scholarly journals Trading Health for Wealth: The Effect of COVID-19 Response Stringency

2020 ◽  
Vol 17 (23) ◽  
pp. 8725
Author(s):  
Megan Cross ◽  
Shu-Kay Ng ◽  
Paul Scuffham
Keyword(s):  
Gross Domestic Product ◽  
Economic Impacts ◽  
Statistical Significance ◽  
Viral Transmission ◽  
Economic Consequences ◽  
Decision Makers ◽  
Infection Rates ◽  
Short Term ◽  
Government Response ◽  
Response Timing

International governments’ COVID-19 responses must balance human and economic health. Beyond slowing viral transmission, strict lockdowns have severe economic consequences. This work investigated response stringency, quantified by the Oxford COVID-19 Government Response Tracker’s Stringency Index, and examined how restrictive interventions affected infection rates and gross domestic product (GDP) in China and OECD countries. Accounting for response timing, China imposed the most stringent restrictions, while Sweden and Japan were the least stringent. Expected GDP declines range from −8% (Japan) to −15.4% (UK). While greater restrictions generally slowed viral transmission, they failed to reach statistical significance and reduced GDP (p = 0.006). Timing was fundamental: governments who responded to the pandemic faster saw greater reductions in viral transmission (p = 0.013), but worse decreases in GDP (p = 0.044). Thus, response stringency has a greater effect on GDP than infection rates, which are instead affected by the timing of COVID-19 interventions. Attempts to mitigate economic impacts by delaying restrictions or decreasing stringency may buoy GDP in the short term but increase infection rates, the longer-term economic consequences of which are not yet fully understood. As highly restrictive interventions were successful in some but not all countries, decision-makers must consider whether their strategies are appropriate for the country on health and economic grounds.

scholarly journals Chameleonic knowledge: a study of ex ante analysis in large infrastructure policy processes

2021 ◽  
Author(s):  
Lars Dorren ◽  
Wouter Van Dooren
Keyword(s):  
Decision Making ◽  
Decision Makers ◽  
Policy Outcomes ◽  
Knowledge Use ◽  
Short Term ◽  
Cost Overruns ◽  
Substantive Content ◽  
Infrastructure Policy ◽  
Decision Outcomes ◽  
Ex Ante

AbstractUsing ex ante analysis to predict policy outcomes is common practice in the world of infrastructure planning. However, accounts of its uses and merits vary widely. Advisory agencies and government think tanks advocate this practice to prevent cost overruns, short-term decision-making and suboptimal choices. Academic studies on knowledge use, on the other hand, are critical of how knowledge can be used in decision making. Research has found that analyses often have no impact at all on decision outcomes or are mainly conducted to provide decision makers with the confidence to decide rather than with objective facts. In this paper, we use an ethnographic research design to understand how it is possible that the use of ex ante analysis can be depicted in such contradictory ways. We suggest that the substantive content of ex ante analysis plays a limited role in understanding its depictions and uses. Instead, it is the process of conducting an ex ante analysis itself that unfolds in such a manner that the analysis can be interpreted and used in many different and seemingly contradictory ways. In policy processes, ex ante analysis is like a chameleon, figuratively changing its appearance based on its environment.

scholarly journals Effect of Short-Term Carbapenem Restriction on Antimicrobial Susceptibility of Resistant Gram-Negative Bacilli in an ICU

2020 ◽  
Vol 41 (S1) ◽  
pp. s200-s201
Author(s):  
Mariana Melo ◽  
Raquel Bandeira ◽  
lio de Castro Giselle Dias ◽  
Braulio Couto
Keyword(s):  
High Mortality ◽  
Bacterial Resistance ◽  
Statistical Significance ◽  
Public Health Problem ◽  
Resistance Rate ◽  
Second Phase ◽  
Short Term ◽  
Intervention Phase ◽  
Carbapenem Resistant ◽  
The Impact

