Academic literature on the topic 'Energy policy – United States – Decision making'

The National Environmental Policy Act of 1970 (NEPA) paved the way for comprehensive federal environmental policy in the United States. NEPA has successfully allowed citizens and others to become active participants in the environmental decision-making process for federal infrastructure projects throughout the evolution of environmental policy in the United States. Its efficacy was enhanced because of an oil spill off the Santa Barbara coast in January 1969. This disaster gave the framers of NEPA an example of the consequences of the lack of environmental policy in federal decision making. Using their original proactive approach along with the reactive response to the spill, they created a policy that has can be seen as a foundation for 21st century sustainability and resilience programs.

Energy regulation in the United States is now at a crossroads. The EPA has begun the process to officially repeal the Clean Power Plan and currently has no plan to replace it with new rulemaking to regulate carbon emissions from the U.S. energy sector. Even though the Clean Power Plan is more or less at its end, its regulatory structure stands as a model of the way decision-makers in the United States regulate the energy sector and the environment. Since the beginning of the modern environmental legal system, decision-makers have chosen to silo the system. Statutes and agencies focus on just one media or one issue. Tackling the climate crisis will inevitably require an integrationist model of lawmaking. The Clean Power Plan took the same problematic route as past regulation. While the Clean Power Plan rightfully addressed rising carbon levels, it failed to account for another growing problem associated with climate change: quickly depleting water resources. Although the consequences of the energy-water nexus are clear, U.S. decision-makers continue to ignore the need to integrate energy and water decision-making. Continuing to compartmentalize environmental problems, rather than addressing climate change impacts in a holistic manner, will not bring about the results that are desperately needed. The tools needed to integrate decision-making exist throughout the three branches of government. Congress can and should step in to pass a new statute, which establishes a legal mandate on agencies to fully consider the implications of energy policy and energy regulation on water resources. The federal courts can read a legal requirement into the Clean Air Act or the Administrative Procedure Act that would require federal action in the energy sphere to account for impacts on water resources. Finally, the President can use his power to force federal agencies to consider water resources more thoroughly than in the past. While some of these mechanisms may be hard to envision given the current political atmosphere, implementation is necessary to ensure water and energy security in the face of a growing climate crisis.

Lack of exercise is an important public health issue in the United States due to its link to obesity and other health risk factors. Despite several policy interventions, many Americans do not exercise sufficiently. Given recent findings that financial literacy helps to improve people’s rational decision-making ability and encourages people to exercise in Japan, we conduct a similar study for the United States, which has also been experiencing lack of exercise but has a different cultural setting. Culture has important influences on decision making and exercise behavior. This study investigates whether financial literacy is associated with exercise behavior in the United States. We used Osaka University’s 2010 Preference Parameters Study dataset and performed a probit regression analysis to test our hypothesis that financially literate people are likely to exercise more. In support of our hypothesis, we find that Americans with better financial literacy are more likely to exercise at least once a week. Additionally, financial education has a similar association with exercise behavior. Our results suggest that authorities could consider using financial literacy as an alternative policy intervention to promote regular exercise among the American population.

Abstract This Policy Insight article argues that a growing security partnership between Russia, Iran, China, Turkey, Iraq, and Syria (rictis) will push the Middle East into an era of bipolarity. The paper demonstrates that rictis has significant convergence on regional security issues, and that these interests are distinct from those held by the American Security Camp, a collection of states that include the United States, Saudi Arabia, Israel, and the United Arab Emirates. The paper also argues that rictis has military and energy advantages that allow it to confront the American Camp’s regional dominance. Our analysis demonstrates how rictis might help deter unilateralism and democratize regional decision-making.

Abstract Food supply chains are essential for distributing goods from production to consumption points. These complex supply chains are important for food security and availability. Recent research has developed novel methods to estimate food flows with high spatial resolution, but we do not currently understand how fine-grained food supply chains vary in time. In this study, we use an improved version of the Food Flow Model to estimate food flows (kg) between all county pairs across all food commodity groups for the years 2007, 2012, and 2017 (which requires estimating 206.3 million links). We then determine the core counties to the US food flow networks through time with a multi-criteria decision analysis technique. Our estimates of county-to-county food flows in time are freely available with this paper and could be useful for future research, policy, and decision-making.

The paper industry is a high-carbon emission and energy-intensive industry. From the perspective of low-carbon trade and carbon neutrality, its energy conservation and emission reduction are worthy of attention. This study used the input-output model to calculate the embodied carbon emissions of China’s paper industry’s export trade to the United States from 2006 to 2020 and used the logarithmic mean division index (LMDI) method to analyze influencing factors of the change of embodied carbon emissions. The study found that the embodied carbon emissions of China’s paper industry’s export trade to the United States generally shows a stable downward trend after reaching the peak with the increase of export trade scale; scale effect is the main factor that causes the embodied carbon emissions, while technological progress, policy support, and environmental regulations are important driving forces to promote carbon emission reduction. The research results of this paper not only can test and guide China’s paper industry trade policies and industrial policies, but they can also provide decision-making reference for China and the United States to promote the carbon emission reduction of the paper industry.

Environmental quality has a profound effect on health and the burden of disease. In the United States, the environment-related burden of disease is increasingly dominated by chronic diseases. At the local level, public health practitioners realize that many policy decisions affecting environmental quality and health transcend the authorities of traditional health department programs. Healthy decisions about the built environment, including housing, transportation, and energy, require broad collaborative efforts. Environmental health professionals have an opportunity to address the shift in public health burden toward chronic diseases and play an important role in the design of healthy communities by bringing data and tools to decision makers. This article provides a guide for community leaders to consider the public health effects of decisions about the built environment. We present a conceptual framework that represents a shift from compartmentalized solutions toward an inclusive systems approach that encourages partnership across disciplines and sectors. We discuss practical tools to assist with environmental decision making, such as Health Impact Assessments, environmental public health tracking, and cumulative risk assessment. We also identify priorities in research, practice, and education to advance the role of public health in decision making to improve health, such as the Health Impact Assessment, as a core competency for environmental health practitioners. We encourage cross-disciplinary communication, research, and education that bring the fields of planning, transportation, and energy in closer collaboration with public health to jointly advance the systems approach to today’s environmental challenges.

Scientific evidence of climate change has never been more profound. Activists around the world now demand climate action from global leaders on almost a daily basis. Yet, decision makers are not in a rush to deal with the climate emergency. The present article looks at the politics of climate change through the lens of decision-making under uncertainty to understand whether uncertainty and risk can explain the lack of decisive action on the part of the global leadership and posits that the politics of climate change reflect the climate system itself: complex, multi-layered, driven by many inter-related elements and diverse in its manifestations.

Precipitation not absorbed by the soil or local vegetation and remain on the surface leading to stormwater can cause soil erosion, flooding, property damage, and overflow to wastewater treatment facilities. This paper introduces a novel multicriteria decision-making model to choose among various sustainable solutions that can help in managing stormwater. This model is intended to help decision-makers in handling stormwater through proper utilization of precipitation while ensuring public safety and adhering to runoff regulations. The model also aims to present sustainable technologies that can help in reducing harmful stormwater overflows. As a way of constructing and validating the model, precipitation and other relevant data from the North-Eastern region of the United States were used. The model can be altered though to suit other regions in the world. The model was further validated by seeking the opinion of a group of experts on its constructs. Statistical analysis identified high item-to-total correlations for model constructs and a model Cronbach’s alpha value of 0.84 leading to conclude that the model is valid. Yet, green solutions presented in this study and the developed model should be considered as a first step in determining sustainable stormwater solutions and further research in this area is needed.

Climate change impacts on agriculture have been intensifying in the Northeastern and Midwestern United States. Few empirical studies have considered how dairy farmers and/or their advisors are interpreting and responding to climate impacts, risks, and opportunities in these regions. This study investigates dairy farmer and advisor views and decisions related to climate change using data from seven farmer and advisor focus groups conducted in New York and Wisconsin. The study examined how farmers and advisors perceived climate impacts on dairy farms, the practices they are adopting, and how perceived risks and vulnerability affect farmers’ decision making related to adaptation strategies. Although dairy farmers articulated concern regarding climate impacts, other business pressures, such as profitability, market conditions, government regulations, and labor availability were often more critical issues that affected their decision making. Personal experience with extreme weather and seasonal changes affected decision making. The findings from this study provide improved understanding of farmers’ needs and priorities, which can help guide land-grant researchers, Extension, and policymakers in their efforts to develop and coordinate a comprehensive strategy to address climate change impacts on dairy in the Northeast and the Midwest US.

