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In recent years the American public has witnessed several hard-fought battles over nominees to the U.S. Supreme Court. In these heated confirmation fights, candidates' legal and political philosophies have been subject to intense scrutiny and debate.Citizens, Courts, and Confirmationsexamines one such fight--over the nomination of Samuel Alito--to discover how and why people formed opinions about the nominee, and to determine how the confirmation process shaped perceptions of the Supreme Court's legitimacy. Drawing on a nationally representative survey, James Gibson and Gregory Caldeira use the Alito confirmation fight as a window into public attitudes about the nation's highest court. They find that Americans know far more about the Supreme Court than many realize, that the Court enjoys a great deal of legitimacy among the American people, that attitudes toward the Court as an institution generally do not suffer from partisan or ideological polarization, and that public knowledge enhances the legitimacy accorded the Court. Yet the authors demonstrate that partisan and ideological infighting that treats the Court as just another political institution undermines the considerable public support the institution currently enjoys, and that politicized confirmation battles pose a grave threat to the basic legitimacy of the Supreme Court.

With every new presidential administration, thousands of highly accomplished individuals face one of the greatest challenges of their lives: learning to become an effective presidential appointee. This handbook will help ease that task. In clear, crisp language, punctuated by numerous examples, Edward DeSeve explains the ten core competencies that distinguish successful presidential appointees. These skills and abilities range from personal dedication to public service and the ability to manage change to global awareness. In illustrating these concepts, DeSeve draws on ideas developed by scholars of public and business management, as well as his many years of government service. Equally important, he presents a guide to the key terms, laws, and regulations that new appointees will have to deal with once in office. Not surprisingly, presidential appointees have typically been successful in their professional lives. These are people accustomed to getting things done. But for many of them, the federal government constitutes a brave new world, full of daunting challenges and potential pitfalls. The Presidential Appointee's Handbook will help them find their footing and effectively formulate, implement, and enforce the policies of the president at whose pleasure they serve. It will also help political observers grasp more fully the enormity of installing and operating a new government.

Missed appointments are detrimental to the healthcare system and to the clients themselves. Autistic youth may be particularly impacted due to unique service needs and limited services available within the system. To date, there is limited literature specific to treatment attendance in autistic populations receiving behavioral services. This study examines prevalence, predictors of, and reasons for missed appointments in an outpatient clinic specializing in addressing behavioral concerns. This retrospective case review examines missed appointments in a sample of 306 autistic youths from an outpatient clinic from 2019 to 2022. An average of 5.2 appointments were cancelled and 9.0 were completed, resulting in an average individual cancellation rate of 38%. Statistically significant predictors of no shows and patient cancellations were younger age and a post-COVID appointment. The most common reasons for missed appointments was sickness, scheduling conflict, insurance authorization issues, and family emergency. Missed appointments may be common in outpatient behavioral settings for autistic youth. Resolving issues related to cancellations (e.g., sleep concerns), identifying families in need of targeted support strategies (e.g., assistance and flexibility with scheduling, transportation support), and advocating for systemic change may help meet the multifaceted needs of this population.

We provide evidence that firms appoint independent directors who are overly sympathetic to management, while still technically independent according to regulatory definitions. We explore a subset of independent directors for whom we have detailed, microlevel data on their views regarding the firm prior to being appointed to the board: sell-side analysts who are subsequently appointed to the boards of companies they previously covered. We find that boards appoint overly optimistic analysts who are also poor relative performers. The magnitude of the optimistic bias is large: 82.0% of appointed recommendations are strong buy/buy recommendations, compared with 56.9% for all other analyst recommendations. We also show that appointed analysts' optimism is stronger at precisely those times when firms' benefits are larger. Last, we find that appointing firms are more likely to have management on the board nominating committee, appear to be poorly governed, and increase earnings management and chief executive officer compensation following these board appointments. This paper was accepted by Brad Barber, finance.

