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Adaptive reuse (AR) refers to the repurposing of a building for a new, more valuable use while preserving as much of the existing structure as possible. A primary application of AR is the conversion of commercial properties for residential use. In this report, the authors provide estimates of the number of residential units that could be produced through the AR of underutilized commercial real estate (CRE) in the Los Angeles area and provide evidence on the financial feasibility of creating these residential units. The results suggest that, if the properties identified as underutilized were all repurposed as housing, they would represent about 9 percent to 14 percent of the total housing Los Angeles County needs to produce over the next eight years, according to the Southern California Association of Governments. The authors also estimate the average financial feasibility of these properties for AR and find that the conversion of hotel/motel properties appears to be broadly feasible. However, they also note that the feasibility of AR using office properties-the most common property type in the sample-depends significantly on area-specific real estate prices and the size of the residential units to be produced (e.g., studio apartments versus one- or two-bedroom apartments).
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Insulin prices have increased dramatically over the past decade in the United States. In this report, the authors compare international prices for insulins using a price index approach. They describe the shares of volume and sales for all insulins and different categories of insulin (including insulin type and timing characteristics) in the United States and 32 comparison Organisation for Economic Co-operation and Development (OECD) countries in 2018. For the market basket of insulins sold in both the United States and comparison countries, the authors report ratios of U.S. insulin prices to insulin prices in other countries. They found that manufacturer prices in the United States were considerably higher (often five to ten times higher) than those in other OECD countries for all insulins combined and for different types of insulin. Although the authors focused their analysis on manufacturer prices rather than on net prices after potential rebates, the analysis suggests that U.S. insulin prices would still have been considerably higher — about four times higher — than those in other countries even when accounting for potential rebates.
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Fiscal year 2022 was one of the worst U.S. military recruitment years on record, with all services apart from the Space Force failing to meet recruitment goals, and fiscal year 2023 saw similar shortfalls. The U.S. public's overall confidence in the military is likewise declining. Although the public still holds the military generally in high esteem compared with other major institutions, that esteem is wavering, influenced by such factors as the end of the war in Afghanistan, the increased polarization of the public, and heightened politicization of the military. How do these trends in recruitment and confidence reflect public perceptions of the U.S. military? Do public perceptions of veterans and the U.S. military influence young people's decisions to join the military? RAND researchers examined a selection of findings from 2022 American Life Panel surveys to gather insights into how Americans think about these issues. The researchers found that the public thinks very highly of U.S. veterans, endorsing positive stereotypes about veterans at a high rate and endorsing negative stereotypes at a very low rate. However, a majority of Americans would discourage a young person close to them from enlisting.
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In 2016, Congress created the Cyber Excepted Service (CES), which granted the U.S. Department of Defense (DoD) flexibilities in setting compensation aimed at supporting the recruitment and retention of personnel critical to the DoD cyber mission. The CES is a distinct personnel system within the federal government and initially was primarily composed of employees voluntarily converting from other personnel systems. Despite limited differences between the competitive service and the CES, a substantial number of employees expressed some concerns and uncertainty regarding converting to the newly created CES, and more than a third of those eligible did not convert. In this report, researchers analyze the characteristics of both employees that choose to convert and employees that choose not to convert to the Cyber Excepted Service. Researchers use these findings to offer recommendations aimed at promoting informed CES conversion decisions for organizations, such as the Army and Air Force Cyber Commands, that will convert to the CES in future.
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The United States spends more on prescription drugs on a per capita basis than most other countries do. Understanding the extent to which drug prices are higher in the United States than in other countries—after accounting for differences in the volume and mix of drugs—is useful when developing and targeting policies to address both growth in drug spending and the financial impact of prescription drugs on consumers. Although several prior studies systematically compare drug prices in the United States with those in other countries, the most recent of these studies used data that are almost a decade old. This report summarizes findings related to international prescription drug price comparisons presented in prior studies and presents new price comparisons that are based on 2018 data—both overall results and narrower analyses on specific categories of drugs, such as brand-name originator drugs, unbranded generic drugs, biologics, and nonbiologic drugs. The report also presents results from sensitivity analyses using different methodological steps and assumptions, such as prices and volume aggregated at different levels and volume weights calculated in different ways. The findings indicate that 2018 drug prices in the United States were substantially higher than those in each of 32 comparison countries when considering all drugs together. Compared with all comparison countries combined, U.S. prices were 256 percent of those in other countries. Prices remained substantially higher than prices in other countries—but with a smaller difference than in our main results—when we adjusted U.S. prices downward based on published estimates of the relative differences between manufacturer and net prices for drugs. U.S. prices for most subsets of drugs, and particularly brand-name originator drugs, were higher than those in comparison countries. The one exception was unbranded generic drugs, for which U.S. prices were on average 84 percent of those in other countries.