Normative economic theory provides justification for at least partially centralized renewable energy provision due to the large, positive externalities associated with renewable energy production. However, the United States is one of the few countries without centralized renewable energy policy. Instead, the federal government actively chooses decentralized renewable energy provision by using fiscal transfers to support subnational renewable energy development. This dissertation explores why U.S. legislators choose decentralized renewable energy provision by asking two primary questions. First, what is the motivation for using federal fiscal transfers for decentralized renewable energy output considering what we know about positive spillovers and market failure associated with decentralized renewable energy production? Second, do fiscal transfers for decentralized renewable energy provision increase renewable energy production at the local level? The theoretical model proposed in Chapter Four posits why policymakers choose decentralized renewable energy provision. The chapter argues that the current political price associated with a specific policy issue affects legislators’ choices regarding good provision. I hypothesize that when the political price associated with vying for centralized good provision is high, legislators are incentivized to choose decentralized good provision. Chapter Five applies this theory to empirically evaluate the choice to decentralize renewable energy provision. The chapter examines whether the current political price of renewable energy policy affects the likelihood of a legislator proposing decentralized funding for renewable energy provision. I hypothesize that legislators will propose funding to support decentralized renewable energy development when the political price associated with renewable energy policies is high at a given time. The results show that when the political price of renewable energy policy is low, a policymaker is less likely to use grants to support renewable energy projects, finding support for the hypothesis. Chapter Six empirically evaluates the effectiveness of renewable energy grants at the local level to further understand the theoretical model proposed in Chapter Four. I hypothesize that receiving a renewable energy grant increases renewable energy output at the local level. The results support this hypothesis by showing that receiving a renewable energy grant is associated with significant and positive increases in solar energy production. These findings provide further insight into legislative decision-making and the role of renewable energy grants in renewable energy development in the U.S.

Thesis (Ph.D.)--Kent State University, 2009.
Title from PDF t.p. (viewed Nov. 24, 2009). Advisor: Steven W. Hook. Keywords: proactive foreign policy, the multiple streams model, preexisting solutions. Includes bibliographical references (p. 218-238).

Thesis (Ph. D.)--Dept. of Political Science and Dept. of History. University of Missouri--Kansas City, 2004.
"A dissertation in political science and history." Advisor: Robert Evanson. Typescript. Vita. Title from "catalog record" of the print edition Description based on contents viewed Feb. 28, 2006. Includes bibliographical references (leaves 236-252). Online version of the print edition.

In recent years a growing number of scholars within the field of Foreign Policy Analysis have asserted that an understanding of the interface between national identity and foreign policy is of paramount importance. Indeed one of the driving forces behind the surge of interest in this topic area is the recognition that foreign policy decision-makers are not immune to the effects of national identity, being themselves a product of the society in which they live. This body of work seeks to highlight the role American exceptionalism played in influencing the Bush administration’s foreign policy decision-making process following the events of September 11th. For many Americans, the events of September 11th served as a cruel re-minder that the United States remained vulnerable to outside attack much like it had been prior to the Japanese bombing of Pearl Harbor. Both events are now indelibly scarred into the American psyche. While each attack left Americans with a sense of vulnerability, they could have at least consoled themselves with the thought that Pearl Harbor was a reaction to the perceived threat that the United States would pose on entering the Second World War. September 11th only lead Americans to the sobering realization that the citizens of other nations took a growing affront to their very ideals and way of life. Sensing this insecurity, the Bush administration seized the opportunity presented by September 11th and began reshaping the identity of the United States, its enemies and the rest of the world in order to justify its foreign policy. This thesis suggests that in the absence of the September 11th terrorist attacks and the resultant shift in identity, the neoconservatives would not have had the same chance to exert their considerable influence on the administration. In order to achieve its objectives, this research notes that the Bush administration employed a foreign policy decision-making process that not only circumvented executive branch proficiency but also often completely disregarded it. Moreover it is also apparent that key foreign policy decision-makers were overconfident in America’s exceptional nature, mainly its economic and military superiority, which consequently clouded its assessment of public diplomacy’s value. Examination of the administration’s defense posture in the wake of September 11th has revealed that many of its early initiatives did not match the threats faced by the United States. One thing is certain, in the absence of the September 11th terrorist attacks, the Bush administration would have been unable to justify a foreign policy doctrine as outlined in the 2002 National Security Strategy. Finally this research seeks to add to the field through an assessment of public opinion in particular that of the Facebook Generation, an up and coming cohort. Appreciation of public opinion is crucial as it provides a perspective through which to understand how the American public sees the nation’s self-image and how it wants the country to act on the international stage. From a foreign policy decision-making perspective, this information is invaluable because it reveals what types of risks the public is willing to take. As a result, it is imperative that researchers begin to understand this generation’s point of view, given the uncertain nature of the international environment that lies ahead.

Most studies of the use of conventional military force by the United States in the twentieth century tend to characterize the decision making process in terms of a unitary state and a unitary presidential decision maker. One alternative to this approach is the Bureaucratic Politics paradigm proposed by Graham Allison. To test the explanatory power of this decision making model in the post-Vietnam era, this thesis applies the specific propositions of Graham Allison's "Governmental Politics Model" concerning the use of military force, to selected case studies. In an attempt to determine the explanatory power of Allison's Governmental Politics model in the wake of Vietnam, this thesis draws on case studies ranging from the Dominican Republic intervention to the recent invasion of Panama. This thesis seeks to measure the theory to present reality.

Master of Arts

AbstractIn 2016, the United Nations (UN) Member States adopted a decision on the role of the UN Educational, Scientific and Cultural Organization (UNESCO) in encouraging girls and women to be leaders in science, technology, engineering, and mathematics (STEM) and in science, technology, engineering, arts, and mathematics (STEAM). This decision poses a special challenge for many sectors in society and posits unique opportunities for women’s leadership in higher education institutions (HEIs). This chapter opens by presenting views on overcoming gender segregation in STEM. The roles of women in leadership positions in the higher education STEM research areas of a large multidisciplinary university in a Nordic country are explored. The unique paths in which four of these women have progressed in their profession, position, and promotion of equality through their diverse and multiple roles within their HEI are examined. From this collection, intertwined opportunities in assuming leadership in the promotion of gender desegregation in STEM are identified on a micropolitical levels. The chapter concludes by elaborating institutional strategies and synergies for overcoming gender segregation in higher education STEM fields from the perspective of leadership. This chapter ends with an annexed declaration useful for local policy development and practical action.

AbstractThe purpose of the present chapter is to investigate Sadat's February 1971 political initiative and the United States' and Israel's response to it. Its main objective is to examine how processes within the inner American arena have influenced the formation of the Israeli policy toward Sadat's diplomatic initiative. In other words, how the two-headed nature of the American foreign policy—the State Department versus the White House—regarding the Middle East and the Vietnam War influenced the decision-making process in Israel.

AbstractIran has been a critical player in the Syrian war since 2011, crafting a complex foreign policy and military strategy to preserve its Syrian ally. What have been the drivers of Iranian decision-making in this conflict? And how has Iranian strategy evolved over the course of the war? This chapter argues that the logic of deterrence has been fundamental not just for shaping the contours of Iran–Syria relations since the Islamic Revolution of 1979, but also for determining the overall trajectory of Iranian strategy in the Syrian war. The authors outline Iran’s decision-making calculus and divide the country’s strategy on Syria after the Arab Spring into four primary phases: (1) a ‘Basij’ strategy to establish local militias in Syria; (2) a regionalization strategy to incorporate transnational fighters and militias in the war effort; (3) an internationalization strategy to incorporate Russia and balance the United States; and (4) a post-ISIS deterrence strategy to balance against the United States, Turkey and Israel. Iran’s Syria strategy progressively escalated in response to the possible defeat of its ally and the deterioration of its forward deterrence capacities against the United States and Israel. Today, the potential for direct inter-state conflict is rising as proxy warfare declines and Iran attempts to maintain the credibility of its forward deterrence.

Local governments in the U.S. have many policy responsibilities and relatively more autonomy in decision making than in many countries. Yet, there is a gap in recent research on the use of policy analysis and data-driven decision making in local governments. Historically, the use of data and evidence has influenced change at the local level, from municipal reform in the 20^th century to reinventing government. Currently, there are calls for more evidence-based policymaking, and we offer some recent survey evidence on the use of policy analysis and data at the local level, as well as case studies that further demonstrate how evidence gets used. Given great variation in government size, capacity, governance and policies at the local level, along with the potential for experimentation and comparison, greater research attention to local use of analysis and data could contribute to both scholarship and practice.