Background Outpatient Clinics (OCs) are under pressure because of increasing patient volumes and provider shortages. At the same time, many patients with chronic diseases receive routine follow-up consultations that are not always necessary. These patients block access to care for patients that are in actual need for care. Pre-assessing patient charts has shown to reduce unnecessary outpatient visits. However, the resulting late cancellations due to the pre-assessment, challenge efficient alignment of capacity with actual patient demand, leading to either empty slots or overtime. This study aims to develop a method to analyse the effect of pre-assessing patients before inviting them to the OC. This involves 1) to select who should come and 2) to optimize the impact of pre-assessment on the schedule and efficient use of OC staff. Methods This prospective mixed-methods evaluation study consists of 1) an expert meeting to determine a pre-assessment strategy; 2) a retrospective cohort study to review the impact of this strategy (12 months of a Dutch nephrology OC); 3) mathematical optimization to develop an optimal criteria-based scheduling strategy; and 4) a computer simulation to evaluate the developed strategy. Primary outcomes are the staff idle time and staff overtime. Secondary outcomes evaluate the number of weekly offered appointments. Results The expert group reached consensus about the pre-assessment criteria. 875 (18%) of the realized appointments in 2022 did not meet the OC visit pre-assessment criteria. In the best performing scheduling strategy, 94 slots (87% of the available capacity) should be scheduled on a weekly basis. For this schedule, 26.8% of the OC weeks will experience idle time ( μ =2.51, σ =1.44 appointment slots), and 21% of the OC weeks will experience overtime ( μ =2.26, σ =1.65 appointment slots) due to the variation in patient appointment requests. Using the pre-assessment strategy combined with the best performing scheduling strategy under full capacity (108 slots), up to 20% increase in patient demand can be handled with equal operational performance. Conclusions This evaluation study allows OC managers to virtually test operational impact of pre-assessment strategies on the capacity of their OC, and shows the potential of increasing efficient use of scarce healthcare capacity. Trial registration Not applicable.

Background Shared medical appointments (SMAs) are doctor-patient visits in which groups of patients are seen by one or more health care providers in a concurrent session. There is a growing interest in understanding the potential benefits of SMAs in various contexts to improve clinical outcomes and reduce healthcare costs. This study builds upon the existing evidence base that suggests SMAs are indeed effective. In this study, we explored how they are effective in terms of the underlying mechanisms of action and under what circumstances. Methods Realist review methodology was used to synthesize the literature on SMAs, which included a broad search of 800+ published articles. 71 high quality primary research articles were retained to build a conceptual model of SMAs and 20 of those were selected for an in depth analysis using realist methodology (i.e.,middle-range theories and and context-mechanism-outcome configurations). Results Nine main mechanisms that serve to explain how SMAs work were theorized from the data immersion process and configured in a series of context-mechanism-outcome configurations (CMOs). These are: (1) Group exposure in SMAs combats isolation, which in turn helps to remove doubts about one’s ability to manage illness; (2) Patients learn about disease self-management vicariously by witnessing others’ illness experiences; (3) Patients feel inspired by seeing others who are coping well; (4) Group dynamics lead patients and providers to developing more equitable relationships; (5) Providers feel increased appreciation and rapport toward colleagues leading to increased efficiency; (6) Providers learn from the patients how better to meet their patients’ needs; (7) Adequate time allotment of the SMA leads patients to feel supported; (8) Patients receive professional expertise from the provider in combination with first-hand information from peers, resulting in more robust health knowledge; and (9) Patients have the opportunity to see how the physicians interact with fellow patients, which allows them to get to know the physician and better determine their level of trust. Conclusions Nine overarching mechanisms were configured in CMO configurations and discussed as a set of complementary middle-range programme theories to explain how SMAs work. It is anticipated that this innovative work in theorizing SMAs using realist review methodology will provide policy makers and SMA program planners adequate conceptual grounding to design contextually sensitive SMA programs in a wide variety of settings and advance an SMA research agenda for varied contexts.

Background In qualitative work, patients report that seemingly short trips to clinic (eg, a supposed 10-minute blood draw) often turn into “all-day affairs.” We sought to quantify the time patients with cancer spend attending ambulatory appointments. Methods We conducted a retrospective study of patients scheduled for oncology-related ambulatory care (eg, labs, imaging, procedures, infusions, and clinician visits) at an academic cancer center over 1 week. The primary exposure was the ambulatory service type(s) (eg, clinician visit only, labs and infusion, etc.). We used Real-Time Location System badge data to calculate clinic times and estimated round-trip travel times and parking times. We calculated and summarized clinic and total (clinic + travel + parking) times for ambulatory service types. Results We included 435 patients. Across all service day type(s), the median (IQR) clinic time was 119 (78-202) minutes. The estimated median (IQR) round-trip driving distance and travel time was 34 (17-49) miles and 50 (36-68) minutes. The median (IQR) parking time was 14 (12-15) minutes. Overall, the median (IQR) total time was 197 (143-287) minutes. The median total times for specific service type(s) included: 99 minutes for lab-only, 144 minutes for clinician visit only, and 278 minutes for labs, clinician visit, and infusion. Conclusion Patients often spent several hours pursuing ambulatory cancer care on a given day. Accounting for opportunity time costs and the coordination of activities around ambulatory care, these results highlight the substantial time burdens of cancer care, and support the notion that many days with ambulatory health care contact may represent “lost days.” This study used real-time location system and geolocation data to assess how much time (in minutes) patients spent on attending clinic appointments. Even seemingly short appointments can take up hours of patients' days, supporting the notion that that day may indeed represent a ''lost day''.

