Aid, growth and peace: A comparative analysis.

yesThe paper examines patterns of post-conflict aid in a sample of 14 countries, with in-depth, qualitative analysis of seven cases (Bosnia, Cambodia, El Salvador, Nicaragua, Guatemala, Mozambique and Rwanda). The study takes previous work by Paul Collier and associates in this area as a starting point, but disaggregates the data by type of aid, time intervals, and historical period. The findings significantly qualify the Collier conclusion to the effect that donors respond to a CNN-effect in a dysfunctional manner by rushing in aid soon after a peace agreement is concluded and scaling back too soon. Rather, disaggregated analysis shows that post-war aid follows several patterns and can best be understood as strategic behavior designed to promote a range of economic and political objectives. This paper also questions the related policy recommendation of the Collier research on post-conflict aid, namely that post-conflict aid should be phased in so as to maximize economic growth on the grounds that this is important to sustain peace during the first post-conflict decade. Instead, this paper finds, aid strategies that demonstrate early and firm donor commitment to the new order are more likely to stabilize peace in the short run, and aid strategies that address the underlying sources of conflict are important to sustain peace in the longer run

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Modeling of Reactivity Controlled Compression Ignition Combustion Using a Stochastic Reactor Model Coupled with Detailed Chemistry

Advanced combustion concepts such as reactivity controlled compression ignition (RCCI) have been proven to be capable of fundamentally improve the conventional Diesel combustion by mitigating or avoiding the soot-NOx trade-off, while delivering comparable or better thermal efficiency. To further facilitate the development of the RCCI technology, a robust and possibly computationally efficient simulation framework is needed. While many successful studies have been published using 3D-CFD coupled with detailed combustion chemistry solvers, the maturity level of the 0D/1D based software solution offerings is relatively limited. The close interaction between physical and chemical processes challenges the development of predictive numerical tools, particularly when spatial information is not available. The present work discusses a novel stochastic reactor model (SRM) based modeling framework capable of predicting the combustion process and the emission formation in a heavy-duty engine running under RCCI combustion mode. The combination of physical turbulence models, detailed emission formation sub-models and state-of-the-art chemical kinetic mechanisms enables the model to be computationally inexpensive compared to the 3D-CFD approaches. A chemical kinetic mechanism composed of 248 species and 1428 reactions was used to describe the oxidation of gasoline and diesel using a primary reference fuel (PRF) mixture and n-heptane, respectively. The model is compared to operating conditions from a single-cylinder research engine featuring different loads, speeds, EGR and gasoline fuel fractions. The model was found to be capable of reproducing the combustion phasing as well as the emission trends measured on the test bench, at some extent. The proposed modeling approach represents a promising basis towards establishing a comprehensive modeling framework capable of simulating transient operation as well as fuel property sweeps with acceptable accuracy