The J Curve Revisited: Assessing Backsliding and Reversal Among Unstable States

Just over ten years ago, Ian Bremmer published a treatise (2006) on the stability of states built on the notion that states fall along a curve resembling a slanted “J” when plotting their stability against openness. The basic idea is that states to the right of the turnover (bottom of the curve) are increasingly open while those to the left are increasingly closed. States on either side of the turnover exhibit increased stability the further they rise along the curve, with the implicit assumption that closed states cannot reach the same level of stability as the most open states As states transition from the left side of the curve to the right, they become more open. States in the turnover process are considered unstable, and are at risk of either reversing to a closed and stable system or even collapsing. In this paper we recast Bremmer’s framework of associated conditions to a causal model. Second, we more accurately specify the causes of reversal in which crises of instability occur. To meet those objectives, we identify states according to the six types characterized by Tikuisis and Carment (2017). We then define stability as a function of two state dimensions: authority and capacity, and apply the remaining state dimension of legitimacy as a proxy for openness. In testing the model, we find that shifts to openness and reversals leading to increasing instability are not as clear cut as Bremmer argues. Transitions can reverse, oscillate, or simply stall, which are exemplified in the different types of states we categorize. For example, we find that the least stable states experience the highest volatility in shifts between stability and openness, while the most stable states exhibit the lowest volatility. Although all state types significantly improved in stability due to capacity but not authority, changes in openness were mixed over the twenty year period of study

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Moving away from aid: The experience of Chile

Chile's development assistance landscape includes a low dependency on aid flows and fully restored relationships with "developed" countries following its transition to democracy in the early 1990s. Chile has experienced the transition from aid in full, completing this process with its formal graduation from the list of overseas development assistance (ODA) eligible countries in January 2018. This report analyses how Chile managed its transition from aid, the type of cooperation the country had expected from development partners since the early 1990s, and the future of development cooperation beyond ODA. The Chile study forms part of a larger project that sets out to investigate country experiences of and key lessons from the transition and graduation from ODA. The other country studies are Botswana, Mexico and the Republic of Korea

Moving away from aid: Lessons from country studies

This report synthesises the experiences of four countries - Botswana, Chile, Mexico and the Republic of Korea - in the transition from aid and graduation from official development assistance (ODA). It presents research on the management of the transition from aid, cooperation with deveopment partners when aid falls and bi- and multilateral cooperation as countries approach ODA graduation. The findings presented in this report are informed by a combination of data analysis, a literature review of the main academic and policy documents and semi-structured interviews. A set of lessons, informed by the country studies, are outlined that are intended to be useful for other countries entering or progressing along the path towards ODA graduation, as well as for development partners to sustain outcomes and renew partnerships. This report forms part of a larger project that sets out to investigate country experiences of and key lessons from the transition and graduation from ODA. The project includes four dedicated country studies, the findings of which inform this report: Botswana, Mexico, Chile and the Republic of Korea

Good for now but not forever: Officials' perspectives on the relevance of the effectiveness agenda and the need for change

This paper investigates whether the current effectiveness agenda-agreed during the 2011 Busan High Level Forum on Development Effectiveness-continues to define best practice in development amidst a rapidly changing development landscape. To do so, we surveyed officials from development agencies and partner countries to understand whether the effectiveness agenda remains relevant for officials who manage official development assistance (ODA) flows, and if not, how it should change. We find that while respondents believe that the effectiveness agenda is relevant, there is strong demand to revise or renew the agenda to overcome technical, strategic, and political challenges that are limiting its implementation. Based on our survey findings, we propose a simple framework for considering options for change, centered around trade-offs related to the inclusiveness of the agenda and the political will available for reform. We conclude by proposing four possible reform scenarios for the next phase of the effectiveness agenda

Moving away from aid: The experience of Botswana

Botswana is one of the few upper-middle-income countries in sub-Saharan Africa and aspires to become a high-income country by 2036. According to OECD estimates, Botswana is expected to graduate from the list of official development assistance (ODA) eligible countries by 2030. This report examines the experience of Botswana in managing its transition from ODA and aid. It presents research into the type of cooperation the country sought from development partners and its expectations for development cooperation beyond aid. The report identifies lessons for other countries in the midst of transitioning from aid, as well as for development partners to sustain development outcomes and policy dialogue. The Botswana study forms part of a larger project that sets out to investigate country experiences of and key lessons from the transition and graduation from ODA. The other country studies are Chile, Mexico and the Republic of Korea

Moving away from aid: The experience of Mexico

Mexico is a large upper-middle-income country (UMIC) in the midst of transition from aid, with gross national income per capita of $8,610 in 2017. Despite aid flows falling in the 1990s and stagnating in the early 2000s, they have been rising since 2008 to support the climate change and security agendas, nearly two decades after the country was reclassified as an UMIC. This report presents research into how Mexico has managed its transition from official development assistance (ODA) in order to sustain and broaden development outcomes. It also examines the type of cooperation the country had expected from development partners since the early 1990s and the evolution of relations with those partners beyond aid. The Mexico study forms part of a larger project that sets out to investigate country experiences of and key lessons from the transition and graduation from ODA. The other country studies are Chile, Botswana and the Republic of Korea

Donor Competition for Influence in Recipient Country

The analysis of official development assistance has always struggled with the contradiction between its more altruistic motivations for global development and its easy adaptation as an instrument for the donor’s pursuit of self-interested foreign policy objectives. In the international system foreign aid may thus become a forum for both cooperative and competitive interactions between donors. This chapter explores the interdependence of aid by reviewing the literature on donor interdependence, with a particular focus on donor competition for influence in recipient states. We then present a simple theoretical framework to examine donor competition, and provide some preliminary empirical testing of resulting hypotheses. We conclude that while the evidence about competition is fixed, the behaviour of some donors is consistent with their pursuit of influence in certain recipient states