3 research outputs found

    Essays on regional inequalities, innovation and global connectivity

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    This dissertation studies how global connectivity shapes local economic development, looking at regional inequalities and innovation. It empirically contributes to our current understanding of the local distributional effects of economic globalisation and the effects of international disintegration. This dissertation comprises five chapters, with the first one introducing and motivating the overarching theme and the four remaining being self-contained empirical papers. It refers to literature from economic geography, international economics, innovation studies, and economics of inequality, exploring the regional perspective in Europe and the US. In the first part, in Chapter 1, the overarching theme of the local distributional effects of economic globalisation is introduced. It describes the evolution of the current wave of economic globalisation, measured by trade, global value chains and the role of global companies such as multinational enterprises. While during this initial phase a stark upward trend in economic globalisation has been observed, concerns over its benefits have been increasingly voiced. In this period of “hyperglobalisation” the costs of economic globalisation have become more salient, spurring a backlash against globalisation. This dissertation provides evidence on globalisation-induced inequality at the regional level for the US and Europe and emphasises the need to address the local distributional effects. This specifically means compensating those that are adversely affected by economic globalisation, in order to avoid potential costs stemming from international disintegration. The second part contains three empirical papers, Chapter 2, Chapter 3 and Chapter 4, which provides evidence on the local distributional effects of economic globalisationin the US and Europe. The regional perspective regarding the effects of economic globalisation on inequality has often been neglected, which is one of the main intended contributions of this dissertation. Analysing the relationship at the regional level is particularly relevant as economic activity significantly varies across space and it can offer valuable insights that are only possible to uncover when examining at a more granular level. In this dissertation, distributional effects describe either inter-firm dynamics like innovation concentration or interpersonal income inequality. Chapter 2 looks at the relationship between multinational enterprises and intra-regional innovation concentration within US states. While patenting concentration measured by the Gini coefficient has increased for more than three decades, we still lack evidence on the role of global firms such as multinationals. Thus, the paper analyses to what extent the presence of multinationals influences inter-firm innovation concentration, showing a positive link between the presence of domestic-owned multinationals and patenting concentration, which is more pronounced with a high share of MNEs and for non-MNEs. Concentration between firms might also affect inequality between people. The second and third paper focus on the distribution of income, showing that engaging more in trade and global value chains is linked to higher interpersonal income inequality within European regions at the NUTS-2 level. Chapter 3 analyses how trade affects income inequality, finding a positive association between trade and regional income inequality changes, which varies based on trading partners. Chapter 4 studies the link between global value chain participation and income inequality, showing that it matters how regions participate in global value chains and in which sectors. In the third and final part of this dissertation, in Chapter 5, I focus on the effects of international disintegration, by looking at the effect of Britain’s decision to leave the European Union. It examines the effect of Brexit on the adoption of digital technologies by small and medium-sized enterprises in the UK from 2013-2019. By providing timely and detailed measures for digital technology adoption, it offers novel and deeper insights into SMEs’ reactions to this shock

    Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

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    Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030
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