This chapter draws on a 40-year history of patchwork efforts to use data to inform the development of public policy and shape its implementation. I begin with a description of the evolution of the policy process, drawing largely on experiences within the U.S. Departments of Health and Human Services, Education, and Labor. All three agencies have been major supporters of and contributors to advances in the methods of policy analysis and the use of program evaluation to guide decision making. The chapter draws on the roles of these agencies in laying the groundwork for the current emphasis on evidence-based policymaking, in part because of their leadership roles and in part because of the author’s first-hand experience working with these agencies. Of particular note is its attention to the lead up to the present context in which policy analysis and program evaluation are central to both the policy development and monitoring processes. The chapter ends with a discussion of the current movement to create and use credible evidence on the impacts and cost-effectiveness of programs, policies and practices as the foundation for more efficient and effective government and, where evidence is lacking, for integrating a knowledge-building agenda into the roll-out of strategies for change.

Electricity generation is a major source of air pollution, contributing to nearly one-third of the total greenhouse gas emissions in the United States. As with most goods, production must keep up with the projected consumer demand, and the industry is subject to government regulations at the federal, state, and local levels. This study models the New Jersey electric grid as a market system, using agent-based modeling to represent individual consumers and power companies making utility-maximizing decisions. Each consumer agent is prescribed a unique value function that includes factors such as income, energy intensity, and environmental sensitivity, and they are able to make decisions about how much energy they use and whether they opt into a renewable energy program. Power producers are modeled to keep up with demand and minimize their cost per unit of electricity produced, and they include options to prefer either on-demand or renewable energy sources. Using this model, different scenarios are examined with respect to producer strategy and government policy. The results provide a proof-of-concept for the modeling approach, and they reveal interesting trends about how the markets are expected to react under different scenarios.

As demand for electricity in the United States continues to increase, it is necessary to explore the means through which the modern power supply system can accommodate both increasing affluence (which is accompanied by increased per-capita consumption) and the continually growing global population. Though there has been a great deal of research into the theoretical optimization of large-scale power systems, research into the use of an existing power system as a foundation for this growth has yet to be fully explored. Current successful and robust power generation systems that have significant renewable energy penetration — despite not having been optimized a priori — can be used to inform the advancement of modern power systems to accommodate the increasing demand for electricity. Leveraging ongoing research projects at Oregon State University and the National Energy Technology Laboratory, this work explores how an accurate and state-of-the-art computational model of the Oregon/Washington (OR/WA) energy system can be employed as part of an overarching power systems optimization scheme that looks to inform the decision making process for next generation power supply systems. Research scenarios that explore an introductory multi-objective power flow analysis for the OR/WA grid will be shown, along with a discussion of future research directions.

Background: Cannabis is the most commonly used drug during pregnancy in the United States and use during pregnancy is increasing along with greater legal and social acceptance. Methods: We conducted a qualitative content analysis of 23 in-depth interviews with pregnant and lactating people in Massachusetts, a state that legalized cannabis for adult use in 2016. Our aim was to explore how policy constrains or facilitates people’s ability to make informed decisions about cannabis use during pregnancy and lactation. Our analysis was conducted using an ecosocial approach, recognizing that the implementation and interpretation of cannabis policy can be understood at multiple levels, which interact with each other and shape the health and experiences of individuals. Additionally, this analysis was informed by a harm reduction approach in which we acknowledge the complexity surrounding cannabis use during pregnancy and lactation, while attempting to identify ways to reduce potentially harmful consequences. Results: Findings revealed that, despite the legal status of cannabis, there continues to be a lack of clarity for pregnant and lactating people regarding the legal implications of cannabis use. Inconsistent state and institutional policies about drug testing of mothers and newborns leave a cloud of fear hanging over the experiences of cannabis users and inhibit their ability to obtain expert advice from healthcare providers. Conclusion: Decision makers in public and institutional policy should work to clarify and update policies regarding substance use during pregnancy following legalization of a new substance, and ensure that pregnant and lactating people are afforded the same legal protections as the general population.

Effective energy planning and governmental decision making policies heavily rely on accurate forecast of energy demand. This paper discusses and compares five different forecasting techniques to model energy demand in the United States using economic and demographic factors. Two Artificial Neural Network (ANN) models, two regression analysis models and one autoregressive integrated moving average (ARIMA) model are developed based on historical data from 1950–2013. While ANN model 1 and regression model 1 use Gross Domestic Product (GDP), Gross National Product (GNP) and per capita personal income as independent input factors, ANN model 2 and regression model 2 employ GDP, GNP and population (POP) as the predictive factors. The forecasted values resulted from these models are compared with the forecast made by the U.S. Energy Information Administration (EIA) for the period of 2014–2019. The forecasted results of ANN models and regression model 1 are close to those of the U.S. EIA, however the results of regression model 2 and ARIMA model are significantly different from the forecast made by the U.S. EIA. Finally, a comparison of the forecasted values resulted from three efficient models showed the energy demand would vary between 95.51 and 100.08 quadrillion British thermal unit for the period of 2014–2019.

Renewed interest in waste-to-energy (WTE) has spurred a number of plans for facility expansions, retrofits and in several cases, new facilities. Complex federal and state regulations governing stationary air pollution sources challenge projects to develop and implement a compliance strategy that meets current and emerging regulatory requirements and which consists of commercially available and technically feasible control technologies, while managing the financial viability of the project. Past experience in the WTE industry is indicative of current challenges, and the deliberate development of WTE in the United States over the last 15 years now creates challenges when technologies developed and implemented elsewhere must be considered. One example is control of nitrogen oxides. Individual projects are subject to regulatory requirements differently, with net emissions increases, location and other attributes establishing the basis for regulatory compliance. This paper will discuss the complex New Source Review permitting requirements that typically apply to WTE projects, review commercially available air pollution control technologies, and discuss, through the use of a case study, the decision-making process used to develop the air pollution control strategy for the York County Resource Recovery Center expansion, one recent development of new WTE capacity in the United States.

The authors present a comparative study on effectiveness of energy policies for the building sector that are presently implemented in selected countries in Europe versus selected states in the U.S. Socio-economic factors affecting energy consumption on both sides of the Atlantic are identified from a human behavior perspective. Various identified factors known to affect energy efficiency and consumption have been positioned in diagrams based on four primary directions: lifestyle, economy, environment, and technology. In a second step various programs and incentives are positioned in the same diagram to demonstrate how well these strategies address the factors identified before. This is done for selected countries and continents in sub-diagrams to allow a comparison of effectiveness and provide a tool for predicting the effectiveness of a possible policy or program transfer to other nations. The research conducted so far suggests that energy efficiency policies and measures implemented in the United States do not always target the factors that have been identified to most significantly influence energy consumption. The results indicate that there might be a significant gap between parameters that are guiding factors affecting energy consumption, and parameters targeting a proper implementation of energy efficient policies. The authors strive to provide a tool that will help policy makers and other decision makers to evaluate and compare their incentives and programs against those from other countries and benefit from lessons learned by mapping various policies towards specific efficiency parameters.

Abstract This study builds a decision support tool to evaluate when it is a good economic decision (least cost with minimum discomfort) for the residential customer to invest in distributed energy resources (DERs) based on different electricity rate structures, DER ownership frameworks, and DER rebates offered by electric utilities. The tool is demonstrated using empirical electricity consumption data from Pecan Street Inc. (a non-profit entity based on Austin, Texas), residential rates from Austin Energy (the municipal electric utility in Austin, Texas), DER ownership costs from various nationwide pilot programs, and incentives offered by electric utilities in the United States. Results show that for constant electricity rates, the overall expenditure is least when the customer owns solar panels without storage, while for time-varying pricing structures, the least expensive scenario is one where the customer does not own any DERs. As the capital costs for DERs decline, utilities incentivize customer ownership of DERs, and more residential customers face the decision of whether to invest in DERs, this study aims to be a key tool in aiding that decision-making process.

