Increase In Budget Research Articles

Informing HPV vaccine pricing for government-funded vaccination in mainland China: a modelling study

The high price of HPV vaccines remains a significant barrier to vaccine accessibility in China, hindering the country's efforts toward cervical cancer elimination and exacerbating health inequity. We aimed to inform HPV vaccine price negotiations by identifying threshold prices that ensure that a government-funded HPV vaccination programme is cost-effective or cost-saving. We used a previously validated transmission model to estimate the health and economic impact of HPV vaccination over a 100-year time horizon from a healthcare payer perspective. Threshold analysis was conducted considering different settings (national, rural, and urban), cervical cancer screening scenarios (cytology-based or HPV DNA-based, with different paces of scale-up), vaccine types (four types available in China), vaccine schedules (two-dose or one-dose), mode of vaccination (routine vaccination with or without later switching to high-valency vaccines), willingness-to-pay thresholds, and decision-making criteria (cost-effective or cost-saving). Furthermore, we examined the budget impact of introducing nationwide vaccination at the identified threshold prices. Using the current market price, national routine HPV vaccination with any currently available vaccine is unlikely cost-effective. Under a two-dose schedule, the prices of the four available HPV vaccine types cannot exceed $26-$36 per dose (44.1%-80.2% reduction from current market prices) depending on vaccine type to ensure the cost-effectiveness of the national programme. Adopting vaccination at threshold prices would require an annual increase of 72.18%-96.95% of the total annual National Immunization Programme (NIP) budget in China. A cost-saving routine vaccination programme requires vaccine prices of $5-$10 per dose (depending on vaccine type), producing a 21.38%-34.23% increase in the annual NIP budget. Adding the second dose is unlikely to be cost-effective compared to a one-dose schedule, with the threshold price approaching or even falling below zero. Rural pilot vaccination programmes require lower threshold prices compared with a national programme. Our study could inform vaccine price negotiation and thus facilitate nationwide scale-up of current HPV vaccination pilot programmes in China. The evidence may potentially be valuable to other countries facing HPV introduction barriers due to high costs. This approach may also be adapted for other contexts that involve the introduction of a pricy vaccine. CAMS Innovation Fund for Medical Sciences (CIFMS); Bill & Melinda Gates Foundation.

Universal Health Coverage of Opioid Agonist Treatment in Norway: An Equity-Adjusted Economic Evaluation.

Detailed information on the efficiency of health services targeting opioid use disorder (OUD) and treatment with opioid agonist treatment (OAT) is sparse. Many countries, including Norway, are still falling short of universal health coverage (UHC) of OAT. This study aims to evaluate the incremental lifetime costs and effects of treating OUD with OAT as compared to no OAT in Norway and scaling up the treatment to a universal coverage level using equity-adjusted health economic evaluations. We conducted cost-utility and budget impact analyses and constructed a two-state Markov model to compare the lifetime costs and outcomes among patients with OUD with and without OAT. Model inputs were derived from routine health information systems and the literature, with costs reported in 2023 Norwegian Kroner (NOK). The analyses were conducted from a Norwegian extended health-service and societal perspectives, with a lifetime time horizon. Quality-adjusted life years (QALYs) was the metric of health benefits. Outcomes were reported as incremental cost-effectiveness ratios (ICERs). The willingness-to-pay (WTP) threshold was equity-adjusted according to the future prognostic healthy life year loss method in Norway (severity of disease criterion), which is sensitive to the size of future undiscounted healthy life year loss due to the affected conditions. The WTP threshold is NOK 825,000 per QALY gained in Norwegian policy for conditions with undiscounted future QALY loss > 20. Uncertainty in the parameters and robustness of the results were assessed with one-way and probabilistic sensitivity analyses and scenario analyses. The mean results from probabilistic sensitivity analysis estimated that OAT was associated with 3.03 additional discounted QALYs gain and incremental lifetime discounted cost of NOK 1.45 million, leading to an ICER of NOK 479,099 per QALY gained when compared with not providing OAT, with the extended health-service perspective. From a societal perspective, OAT was cost-saving, i.e. OAT produced greater health benefits while resulting in lower overall societal costs compared to no OAT. The mean undiscounted future health loss was estimated to be 21.34 QALYs for the Norwegian patient group with OUD. A total 5-year budget increase of NOK 1.208 billion was estimated if OAT was going to be scaled up from the current coverage level of 70% to UHC. Compared with the current coverage, 100% coverage of OAT was associated with an additional lifetime cost of NOK 4.332 billion but also an additional 6760 QALYs gained. Our analysis suggests that OAT is cost-effective in Norway and has the potential to be cost-saving from a societal perspective. Therefore, Norwegian policy should consider scaling up treatment to extend the coverage of OAT.

