Her Majesty's Revenue and Customs

Policies must keep pace with new ideas about what, when, and how teachers learn and must focus on developing schools' and teachers' capacities to be responsible for student learning.

This paper analyzes a tax enforcement field experiment in Denmark. In the base year, a stratified and representative sample of over 40,000 individual income tax filers was selected for the experiment. Half of the tax filers were randomly selected to be thoroughly audited, while the rest were deliberately not audited. The following year, threat-of-audit letters were randomly assigned and sent to tax filers in both groups. We present three main empirical findings. First, using baseline audit data, we find that the tax evasion rate is close to zero for income subject to third-party reporting, but substantial for self-reported income. Since most income is subject to third-party reporting, the overall evasion rate is modest. Second, using quasi-experimental variation created by large kinks in the income tax schedule, we find that marginal tax rates have a positive impact on tax evasion for self-reported income, but that this effect is small in comparison to legal avoidance and behavioral responses. Third, using the randomization of enforcement, we find that prior audits and threat-of-audit letters have significant effects on self-reported income, but no effect on third-party reported income. All these empirical results can be explained by extending the standard model of (rational) tax evasion to allow for the key distinction between self-reported and third-party reported income.

The HeartMate 3 (HM3) left ventricular assist device (LVAD) is designed to support advanced heart failure patients. This centrifugal flow pump has a magnetically levitated rotor, artificial pulse, textured blood-contacting surfaces, optimized fluid dynamics, large blood-flow gaps, and low shear stress. Preclinical tests were conducted to assess hemocompatibility. A computational fluid dynamics (CFD) model guided design for low shear stress and sufficient washing. Hemolysis testing was conducted on six pumps. Plasma-free hemoglobin (PfHb) and modified index of hemolysis (MIH) were compared with HeartMate II (HMII). CFD showed secondary flow path residence times between 27 and 798 min, comparable with main flow residence times between 118 and 587 min; HM3 vs. HMII shear stress exposure above 150 Pa was 3.3 vs. 11 mm within the pump volume and 134 vs. 604 mm on surfaces. In in vitro hemolysis tests at 2, 5, and 10 L/min, average pfHb 6 hours after test initiation was 58, 74, and 157 mg/dl, compared with 112, 123, and 353 mg/dl for HMII. The HM3/HMII ratio of average MIH at 2, 5, and 10 L/min was 0.29, 0.36, and 0.22. Eight 60 day bovine implants were tested with average flow rates from 5.6 to 6.4 L/min with no device failures, thrombosis, or hemolysis. Results support advancing HM3 to clinical trials.

BACKGROUND: Caspofungin inhibits synthesis of beta-1,3-glucan, an essential component of the Aspergillus cell wall. This echinocandin has demonstrated efficacy (45% success) as salvage monotherapy of invasive aspergillosis (IA). Interest remains as to whether caspofungin, in combination with other antifungal classes, can improve the efficacy against IA. METHODS: The study involved 53 adults with documented IA who were refractory to or intolerant of standard antifungal therapy and received caspofungin and 1 other mold-active antifungal agent (at the investigator's discretion). Efficacy was assessed by signs, symptoms, and radiographs at the end of combination therapy and Day 84 after combination therapy initiation. Favorable (complete or partial) responses required significant clinical and radiographic improvement. Diagnoses and outcomes were assessed by an independent expert. RESULTS: Among the 53 patients enrolled the most common underlying diseases were acute leukemia (53%), lymphoma (11%), and chronic leukemia (6%). Pulmonary aspergillosis (81%) was the most common site, and most patients (87%) were refractory to prior therapy. Success at the end of combination therapy and Day 84 was 55% (29/53) and 49% (25/51), respectively. Fifty-seven percent of patients with neutropenia and 54% who received an allogeneic hematopoietic stem cell transplant responded favorably. Survival at Day 84 was 55%. Combination therapy, dosed on average for 31.3 days, was well tolerated. Two (4%) serious drug-related adverse events, both attributed to voriconazole, occurred. None of the patients discontinued caspofungin due to toxicity. CONCLUSIONS: Caspofungin in combination with a triazole or polyene was an effective alternative as salvage therapy for patients with recalcitrant Aspergillus infections.