Background: Carbapenem-resistant GNB infections are a serious public health problem worldwide, particularly due to the high mortality associated with them and the low number of therapeutic options. One approach to this challenge is the development of antimicrobial stewardship programs. Objective: We evaluated the impact of a carbapenem restriction program on reducing of bacterial resistance in an intensive care unit (ICU). Methods: A retrospective study conducted in 2 phases in the 80-bed ICU of an acute-care public hospital in Minas Gerais, Brazil. The preintervention phase lasted 16 months (January 2018–April 2019) and the second phase (carbapenem restriction), after the intervention, lasted 4 months (May–August 2019). The intervention was defined as carbapenem-sparing and the use of meropenem was authorized in 3 situations: (1) treatment of serious infections documented by extended-spectrum β-lactamase–producing Enterobacteriacea (ESBL); (2) therapeutic failure with the use of another antimicrobial; and (3) infectious disease recommendation. Data were obtained through consultation of electronic medical records and microbiological results, as standardized by the CLSI, for patients with a >48-hour stay in the ICU and who met the criteria for healthcare-associated infection (HAI) according to the CDC NHSN definition. Results: Before the intervention, on average, 50 cultures were obtained with positive results for multidrug-resistant GNB–MER-GNB (SD, 12.2) and in the intervention phase, this number was 31 cultures (SD, 12.8; P = .010). Average carbapenem consumption decreased significantly with corresponding increase in cefepime consumption in the same period (Fig. 1). The ATB (DDD per 1,000 patient days) before the intervention for carbapenems was 110.6 (SD, 97.1) and for cefepime was 8.2 (SD, 5.9). In the intervention phase, the ATB for carbapenems was 44.7 (SD, 38.5; P = .015) and for cefepime it was 32.0 (SD, 20.3; P < .001). In terms of multidrug resistance rate, before the intervention, 95 of 149 of Acinetobacter (64%) were resistant and during the intervention, 13 of 30 Acinetobacter (43%) were resistant (P = .043). Other GNB (Klebsiella, Proteus, Escherichia coli, and Pseudomonas) reduced the resistance rate, but without statistical significance. We observed a reduction in the HAI rate per MDR-GNB (Fig. 2): before the intervention, it was 22.7 (SD, 5.5) and during the intervention phase it was 16.5 (SD, 7.7; P = .07), although this change did not reach statistical significance. Nevertheless, the ICU Klebsiella infection rate did significantly decrease; it was 5.5 (SD, 1.9) before the intervention and 2.4 (SD, 1.8) after the intervention (P = .009). Conclusions: Short-term carbapenem restriction may be an effective strategy to reduce the incidence of carbapenem-resistant GNB infections in the ICU. The scarce arsenal available for the treatment of MDR-GNB and the high mortality rate justify the growing need for stewardship programs in Brazilian ICUs.Funding: NoneDisclosures: None

Measuring Benefits of Rural and Small Urban Transit in Greater Minnesota

2021 ◽  
pp. 036119812199001
Author(s):  
Jeremy Mattson ◽  
Del Peterson
Keyword(s):  
Economic Impacts ◽  
Value Added ◽  
Decision Makers ◽  
Labor Income ◽  
Urban Transit ◽  
Societal Benefits ◽  
Transit Services ◽  
Potential Benefits ◽  
Transit Agencies ◽  
Benefit Cost

The objective of this research was to measure the benefits of rural and small urban transit services in Minnesota. The study accomplished this by first identifying, describing, and classifying the potential benefits of transit. Second, a method was developed to measure these benefits. Where possible, benefits were quantified in dollar values. Other benefits that could not be quantified in monetary terms were either quantified in another way or described qualitatively. The study included an analysis of societal benefits and economic impacts within local communities. Third, the developed method was applied to a series of six case studies across Greater Minnesota. Data were collected through onboard rider surveys for each of the six transit agencies. Total benefits and benefit-cost ratios were estimated for the six transit agencies—all showed benefits that exceeded costs—and results were generalized to Greater Minnesota. Economic impacts were also estimated showing the effect on jobs, labor income, and value added. This research provides information to assess the benefits of public spending on transit, which gives decision makers the data needed to inform investment decisions.

Representing Social Construction in Consumer Activities: Single-Period and Multi-Period Activity Production

1994 ◽  
Vol 5 (3) ◽  
pp. 139-156
Author(s):  
Steven D. Silver
Keyword(s):  
Social Construction ◽  
Evolutionary Process ◽  
Decision Makers ◽  
Maximization Problem ◽  
Activity Levels ◽  
Short Term ◽  
Subsequent Period ◽  
Single Period ◽  
The Social ◽  
Endogenous Variables

Consumers are seen as limited decision makers who set short-term activity levels from their budgets, stocks of experience, and values following a preference-maximizing heuristic. Disturbances to activity levels in their evolution by exogeneties of social and economic environments, and the feedback of activity levels which agents have no systematic ability to anticipate, reset stock and value levels through the interactive relationships among endogenous variables. Agents then solve the maximization problem for a subsequent period using stock and value levels as modified by the evolutionary process. The dependence of a single-period decision on the stock and value constructs is examined and forms for the dynamic evolution of stock and value constructs that represent the feedback of activity levels to stock and value levels are also introduced. Implications of these forms for the social construction of activities are discussed.

Revolving door syndrome: A new meaning for an old concept?