Public spending on Energy innovations and CO2 impacts: Evidence from selected OECD countries

The relationship between public spending on Energy innovations (R&D of renewable and non-renewable energy, and energy efficiency) and CO2 intensity at constant purchasing power are investigated in this study. A Panel-NARDL model was used for the first time in 10 OECD countries (1990–2020) to evaluate the asymmetric relationship between energy innovative variables and CO2 impacts in the long and short run. In other words, this study aims to monitor how changes in public spending on R&D for renewable and non-renewable influence CO2 emissions. The results show that while an increase in the public budget for R&D of renewable energy will decrease the CO2 intensity in the long run, a positive relationship exists between these variables in the short run. Likewise, the result demonstrates that a cut in public spending on Fossil fuel R&D leads to an increase in the short horizon and a decrease in the long-run CO2 emissions per unit of GDP. The finding implies the substantial impact of R&D in both renewable and non-renewable energy on reducing CO2 emissions over time. In addition, CO2 emissions per unit of GDP respond positively to R&D public spending on energy efficiency. An increase in public expenditure on R&D of energy efficiency can induce economic activity and enhance CO2 emissions. All in all, the 30 years’ analysis of data from the selected OECD countries substantiates the right strategy of reducing the CO2 emissions of these countries by applying the public budget to promote R&D in energy sectors. This study results in contrast with those studies that found no relationship between R&D on renewable energy and CO2 impacts. Significance Statement This paper evaluated the asymmetric impacts of public spending on R&D of renewable energy and fossil fuel, and energy efficiency on CO2 intensity at constant purchasing power. Although a growing body of research has analyzed the impact of R&D on CO2 emission, research on the asymmetric effects of R&D public expenditure in energy sectors on CO2 emission is still narrow. Moreover, by employing Panel Nonlinear ARDL, we delve into the spillover impacts of selected OECD public budget on R&D over the short and long horizons. In addition, we estimate the impacts of both Renewable and non-renewable R&D budgets which help us to explore and compare the effectiveness of budget allocation on R&D with the strategy of reducing CO2 emission. Finally, this study found how the R&D and technology budget surging and declining in energy sectors would influence CO2 emission per unit of GDP.

A-206 Exploring the Surge in Clinical Laboratory Inflation: A Comprehensive Review

Abstract Background The healthcare industry has been experiencing significant inflationary trends, particularly in clinical laboratory services. This surge in inflation is attributed to various factors, including the increased demand for laboratory services, changes in the practice of clinical laboratory science due to technological advances, and vacancy rates that exceed the number of Medical Laboratory Science (MLS) graduates. Additionally, supply chain shortages, increased operational costs, and staffing budget increases, further exacerbating the inflationary pressures on clinical laboratory services. Methods The review of the factors behind the surge in clinical laboratory inflation involved a comprehensive review of industry data and insights from supply chain leaders, and recent surveys conducted by the author sent to 50 laboratory leaders with a response rate of 50%, Data from the Bureau of Labor Statistics (BLS) and industry interviews were integrated to provide an understanding of the inflationary trends affecting the healthcare industry, with a specific focus on clinical laboratory services. Results The review revealed that domestically produced healthcare inputs, labor, diagnostics, and lab equipment have seen dramatic price increases. For instance, prices manufacturers charge for diagnostic reagents for testing have increased by 9.2%, while lab equipment prices have risen by 7.1%. Some product lines have experienced increases of 15-20%. Moreover, the post pandemic has led to attrition rates climbing from 10%-37% to the current rate of 35%-61%, resulting in 30%-50% staffing budget increases. 36% of lab leaders feel Group Purchasing Organizations (GPO’s) are incentivized to allow increases, it’s estimated that as much as 80% of GPO revenue is generated by fees paid by vendors. 28% feel the vendors are passing along but not sharing in the inflationary pressures as reimbursements decline. 20% feel it’s an excuse for vendors to pad margins. 16% feel that it’s due to lack resources or lab specific procurement expertise in supply chain departments. Conclusions These factors have contributed to the significant surge in clinical laboratory inflation. The surge in is a complex phenomenon influenced by multiple interconnected factors. Addressing this inflationary trend will require a collaborative approach that considers the impact of supply chain shortages, increased operational costs, and staffing. Proactive measures to mitigate the adverse effects of inflation on clinical laboratory services, such as ensuring reliable data in negotiations, addressing the workforce shortage and strong negotiations with vendors will be essential to sustain the cost, quality, and accessibility of these critical healthcare services.