When local governments evaluate the environmental benefits and costs of alternatives for managing non-recyclable municipal solid waste, the relative costs of modern waste-to-energy (WTE) technology can be a significant stumbling block despite WTE technology’s environmental benefits. Although the preceding point is an important economic reality that has constrained WTE development in the United States, fortunately there is a highly effective means — the use of municipal solid waste “flow control” (or “facility designation”) authority — to overcome WTE’s perceived cost disadvantage. The relationship between flow control and WTE development, including significant encouragement for use of flow control as a result of the U.S. Supreme Court’s recent decision in United Haulers Association v. Oneida-Herkimer Solid Waste Management Authority, 127 S.Ct. 1786 (2007), is the focus of this paper, which will address the following topics: Policy Basis for Flow Control — Absent government intervention, management of municipal solid waste will seek the lowest cost (i.e., short-term cost) and frequently less environmentally protective alternatives. Flow control can counter the tendency to choose alternatives with lower short-term costs and at the same time facilitate implementation of the environmentally-preferable waste management alternatives a local government selects, such as WTE technology and other aspects of “integrated waste management.” Flow Control and the Courts — While the authority of a given local government to use flow control is grounded in state law, flow control also implicates matters that arise under federal law, such as Commerce Clause issues, given the possibility that solid waste regulation in one state can affect commercial interests in solid waste management in another state. Although concerns regarding claims of impact on interstate commerce prompted a negative Supreme Court response to flow control in C&A Carbone, Inc. v. Town of Clarkstown, 511 U.S. 383 (1994), the Court’s decision 13 years later in the Oneida-Herkimer case was in many ways just the opposite. WTE’s Correlation with Flow Control and Practical Guideposts — WTE development can be significantly advanced by the use of flow control. That conclusion is borne out by empirical data. The concluding portion of this paper addresses that topic as well as corollary issues, such as public-private collaboration for WTE development and other practical guideposts for implementing flow control ordinances.

The U.S. Department of Energy Office of Nuclear Energy (DOE-NE), Office of Fuel Cycle Technologies (OFCT) has established the Used Fuel Disposition Campaign (UFDC) to conduct research and development (R&D) activities related to storage, transportation and disposal of used nuclear fuel (UNF) and high level radioactive waste (HLW). The U.S. has, in accordance with the U.S. Nuclear Waste Policy Act (as amended), focused efforts for the past twenty-plus years on disposing of UNF and HLW in a geologic repository at Yucca Mountain, Nevada. The recent decision by the U.S. DOE to no longer pursue the development of that repository has necessitated investigating alternative concepts for the disposal of UNF and HLW that exists today and that could be generated under future fuel cycles. The disposal of UNF and HLW in a range of geologic media has been investigated internationally. Considerable progress has been made by in the U.S and other nations, but gaps in knowledge still exist. The U.S. national laboratories have participated in these programs and have conducted R&D related to these issues to a limited extent. However, a comprehensive R&D program investigating a variety of storage, geologic media, and disposal concepts has not been a part of the U.S. waste management program since the mid 1980s because of its focus on the Yucca Mountain site. Such a comprehensive R&D program is being developed and executed in the UFDC using a systematic approach to identify potential R&D opportunities. This paper describes the process used by the UFDC to identify and prioritize R&D opportunities. The U.S. DOE has cooperated and collaborated with other countries in many different “arenas” including the Nuclear Energy Agency (NEA) within the Organisation for Economic Co-operation and Development (OECD), the International Atomic Energy Agency (IAEA), and through bilateral agreements with other countries. These international activities benefited the DOE through the acquisition and exchange of information, database development, and peer reviews by experts from other countries. Recognizing that programs in other countries have made significant advances in understanding a wide range of geologic environments, the UFDC has developed a strategy for continued, and expanded, international collaboration. This paper also describes this strategy.

Abstract Buildings are one of the largest energy consumers in the United States. K-12 schools are responsible for nearly 8% of energy consumption by commercial buildings which is equivalent to 1.44% of total annual energy consumption in the country. Understanding the baseline energy consumption of the schools as well as identifying effective energy efficiency measures (EEMs) that result in significant energy savings without compromising occupant’s comfort in a given climate condition are essential factors in moving towards a sustainable future. In a collaboration between Florida Institute of Technology and Brevard Public Schools, three schools are identified for a test study in Melbourne, FL, representing the humid subtropical climate. Energy audit is conducted for these schools and monthly utility bill data as well as background information, end-user’s data and their associated operating schedules are obtained. A detailed analysis is performed on the utility bill data and energy consumption by each end-user is estimated. Several EEMs are considered and evaluated to achieve an improved energy efficiency for the schools. The implementation cost of each EEM and the associated simple payback period is also determined. A study is also conducted to explore possibility of using solar power to cover 50% of energy requirements of each school and the cost and payback period of the project are evaluated. The results of this paper provide insights regarding prioritizing energy efficiency projects in K-12 schools in humid subtropical climates and particularly the state of Florida and help with decision making regarding investment in on-site power generation using solar energy.

This document summarizes the notable outcomes of the workshop “Quantifying and Incorporating Social and Environmental Outputs in Decision-Making—Research and Development Needs and Strategy Workshop.” The workshop was held 24 and 25 July 2019 in Alexandria, Virginia, at the US Army Corps of Engineers’ (USACE) Institute for Water Resources (IWR). The workshop sought to identify gaps in knowledge, methods, data, and tools and to identify types of subject matter experts who would be needed for the research team. A total of 22 participants attended the facilitated workshop, representing a broad array of expertise: economists, scientists, planners, social scientists, project managers, and researchers from a number of USACE organizations and partnering academics across the United States. Together, these attendees reviewed existing policy and research and prioritized future work to fill gaps in methods and procedures for incorporating social and environmental inputs across a broad range of USACE projects.

Eminent Domain is the power of the government or quasi-government entities to take private or public property interests through condemnation. Eminent Domain has been a significant issue since 1879 when, in the case of Boom Company v. Patterson, the Supreme Court first acknowledged that the power of eminent domain may be delegated by state legislatures to agencies and non-governmental entities. Thus, the era of legal takings began. Though an important legal dispute then, more recently eminent domain has blossomed into an enduring contentious social and political problem throughout the United States. The Fifth Amendment to the United States Constitution states, “nor shall private property be taken for public use, without just compensation.” Thus, in the wake of the now infamous decision in Kelo v. City of New London, where the Court upheld the taking of private property for purely economic benefit as a “public use,” the requirement of “just compensation” stands as the primary defender of constitutionally protected liberty under the federal constitution. In response to Kelo, many state legislatures passed a variety of eminent domain reforms specifically tailoring what qualifies as a public use and how just compensation should be calculated. Texas landowners recognize that the state’s population is growing at a rapid pace. There is an increasing need for more land and resources such as energy and transportation. But, private property rights are equally important, especially in Texas, and must be protected as well. Eminent domain and the condemnation process is not a willing buyer and willing seller transition; it is a legally forced sale. Therefore, it is necessary to consider further improvements to the laws that govern the use of eminent domain so Texas landowners can have more assurance that this process is fair and respectful of their private property rights when they are forced to relinquish their land. This report compiles statutes and information from the other forty-nine states to illustrate how they address key eminent domain issues. Further, this report endeavors to provide a neutral third voice in Texas to strike a more appropriate balance between individual’s property rights and the need for increased economic development. This report breaks down eminent domain into seven major topics that, in addition to Texas, seemed to be similar in many of the other states. These categories are: (1) Awarding of Attorneys’ Fee; (2) Compensation and Valuation; (3) Procedure Prior to Suit; (4) Condemnation Procedure; (5) What Cannot be Condemned; (6) Public Use & Authority to Condemn; and (7) Abandonment. In analyzing these seven categories, this report does not seek to advance a particular interest but only to provide information on how Texas law differs from other states. This report lays out trends seen across other states that are either similar or dissimilar to Texas, and additionally, discusses interesting and unique laws employed by other states that may be of interest to Texas policy makers. Our research found three dominant categories which tend to be major issues across the country: (1) the awarding of attorneys’ fees; (2) the valuation and measurement of just compensation; and (3) procedure prior to suit.