2011 ◽  
Vol 26 (S2) ◽  
pp. 1114-1114
Author(s):  
P. Garrido ◽  
C. Saraiva
Keyword(s):  
Health Care ◽  
Hospital Admissions ◽  
Strong Predictor ◽  
Statistical Significance ◽  
Revolving Door ◽  
Full Time ◽  
University Hospitals ◽  
Short Term ◽  
Care Services ◽  
Psychiatric Units

Introduction“Revolving Door Syndrome” is usually defined as a cyclical pattern of short-term readmissions to the psychiatric units of health care centers, by young adults with chronic psychiatric disorders. Concerning the actual politics in health care sistems, with sucessive budget cuts and reduction of full-time hospital beds, the authors' aim has been to identify the patients that enter into a vicious circle of being admitted to hospital, discharged, and admitted again, as well as the underlying psychosocial reasons.ObjectivesThe purpose of this study was to identify factors associated with short-term readmissions to psychiatric acute care services, with statistical significance, and clinical interest, within a portuguese sample.Material and methodsRetrospective cohort study, in which the medical records of patients admitted to Coimbra University Hospitals two or more times (with short-term readmissions) between January and December of 2009, were analysed for socio-demographic characteristics, psychiatric diagnostic, presence of comorbidities, number of hospital admissions within that year, psychofarmacological treatments and presence of social and familiar support.Results and conclusionsThe authors found that lack of social and familiar support is a strong predictor for “Revolving Door Syndrome”, as well as the presence of a chronic psychiatric disorder.

94 Short-term use of therapeutic opioids for children and future opioid use disorders: A systematic review and qualitative study of decision-maker information needs

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e68-e68
Author(s):  
Malema Ahrari ◽  
Samina Ali ◽  
Michele Dyson ◽  
Lisa Hartling
Keyword(s):  
Systematic Review ◽  
Qualitative Study ◽  
Information Needs ◽  
Policy Decision ◽  
Decision Makers ◽  
Snowball Sampling ◽  
Opioid Use ◽  
Short Term ◽  
Short Term Exposure ◽  
Evidence Summary

Abstract Primary Subject area Emergency Medicine - Paediatric Background Healthcare visits, hospitalizations, and deaths due to opioid-related harms continue to rise for children, despite an overall decline in opioid prescriptions. Decision-makers (including patients and families, clinicians, and policy-makers) require high quality syntheses to inform decisions regarding opioid use. Previous research has found that how systematic review (SR) results are presented may influence uptake by decision-makers. Evidence summaries are appealing to decision-makers as they provide key messages in a succinct manner. Objectives 1) To conduct an SR examining the association between short-term therapeutic exposure to opioids in children and development of opioid use disorder, and 2) To gain perspectives from policy decision-makers on the usability and presentation of results through the form of an evidence summary. Design/Methods We conducted an SR following methods recommended by Cochrane. A medical librarian conducted a comprehensive search and two authors were involved in study selection, data extraction and quality assessment. Studies were eligible if they reported primary research in English or French, and study participants had therapeutic exposure to opioids before age 18 years. Results were described narratively. Decision makers were recruited through purposive and snowball sampling methods, and they participated in interviews to discuss an evidence summary based on the SR. Interviews were transcribed and data were analyzed using content analysis. Ethics approval was obtained for the qualitative study. Results Nineteen American studies involving 47,191,990 participants were included. One study demonstrated that short-term therapeutic exposure may be associated with opioid abuse. Four others showed an association without specifying duration of exposure. Fourteen studies provided information on prevalence or incidence of opioid misuse following therapeutic exposure, median 27.8% [interquartile range 21.4% – 30.7%]; notably, 12 of them did not specify duration of therapeutic exposure. Identified risk factors were contradictory and remain unclear. Decision makers had mixed preferences for the presentation of evidence, depending on their degree of involvement in research versus practice. A majority preferred having methods and key characteristics of studies included in the first page of the evidence summary. They noted that the summary should not be text-heavy and details should be appended. Conclusion A number of studies suggest there is an association between lifetime therapeutic opioid use (unknown duration) and future nonmedical opioid use; however, there is limited evidence to determine whether short-term exposure is specifically associated with these outcomes. Policy and decision-makers prefer a succinct evidence summary for this SR, with study-specific details provided as an appendix. PROSPERO Registration: 122681.

scholarly journals Short-Term Association between Black Carbon Exposure and Cardiovascular Diseases in Pakistan’s Largest Megacity

