, and per pregnancy. RESULT(S): Pregnancy rates were higher in group 2 than in group 1. Costs per couple were not statistically different, although a trend toward higher costs was apparent in group 1, reflected by a higher median cost per clinical pregnancy established and a higher cost per month of treatment. Whereas cost differences between the groups diminished over time, pregnancy rates remained the same. CONCLUSION(S): In vitro fertilization currently does not represent an appropriate first-line treatment option for couples with infertility. The use of a standard infertility treatment algorithm results in a higher pregnancy rate and lower cost and therefore should be the preferred treatment approach.     

Preeclampsia-associated hepatic hemorrhage and rupture: mode of management related to maternal and perinatal outcome

This article is a critical review of the obstetric literature concerning preeclampsia-associated hepatic hemorrhage to develop guidelines conducive to optimal maternal and perinatal outcomes. An English literature search was performed for reports of hepatic hemorrhage or hepatic rupture in pregnancy during 1960 to 1997. Data were analyzed by Statmost packages using ANOVA, Chi-square, and Fisher's exact tests. One hundred forty-one patients with hepatic rupture/hemorrhage were reported. The three most common presenting findings were epigastric pain, hypertension, and shock. With rare exception, patients had evidence of preeclampsia. Diagnosis was elusive and most frequently accomplished at laparotomy. When utilized, ultrasound and computed tomography (CT) were helpful diagnostic modalities. Maternal survival was highest in the arterial embolization treatment group. Maternal and perinatal survival improved considerably during the study interval. Route of delivery did not seem to impact survival rates. It was concluded that the application of ultrasound and CT for diagnosis and the use of hepatic artery embolization for treatment of hepatic hemorrhage/rupture seem to be beneficial management options for this rare event.     

Evaluation of the chronic inhalation toxicity of a manganese oxide aerosol--I. Introduction, experimental design, and aerosol generation methods.

A brief literature review on manganese toxicity is presented; as related to designing a chronic inhalation study for evaluating methylcyclopentadienyl manganese tricarbonyl when utilized as a motor fuel additive. The experimental design of this study is described. The generation system utilized to simulate the manganese aerosol produced by an internal combustion engine is described in detail. This generation system operated twenty-four hours per day, seven days per week producing aerosols at 11.6, 112.5, and 1152 micrograms Mn/m3 with an aerodynamic diameter of approximately 0.11 micron.