Instead of laboratory: Analyzing data from natural experiments (Nobel Memorial Prize in Economic Sciences 2021)

The 2021 Nobel Prize in Economic Sciences was awarded to David Card, Joshua Angrist, and Guido Imbens for advancing methodology to establish casual relationships in economics. Their approach brought the notion of the natural experiment, situations in which heterogeneous reactions of different groups of people to chance shocks or policy changes allows to elicit causal effects, to the forefront of empirical analysis, and spearheaded a revolution in development of statistical methods needed to analyze the data. After the initial contributions in labor economics and economics of education, the new approach has become a new standard in economic sciences.

Changes in cannabis policy and prevalence of recreational cannabis use among adolescents and young adults in Europe—An interrupted time-series analysis

Background Cannabis policy varies greatly across European countries, but evidence of how such policy impacts on recreational cannabis use among young people is conflicting. This study aimed to clarify this association by investigating how changes in cannabis legislation influenced cannabis use. Methods Available data on self-reports of recreational cannabis use among individuals aged 15–34 years was retrieved from EMCDDA. Information on cannabis policy changes was categorized as more lenient (decriminalisation or depenalisation) or stricter (criminalisation, penalisation). Countries that had implemented changes in cannabis legislation or had information on prevalence of use for at least eight calendar years, were eligible for inclusion. We used interrupted time-series linear models to investigate changes in country-specific trajectories of prevalence over calendar time and in relation to policy changes. Results Data from Belgium, Czech Republic, Germany, Italy, Netherlands, Norway, Portugal, Slovakia, Spain, Sweden and United Kingdom, for 1994–2017 was available for analyses. Cannabis use varied considerably over the study period and between countries. On average, use was stable or weakly increasing in countries where legislation was not changed or changed at the extremes of the study period (+0.08 percent per year [95% CI -0.01, 0.17 percent]). In contrast, the pooled average use decreased after changes in legislation, regardless of whether it had become more lenient (-0.22 [-1.21, 0.77]) or stricter (-0.44 [-0.91, 0.03]). Conclusions Our findings do not support any considerable impact of cannabis legislation on the prevalence of recreational cannabis use among youth and young adults in Europe.

Observed effects of the COVID-19 pandemic on the life satisfaction, psychological distress and loneliness of Australian carers and non-carers

Using six waves of longitudinal data, we investigate wellbeing, psychological distress and loneliness differences between informal carers and non-carers in the context of COVID-19-related policy changes in Australia. Wellbeing levels fluctuated along with the virus case numbers. Free childcare temporarily alleviated the disparity between carers and non-carers, but by its cessation, carers, in particular, reported lower wellbeing and higher psychological distress. Wage subsidies and income supports had opposing effects for carers’ and non-carers’ mental health but decreased the loneliness of both groups. Victorians, living in the state where the second wave of infections in Australia was concentrated, experienced worse outcomes than other Australians.

Impact of Delaying Effective and Cost-Effective Policy Decisions: An Example From Cervical Cancer Prevention in Norway

Introduction. Delayed implementation of evidence-driven interventions has consequences that can be formally evaluated. In Norway, programs to prevent cervical cancer (CC)—screening and treatment of precancerous lesions and prophylactic vaccination against human papillomavirus (HPV) infection—have been implemented, but each encountered delays in policy implementation. To examine the effect of these delays, we project the outcomes that would have been achieved with timely implementation of two policy changes compared with the de facto delays in implementation (in Norway). Methods. We used a multimodeling approach that combined HPV transmission and cervical carcinogenesis to estimate the health outcomes and timeline for CC elimination associated with the implementation of two CC prevention policy decisions: a multicohort vaccination program of women up to age 26 years with bivalent vaccine in 2009 compared with actual “delayed” implementation in 2016, and a switch from cytology to primary HPV-based testing in 2015 compared with “delayed” rollout in 2020. Results. Timely implementation of two policy changes compared with current Norwegian prevention policy timeline could have averted approximately 970 additional cases (range of top 10 sets: 830–1060) and accelerated the CC elimination timeline by around 4 years (from 2039 to 2035). Conclusions. If delaying implementation of effective and cost-effective interventions is being considered, the decision-making process should include quantitative analyses on the effects of delays.