Abstract The rapid identification for drugs‐of‐abuse in airports is of critical importance. In this study we demonstrate the viability of Raman spectroscopy for the rapid identification of illicit substances in their containers in an airport environment. Raman spectra of drugs‐of‐abuse in situ were collected using portable Raman spectrometers; this technique offers distinct advantages to government agencies, first responders and forensic scientists working in the security field. We have demonstrated that the spectrometers are able to collect the spectra of suspect powders, including cocaine HCl and d ‐amphetamine sulphate with unknown constituents rapidly and with a high degree of discrimination. Copyright © 2008 John Wiley & Sons, Ltd.

Abstract Drawing from the results of theoretical studies about the behaviour of constant‐coefficients semi‐implicit schemes, the dynamical kernel of the Aladin–NH spectral limited‐area numerical weather prediction (NWP) model has been modified in order to allow for a stable and efficient integration of the fully elastic Euler equations. The resulting dynamical kernel offers the possibility to use semi‐Lagrangian transport schemes together with two‐time‐level discretizations at kilometric scales for NWP purposes. The main characteristics of the adiabatic part of the model formulation and the space and time discretization are described in this article. In order to illustrate the dependence of the results on adjustable parameters of the dynamical kernel, some real‐case dynamical‐adaptation forecasts performed with a basic physical parameterization package are presented. The results obtained with this model in real‐case experiments fully confirm the conclusions drawn in previous numerical analysis studies. The good quality of the results is found to be compatible with a routine exploitation in a NWP framework. The Aladin–NH dynamical kernel has been used in the operational NWP ‘AROME’ model since December 2008 at the kilometric scale, with an appropriate physical parameterization package and data assimilation system. Copyright © 2010 Royal Meteorological Society and Crown Copyright.

In Brief Study Design. Review article. Objective. To outline current concepts regarding the assessment and treatment of odontoid fractures. Summary of Background Data. Odontoid fractures account for 9% to 15% of adult, cervical spine fractures. These injuries usually result from hyperflexion or hyperextension of the cervical spine during low-energy impacts in the elderly or high-energy impacts in the young and middle aged. Neurologic injury associated with these fractures is rare. Methods. A review of pertinent literature was conducted. The information gleaned from this review was summarized. Results. Odontoid fractures should be evaluated with appropriate imaging to assess the fracture itself as well as exclude other contiguous or noncontiguous fractures. The Anderson and D’Alonzo classification system is most commonly used. True type I and III odontoid fractures are generally thought to be relatively stable and are often treated nonoperatively with immobilization. Type II fractures at the base of the odontoid are less stable, and there are differing opinions regarding the precise definition and optimal treatment of these injuries. Nonoperative treatment options for odontoid fractures include external immobilization with a collar or halo. Operative treatment options for odontoid fractures include one of several posterior C1-C2 fusion constructs or anterior odontoid fixation if the fracture pattern is amenable. Conclusions. Despite the frequency of odontoid fractures, there is still much debate regarding the optimal treatment of these fractures, especially the type II fractures. This fact may be because of the absence of an ideal solution for this clinical problem. Certainly, prospective controlled clinical studies are needed. Classification and treatment options for odontoid fractures are reviewed. The Anderson and D’Alonzo classification is the most commonly used. Modifications to this classification have been suggested. Odontoid fractures may be treated with collar or halo immobilization, or posterior fusion or anterior odontoid screw fixation.

Peripheral venoarterial extracorporeal membrane oxygenation (VA ECMO) for acute cardiac failure reestablishes normal oxygen delivery and perfusion. However, VA ECMO can be limited by insufficient ventricular unloading, resulting in thrombus formation and pulmonary edema. Impella 2.5 has been used to unload the left ventricle and provide hemodynamic support during acute heart failure. We present our experience of the Impella 2.5 as an adjunct for left ventricular unloading during peripheral VA ECMO support and as a bridge for the HeartMate II left ventricular assist device (LVAD). An Impella 2.5 was placed in patients who were on peripheral VA ECMO with evidence of left ventricular distension. Patients who were candidates for heart transplant were transitioned to the HeartMate II LVAD. Five patients on VA ECMO with ventricular distension underwent Impella 2.5 implantation, resulting in a decreased left ventricular end-diastolic diameter as measured by echocardiography (7.8 ± 1.4 vs. 6.2 ± 0.8 cm, p = 0.001). Four patients were subsequently transitioned to the HeartMate II LVAD after restoration of end-organ function. Impella 2.5 is a safe means to unload the left ventricle while on peripheral VA ECMO to prevent left ventricle thrombus formation and worsening pulmonary edema in patients transitioning to a HeartMate II LVAD.

