The Complexity of Fairness through Equilibrium

Competitive equilibrium with equal incomes (CEEI) is a well known fair allocation mechanism; however, for indivisible resources a CEEI may not exist. It was shown in [Budish '11] that in the case of indivisible resources there is always an allocation, called A-CEEI, that is approximately fair, approximately truthful, and approximately efficient, for some favorable approximation parameters. This approximation is used in practice to assign students to classes. In this paper we show that finding the A-CEEI allocation guaranteed to exist by Budish's theorem is PPAD-complete. We further show that finding an approximate equilibrium with better approximation guarantees is even harder: NP-complete.Comment: Appeared in EC 201

Finding Fair and Efficient Allocations

We study the problem of allocating a set of indivisible goods among a set of agents in a fair and efficient manner. An allocation is said to be fair if it is envy-free up to one good (EF1), which means that each agent prefers its own bundle over the bundle of any other agent up to the removal of one good. In addition, an allocation is deemed efficient if it satisfies Pareto optimality (PO). While each of these well-studied properties is easy to achieve separately, achieving them together is far from obvious. Recently, Caragiannis et al. (2016) established the surprising result that when agents have additive valuations for the goods, there always exists an allocation that simultaneously satisfies these two seemingly incompatible properties. Specifically, they showed that an allocation that maximizes the Nash social welfare (NSW) objective is both EF1 and PO. However, the problem of maximizing NSW is NP-hard. As a result, this approach does not provide an efficient algorithm for finding a fair and efficient allocation. In this paper, we bypass this barrier, and develop a pseudopolynomial time algorithm for finding allocations that are EF1 and PO; in particular, when the valuations are bounded, our algorithm finds such an allocation in polynomial time. Furthermore, we establish a stronger existence result compared to Caragiannis et al. (2016): For additive valuations, there always exists an allocation that is EF1 and fractionally PO. Another contribution of our work is to show that our algorithm provides a polynomial-time 1.45-approximation to the NSW objective. This improves upon the best known approximation ratio for this problem (namely, the 2-approximation algorithm of Cole et al. (2017)). Unlike many of the existing approaches, our algorithm is completely combinatorial.Comment: 40 pages. Updated versio

Practical algorithms and experimentally validated incentives for equilibrium-based fair division (A-CEEI)

Approximate Competitive Equilibrium from Equal Incomes (A-CEEI) is an equilibrium-based solution concept for fair division of discrete items to agents with combinatorial demands. In theory, it is known that in asymptotically large markets: 1. For incentives, the A-CEEI mechanism is Envy-Free-but-for-Tie-Breaking (EF-TB), which implies that it is Strategyproof-in-the-Large (SP-L). 2. From a computational perspective, computing the equilibrium solution is unfortunately a computationally intractable problem (in the worst-case, assuming $\textsf{PPAD}\ne \textsf{FP}$). We develop a new heuristic algorithm that outperforms the previous state-of-the-art by multiple orders of magnitude. This new, faster algorithm lets us perform experiments on real-world inputs for the first time. We discover that with real-world preferences, even in a realistic implementation that satisfies the EF-TB and SP-L properties, agents may have surprisingly simple and plausible deviations from truthful reporting of preferences. To this end, we propose a novel strengthening of EF-TB, which dramatically reduces the potential for strategic deviations from truthful reporting in our experiments. A (variant of) our algorithm is now in production: on real course allocation problems it is much faster, has zero clearing error, and has stronger incentive properties than the prior state-of-the-art implementation.Comment: To appear in EC 202

Barriers to smart waste management for a circular economy in China

Waste management requires a new vision and drastic improvements for a transition to a zero-waste circular economy. In reality, however, many economies are producing more and more waste, which poses a serious challenge to environmental sustainability. The problem is enormously complex as it involves a variety of stakeholders, demands behavioral changes, and requires a complete rethinking of the current waste management systems and the dominant linear economic model. Smart enabling technologies can aid in a transformation of waste management toward a circular economy, but many barriers persist. This study first shortlists twelve important barriers to smart waste management in China based on interviews with experienced practitioners. It then prioritizes these barriers through a scientific prioritization technique, fuzzy Decision-Making Trial and Evaluation Laboratory (DEMATEL), based on the survey data from three representative stakeholders. It identified three key causal barriers: the lack of regulatory pressures, the lack of environmental education and culture of environmental protection, and the lack of market pressures and demands. Practical and theoretical implications were discussed based on the research results and findings

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

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

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century