Access to Debt Finance: Which Policies Work? Empirical Evidence from Sub-Saharan Africa

Are the structural policy reforms effective in reducing debt financing constraints on formal sector enterprises in sub-Saharan Africa? We do not know. And the reason is the relatively limited research on the effectiveness of policies in the credit market. Using policy variables from the World Bank and the Enterprise Surveys data, the analysis involves three-way error component models. The results are indicative that taken together; structural policy reforms reduce debt financing constraints, at least, as it pertains to working capital needs. There is heterogeneity in the results. Changes in the business regulatory environment benefit large firms more than small ones. Financial sector reforms affect enterprises of all sizes relatively equally. For all the twelve countries, together, trade sector reforms initially increase the likelihood of access to debt finance by 20 percent until a policy threshold, beyond which progressive reforms in the trade sector reduce the probability by as much as 13 percent. Also, not all countries experience the same effects from trade sector reforms. The result is robust to different indicators of credit constraint and measures of structural reforms. The results have implications on the World Bank's push towards reforms on trade policy across countries

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

A Demand System for Major Dairy Products in Ontario

Despite significant media and research interests drawn into the Canadian dairy sector in recent years, no study has estimated price and income elasticities of demand for major dairy products at the provincial level using longitudinal data. This article attempts to bridge this gap by estimating a demand system for seven major dairy products in Ontario. Employing Barten’s General Model, four alternative demand systems were nested and the NBR demand system was found to be the most appropriate for the data set in Ontario on both theoretical and empirical grounds. The symmetry, homogeneity and concavity conditions are all supported by the data. Empirically, all own-price elasticities are negative and statistically significant. The expenditure elasticities of all dairy products are positive, less than unity and statistically significant. Finally, most dairy products are net substitutes in consumption

Effect of Mechanical Harvesting Technology Type and Harvester Ownership and Services Acquisition Methods on Profitability of Wild Blueberry Production

ABSTRACTThe profitability of wild blueberry (Vaccinium angustifolium) production using two alternative mechanical harvesters was evaluated under three different harvester ownership/service arrangements commonly used by farmers. Production data for the economic analysis were obtained from on-farm trials conducted in Nova Scotia, Canada. Net returns were CAD$323 ha−1 using a semi-automatic bin handling system compared with CAD$281 ha−1 for a small box handling system with outright harvester purchase. By comparison, net returns were CAD$90 ha−1 using the semi-automatic bin handling system and CAD$63 ha−1 using the small box system using rental harvesting services. The results are more sensitive to changes in yield than price

Economic Comparison of Traditional Small Box and Semi-Automatic Bin Handling HarvestingTechnologies for Wild Blueberries from a Field Trial: A Stochastic Approach

The type of handling system (i.e., traditional small box versus semi-automatic binhandling) distinguishes the two main types of existing commercial wild blueberrymechanical harvesters commonly used by farmers in Atlantic Canada and thenortheastern United States. However, their impacts on costs and returns to farmers havenot been evaluated. Partial budgeting (PB) methods were used to quantify and compareeconomic performance of the two technologies. Stochastic PB involved probabilisticsensitivity analysis, where multiple parameters were allowed to vary simultaneously, andthe results evaluated. Net change in profit, estimated using a deterministic PB modelbased on two alternative measures of harvest rate (tonnes ha-1and hours ha-1) for 2017data was CAD$0.52 tonne-1, and CAD$674 ha-1, and implies that switching from the small box handling system to the semi-automatic bin handling system is economic allyviable. Economic performance using stochastic PB analysis is consistent with the deterministic model results

Additional file 1 of An ex-ante cost-utility analysis of the deemed consent legislation compared to expressed consent for kidney transplantations in Nova Scotia