Law and policy is one thing, but their implementation and administration is affected by organizational cultures. Meidinger has argued that knowledge of regulatory and organizational cultures assists understanding of how law and policy work in practice. This article examines three revenue administrations that are moving from a command‐and‐control style of regulation to a more persuasive and responsive style of regulation. The central argument is that there is a determining step in the process of clarification, reconciliation, responsiveness, and design of a tax system. That step is the extent to which organizational culture can be changed to embrace inclusive discussion and creative solutions to the administration of tax law and policy.

This paper uses newly available data from the IRS to assess the distributional consequences of U.S. federal income tax noncompliance for the tax year 2001. We find that, when taxpayers are arrayed by their estimated "true "income, defined as reported income adjusted for underreporting, the ratio of aggregate misreported income to true income generally increases with income, although it peaks among taxpayers with adjusted gross income in the 99.0 to 99.5 percentile. In sharp contrast, the ratio of underreported tax to true tax is highest for lower-income taxpayers.

ABSTRACT Although subsidiary disclosures in firms’ filings with the Securities and Exchanges Commission (SEC; Exhibit 21) represent the most granular required public disclosure of a firm's geographic footprint, little is understood about the quality of the disclosure, and anecdotal evidence suggests firms may not fully comply with the disclosure requirements. We use data provided by multinational firms to the Internal Revenue Service regarding their foreign subsidiary locations to explore the accuracy of public subsidiary disclosures on Exhibit 21 of Form 10‐K per SEC rules. The overall incidence of nondisclosure is low, suggesting that most firms comply with Exhibit 21 disclosure rules, and that for most applications, Exhibit 21 disclosures provide a reasonable proxy for locations of significant subsidiaries. Nevertheless, there is some evidence of nondisclosure, particularly when subsidiaries are in tax havens, when the firm is more highly scrutinized in the media, or when the firm has other characteristics consistent with low‐quality disclosures such as SEC comment letters.

Abstract In this paper, we suggest that individuals’ tax compliance behaviours are affected by the behaviour of their ‘neighbours’, or those about whom they may have information, whom they may know, or with whom they may interact on a regular basis. Individuals are more likely to file and to report their taxes when they believe that other individuals are also filing and reporting their taxes; conversely, when individuals believe that others are cheating on their taxes, they may well become cheaters themselves. We use experimental methods to test the role of such information about peer effects on compliance behaviour. In one treatment setting, we inform individuals about the frequency that their neighbours submit a tax return. In a second treatment setting, we inform them about the number of their neighbours who are audited, together with the penalties that they pay. In both cases, we examine the impact of information on filing behaviour and also on subsequent reporting behaviour. We find that providing information on whether one's neighbours are filing returns and/or reporting income has a statistically significant and economically large impact on individual filing and reporting decisions. However, this ‘neighbour’ information does not always improve compliance, depending on the exact content of the information.

This is a subject which may seem a little remote from the normal run of discussions at these meetings. But with the increasing tendency for actuaries to take up posts in Government service, in industry and in commerce, in which official statistics are an everyday need, I hope that some of you, at least, will find it interesting to have this brief account of the work of a Government statistics division. The Statistics Division forms part of the Secretaries' Office of the Board of Inland Revenue. Its primary function is to supply the Board with the figures which the Chancellor of the Exchequer needs for Budget purposes, i.e. estimates of the future yield of taxation at current levels and of the cost or yield of possible changes in rates and allowances. The whole of the year's work centres on those requirements, but in the course of it many figures useful for other purposes emerge or can be collected with little additional effort.