1.1 Macroeconomic summary Economic recovery has consistently outperformed the technical staff’s expectations following a steep decline in activity in the second quarter of 2020. At the same time, total and core inflation rates have fallen and remain at low levels, suggesting that a significant element of the reactivation of Colombia’s economy has been related to recovery in potential GDP. This would support the technical staff’s diagnosis of weak aggregate demand and ample excess capacity. The most recently available data on 2020 growth suggests a contraction in economic activity of 6.8%, lower than estimates from January’s Monetary Policy Report (-7.2%). High-frequency indicators suggest that economic performance was significantly more dynamic than expected in January, despite mobility restrictions and quarantine measures. This has also come amid declines in total and core inflation, the latter of which was below January projections if controlling for certain relative price changes. This suggests that the unexpected strength of recent growth contains elements of demand, and that excess capacity, while significant, could be lower than previously estimated. Nevertheless, uncertainty over the measurement of excess capacity continues to be unusually high and marked both by variations in the way different economic sectors and spending components have been affected by the pandemic, and by uneven price behavior. The size of excess capacity, and in particular the evolution of the pandemic in forthcoming quarters, constitute substantial risks to the macroeconomic forecast presented in this report. Despite the unexpected strength of the recovery, the technical staff continues to project ample excess capacity that is expected to remain on the forecast horizon, alongside core inflation that will likely remain below the target. Domestic demand remains below 2019 levels amid unusually significant uncertainty over the size of excess capacity in the economy. High national unemployment (14.6% for February 2021) reflects a loose labor market, while observed total and core inflation continue to be below 2%. Inflationary pressures from the exchange rate are expected to continue to be low, with relatively little pass-through on inflation. This would be compatible with a negative output gap. Excess productive capacity and the expectation of core inflation below the 3% target on the forecast horizon provide a basis for an expansive monetary policy posture. The technical staff’s assessment of certain shocks and their expected effects on the economy, as well as the presence of several sources of uncertainty and related assumptions about their potential macroeconomic impacts, remain a feature of this report. The coronavirus pandemic, in particular, continues to affect the public health environment, and the reopening of Colombia’s economy remains incomplete. The technical staff’s assessment is that the COVID-19 shock has affected both aggregate demand and supply, but that the impact on demand has been deeper and more persistent. Given this persistence, the central forecast accounts for a gradual tightening of the output gap in the absence of new waves of contagion, and as vaccination campaigns progress. The central forecast continues to include an expected increase of total and core inflation rates in the second quarter of 2021, alongside the lapse of the temporary price relief measures put in place in 2020. Additional COVID-19 outbreaks (of uncertain duration and intensity) represent a significant risk factor that could affect these projections. Additionally, the forecast continues to include an upward trend in sovereign risk premiums, reflected by higher levels of public debt that in the wake of the pandemic are likely to persist on the forecast horizon, even in the context of a fiscal adjustment. At the same time, the projection accounts for the shortterm effects on private domestic demand from a fiscal adjustment along the lines of the one currently being proposed by the national government. This would be compatible with a gradual recovery of private domestic demand in 2022. The size and characteristics of the fiscal adjustment that is ultimately implemented, as well as the corresponding market response, represent another source of forecast uncertainty. Newly available information offers evidence of the potential for significant changes to the macroeconomic scenario, though without altering the general diagnosis described above. The most recent data on inflation, growth, fiscal policy, and international financial conditions suggests a more dynamic economy than previously expected. However, a third wave of the pandemic has delayed the re-opening of Colombia’s economy and brought with it a deceleration in economic activity. Detailed descriptions of these considerations and subsequent changes to the macroeconomic forecast are presented below. The expected annual decline in GDP (-0.3%) in the first quarter of 2021 appears to have been less pronounced than projected in January (-4.8%). Partial closures in January to address a second wave of COVID-19 appear to have had a less significant negative impact on the economy than previously estimated. This is reflected in figures related to mobility, energy demand, industry and retail sales, foreign trade, commercial transactions from selected banks, and the national statistics agency’s (DANE) economic tracking indicator (ISE). Output is now expected to have declined annually in the first quarter by 0.3%. Private consumption likely continued to recover, registering levels somewhat above those from the previous year, while public consumption likely increased significantly. While a recovery in investment in both housing and in other buildings and structures is expected, overall investment levels in this case likely continued to be low, and gross fixed capital formation is expected to continue to show significant annual declines. Imports likely recovered to again outpace exports, though both are expected to register significant annual declines. Economic activity that outpaced projections, an increase in oil prices and other export products, and an expected increase in public spending this year account for the upward revision to the 2021 growth forecast (from 4.6% with a range between 2% and 6% in January, to 6.0% with a range between 3% and 7% in April). As a result, the output gap is expected to be smaller and to tighten more rapidly than projected in the previous report, though it is still expected to remain in negative territory on the forecast horizon. Wide forecast intervals reflect the fact that the future evolution of the COVID-19 pandemic remains a significant source of uncertainty on these projections. The delay in the recovery of economic activity as a result of the resurgence of COVID-19 in the first quarter appears to have been less significant than projected in the January report. The central forecast scenario expects this improved performance to continue in 2021 alongside increased consumer and business confidence. Low real interest rates and an active credit supply would also support this dynamic, and the overall conditions would be expected to spur a recovery in consumption and investment. Increased growth in public spending and public works based on the national government’s spending plan (Plan Financiero del Gobierno) are other factors to consider. Additionally, an expected recovery in global demand and higher projected prices for oil and coffee would further contribute to improved external revenues and would favor investment, in particular in the oil sector. Given the above, the technical staff’s 2021 growth forecast has been revised upward from 4.6% in January (range from 2% to 6%) to 6.0% in April (range from 3% to 7%). These projections account for the potential for the third wave of COVID-19 to have a larger and more persistent effect on the economy than the previous wave, while also supposing that there will not be any additional significant waves of the pandemic and that mobility restrictions will be relaxed as a result. Economic growth in 2022 is expected to be 3%, with a range between 1% and 5%. This figure would be lower than projected in the January report (3.6% with a range between 2% and 6%), due to a higher base of comparison given the upward revision to expected GDP in 2021. This forecast also takes into account the likely effects on private demand of a fiscal adjustment of the size currently being proposed by the national government, and which would come into effect in 2022. Excess in productive capacity is now expected to be lower than estimated in January but continues to be significant and affected by high levels of uncertainty, as reflected in the wide forecast intervals. The possibility of new waves of the virus (of uncertain intensity and duration) represents a significant downward risk to projected GDP growth, and is signaled by the lower limits of the ranges provided in this report. Inflation (1.51%) and inflation excluding food and regulated items (0.94%) declined in March compared to December, continuing below the 3% target. The decline in inflation in this period was below projections, explained in large part by unanticipated increases in the costs of certain foods (3.92%) and regulated items (1.52%). An increase in international food and shipping prices, increased foreign demand for beef, and specific upward pressures on perishable food supplies appear to explain a lower-than-expected deceleration in the consumer price index (CPI) for foods. An unexpected increase in regulated items prices came amid unanticipated increases in international fuel prices, on some utilities rates, and for regulated education prices. The decline in annual inflation excluding food and regulated items between December and March was in line with projections from January, though this included downward pressure from a significant reduction in telecommunications rates due to the imminent entry of a new operator. When controlling for the effects of this relative price change, inflation excluding food and regulated items exceeds levels forecast in the previous report. Within this indicator of core inflation, the CPI for goods (1.05%) accelerated due to a reversion of the effects of the VAT-free day in November, which was largely accounted for in February, and possibly by the transmission of a recent depreciation of the peso on domestic prices for certain items (electric and household appliances). For their part, services prices decelerated and showed the lowest rate of annual growth (0.89%) among the large consumer baskets in the CPI. Within the services basket, the annual change in rental prices continued to decline, while those services that continue to experience the most significant restrictions on returning to normal operations (tourism, cinemas, nightlife, etc.) continued to register significant price declines. As previously mentioned, telephone rates also fell significantly due to increased competition in the market. Total inflation is expected to continue to be affected by ample excesses in productive capacity for the remainder of 2021 and 2022, though less so than projected in January. As a result, convergence to the inflation target is now expected to be somewhat faster than estimated in the previous report, assuming the absence of significant additional outbreaks of COVID-19. The technical staff’s year-end inflation projections for 2021 and 2022 have increased, suggesting figures around 3% due largely to variation in food and regulated items prices. The projection for inflation excluding food and regulated items also increased, but remains below 3%. Price relief measures on indirect taxes implemented in 2020 are expected to lapse in the second quarter of 2021, generating a one-off effect on prices and temporarily affecting inflation excluding food and regulated items. However, indexation to low levels of past inflation, weak demand, and ample excess productive capacity are expected to keep core inflation below the target, near 2.3% at the end of 2021 (previously 2.1%). The reversion in 2021 of the effects of some price relief measures on utility rates from 2020 should lead to an increase in the CPI for regulated items in the second half of this year. Annual price changes are now expected to be higher than estimated in the January report due to an increased expected path for fuel prices and unanticipated increases in regulated education prices. The projection for the CPI for foods has increased compared to the previous report, taking into account certain factors that were not anticipated in January (a less favorable agricultural cycle, increased pressure from international prices, and transport costs). Given the above, year-end annual inflation for 2021 and 2022 is now expected to be 3% and 2.8%, respectively, which would be above projections from January (2.3% and 2,7%). For its part, expected inflation based on analyst surveys suggests year-end inflation in 2021 and 2022 of 2.8% and 3.1%, respectively. There remains significant uncertainty surrounding the inflation forecasts included in this report due to several factors: 1) the evolution of the pandemic; 2) the difficulty in evaluating the size and persistence of excess productive capacity; 3) the timing and manner in which price relief measures will lapse; and 4) the future behavior of food prices. Projected 2021 growth in foreign demand (4.4% to 5.2%) and the supposed average oil price (USD 53 to USD 61 per Brent benchmark barrel) were both revised upward. An increase in long-term international interest rates has been reflected in a depreciation of the peso and could result in relatively tighter external financial conditions for emerging market economies, including Colombia. Average growth among Colombia’s trade partners was greater than expected in the fourth quarter of 2020. This, together with a sizable fiscal stimulus approved in the United States and the onset of a massive global vaccination campaign, largely explains the projected increase in foreign demand growth in 2021. The resilience of the goods market in the face of global crisis and an expected normalization in international trade are additional factors. These considerations and the expected continuation of a gradual reduction of mobility restrictions abroad suggest that Colombia’s trade partners could grow on average by 5.2% in 2021 and around 3.4% in 2022. The improved prospects for global economic growth have led to an increase in current and expected oil prices. Production interruptions due to a heavy winter, reduced inventories, and increased supply restrictions instituted by producing countries have also contributed to the increase. Meanwhile, market forecasts and recent Federal Reserve pronouncements suggest that the benchmark interest rate in the U.S. will remain stable for the next two years. Nevertheless, a significant increase in public spending in the country has fostered expectations for greater growth and inflation, as well as increased uncertainty over the moment in which a normalization of monetary policy might begin. This has been reflected in an increase in long-term interest rates. In this context, emerging market economies in the region, including Colombia, have registered increases in sovereign risk premiums and long-term domestic interest rates, and a depreciation of local currencies against the dollar. Recent outbreaks of COVID-19 in several of these economies; limits on vaccine supply and the slow pace of immunization campaigns in some countries; a significant increase in public debt; and tensions between the United States and China, among other factors, all add to a high level of uncertainty surrounding interest rate spreads, external financing conditions, and the future performance of risk premiums. The impact that this environment could have on the exchange rate and on domestic financing conditions represent risks to the macroeconomic and monetary policy forecasts. Domestic financial conditions continue to favor recovery in economic activity. The transmission of reductions to the policy interest rate on credit rates has been significant. The banking portfolio continues to recover amid circumstances that have affected both the supply and demand for loans, and in which some credit risks have materialized. Preferential and ordinary commercial interest rates have fallen to a similar degree as the benchmark interest rate. As is generally the case, this transmission has come at a slower pace for consumer credit rates, and has been further delayed in the case of mortgage rates. Commercial credit levels stabilized above pre-pandemic levels in March, following an increase resulting from significant liquidity requirements for businesses in the second quarter of 2020. The consumer credit portfolio continued to recover and has now surpassed February 2020 levels, though overall growth in the portfolio remains low. At the same time, portfolio projections and default indicators have increased, and credit establishment earnings have come down. Despite this, credit disbursements continue to recover and solvency indicators remain well above regulatory minimums. 1.2 Monetary policy decision In its meetings in March and April the BDBR left the benchmark interest rate unchanged at 1.75%.

