Modeling the Mutual Enhancement of Regional Economy and Personal Quality of Life (QOL): A Case Study on the Mumbai–Ahmedabad High-Speed Rail Corridor in India

Among the various effects of high-speed rail (HSR), a direct benefit to users has been measured as an increase in the gross domestic product (GDP) by the conventional cost–benefit analysis (CBA), which was institutionalized in the U.K. In recent years, the importance of capturing indirect benefits to non-users has also been broadly discussed. The indirect benefits of HSR can mainly be classified into two perspectives: regional economy and personal quality of life (QOL). In this study, we modeled the mutual enhancement between those effects and analyzed the indirect benefits of the Mumbai–Ahmedabad high-speed rail (MAHSR), which is currently under construction as the first HSR in India, an emerging country with a rapidly growing economy. The indirect benefit to the regional economy along the MAHSR corridor was estimated by industry and by zone. Additionally, the indirect benefit on personal QOL by individuals’ attributes and by zone through the mutual enhancement with the regional economy was also estimated. The personal QOL tends to show greater effects in the middle cities than those in the two metropolitan areas of Mumbai and Ahmedabad. This method can evaluate interregional disparity by identifying the differences in benefits by person, according to age, income, etc., which cannot be evaluated based on a mass measure, e.g., GDP, in the conventional CBA

National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

Objectives To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan.Design Retrospective study.Setting Six hundred and thirty-one primary care institutions in Japan.Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3–6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1–25 points).Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality.Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era