Chronic wounds present a significant societal burden in their cost of care, and they reduce patient quality of life. Key components of wound care include such measures as debridement, irrigation, and wound cleaning. Appropriate care removes necrotic tissue and reduces wound bioburden to enhance wound healing. Physical cleaning with debridement and irrigation is of documented efficacy. Wounds may be washed with water, saline, or Ringer's solution or cleaned with active ingredients, such as hydrogen peroxide, sodium hypochlorite, acetic acid, alcohol, ionized silver preparations, chlorhexidine, polyhexanide/betaine solution, or povidone-iodine--the majority of which are locally toxic and of limited or no proven efficacy in enhancing wound healing. Although the consensus opinion is that these topical cleaning agents should not be routinely used, recent clinical evidence suggests that polyhexanide/betaine may be nontoxic and effective in enhancing wound healing. Further well-designed studies are needed.

There is a growing literature on the contribution of behavioural economics to the design and improvement of tax policy. A less well-developed area is the potential for behavioural research to contribute to better tax administration. Better understanding of the motives of taxpayers and their attitudes and behaviour towards taxation can improve both voluntary compliance and the efficiency of the tax administration. The literature suggests tax compliance is determined by five broad factors: deterrence; norms (both personal and social); fairness and trust (in the tax administration); complexity of the tax system; and the role of government and the broader economic environment. Research in Ireland suggests that deterrence, the more traditional tool of tax administrations, is important but not sufficient to explain the level of tax compliance in society. Other factors are shown to be important, particularly the influence of personal norms and the level of trust in the tax administration. Perceptions of the prevailing social norms are also important determinants of compliance but appear to exert less influence on taxpayers than personal norms. The experiences of tax administrations in using behavioural research to influence taxpayers are examined and work in this area in Ireland is outlined.

OBJECTIVE: A cost-effectiveness analysis compared the potential economic benefit of an autologous, platelet-rich plasma (PRP) gel to alternative therapies in treating nonhealing diabetic foot ulcers. DESIGN: An economic model used peer-reviewed data to simulate clinical and cost outcomes and quality-adjusted life-years (QALYs) associated with PRP gel and other treatment modalities. PATIENTS: The model varies rates of healing, recurrence, infection, amputation, death, and associated costs for a hypothetical group of 200,000 patients with full-thickness, nonhealing diabetic foot ulcers for 5 years or until death. MAIN OUTCOME MEASURES: The model simulates the clinical, cost, and QALY outcomes associated with PRP gel versus other modalities in treating nonhealing diabetic foot ulcers over a 5-year period. MAIN RESULTS: The average 5-year direct wound care cost per modality and QALYs were PRP gel, $15,159 (2.87); saline gel, $33,214 (2.70); standard of care, $40,073 (2.65); noncontact kilohertz ultrasound therapy, $32,659 (2.73); human fibroblast-derived dermal substitute, $40,569 (2.65); allogenic bilayered culture skin substitute, $24,374 (2.79); bilayered cellular matrix, $37,340 (2.71); negative pressure wound therapy, $20,964 (2.81); and recombinant human platelet-derived growth factor BB, $47,252 (2.69). CONCLUSION: Use of PRP gel resulted in improved quality of life and lower cost of care over a 5-year period than other treatment modalities for nonhealing diabetic foot ulcers. Although actual treatment outcomes may differ from those modeled, PRP gel represents a potentially attractive treatment alternative for insurers and health care providers to address the cost burden and health effects of nonhealing diabetic foot ulcers.

A group of homologous, nonmethylene-interrupted dienoic fatty acids (NMID) recently reported in oysters has been found in several other shellfish species and also in other marine phyla. The distribution of most other "normal" fatty acids among several species of shellfish is basically similar but mantle lipids from two other molluscan species, both squid, differ radically. The squid mantle fatty acids do not include NMID, suggesting that in molluscs NMID may accumula-e primarily in filter-feeders or herbovores. The distribution of these anomalous fatty acid components in higher species suggests that they reflect invertebrates in the diet and are biochemically inert.