Despite the sharp drop in transit ridership throughout the USA that began in March 2020, two different uses of land near transit stations continue to be implemented in the United States to promote ridership. Since 2010, transit agencies have given priority to multi-family residential construction referred to as transit oriented development (TOD), with an emphasis on housing affordability. In second place for urban planners but popular with suburban commuters is free or inexpensive parking near rail or bus transit centers, known as park-and-ride (PnR). Sometimes, TOD and PnR are combined in the same development. Public policy seeks to gain high community value from both of these land uses, and there is public interest in understanding the circumstances and locations where one of these two uses should be emphasized over the other. Multiple justifications for each are offered in the professional literature and reviewed in this report. Fundamental to the strategic decision making necessary to allocate public resources toward one use or the other is a determination of the degree to which each approach generates transit ridership. In the research reported here, econometric analysis of GIS data for transit stops, PnR locations, and residential density was employed to measure their influence on transit boardings for samples of transit stops at the main transit agencies in Seattle, Los Angeles, and San José. Results from all three cities indicate that adding 100 parking spaces close to a transit stop has a larger marginal impact than adding 100 housing units. Previous academic research estimating the higher ridership generation per floor area of PnR compared to multi-family TOD housing makes this show of strength for parking an expected finding. At the same time, this report reviews several common public policy justifications for TOD as a preferred land development emphasis near transit stations, such as revenue generation for the transit agency and providing a location for below-market affordable housing where occupants do not need to have a car. If increasing ridership is important for a transit agency, then parking for customers who want to drive to a station is an important option. There may also be additional benefits for park-and-ride in responding to the ongoing pandemic.

Objectives. Diagnostic errors are a known patient safety concern across all clinical settings, including the emergency department (ED). We conducted a systematic review to determine the most frequent diseases and clinical presentations associated with diagnostic errors (and resulting harms) in the ED, measure error and harm frequency, as well as assess causal factors. Methods. We searched PubMed®, Cumulative Index to Nursing and Allied Health Literature (CINAHL®), and Embase® from January 2000 through September 2021. We included research studies and targeted grey literature reporting diagnostic errors or misdiagnosis-related harms in EDs in the United States or other developed countries with ED care deemed comparable by a technical expert panel. We applied standard definitions for diagnostic errors, misdiagnosis-related harms (adverse events), and serious harms (permanent disability or death). Preventability was determined by original study authors or differences in harms across groups. Two reviewers independently screened search results for eligibility; serially extracted data regarding common diseases, error/harm rates, and causes/risk factors; and independently assessed risk of bias of included studies. We synthesized results for each question and extrapolated U.S. estimates. We present 95 percent confidence intervals (CIs) or plausible range (PR) bounds, as appropriate. Results. We identified 19,127 citations and included 279 studies. The top 15 clinical conditions associated with serious misdiagnosis-related harms (accounting for 68% [95% CI 66 to 71] of serious harms) were (1) stroke, (2) myocardial infarction, (3) aortic aneurysm and dissection, (4) spinal cord compression and injury, (5) venous thromboembolism, (6/7 – tie) meningitis and encephalitis, (6/7 – tie) sepsis, (8) lung cancer, (9) traumatic brain injury and traumatic intracranial hemorrhage, (10) arterial thromboembolism, (11) spinal and intracranial abscess, (12) cardiac arrhythmia, (13) pneumonia, (14) gastrointestinal perforation and rupture, and (15) intestinal obstruction. Average disease-specific error rates ranged from 1.5 percent (myocardial infarction) to 56 percent (spinal abscess), with additional variation by clinical presentation (e.g., missed stroke average 17%, but 4% for weakness and 40% for dizziness/vertigo). There was also wide, superimposed variation by hospital (e.g., missed myocardial infarction 0% to 29% across hospitals within a single study). An estimated 5.7 percent (95% CI 4.4 to 7.1) of all ED visits had at least one diagnostic error. Estimated preventable adverse event rates were as follows: any harm severity (2.0%, 95% CI 1.0 to 3.6), any serious harms (0.3%, PR 0.1 to 0.7), and deaths (0.2%, PR 0.1 to 0.4). While most disease-specific error rates derived from mainly U.S.-based studies, overall error and harm rates were derived from three prospective studies conducted outside the United States (in Canada, Spain, and Switzerland, with combined n=1,758). If overall rates are generalizable to all U.S. ED visits (130 million, 95% CI 116 to 144), this would translate to 7.4 million (PR 5.1 to 10.2) ED diagnostic errors annually; 2.6 million (PR 1.1 to 5.2) diagnostic adverse events with preventable harms; and 371,000 (PR 142,000 to 909,000) serious misdiagnosis-related harms, including more than 100,000 permanent, high-severity disabilities and 250,000 deaths. Although errors were often multifactorial, 89 percent (95% CI 88 to 90) of diagnostic error malpractice claims involved failures of clinical decision-making or judgment, regardless of the underlying disease present. Key process failures were errors in diagnostic assessment, test ordering, and test interpretation. Most often these were attributed to inadequate knowledge, skills, or reasoning, particularly in “atypical” or otherwise subtle case presentations. Limitations included use of malpractice claims and incident reports for distribution of diseases leading to serious harms, reliance on a small number of non-U.S. studies for overall (disease-agnostic) diagnostic error and harm rates, and methodologic variability across studies in measuring disease-specific rates, determining preventability, and assessing causal factors. Conclusions. Although estimated ED error rates are low (and comparable to those found in other clinical settings), the number of patients potentially impacted is large. Not all diagnostic errors or harms are preventable, but wide variability in diagnostic error rates across diseases, symptoms, and hospitals suggests improvement is possible. With 130 million U.S. ED visits, estimated rates for diagnostic error (5.7%), misdiagnosis-related harms (2.0%), and serious misdiagnosis-related harms (0.3%) could translate to more than 7 million errors, 2.5 million harms, and 350,000 patients suffering potentially preventable permanent disability or death. Over two-thirds of serious harms are attributable to just 15 diseases and linked to cognitive errors, particularly in cases with “atypical” manifestations. Scalable solutions to enhance bedside diagnostic processes are needed, and these should target the most commonly misdiagnosed clinical presentations of key diseases causing serious harms. New studies should confirm overall rates are representative of current U.S.-based ED practice and focus on identified evidence gaps (errors among common diseases with lower-severity harms, pediatric ED errors and harms, dynamic systems factors such as overcrowding, and false positives). Policy changes to consider based on this review include: (1) standardizing measurement and research results reporting to maximize comparability of measures of diagnostic error and misdiagnosis-related harms; (2) creating a National Diagnostic Performance Dashboard to track performance; and (3) using multiple policy levers (e.g., research funding, public accountability, payment reforms) to facilitate the rapid development and deployment of solutions to address this critically important patient safety concern.

