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Percutaneous tibial nerve stimulation (PTNS) is a simple neuromodulation technique to treat an overactive bladder. It is unclear whether the response to PTNS would suggest a similar response to sacral nerve stimulation (SNS), and whether PTNS could be utilized as an alternative test phase for an SNS implant. This study assessed whether PTNS response was a reliable indicator for subsequent SNS trials.We performed a retrospective review of the hospital databases to collect all patients who had PTNS and who subsequently had an SNS trial in two tertiary hospitals from 2014 to 2020. Response to both interventions was assessed. A 50% reduction in overactive symptoms (frequency-volume charts) was considered a positive response. McNemar's tests using exact binomial probability calculations were used. The statistical significance level was set to 0.05.Twenty-three patients who had PTNS subsequently went on to a trial of SNS. All patients except one had previously poor response to PTNS treatment. Eight of them also failed the SNS trial. However, 15 patients (including the PTNS responder) had a successful SNS trial and proceeded with the second-stage battery implantation. The difference in response rates between the PTNS and SNS trial was statistically significant (p 0.001).Poor response to PTNS does not seem to predict the likelihood of patients responding to SNS. A negative PTNS trial should not preclude a trial of a sacral nerve implant. The predictive factors for good and poor responses will be the subject of a larger study.

As the result of accumulated public policy, the distribution of personal income in the United States has been drastically altered over the last twenty-five to thirty years. Over the same period, there have been massive increases in both private and public debt. These changes are important factors behind an unprecedented redistribution of income. While the causes are multiple, one major driving force behind the altered distribution of income is change in the revenue structure of our three levels of government: a) in terms of who pays the taxes and other revenue sources (and who does not), and b) change in emphasis, rates, and revenue sources collected. This presentation and analysis focuses on a) personal income, b) revenue collection across the range personal of income, and c) the incidence of revenue as it relates to business versus personal income and wealth by federal and sub-national (state and local) governments. Over time, the revenue structure of the federal system has been downloaded on the personal income of middle- and low-income residents. The class war is over. It has already been won - by the very wealthy, the corporate elites, and the multinationals.

Urban scholars have paid little or no attention to ramifications of the way the U.S. Senate is structured. Because of the Connecticut Compromise, the 26 smallest states with less than 18% of the U.S. population have an institutional lock on, and a potential veto over, basic public policies and all legislation going through Congress. Because small states are generally less urban, the Senate heavily underrepresents central cities and ethnic minorities and massively overrepresents suburban and rural/small-town residents, as well as the inhabitants of Mountain, New England, and West North Central regions. Moreover, federal grants unduly support not only small, less urban states but also tax-rich states.

Scholars in the area of state and local government, for the most part, ignore local governments called towns and townships, write them off as insignificant, or assume they will wither away and disappear over the next few years. Yet, these presumably insignificant local governments serve 51 million residents, nearly half the population of township states, and are of increasing importance as local governing bodies in urban and suburban areas. The activities of township governments range from providing very limited service to acting as full-scale municipal corporations that provide all local public schools and even county-type services.

IN RECENT YEARS a great deal of attention has been given to the subject of intergovernmental relations, but little has been done to document the changing role of the state vis-a-vis local government and the centralization of the state/local service and policy complex. It is impossible to analyze effectively the current condition of local government and the problems associated with it and at the same time neglect detailed consideration of the roles played by state and national agencies and programs. There has been considerable verbalization about the increasingly influential role of the national government in state and local affairs-verbalization that has presum