OBJECTIVE: Pressure ulcers often occur at sites subjected to pressure and wetness. Although skin wetness is a risk factor for pressure ulcers,the mechanisms and effects of wetness versus urine constituents on skin breakdown is unclear. The hypothesis that wetness reduces skin hardness and, thereby, increases vulnerability of underlying blood vessels to pressure-induced flow reductions was tested in this study. DESIGN: Pads saturated with water and with a water solution mixed with the main chemical constituents of urine (synthetic urine; s-urine) were applied to forearm skin of 10 healthy subjects for 5.5 hours. Skin hardness, blood flow change caused by 60 mm Hg of pressure, erythema, and temperature were compared among dry, water, and s-urine test sites. PARTICIPANTS: 10 healthy women. SETTING: Research Center, Nova Southeastern University, Health Professions Division, Fort Lauderdale, FL. MAIN RESULTS: S-urine and water caused significant reductions in initial hardness and caused greater initial perfusion decreases during pressure load when compared with dry sites. Skin temperature and erythema were lower at wet sites when compared with dry sites. CONCLUSIONS: The findings of this study are consistent with the concept that sustained skin wetness increases vulnerability to pressure-induced blood flow reduction. The effect appears to be mainly dependent on wetness, but urine constituents may exacerbate the effect. In addition, wetness-related skin cooling may play a role. In the healthy subjects studied, the blood flow decrease was not sustained due to perfusion recovery under pressure. Skin wetness would likely have more sustained effects in patients with compromised recovery mechanisms. Measures to diminish skin exposure to wetness in these patients, whatever the wetness source, are an important consideration in a multifaceted strategy to reduce the risk of pressure ulcers.

PURPOSE To offer an educational experience that will help improve the participant's understanding of diabetic foot ulcers and infections. TARGET AUDIENCE This CME/CE activity is intended for physicians and nurses with an interest in the prevention and treatment of diabetic foot ulcers and infections. LEARNING OBJECTIVES Describe the factors that put a diabetic patient's foot at risk for ulceration. Identify the components of optimal treatment of diabetic foot ulcers. Explain the roles of vascular and orthopaedic surgery in the treatment of diabetic foot ulcers and infections.

BACKGROUND: Health system weaknesses in Africa are broadly well known, constraining progress on reducing the burden of both communicable and non-communicable disease (Afr Health Monitor, Special issue, 2011, 14-24), and the key challenges in leadership, governance, health workforce, medical products, vaccines and technologies, information, finance and service delivery have been well described (Int Arch Med, 2008, 1:27). This paper uses focus group methodology to explore health worker perspectives on the challenges posed to integration of mental health into primary care by generic health system weakness. METHODS: Two ninety minute focus groups were conducted in Nyanza province, a poor agricultural region of Kenya, with 20 health workers drawn from a randomised controlled trial to evaluate the impact of a mental health training programme for primary care, 10 from the intervention group clinics where staff had received the training programme, and 10 health workers from the control group where staff had not received the training). RESULTS: These focus group discussions suggested that there are a number of generic health system weaknesses in Kenya which impact on the ability of health workers to care for clients with mental health problems and to implement new skills acquired during a mental health continuing professional development training programmes. These weaknesses include the medicine supply, health management information system, district level supervision to primary care clinics, the lack of attention to mental health in the national health sector targets, and especially its absence in district level targets, which results in the exclusion of mental health from such district level supervision as exists, and the lack of awareness in the district management team about mental health. The lack of mental health coverage included in HIV training courses experienced by the health workers was also striking, as was the intensive focus during district supervision on HIV to the detriment of other health issues. CONCLUSION: Generic health system weaknesses in Kenya impact on efforts for horizontal integration of mental health into routine primary care practice, and greatly frustrate health worker efforts.Improvement of medicine supplies, information systems, explicit inclusion of mental health in district level targets, management and supervision to primary care are likely to greatly improve primary care health worker effectiveness, and enable training programmes to be followed by better use in the field of newly acquired skills. A major lever for horizontal integration of mental health into the health system would be the inclusion of mental health in the national health sector reform strategy at community, primary care and district levels rather than just at the higher provincial and national levels, so that supportive supervision from the district level to primary care would become routine practice rather than very scarce activity. TRIAL REGISTRATION: Trial registration ISRCTN 53515024.