Macroeconomic summary Several factors contributed to an increase in projected inflation on the forecast horizon, keeping it above the target rate. These included inflation in December that surpassed expectations (5.62%), indexation to higher inflation rates for various baskets in the consumer price index (CPI), a significant real increase in the legal minimum wage, persistent external and domestic inflationary supply shocks, and heightened exchange rate pressures. The CPI for foods was affected by the persistence of external and domestic supply shocks and was the most significant contributor to unexpectedly high inflation in the fourth quarter. Price adjustments for fuels and certain utilities can explain the acceleration in inflation for regulated items, which was more significant than anticipated. Prices in the CPI for goods excluding food and regulated items also rose more than expected. This was partly due to a smaller effect on prices from the national government’s VAT-free day than anticipated by the technical staff and more persistent external pressures, including via peso depreciation. By contrast, the CPI for services excluding food and regulated items accelerated less than expected, partly reflecting strong competition in the communications sector. This was the only major CPI basket for which prices increased below the target inflation rate. The technical staff revised its inflation forecast upward in response to certain external shocks (prices, costs, and depreciation) and domestic shocks (e.g., on meat products) that were stronger and more persistent than anticipated in the previous report. Observed inflation and a real increase in the legal minimum wage also exceeded expectations, which would boost inflation by affecting price indexation, labor costs, and inflation expectations. The technical staff now expects year-end headline inflation of 4.3% in 2022 and 3.4% in 2023; core inflation is projected to be 4.5% and 3.6%, respectively. These forecasts consider the lapse of certain price relief measures associated with the COVID-19 health emergency, which would contribute to temporarily keeping inflation above the target on the forecast horizon. It is important to note that these estimates continue to contain a significant degree of uncertainty, mainly related to the development of external and domestic supply shocks and their ultimate effects on prices. Other contributing factors include high price volatility and measurement uncertainty related to the extension of Colombia’s health emergency and tax relief measures (such as the VAT-free days) associated with the Social Investment Law (Ley de Inversión Social). The as-yet uncertain magnitude of the effects of a recent real increase in the legal minimum wage (that was high by historical standards) and high observed and expected inflation, are additional factors weighing on the overall uncertainty of the estimates in this report. The size of excess productive capacity remaining in the economy and the degree to which it is closing are also uncertain, as the evolution of the pandemic continues to represent a significant forecast risk. margin, could be less dynamic than expected. And the normalization of monetary policy in the United States could come more quickly than projected in this report, which could negatively affect international financing costs. Finally, there remains a significant degree of uncertainty related to the duration of supply chocks and the degree to which macroeconomic and political conditions could negatively affect the recovery in investment. The technical staff revised its GDP growth projection for 2022 from 4.7% to 4.3% (Graph 1.3). This revision accounts for the likelihood that a larger portion of the recent positive dynamic in private consumption would be transitory than previously expected. This estimate also contemplates less dynamic investment behavior than forecast in the previous report amid less favorable financial conditions and a highly uncertain investment environment. Third-quarter GDP growth (12.9%), which was similar to projections from the October report, and the fourth-quarter growth forecast (8.7%) reflect a positive consumption trend, which has been revised upward. This dynamic has been driven by both public and private spending. Investment growth, meanwhile, has been weaker than forecast. Available fourth-quarter data suggest that consumption spending for the period would have exceeded estimates from October, thanks to three consecutive months that included VAT-free days, a relatively low COVID-19 caseload, and mobility indicators similar to their pre-pandemic levels. By contrast, the most recently available figures on new housing developments and machinery and equipment imports suggest that investment, while continuing to rise, is growing at a slower rate than anticipated in the previous report. The trade deficit is expected to have widened, as imports would have grown at a high level and outpaced exports. Given the above, the technical staff now expects fourth-quarter economic growth of 8.7%, with overall growth for 2021 of 9.9%. Several factors should continue to contribute to output recovery in 2022, though some of these may be less significant than previously forecast. International financial conditions are expected to be less favorable, though external demand should continue to recover and terms of trade continue to increase amid higher projected oil prices. Lower unemployment rates and subsequent positive effects on household income, despite increased inflation, would also boost output recovery, as would progress in the national vaccination campaign. The technical staff expects that the conditions that have favored recent high levels of consumption would be, in large part, transitory. Consumption spending is expected to grow at a slower rate in 2022. Gross fixed capital formation (GFCF) would continue to recover, approaching its pre-pandemic level, though at a slower rate than anticipated in the previous report. This would be due to lower observed GFCF levels and the potential impact of political and fiscal uncertainty. Meanwhile, the policy interest rate would be less expansionary as the process of monetary policy normalization continues. Given the above, growth in 2022 is forecast to decelerate to 4.3% (previously 4.7%). In 2023, that figure (3.1%) is projected to converge to levels closer to the potential growth rate. In this case, excess productive capacity would be expected to tighten at a similar rate as projected in the previous report. The trade deficit would tighten more than previously projected on the forecast horizon, due to expectations of an improved export dynamic and moderation in imports. The growth forecast for 2022 considers a low basis of comparison from the first half of 2021. However, there remain significant downside risks to this forecast. The current projection does not, for example, account for any additional effects on economic activity resulting from further waves of COVID-19. High private consumption levels, which have already surpassed pre-pandemic levels by a large margin, could be less dynamic than expected. And the normalization of monetary policy in the United States could come more quickly than projected in this report, which could negatively affect international financing costs. Finally, there remains a significant degree of uncertainty related to the duration of supply chocks and the degree to which macroeconomic and political conditions could negatively affect the recovery in investment. External demand for Colombian goods and services should continue to recover amid significant global inflation pressures, high oil prices, and less favorable international financial conditions than those estimated in October. Economic activity among Colombia’s major trade partners recovered in 2021 amid countries reopening and ample international liquidity. However, that growth has been somewhat restricted by global supply chain disruptions and new outbreaks of COVID-19. The technical staff has revised its growth forecast for Colombia’s main trade partners from 6.3% to 6.9% for 2021, and from 3.4% to 3.3% for 2022; trade partner economies are expected to grow 2.6% in 2023. Colombia’s annual terms of trade increased in 2021, largely on higher oil, coffee, and coal prices. This improvement came despite increased prices for goods and services imports. The expected oil price trajectory has been revised upward, partly to supply restrictions and lagging investment in the sector that would offset reduced growth forecasts in some major economies. Elevated freight and raw materials costs and supply chain disruptions continue to affect global goods production, and have led to increases in global prices. Coupled with the recovery in global demand, this has put upward pressure on external inflation. Several emerging market economies have continued to normalize monetary policy in this context. Meanwhile, in the United States, the Federal Reserve has anticipated an end to its asset buying program. U.S. inflation in December (7.0%) was again surprisingly high and market average inflation forecasts for 2022 have increased. The Fed is expected to increase its policy rate during the first quarter of 2022, with quarterly increases anticipated over the rest of the year. For its part, Colombia’s sovereign risk premium has increased and is forecast to remain on a higher path, to levels above the 15-year-average, on the forecast horizon. This would be partly due to the effects of a less expansionary monetary policy in the United States and the accumulation of macroeconomic imbalances in Colombia. Given the above, international financial conditions are projected to be less favorable than anticipated in the October report. The increase in Colombia’s external financing costs could be more significant if upward pressures on inflation in the United States persist and monetary policy is normalized more quickly than contemplated in this report. As detailed in Section 2.3, uncertainty surrounding international financial conditions continues to be unusually high. Along with other considerations, recent concerns over the potential effects of new COVID-19 variants, the persistence of global supply chain disruptions, energy crises in certain countries, growing geopolitical tensions, and a more significant deceleration in China are all factors underlying this uncertainty. The changing macroeconomic environment toward greater inflation and unanchoring risks on inflation expectations imply a reduction in the space available for monetary policy stimulus. Recovery in domestic demand and a reduction in excess productive capacity have come in line with the technical staff’s expectations from the October report. Some upside risks to inflation have materialized, while medium-term inflation expectations have increased and are above the 3% target. Monetary policy remains expansionary. Significant global inflationary pressures and the unexpected increase in the CPI in December point to more persistent effects from recent supply shocks. Core inflation is trending upward, but remains below the 3% target. Headline and core inflation projections have increased on the forecast horizon and are above the target rate through the end of 2023. Meanwhile, the expected dynamism of domestic demand would be in line with low levels of excess productive capacity. An accumulation of macroeconomic imbalances in Colombia and the increased likelihood of a faster normalization of monetary policy in the United States would put upward pressure on sovereign risk perceptions in a more persistent manner, with implications for the exchange rate and the natural rate of interest. Persistent disruptions to international supply chains, a high real increase in the legal minimum wage, and the indexation of various baskets in the CPI to higher inflation rates could affect price expectations and push inflation above the target more persistently. These factors suggest that the space to maintain monetary stimulus has continued to diminish, though monetary policy remains expansionary. 1.2 Monetary policy decision Banco de la República’s board of directors (BDBR) in its meetings in December 2021 and January 2022 voted to continue normalizing monetary policy. The BDBR voted by a majority in these two meetings to increase the benchmark interest rate by 50 and 100 basis points, respectively, bringing the policy rate to 4.0%.

