Is economic analysis of projects still useful?

The author argues for a shift in the focus of economic analysis of projects. First, project analysts need to make full use of project information, especially identifying the source of the divergence between market prices and economic costs as well as the source of the divergence between economic and private flows, and the group that pays the cost or enjoys the benefits. This information identifies gainers, and losers, likely project supporters and detractors, and fiscal impact. Second, project analysts need to look at the project from the perspective of the main stakeholders, principally the implementing agency, the government, and the country. Third, they should also assess whether all of the main actors have the economic and financial incentives to implement the project as designed. Fourth, they should take advantage of advancesin technology and attempt to identify and measure any external effects of projects, as well as the benefits of education and health projects. Finally, they should take advantage of the advances in personal computing to provide a more systematic assessment of risk.Economic Theory&Research,Decentralization,Public Health Promotion,Environmental Economics&Policies,Health Economics&Finance,Economic Theory&Research,Health Economics&Finance,Banks&Banking Reform,Health Monitoring&Evaluation,Environmental Economics&Policies

The comparative advantage of government : a review

In theory, market failures are necessary but not sufficient conditions for justifying government intervention in the production of goods and services. Even without market failures, there might be a case for government intervention on the grounds of poverty reduction or merit goods (for example, mandatory elementary education and mandatory use of seatbelts in cars and of helmets on motorbikes). In every case, contends the author, a case for government intervention must first identify the particular market failure that prevents the private sector from producing the socially optimal quantity of the good or service. Second, it must select the intervention that will most improve welfare. Third, it must show that society will be better off as a result of government involvement--must show that the benefits will outweigh the costs. It is impossible to judge a priori whether or what type of government intervention is appropriate to a particular circumstance or even to a class of situations. Such judgments are both country- and situation-specific and must be made on a case-by-case basis. To be sure, it is easier to make such judgments about market failures based on externalities, public goods, and so on, than about the market failures based on imperfect information. Market failures rooted in incomplete markets and imperfect information are pervasive: Markets are almost always incomplete, and information is always imperfect. This does not mean that there is always a case for government intervention and that further analysis is unnecessary. On the contrary, there is a keener need for analysis. The welfare consequences of the"new market failures"are more difficult to measure so government intervention's contribution to welfare is likely to be more difficult to assess and the case for intervention (especially the provision of goods and services) is more difficult to make. One must also keep in mind that government interventions are often poorly designed and overcostly. Poorly designed interventions may create market failures of their own. Governments concerned about low private investment in high-risk projects, for example, may guarantee them against risk but in the process create problems of moral hazard and induce investors to take no actions to mitigate such risks. And some interventions may turn out to be too costly relative to the posited benefits. In seeking to provide extension services, for example, governments may incur costs that are higher than the benefits farmers receive.Decentralization,Environmental Economics&Policies,Economic Theory&Research,Health Economics&Finance,Labor Policies,Health Economics&Finance,Banks&Banking Reform,Knowledge Economy,Environmental Economics&Policies,Economic Theory&Research

FUNCIÓN INTELECTUAL DE LA CAPACIDAD DE MEMORIA DE TRABAJO EN ESTUDIANTES UNIVERSITARIOS: UN ESTUDIO DE CASO

The aim of the study was to describe the intellectual function of working memory capacity (WMC) in university students from a case study. The study was conducted from June to July 2022 and in a random probabilistic way, six research seed students belonging to the National University "San Luis Gonzaga" (Ica, Peru) were selected. The WMC analysis was through two types of didactic games (DG) with different degrees of complexity: 1st) Divinance of colored cubes and 2nd) marking and recognition of three sea shells between a total number of 100 shells. Each DG was replicated twice being the first for stimulation of mental concentration in the face of the WMC analysis. The DG were replicated twice and in the case of the second the immediate time (s) of recognition was measured where the comparison of the medians was, through the U-Whitney test. It was observed that the time of each replica and the coincidence error in the DG of the marking and recognition of the three shells was: U = 11.0 and p = 0.25. Although the coincidence error decreased in replica 2 and denoted higher CMT. It is concluded that the intellectual function of the CMT is possible from the JD, since they represent an emotional stimulus. However, practices are needed that improve learning and particularly, from observation to understanding about objects to be selected.El objetivo del estudio fue describir la función intelectual de la capacidad de memoria de trabajo (CMT) en estudiantes universitarios desde un caso de estudio. Se realizó, el estudio de junio a julio de 2022 y de forma probabilística aleatoria se seleccionaron, seis estudiantes de semilleros de investigación que pertenecen a la Universidad Nacional “San Luis Gonzaga” (Ica, Perú). El análisis de la CMT fue mediante dos tipos de juegos didácticos (JD) con diferentes grados de complejidad: 1ro) adivinanza de cubos de colores y 2do) marcaje y reconocimiento de tres conchas de mar entre un número total de 100 conchas. Cada JD se replicó dos veces siendo preparatorio el primero para la estimulación de la concentración mental ante el análisis de la CMT. Los JD se replicaron dos veces y en caso del segundo se midió el tiempo (s) inmediato de reconocimiento donde la comparación de las medianas fue, a través de la prueba U de Mann-Whitney. Se observó, que el tiempo de cada réplica y el error de coincidencia en el JD del marcaje y reconocimiento de las tres conchas fue: U = 11,0 y p = 0,25. Aunque, disminuyó el error de coincidencia en la réplica 2 y denotó mayor CMT. Se concluye, que la función intelectual de la CMT se posibilita desde los JD, pues representan un estímulo emocional. Sin embargo, se necesitan prácticas que mejoren el aprendizaje y particularmente, desde la observación para la comprensión sobre objetos a seleccionarse