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Drug shortages, which occur when the supply of drugs does not meet the demand, are a persistent policy and public health concern in the United States and in other countries. Shortages can adversely affect the quality and safety of care provided to patients, and they have implications for morbidity and mortality. Although there is broad international agreement about the importance of mitigating or preventing drug shortages, approaches to defining and tracking them remain fragmented. As a result, the extent to which drug shortages are truly global in nature is often unclear. The authors of this report contribute to the developing literature on the global scope of drug shortages by assessing whether U.S. drug shortages result in (1) measurable changes in U.S. volume, price, and other metrics, and (2) measurable changes in the same outcomes in other countries. The authors combined information from two U.S. drug shortage databases, one from the Food and Drug Administration (FDA) and the other from the American Society of Health-System Pharmacists (ASHP). The authors also used international prescription drug market data from IQVIA's MIDAS database. They found that most U.S. shortages appear to be domestic in scope. The most-severe U.S. shortages, measured by decreases in volume, only occasionally affected other countries in the same way. Although it is important to keep the global perspective in mind when addressing drug shortages, regulators, other policymakers, and the entire health care system should explore ways to leverage the supply of drugs in other countries in response to U.S. shortages.
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The U.S. Army has several levers at its disposal to try to meet its recruiting mission, with resources jointly used for both Regular Army (RA) and U.S. Army Reserve (USAR) accessions. These resources differ in their cost per additional recruit produced and the lead time necessary to change individual resourcing levels and affect enlistments. The Army can also modify recruit eligibility policies to help it achieve its accession requirement within available resources. Recruiting resources and enlistment eligibility policies work together as a system to produce RA and USAR recruits, and understanding their interactions under varying requirements and environments enables decisionmakers to use their limited resources more effectively and efficiently to achieve the Army's accession requirements. The authors present a model-the Reserve Recruiting Resource Model (RRRM)-designed to optimize the resource levels and mix needed to achieve future USAR recruiting goals under changing enlisted accession requirements and recruiting environments and alternative eligibility policies for potential recruits. The model also enables comparison of alternative courses of action. This research builds on prior work by the RAND Arroyo Center on the effectiveness and lead times of alternative recruiting resources. In their results, the authors discuss using the RRRM to predict annual accessions from a specified baseline resourcing plan and provide several examples of how the tool can be used to assess potential recruiting resource and policy trade-offs or to prepare for alternative recruiting requirements via optimization of recruiting resources used for USAR recruiting.
Soldiers --- Supply and demand --- Forecasting. --- United States. --- Recruiting, enlistment, etc. --- Evaluation. --- United States
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Although U.S. veterans are less likely than nonveterans to live in poverty, past estimates have found that millions of veteran households spend more than half their income on housing costs, suggesting they are at increased risk of experiencing housing instability and, in some cases, might be at risk of becoming homeless. The authors of this report compared trends between veterans and nonveterans to (1) estimate the number of U.S. military veterans who experience financial burden from housing costs and (2) provide context for how these estimates have changed over the past 15 years. The authors also take a deeper look at these observed differences between veteran and nonveteran households, considering how they vary among various subgroups.
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In 2016, Congress created the Cyber Excepted Service (CES) and granted the U.S. Department of Defense (DoD) flexibilities when setting compensation to support the recruitment and retention of personnel who are critical to the DoD cyber warfare mission. To justify a market-based permanent pay adjustment, there must be evidence that existing compensation is insufficient to attract and retain a required number of qualified employees. A persistent labor shortage signifies that compensation is insufficient and can be identified by high employee turnover or difficulty in filling posted vacancies. In this report, the authors analyze the labor demand and supply for seven DoD cyber work roles that were collectively identified as high priority by the service components and the Office of the DoD Chief Information Officer (CIO). The authors provide a framework for adjusting pay according to economic theory, identify private-sector occupational counterparts for the seven work roles, discuss findings from DoD employment and compensation questionnaires completed by CES organizations, compare characteristics and life-cycle pay between DoD cyber civilians and their private-sector counterparts, and make recommendations for the DoD CIO when setting compensation policy.
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Army enlistment standards are intended to ensure that applicants are able to perform military duties successfully and to select those who are the most trainable and adaptable to service life. However, these standards might also inadvertently screen out individuals who could have had successful careers if mitigating factors had been considered. Waiver authority provides the Army with the ability to reconsider initially disqualified applicants and make them eligible to enlist. Two trends of relevance to Army waiver policy are the dramatic expansion of the legalization of marijuana at the state level and the rising prevalence of attention-deficit/hyperactivity disorder (ADHD), anxiety disorders, and depression among children. Army standards continue to stipulate that applicants who test positive for marijuana require a waiver to be eligible for enlistment, and applicants with a history of ADHD, depression, or anxiety will not meet enlistment standards and might not even qualify for a waiver, depending on their specific case. To provide information on how the Army can strengthen its waiver policy, especially in light of these societal trends, RAND researchers conducted empirical analyses of the performance of recent recruits who receive waivers, including (but not limited to) those with a documented history of marijuana, ADHD, or depression/anxiety. The authors also examined the extent to which increasing the share of recruits who receive waivers (or who have a documented history of marijuana, ADHD, or depression/anxiety) affects the overall performance of that accession cohort.
United States. --- Mental health. --- Recruiting, enlistment, etc. --- Standards --- Evaluation. --- United States. --- United States. --- Recruiting, enlistment, etc. --- 2000-2099
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