In the UK, there is a debate as to whether Parliament should have a role in judicial appointments similar to the that of the US Senate. The minority in favour of this position argues that it would enhance the democratic legitimacy of the judiciary – who are currently selected by various independent commissions – and refers to the proposed reform’s coherence with the general practice of pre-appointment hearings in the UK (such as for the Chair of the Equality and Human Rights Commission) and other parliamentary systems. However, the majority against this position argues that meaningful input into judicial appointments, by parliamentarians, would necessarily undermine the impartiality of the judiciary and outweigh the benefits of judicial democratisation. This paper seeks to add to the debate by establishing a detailed proposal for a parliamentary confirmation model for nominations to the UKSC and arguing that it would be both consistent with and enhancing to judicial independence. The research compares the constitutional foundations and historical origins of the Comptroller and Auditor General – an independent office co-nominated by the Government and Opposition, but confirmed by Parliament – and the UKSC, plus the American and Canadian Supreme Courts. This paper fundamentally argues three points: that there is a democratic deficit in the UKSC judicial appointment model; that the Comptroller and Auditor General is sufficiently equivalent to the UKSC so that its appointment model could be translated onto judicial appointments; and that said translation would remedy said democratic deficit, without compromising the non-partisanship of the UKSC.

Shared medical appointments (SMA) help patients learn skills to self-manage chronic medical conditions. While this model of care delivery is thought to improve access to care with an efficient use of healthcare providers’ time, many healthcare teams struggle to implement this healthcare model. Guidance and training resources on the implementation of SMAs is expected to improve adoption, implementation and sustainability of SMAs. Our evaluation team collaborated with the HF SMA trainer to complete a developmental formative evaluation of a two-day training program with a goal of adapting the training program and to better suit the needs and resources of healthcare teams interested in implementing HF-SMAs. Our evaluation team interviewed members of healthcare teams participating during each stage of training: pre-training, post-training, and post-implementation. The evaluation team also observed training sessions and reviewed minutes from debrief and training team meetings. Qualitative data collected from interviews, observations and document reviews were analyzed using matrix analysis with a focus on identifying potential adaptations to improve the HF-SMA training program. Data summaries were presented by the evaluation team to the training team for consideration. Training program participants found the training comprehensive, useful, and helpful; they highlighted how the trainers were experienced SMA providers who shared lessons learned. While participants found the training to be useful, opportunities for improvement, success of the virtual format and identified six adaptations: 1) the two-day training was reduced to short online modules, 2) curriculum was adapted to fit local site’s needs, 3) added periodic one-on-one coaching, 4) shifted training to focus on skills and knowledge needed for each team member requirements, 5) adapted curriculum provides for more team building during premeeting assignments, and 6) training had more information included. We offer/present an improved model for a HF-SMA training program. Future studies, potentially using comparative designs to measure success and sustainability are needed.

This study examines one of the most significant administrative offices in the Abbasid Caliphate during the Seljuk period—the office of the ḥijābah (Chamberlain). During this time, the position rose in prominence to the extent that the ḥājib (Chamberlain) became the caliph’s adviser in all major affairs. Moreover, the number of ḥujjāb within the Abbasid state increased in accordance with the various places in which they served and the domains over which they exercised supervision. In this study, we shed light on those ḥujjāb whose duties were directly connected to the caliphal palace, such as the ḥājib (Chamberlain) al-ḥujjāb and the ḥujjāb al-abwāb, who were responsible for the gates of the caliphal residence. These officials played an important and influential role in the course of political, administrative, and security affairs in Iraq during the Seljuk period. The Abbasid caliph found in some of those who assumed this office the ability to bear the responsibility entrusted to them—namely, overseeing the protection of the gates of the caliphal palace and regulating those who entered through them. This competence was a factor in their appointment to the office and in the length of their tenure. As for the causes of dismissal from the position, there were numerous reasons. Among them was the appointment of unqualified individuals due to competition for the office, which led to disruptions in state affairs. Some resorted to bribery and the extortion of people; in other cases, dismissal was motivated by promotion to a higher office, or by inclination toward a particular sect. Thus, the reasons for appointment and dismissal in the office of the ḥijābah (Chamberlain) during this period were manifold and varied.