A National Survey of Endophthalmitis Prophylaxis during Cataract Surgery in Pakistan: A 2020 Perspective

Purpose: To assess national endophthalmitis prophylaxis practice patterns during phacoemulsification surgery in Pakistan. Study Design: Cross sectional survey. Place and Duration of Study: Eye units registered with the British Pakistani Ophthalmic Society (BPOS) between September and November 2020. Methods: A survey-based cross sectional study was conducted in Pakistan between September and November 2020. A proforma was designed using a survey client (Survey Monkey) and distributed to the eye units registered with the British Pakistani Ophthalmic Society (BPOS). The survey explored demographic factors, current antibiotic prophylaxis practice during cataract surgery and audit practice in Pakistan. Results: A total of 339 respondents completed the survey. The survey was representative of ophthalmic surgeons working in the major provinces of Pakistan. A small majority of ophthalmic surgeons provided some form of routine antibiotic prophylaxis (n = 140, 53.8%). Povidone iodine 5% (PVP-I) solution on skin and in the conjunctival sac proved the most popular protocol (n = 163, 66.3%). This was followed by immediate postoperative topical antibiotics (n = 101, 41.1%). Intracameral antibiotic prophylaxis accounted for less than half of current antibiotic practice during cataract surgery in Pakistan (n=99, 40.3%). Most of the respondents did not conduct any audit regarding endophthalmitis (n = 119, 55.6%). Conclusion: Our survey provides an up-to-date view on the state of antibiotic prophylaxis during cataract surgery in Pakistan and highlights several areas for improvement. This includes policy changes to increase adherence to gold standard antibiotic prophylaxis guidelines, improvement in transparency of surgical outcomes and to audit current postoperative outcomes. Key Words: Acute postoperative endophthalmitis, Surgical wound infection, Antibiotic, Cataract, Pakistan.

Optimized operation of regional reserve forces in a changing future security environment

The Republic of Korea Reserve Forces (ROKRF), established in 1968, continue to function through continuous changes such as improving laws and systems and optimizing organizations while complying with social and policy changes. However, the reduction of standing forces, changes in the operating environment, and the reduction of reserve forces required to carry out operations require the re-establishment of the concept of operation of regional reserve forces. In this study, we aimed to diagnose the phenomenon of regional reserve groups and derive an optimized operation plan for regional reserve groups in consideration of changes in the future security environment, operation support system, and law and order system. The operating system presented the mission of establishing local reserve forces suitable for the operating environment, organization, and organization maintenance for the future as well as maintenance and development of combat power through education and training. Finally, in the law and order system section, a plan to revise laws was proposed in consideration of the task of operating and constructing regional reserve forces and re-establishing them.

Macroeconomic Policy Changes and Its Impact on Trade Unions, an Empirical Study on OECD Countries for the Period 2001-2020

This study examines the macroeconomic variables affecting trade union rate membership in OECD nations from 2001 to 2020. The Organization for Economic Cooperation and Development (OECD) has 38 of the most industrialized countries globally, which counts more than 80% of the global GDP; analyzing the macroeconomic movements of these countries means that we most likely know the variance of the global macroeconomic changes. We target the effect of employability, expenditure on education, unemployment, inflation, FDI, economic growth, wages, and salaries on trade union participation of employers. To conduct this research, we used data from World Bank, ILO, and OECD for 38 countries during the period 2001-2020, conducting a panel data Fixed Effect non-linear regression model with robust effect considering the non-normality and the possibility of heteroscedasticity of some of the variables. The results show that employers in the industry, the productivity in the service sector, and wages will increase the enrolment in a trade union, but on the other side, an increase of FDI and unemployment rates will decrease the association of employers to be in a trade union.

Dynamic decision policy reconfiguration under outcome uncertainty

In uncertain or unstable environments, sometimes the best decision is to change your mind. To shed light on this flexibility, we evaluated how the underlying decision policy adapts when the most rewarding action changes. Human participants performed a dynamic two-armed bandit task that manipulated the certainty in relative reward (conflict) and the reliability of action-outcomes (volatility). Continuous estimates of conflict and volatility contributed to shifts in exploratory states by changing both the rate of evidence accumulation (drift rate) and the amount of evidence needed to make a decision (boundary height), respectively. At the trialwise level, following a switch in the optimal choice, the drift rate plummets and the boundary height weakly spikes, leading to a slow exploratory state. We find that the drift rate drives most of this response, with an unreliable contribution of boundary height across experiments. Surprisingly, we find no evidence that pupillary responses associated with decision policy changes. We conclude that humans show a stereotypical shift in their decision policies in response to environmental changes.