Aides et fiscalité : explorer leurs relations à la lumière des nouvelles données

This ICTD Research in Brief is a two-page summary of ICTD Working Paper 21 by Oliver Morrissey, Wilson Prichard and Samantha Torrance. This series is aimed at policy makers, tax administrators, fellow researchers and anyone else who is big on interest and short on time. This paper examines cross country evidence concerning the relationship between aid and taxation using a new dataset complied by the International Centre for Tax and Development (ICTD). It finds no support for the claim that aid reduces tax effort.Résumé du document de travail 21 par Oliver Morrissey, Wilson Prichard et Samantha Torrance. Ce document examine des données transnationales concernant la relation entre les aides et la fiscalité en utilisant un nouvel ensemble de données compilé par l’International Centre for Tax and Development (ICTD). Il n’en ressort aucun argument permettant de supporter l’affirmation selon laquelle l’aide réduit l’effort fiscal

Evaluation of planned dosimetry when beam energies are substituted for a fraction of the treatment course

Purpose: The purpose of this technical study was to evaluate how the effect of changing beam energies for one to multiple fractions of a patient’s plan affected the overall dose delivered to the planning target volume (PTV) and surrounding organs at risk (OAR’s). Method: In this study, twenty-eight patient plans from treatment sites including the oesophagus, prostate, lung, spine, rectum, bladder, chest, scapula, and breast were evaluated in the Philips Pinnacle treatment planning system (TPS), of these 14 were originally planned with 15MV and 14 with 10MV. Each of these plans were substituted with a single to multiple fractions with 10MV and 15MV respectively while keeping the original monitor units the same.Results: It was determined that when the number of fractions of the substituted beam energy remained at one fifth or less of the overall fractions a change of dose of less than 2% to the PTV could be maintained. The OAR’s dose, when the plan had 20% of its fractions substituted with a different energy, were found to change by on average up to 3.5% and 2.3% for original plan energies of 15MV and 10MV respectively. The dose change calculated in the TPS was then verified using ion chamber measurements for bladder and oesophagus treatment plans. Conclusion: Results appear to indicate that the site of treatment was not an important factor when changing energy but the overall number of fractions versus the number of fractions substituted with an alternative energy was fundamental. These results may be clinically useful when a radiotherapy department have machines with different photon energies. In the event of a break down, when a patient needs to be urgently treated, it may be possible to treat them on another machine with a different energy, without an immediate recalculation in the TPS. This decision would depend upon the percentage of fractions of their overall treatment needing to be treated before the machine was repaired-------------------------------Cite this article as:Hawke S, Torrance A, Tremethick L. Evaluation of planned dosimetry when beam energies are substituted for a fraction of the treatment course. Int J Cancer Ther Oncol 2013; 1(2):01014.DOI: http://dx.doi.org/10.14319/ijcto.0102.

‘I know my rights, but am I better off?’: institutions and disability in Uganda

Uganda is internationally recognised for both its legal and constitutional provisions for people with disabilities, and the presence of disabled persons’ organisations that provide informal advocacy and support. Using a unique dataset of 579 Ugandans with physical disabilities, we develop a conceptual framework on social capital to investigate the factors correlated with knowledge of formal institutions that target disability. In examining whether this knowledge results in higher incomes we find that gender matters. A woman’s education and membership of external networks are correlates of knowledge; higher levels of this knowledge are associated with substantially higher levels of income

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

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

Protocol for evaluation of the cost-effectiveness of ePrescribing systems and candidate prototype for other related health information technologies

Background: This protocol concerns the assessment of cost-effectiveness of hospital health information technology (HIT) in four hospitals. Two of these hospitals are acquiring ePrescribing systems incorporating extensive decision support, while the other two will implement systems incorporating more basic clinical algorithms. Implementation of an ePrescribing system will have diffuse effects over myriad clinical processes, so the protocol has to deal with a large amount of information collected at various ‘levels’ across the system. Methods/Design: The method we propose is use of Bayesian ideas as a philosophical guide. Assessment of cost-effectiveness requires a number of parameters in order to measure incremental cost utility or benefit – the effectiveness of the intervention in reducing frequency of preventable adverse events; utilities for these adverse events; costs of HIT systems; and cost consequences of adverse events averted. There is no single end-point that adequately and unproblematically captures the effectiveness of the intervention; we therefore plan to observe changes in error rates and adverse events in four error categories (death, permanent disability, moderate disability, minimal effect). For each category we will elicit and pool subjective probability densities from experts for reductions in adverse events, resulting from deployment of the intervention in a hospital with extensive decision support. The experts will have been briefed with quantitative and qualitative data from the study and external data sources prior to elicitation. Following this, there will be a process of deliberative dialogues so that experts can “re-calibrate” their subjective probability estimates. The consolidated densities assembled from the repeat elicitation exercise will then be used to populate a health economic model, along with salient utilities. The credible limits from these densities can define thresholds for sensitivity analyses. Discussion: The protocol we present here was designed for evaluation of ePrescribing systems. However, the methodology we propose could be used whenever research cannot provide a direct and unbiased measure of comparative effectiveness

Evaluation of planned dosimetry when beam energies are substituted for a fraction of the treatment course

Purpose: The purpose of this technical study was to evaluate how the effect of changing beam energies for one to multiple fractions of a patient’s plan affected the overall dose delivered to the planning target volume (PTV) and surrounding organs at risk (OAR’s). Method: In this study, twenty-eight patient plans from treatment sites including the oesophagus, prostate, lung, spine, rectum, bladder, chest, scapula, and breast were evaluated in the Philips Pinnacle treatment planning system (TPS), of these 14 were originally planned with 15MV and 14 with 10MV. Each of these plans were substituted with a single to multiple fractions with 10MV and 15MV respectively while keeping the original monitor units the same.Results: It was determined that when the number of fractions of the substituted beam energy remained at one fifth or less of the overall fractions a change of dose of less than 2% to the PTV could be maintained. The OAR’s dose, when the plan had 20% of its fractions substituted with a different energy, were found to change by on average up to 3.5% and 2.3% for original plan energies of 15MV and 10MV respectively. The dose change calculated in the TPS was then verified using ion chamber measurements for bladder and oesophagus treatment plans. Conclusion: Results appear to indicate that the site of treatment was not an important factor when changing energy but the overall number of fractions versus the number of fractions substituted with an alternative energy was fundamental. These results may be clinically useful when a radiotherapy department have machines with different photon energies. In the event of a break down, when a patient needs to be urgently treated, it may be possible to treat them on another machine with a different energy, without an immediate recalculation in the TPS. This decision would depend upon the percentage of fractions of their overall treatment needing to be treated before the machine was repaired-------------------------------Cite this article as:Hawke S, Torrance A, Tremethick L. Evaluation of planned dosimetry when beam energies are substituted for a fraction of the treatment course. Int J Cancer Ther Oncol 2013; 1(2):01014.DOI: http://dx.doi.org/10.14319/ijcto.0102.4</p