Atmosphere ◽  
2018 ◽  
Vol 9 (11) ◽  
pp. 420 ◽  
Author(s):  
Daniel Malashock ◽  
Haider Khwaja ◽  
Zafar Fatmi ◽  
Azhar Siddique ◽  
Yi Lu ◽  
...  
Keyword(s):  
Cardiovascular Diseases ◽  
Black Carbon ◽  
Hospital Admissions ◽  
Statistical Significance ◽  
Fine Particulate Matter ◽  
Tertiary Care ◽  
Short Term ◽  
Residential Site ◽  
Fine Particulate ◽  
Tertiary Care Hospitals

This study investigated the association between black carbon (BC) exposure and hospital admissions (HAs) and outpatient department/emergency room (OPD/ER) visits for cardiovascular diseases (CVD) among residents of Karachi, the largest city in Pakistan. We measured daily concentrations of BC in fine particulate matter (PM2.5) and collected records of HAs and OPD/ER visits for CVD from 2 major tertiary care hospitals serving Karachi for 6 weeks continuously during each quarter over 1 year (August 2008–August 2009). We subsequently analyzed daily counts of hospital and BC data over 0–3 lag days. Daily mean BC concentrations varied from 1 to 32 µg/m3. Results suggest that BC concentrations are associated with CVD HAs and OPD/ER visits. However, associations were generally only observed when modeled with BC from Tibet Center, the commercial-residential site, as compared to Korangi, the industrial-residential site. Overall, low statistical significance suggests that while BC may be a valuable indicator for CVD health risks from combustion-derived particles, further evaluation of the constituents of PM2.5 and their relative contributions to CVD health impacts is necessary.

scholarly journals Religious Engagement and the Migration Issue: Towards Reconciling Political and Moral Duty

Religions ◽  
2020 ◽  
Vol 11 (5) ◽  
pp. 236
Author(s):  
Joanna Kulska
Keyword(s):  
Ethical Issues ◽  
Decision Makers ◽  
Religious Communities ◽  
The Political ◽  
Political Decision ◽  
Short Term ◽  
Nation States ◽  
Religious Engagement ◽  
The Face ◽  
Religious Actors

The increasingly acknowledged post-secular perspective has resulted in the emergence of some new approaches theorizing this phenomenon. One such approach has been the concept of religious engagement, which calls for the redefinition of the perception of religious non-state actors towards including them as important partners in the process of identifying and realizing political goals. According to this view, due to the multidimensional role played by religious communities and non-state religious actors, they need to be recognized as pivotal in creating a new form of knowledge generated through encounter and dialogue of the political decision-makers with these subjects. Among numerous others, the challenge of migration calls for enhanced debate referring to both political and ethical issues. When such a perspective is applied, the question is raised of the duties and limits of nation-states using more or less harsh political measures towards refugees and migrants based on the concept of security, but also short-term political goals. In the face of a state’s lack of will or capacity to deal with the problem of migration, the question of religion serving not only as the service-provider but also as the “trend-setter” with regard to fundamental ethical questions needs to be considered.

Comparative study of episiotomy repair: absorbable synthetic versus chromic catgut suture material

2017 ◽  
Vol 6 (6) ◽  
pp. 2186
Author(s):  
Devika Perumal ◽  
Divya Selvaraju
Keyword(s):  
Comparative Study ◽  
Suture Material ◽  
Statistical Significance ◽  
Wound Dehiscence ◽  
Chromic Catgut ◽  
Control Group ◽  
Absorbable Suture ◽  
Perineal Laceration ◽  
Short Term ◽  
Significant Difference

Background: The choice of suture material for repair of episiotomy or perineal laceration is largely of one’s personal preference. Chromic catgut was widely used in most institutions. It now appears that chromic catgut is associated with more postpartum discomfort and hence chromic catgut has been largely replaced by synthetic absorbable materials like polyglactin and polyglycolic acid.Methods: The study was conducted in Institute of Social Obstetrics and Government Kasturba Gandhi Hospital, Chennai. This is a prospective, comparative study involving two groups. The use of a rapidly absorbing form of synthetic absorbable suture material, in the repair of episiotomy or perineal laceration in 100 patients during the study period February 2012 to July 2012, were simultaneously compared with the traditional natural absorbable suture material.Results: With the use of rapidly absorbing polyglactin 910, there was a significant reduction (p=0.000) in the short-term pain, 19 compared to 80 in the control group. With regard to wound dehiscence and the need for resuturing, there was statistically significant difference in the control group (15%) compared to the study group (0%). There was no statistical significance between the two groups in terms of dyspareunia (12.4% vs 10.7%).Conclusions: Fast-absorbing form of Polyglactin seems to be effective in reducing some of the morbidity associated with perineal repair following childbirth. There was significant reduction in the short-term pain and the need for analgesia. The incidence of wound dehiscence was markedly reduced.

Sign in / Sign up

Export Citation Format

Share Document