Does Aid Promote Electoral Integrity?

Since the late 1990s, aid spending for elections has witnessed a dramatic increase. Yet, we lack a comprehensive evaluation of aid effectiveness in this particular programme area. Here, we investigate the impact of aid on electoral integrity using panel data on purpose-disaggregated aid disbursements and a multi-dimensional index of electoral quality from the Varieties of Democracy project. Based on 502 elections in 126 aid-receiving countries during 2002–2015, we estimate a statistically significant effect of election-support ODA on the integrity of elections. The estimated effect is, however, economically small and not very persistent. In the long run, a permanent increase in aid spending by one million US$ leads to an improvement in electoral quality of 1.4 per cent of a standard deviation on the integrity index. We also find that different dimensions of electoral integrity are variably responsive to donor interventions. Additionally, aid spending for elections is subject to diminishing marginal returns, and is less effective at higher levels of development. These findings underline the difficulty of promoting democratic change in countries with adverse structural conditions. Still, donors may improve the cost-effectiveness of electoral assistance programmes by targeting specific countries and prioritising certain types of intervention

The adverse effects of bisphosphonates in breast cancer: A systematic review and network meta-analysis.

BACKGROUND: Bisphosphonate drugs can be used to improve the outcomes of women with breast cancer. Whilst many meta-analyses have quantified their potential benefits for patients, attempts at comprehensive quantification of potential adverse effects have been limited. We undertook a meta-analysis with novel methodology to identify and quantify these adverse effects. METHODS: We systematically reviewed randomised controlled trials in breast cancer where at least one of the treatments was a bisphosphonate (zoledronic acid, ibandronate, pamidronate, alendronate or clodronate). Neoadjuvant, adjuvant and metastatic settings were examined. Primary outcomes were adverse events of any type or severity (excluding death). We carried out pairwise and network meta-analyses to estimate the size of any adverse effects potentially related to bisphosphonates. In order to ascertain whether adverse effects differed by individual factors such as age, or interacted with other common adjuvant breast cancer treatments, we examined individual-level patient data for one large trial, AZURE. FINDINGS: We identified 56 trials that reported adverse data, which included a total of 29,248 patients (18,301 receiving bisphosphonate drugs versus 10,947 not). 24 out of the 103 different adverse outcomes analysed showed a statistically and practically significant increase in patients receiving a bisphosphonate drug compared with those not (2 additional outcomes that appeared statistically significant came only from small studies with low event counts and no clinical suspicion so are likely artifacts). Most of these 24 are already clinically recognised: 'flu-like symptoms, fever, headache and chills; increased bone pain, arthralgia, myalgia, back pain; cardiac events, thromboembolic events; hypocalcaemia and osteonecrosis of the jaw; as well as possibly stiffness and nausea. Oral clodronate appeared to increase the risk of vomiting and diarrhoea (which may also be increased by other bisphosphonates), and there may be some hepatotoxicity. Four additional potential adverse effects emerged for bisphosphonate drugs in this analysis which have not classically be recognised: fatigue, neurosensory problems, hypertonia/muscle spasms and possibly dysgeusia. Several symptoms previously reported as potential side effects in the literature were not significantly increased in this analysis: constipation, insomnia, respiratory problems, oedema or thirst/dry mouth. Individual patient-level data and subgroup analysis revealed little variation in side effects between women of different ages or menopausal status, those with metastatic versus non-metastatic cancer, or between women receiving different concurrent breast cancer therapies. CONCLUSIONS: This meta-analysis has produced estimates for the absolute frequencies of a range of side effects significantly associated with bisphosphonate drugs when used by breast cancer patients. These results show good agreement with previous literature on the subject but are the first systematic quantification of side effects and their severities. However, the analysis is limited by the availability and quality of data on adverse events, and the potential for bias introduced by a lack of standards for reporting of such events. We therefore present a table of adverse effects for bisphosphonates, identified and quantified to the best of our ability from a large number of trials, which we hope can be used to improve the communication of the potential harms of these drugs to patients and their healthcare providers

Are Commonly Used Resident Measurements Associated with Procedural Skills in Internal Medicine Residency Training?

BACKGROUND: Acquisition of competence in performing a variety of procedures is essential during Internal Medicine (IM) residency training. PURPOSES: Determine the rate of procedural complications by IM residents; determine whether there was a correlation between having 1 or more complications and institutional procedural certification status or attending ratings of resident procedural skill competence on the American Board of Internal Medicine (ABIM) monthly evaluation form (ABIM-MEF). Assess if an association exists between procedural complications and in-training examination and ABIM board certification scores. METHODS: We retrospectively reviewed all procedure log sheets, procedural certification status, ABIM-MEF procedural skills ratings, in-training exam and certifying examination (ABIM-CE) scores from the period 1990–1999 for IM residency program graduates from a training program. RESULTS: Among 69 graduates, 2,212 monthly procedure log sheets and 2,475 ABIM-MEFs were reviewed. The overall complication rate was 2.3/1,000 procedures (95% CI: 1.4–3.1/1,000 procedure). With the exception of procedural certification status as judged by institutional faculty, there was no association between our resident measurements and procedural complications. CONCLUSIONS: Our findings support the need for a resident procedural competence certification system based on direct observation. Our data support the ABIM’s action to remove resident procedural competence from the monthly ABIM-MEF ratings

Evolution from syn-rift carbonates to early post-rift deep-marine intraslope lobes: The role of rift basin physiography on sedimentation patterns

The stratigraphic architecture of Early Jurassic strata exposed along a >10 km long transect in the Chachil Graben, an exhumed marine rift depocentre in the Neuquén Basin (Argentina), provides insights into the sedimentological and stratigraphic expression of the syn-rift to post-rift transition. A change from syn-rift intrabasinal carbonate to post-rift extrabasinal siliciclastic sedimentation is recorded, as well as variations in sediment supply and dispersal patterns across rift-related topography. The late syn-rift was marked by a transgression and development of a shallow-marine carbonate system, including carbonate platform deposits perched on fault-block highs and periplatform deposits accumulated in fault-block lows, which overlies continental volcano-sedimentary syn-rift deposits. Differential subsidence and basin deepening induced retrogradation of the carbonate system, which was progressively drowned and overlain by organic-rich calcareous mudstone that draped across rift structures at the onset of the early post-rift. The first extrabasinal siliciclastic influx led to progradation of an early post-rift intraslope lobe complex into the graben, which is associated with kilometre-scale clastic injectites. The depositional architecture, facies distribution and pinch-out style of intraslope lobes record the effects of an inherited compaction hinge, which acted as an oblique counterslope to sediment gravity flows. The occurrence of combined-flow bedforms, widespread erosion, and limited facies segregation across lobes bearing different hybrid event bed types, is in sharp contrast to sedimentological characteristics of existing intraslope lobe models. Documentation of the syn-rift to post-rift transition stratigraphy permitted identification of changes in thickness and facies resulting from the passive infill of inherited topography with early post-rift differential compaction. This architecture contrasts markedly with those developed during syn-rift normal faulting. Furthermore, the influence of local inherited topography on the development of early post-rift lobes is key to improve subsurface prediction of sandstone distribution and quality during assessment of hydrocarbon reservoirs and carbon storage sites