Additional file 1: Table S1. Cost-effectiveness analysis results for various changes in deceased donor kidney transplantation probability. Table S2. Cost-effectiveness analyses result for various percentage changes in living donor kidney transplantation probability, assuming a 1% increase in deceased donor kidney transplantation probability. Table S3. Cost-effectiveness analyses result for various percentage changes in living donor kidney transplantation probability, assuming a 26% increase in deceased donor kidney transplantation probability. Figure S1. Cost-effectiveness acceptability curve for a 26% increase in deceased donor kidney transplantation probability. Figure S2. Cost-effectiveness plane for a 26% increase in deceased donor kidney transplantation probability. Figure S3. The sensitivity of ICUR to changes in dialysis and maintenance immunosuppressant drug costs for a 26% increase in deceased donor KT probability. ICUR, incremental cost-utility ratio; QALY, quality-adjusted life-year; WTP, willingness to pay; KT, kidney transplantation; HD, hemodialysis; PD, peritoneal dialysis; EV expected value

Field Capacity and Harvest Efficiency Evaluation of Traditional Small Box and Semi-Automated Bin Handling Systems for Wild Blueberries

Mechanical harvesters with small box and semi-automated bin handling systems are increasingly being used for harvesting wild blueberries in Eastern Canada, and Northeastern, USA. However, their field capacity and performance have not been quantified and compared. Important measures of field capacity and efficiency for a traditional mechanical harvester were compared with a novel semi-automatic bin handling harvester. Data were obtained from on-farm field trials conducted at four sites in Nova Scotia, Canada in 2017 and 2018. Both harvesters had double head configurations, along with other similar engineering configurations: (i) 0.66 m picking reels; (ii) 16 picker bars per head and 65 teeth per bar; (iii) 1.72 m picking width; (iv) 21 rpm head speed; and (v) 0.31 ms−1 ground speed. Each harvester was operated for 120 min and data such as berry harvesting time and box handling time were recorded, with six replications during each year. Statistical methods were used to compare the harvest efficiency of the two mechanical harvesters. Harvest time efficiency was significantly higher for the semi-automatic bin handling technology than for the small box handling technology both in 2017 (p < 0.001), and 2018 (p < 0.001). Weed coverage did not have a significant effect of harvest time in either 2017 (p = 0.694) or 2018 (p = 0.765), though it did significantly affect yield in both 2017 (p = 0.011) and 2018 (p = 0.045). The findings provide useful insights for decision-makers contemplating the choice of harvesting technology to sustain profits from wild blueberry production

Wheelchair skills training for caregivers of manual wheelchair users: a randomized controlled trial comparing self-study and remote training

In this single-blind randomized controlled trial, we tested the hypotheses that, in comparison with control participants receiving only self-study materials (SS group), caregivers of manual wheelchair users who additionally receive remote training (RT group) have greater total Wheelchair Skills Test Questionnaire (WST-Q) performance and confidence scores post-training and at follow-up; and that self-study and remote training each individually lead to such gains. We studied 23 dyads of wheelchair users and their caregivers. Caregivers in the SS group received a handbook and videorecording. Those in the RT group also received up to four real-time (“synchronous”) sessions remotely. The WST-Q 5.1 was administered pre-training (T1), post-training (T2), and after a 3-month follow-up (T3). The mean total WST-Q scores of both groups rose slightly at each new assessment. For the T2-T1 and T3-T1 gains, there were no statistically significant differences between the groups for either WST-Q performance or WST-Q confidence. For performance, the T2-T1 gain was statistically significant for the RT group and the T3-T2 gain was statistically significant for the SS group. For both groups, the T3-T1 gains in performance were statistically significant with gains of 12.9% and 18.5% relative to baseline for the SS and RT groups. For confidence, only the T3-T1 gain for the SS group was statistically significant with a gain of 4.5% relative to baseline. Although less than the gains previously reported for in-person training, modest but important gains in total WST-Q performance scores can be achieved by self-study, with or without remote training. NCT03856749. Self-study can improve the manual wheelchair skills of caregivers.Remote training can improve the manual wheelchair skills of caregivers.Improvements are slightly less than those reported in the literature for in-person training. Self-study can improve the manual wheelchair skills of caregivers. Remote training can improve the manual wheelchair skills of caregivers. Improvements are slightly less than those reported in the literature for in-person training.</p

Preventing Respiratory Viral Illness Invisibly (PRiVII): protocol for a pragmatic cluster randomized trial evaluating far-UVC light devices in long-term care facilities to reduce infections