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Machine learning algorithms performed no better than regression models for prognostication in traumatic brain injury

Objective: We aimed to explore the added value of common machine learning (ML) algorithms for prediction of outcome for moderate and severe traumatic brain injury. Study Design and Setting: We performed logistic regression (LR), lasso regression, and ridge regression with key baseline predictors in the IMPACT-II database (15 studies, n = 11,022). ML algorithms included support vector machines, random forests, gradient boosting machines, and artificial neural networks and were trained using the same predictors. To assess generalizability of predictions, we performed internal, internal-external, and external validation on the recent CENTER-TBI study (patients with Glasgow Coma Scale <13, n = 1,554). Both calibration (calibration slope/intercept) and discrimination (area under the curve) was quantified. Results: In the IMPACT-II database, 3,332/11,022 (30%) died and 5,233(48%) had unfavorable outcome (Glasgow Outcome Scale less than 4). In the CENTER-TBI study, 348/1,554(29%) died and 651(54%) had unfavorable outcome. Discrimination and calibration varied widely between the studies and less so between the studied algorithms. The mean area under the curve was 0.82 for mortality and 0.77 for unfavorable outcomes in the CENTER-TBI study. Conclusion: ML algorithms may not outperform traditional regression approaches in a low-dimensional setting for outcome prediction after moderate or severe traumatic brain injury. Similar to regression-based prediction models, ML algorithms should be rigorously validated to ensure applicability to new populations

Variation in Structure and Process of Care in Traumatic Brain Injury: Provider Profiles of European Neurotrauma Centers Participating in the CENTER-TBI Study.

INTRODUCTION: The strength of evidence underpinning care and treatment recommendations in traumatic brain injury (TBI) is low. Comparative effectiveness research (CER) has been proposed as a framework to provide evidence for optimal care for TBI patients. The first step in CER is to map the existing variation. The aim of current study is to quantify variation in general structural and process characteristics among centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. METHODS: We designed a set of 11 provider profiling questionnaires with 321 questions about various aspects of TBI care, chosen based on literature and expert opinion. After pilot testing, questionnaires were disseminated to 71 centers from 20 countries participating in the CENTER-TBI study. Reliability of questionnaires was estimated by calculating a concordance rate among 5% duplicate questions. RESULTS: All 71 centers completed the questionnaires. Median concordance rate among duplicate questions was 0.85. The majority of centers were academic hospitals (n = 65, 92%), designated as a level I trauma center (n = 48, 68%) and situated in an urban location (n = 70, 99%). The availability of facilities for neuro-trauma care varied across centers; e.g. 40 (57%) had a dedicated neuro-intensive care unit (ICU), 36 (51%) had an in-hospital rehabilitation unit and the organization of the ICU was closed in 64% (n = 45) of the centers. In addition, we found wide variation in processes of care, such as the ICU admission policy and intracranial pressure monitoring policy among centers. CONCLUSION: Even among high-volume, specialized neurotrauma centers there is substantial variation in structures and processes of TBI care. This variation provides an opportunity to study effectiveness of specific aspects of TBI care and to identify best practices with CER approaches

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Current Research into Applications of Tomography for Fusion Diagnostics

Retrieving spatial distribution of plasma emissivity from line integrated measurements on tokamaks presents a challenging task due to ill-posedness of the tomography problem and limited number of the lines of sight. Modern methods of plasma tomography therefore implement a-priori information as well as constraints, in particular some form of penalisation of complexity. In this contribution, the current tomography methods under development (Tikhonov regularisation, Bayesian methods and neural networks) are briefly explained taking into account their potential for integration into the fusion reactor diagnostics. In particular, current development of the Minimum Fisher Regularisation method is exemplified with respect to real-time reconstruction capability, combination with spectral unfolding and other prospective tasks