Macroeconomic summary Annual inflation continued to rise in the first quarter (8.5%) and again outpaced both market expectations and the technical staff’s projections. Inflation in major consumer price index (CPI) baskets has accelerated year-to-date, rising in March at an annual rate above 3%. Food prices (25.4%) continued to contribute most to rising inflation, mainly affected by a deterioration in external supply and rising costs of agricultural inputs. Increases in transportation prices and in some utility rates (energy and gas) can explain the acceleration in regulated items prices (8.3%). For its part, the increase in inflation excluding food and regulated items (4.5%) would be the result of shocks in supply and external costs that have been more persistent than expected, the effects of indexation, accumulated inflationary pressures from the exchange rate, and a faster-than-anticipated tightening of excess productive capacity. Within the basket excluding food and regulated items, external inflationary pressures have meaningfully impacted on goods prices (6.4%), which have been accelerating since the last quarter of 2021. Annual growth in services prices (3.8%) above the target rate is due primarily to food away from home (14.1%), which was affected by significant increases in food and utilities prices and by a rise in the legal monthly minimum wage. Housing rentals and other services prices also increased, though at rates below 3%. Forecast and expected inflation have increased and remain above the target rate, partly due to external pressures (prices and costs) that have been more persistent than projected in the January report (Graphs 1.1 and 1.2). Russia’s invasion of Ukraine accentuated inflationary pressures, particularly on international prices for certain agricultural goods and inputs, energy, and oil. The current inflation projection assumes international food prices will increase through the middle of this year, then remain high and relatively stable for the remainder of 2022. Recovery in the perishable food supply is forecast to be less dynamic than previously anticipated due to high agricultural input prices. Oil prices should begin to recede starting in the second half of the year, but from higher levels than those presented in the previous report. Given the above, higher forecast inflation could accentuate indexation effects and increase inflation expectations. The reversion of a rebate on value-added tax (VAT) applied to cleaning and hygiene products, alongside the end of Colombia’s COVID-19 health emergency, could increase the prices of those goods. The elimination of excess productive capacity on the forecast horizon, with an output gap close to zero and somewhat higher than projected in January, is another factor to consider. As a consequence, annual inflation is expected to remain at high levels through June. Inflation should then decline, though at a slower pace than projected in the previous report. The adjustment process of the monetary policy rate wouldcontribute to pushing inflation and its expectations toward the target on the forecast horizon. Year-end inflation for 2022 is expected to be around 7.1%, declining to 4.8% in 2023. Economic activity again outperformed expectations. The technical staff’s growth forecast for 2022 has been revised upward from 4.3% to 5% (Graph 1.3). Output increased more than expected in annual terms in the fourth quarter of 2021 (10.7%), driven by domestic demand that came primarily because of private consumption above pre-pandemic levels. Investment also registered a significant recovery without returning to 2019 levels and with mixed performance by component. The trade deficit increased, with significant growth in imports similar to that for exports. The economic tracking indicator (ISE) for January and February suggested that firstquarter output would be higher than previously expected and that the positive demand shock observed at the end of 2021 could be fading slower than anticipated. Imports in consumer goods, retail sales figures, real restaurant and hotel income, and credit card purchases suggest that household spending continues to be dynamic, with levels similar to those registered at the end of 2021. Project launch and housing starts figures and capital goods import data suggest that investment also continues to recover but would remain below pre-pandemic levels. Consumption growth is expected to decelerate over the year from high levels reached over the last two quarters. This would come amid tighter domestic and external financial conditions, the exhaustion of suppressed demand, and a deterioration of available household income due to increased inflation. Investment is expected to continue to recover, while the trade deficit should tighten alongside high oil and other export commodity prices. Given all of the above, first-quarter economic growth is now expected to be 7.2% (previously 5.2%) and 5.0% for 2022 as a whole (previously 4.3%). Output growth would continue to moderate in 2023 (2.9%, previously 3.1%), converging similar to long-term rates. The technical staff’s revised projections suggest that the output gap would remain at levels close to zero on the forecast horizon but be tighter than forecast in January (Graph 1.4). These estimates continue to be affected by significant uncertainty associated with geopolitical tensions, external financial conditions, Colombia’s electoral cycle, and the COVID-19 pandemic. External demand is now projected to grow at a slower pace than previously expected amid increased global inflationary pressures, high oil prices, and tighter international financial conditions than forecast in January. The Russian invasion of Ukraine and its inflationary effects on prices for oil and certain agricultural goods and inputs accentuated existing global inflationary pressures originating in supply restrictions and increased international costs. A decline in the supply of Russian oil, low inventory levels, and continued production limits on behalf of the Organization of Petroleum Exporting Countries and its allies (OPEC+) can explain increased projected oil prices for 2022 (USD 100.8/barrel, previously USD 75.3) and 2023 (USD 86.8/barrel, previously USD 71.2). The forecast trajectory for the U.S. Federal Reserve (Fed) interest rate has increased for this and next year to reflect higher real and expected inflation and positive performance in the labormarket and economic activity. The normalization of monetary policy in various developed and emerging market economies, more persistent supply and cost shocks, and outbreaks of COVID-19 in some Asian countries contributed to a reduction in the average growth outlook for Colombia’s trade partners for 2022 (2.8%, previously 3.3%) and 2023 (2.4%, previously 2.6%). In this context, the projected path for Colombia’s risk premium increased, partly due to increased geopolitical global tensions, less expansionary monetary policy in the United States, an increase in perceived risk for emerging markets, and domestic factors such as accumulated macroeconomic imbalances and political uncertainty. Given all the above, external financial conditions are tighter than projected in January report. External forecasts and their impact on Colombia’s macroeconomic scenario continue to be affected by considerable uncertainty, given the unpredictability of both the conflict between Russia and Ukraine and the pandemic. The current macroeconomic scenario, characterized by high real inflation levels, forecast and expected inflation above 3%, and an output gap close to zero, suggests an increased risk of inflation expectations becoming unanchored. This scenario offers very limited space for expansionary monetary policy. Domestic demand has been more dynamic than projected in the January report and excess productive capacity would have tightened more quickly than anticipated. Headline and core inflation rose above expectations, reflecting more persistent and important external shocks on supply and costs. The Russian invasion of Ukraine accentuated supply restrictions and pressures on international costs. This partly explains the increase in the inflation forecast trajectory to levels above the target in the next two years. Inflation expectations increased again and are above 3%. All of this increased the risk of inflation expectations becoming unanchored and could generate indexation effects that move inflation still further from the target rate. This macroeconomic context also implies reduced space for expansionary monetary policy. 1.2 Monetary policy decision Banco de la República’s board of directors (BDBR) continues to adjust its monetary policy. In its meetings both in March and April of 2022, it decided by majority to increase the monetary policy rate by 100 basis points, bringing it to 6.0% (Graph 1.5).