Abstract Background Respiratory viral illness (RVI)—e.g., influenza, COVID-19—is a serious threat in long-term care (LTC) facilities. Standard infection control measures are suboptimal in LTC facilities because of residents’ cognitive impairments, care needs, and susceptibility to loneliness and mental illness. Further, LTC residents living with high degrees of frailty who contract RVIs often develop the so-called atypical symptoms (e.g., delirium, worse mobility) instead of typical cough and fever, delaying infection diagnosis and treatment. Although far-UVC (222 nm) light devices have shown potent antiviral activity in vitro, clinical efficacy remains unproven. Methods Following a study to assay acceptability at each site, this multicenter, double-blinded, cluster-randomized, placebo-controlled trial aims to assess whether far-UVC light devices impact the incidence of RVIs in LTC facilities. Neighborhoods within LTC facilities are randomized to receive far-UVC light devices (222 nm) or identical placebo light devices that emit only visible spectrum light (400–700 nm) in common areas. All residents are monitored for RVIs using both a standard screening protocol and a novel screening protocol that target atypical symptoms. The 3-year incidence of RVIs will be compared using intention-to-treat analysis. A cost-consequence analysis will follow. Discussion This trial aims to inform decisions about whether to implement far-UVC light in LTC facilities for RVI prevention. The trial design features align with this pragmatic intent. Appropriate additional ethical protections have been implemented to mitigate participant vulnerabilities that arise from conducting this study. Knowledge dissemination will be supported through media engagement, peer-reviewed presentations, and publications. Trial registration ClinicalTrials.gov NCT05084898. October 20, 2021

Reducing wait times and avoiding unnecessary use of high-cost mental health services through a Rapid Access and Stabilization Program: protocol for a program evaluation study

Abstract Background Emergency psychiatric care, unplanned hospital admissions, and inpatient health care are the costliest forms of mental health care. According to Statistics Canada (2018), almost 18% (5.3 million) of Canadians reported needing mental health support. However, just above half of this figure (56.2%) have reported their needs were fully met. In light of this evidence there is a pressing need to provide accessible mental health services in flexible yet cost-effective ways. To further expand capacity and access to mental health care in the province, Nova Scotia Health has launched a novel mental health initiative for people in need of mental health care without requiring emergency department visits or hospitalization. This new service is referred to as the Rapid Access and Stabilization Program (RASP). This study evaluates the effectiveness and impact of the RASP on high-cost health services utilization (e.g. ED visits, mobile crisis visits, and inpatient treatments) and related costs. It also assesses healthcare partners' (e.g. healthcare providers, policymakers, community leaders) perceptions and patient experiences and satisfaction with the program and identifies sociodemographic characteristics, psychological conditions, recovery, well-being, and risk measures in the assisted population. Method This is a hypothesis-driven program evaluation study that employs a mixed methods approach. A within-subject comparison (pre- and post-evaluation study) will examine health services utilization data from patients attending RASP, one year before and one year after their psychiatry assessment at the program. A controlled between-subject comparison (cohort study) will use historical data from a control population will examine whether possible changes in high-cost health services utilization are associated with the intervention (RASP). The primary analysis involves extracting secondary data from provincial information systems, electronic medical records, and regular self-reported clinical assessments. Additionally, a qualitative sub-study will examine patient experience and satisfaction, and health care partners' impressions. Discussion We expect that RASP evaluation findings will demonstrate a minimum 10% reduction in high-cost health services utilization and corresponding 10% cost savings, and also a reduction in the wait times for patient consultations with psychiatrists to less than 30 calendar days, in both within-subject and between-subject comparisons. In addition, we anticipate that patients, healthcare providers and healthcare partners would express high levels of satisfaction with the new service. Conclusion This study will demonstrate the results of the Mental Health and Addictions Program (MHAP) efforts to provide stepped-care, particularly community-based support, to individuals with mental illnesses. Results will provide new insights into a novel community-based approach to mental health service delivery and contribute to knowledge on how to implement mental health programs across varying contexts