Budget Impact Analysis of Dapagliflozin in Treating Patients With Heart Failure With Reduced Ejection Fraction From the Perspective of Malaysian Public Healthcare System

PurposeThis is a budget impact analysis that compared the scenario of treating heart failure with reduced ejection fraction (HFrEF) using dapagliflozin plus standard of care (SoC) versus a scenario without dapagliflozin, from the perspective of Ministry of Health (MOH) Malaysia over a 5-year time horizon. MethodsA Microsoft Excel-based cost calculator was developed for such comparison. The estimated size of eligible population, uptake rates for dapagliflozin, as well as costs related to drugs, clinical events, and adverse events were based on published data, official tariffs, and databases, and expert opinion. Clinical data from the DAPA-HF trial were used to inform efficacy and safety inputs (i.e., hospitalization for heart failure (hHF), cardiovascular death, and adverse events). Results were reported as total annual and cumulative costs (in 2023 Malaysian Ringgits [RM], United States Dollars [USD], and European Union Euros, [EUR]; with exchange rates of 1 USD = RM 4.40 and 1 EUR = RM 4.90]), as well as the number of clinical events. Sensitivity and scenario analyses were also conducted. FindingsThe base-case analysis estimated that over a five-year period, the adoption of dapagliflozin for HFrEF treatment would result in a cumulative cost-saving of RM 2.6 million (USD 0.6 million/EUR 0.5 million), representing a 0.3% reduction in costs, driven primarily by reduced expenditure on hHF. Moreover, dapagliflozin treatment would lead to 731 fewer hHF and 366 fewer cardiovascular deaths. Sensitivity and scenario analyses revealed that the results were most sensitive to assumptions regarding loop diuretic requirements and the cost of dapagliflozin. Although cost savings or a net-zero balance were projected for the first four years, an anticipated 2.5% annual increase in dapagliflozin uptake in the longer term would lead to additional costs for the MOH, starting from the fifth year. ImplicationsIncorporating dapagliflozin into the SoC can improve health outcomes for HFrEF patients and may generate cost savings, potentially easing the economic strain of HFrEF management on Malaysia's public healthcare system in the short term. Nonetheless, a modest increase in budget should be anticipated as more patients gain access to the treatment over time.

Reversible Carrier Concentration Control on Ultra-Thin in2O3 By Viologen Molecules Charge Transfer Method

Ultra-thin Oxide semiconductor fabricated by atomic layer deposition (ALD) is one of the promising candidates, due to their ultra-thin thickness and being highly compatible with the silicon process.[1] However, further tuning the oxide semiconductor's carrier concentration is still an interesting issue. Although annealing is a widely used way, the increase in thermal budget is unwilling to be met. To adjust the carrier concentration without increasing the thermal budget, viologen molecule, a strongly n-type dopant which have been successfully applied to different material systems including 2D,[2] CNT,[3] ultra-thin Ⅲ-Ⅴ,[4] has been used in the In2O3 transistor(as shown in Figure 1a). After viologen treatment, the viologen dopants increased the carrier concentration and caused a difference of n 2D, which is 2 × 1012 cm-2 of 2 nm thickness in In2O3, without degrading the mobility under the same overdrive voltage. The In2O3 transistor achieves an electron sheet density of 6.8 × 1012 cm−2. To further expand the function, viologen dopants are modified by hydroxy group. With hydroxy group modifying, the viologen dopants can be removed by acetone and be re-treated back on the In2O3 again. The reversible cycle of viologen treatment can be repeated multiple times without harming the In2O3 device (as shown in Figure 1b). Precise control of the threshold voltage allows for fine-tuning of the transistor between depletion mode and enhancement mode. Based on this, a depletion load inverter has been demonstrated. This result shows that the viologen dopants and In2O3 have the potential to be further integrated with other low dimensional materials in BEOL without raising the thermal budget while tuning the carrier concentrations. Figure 1. a) Schematic representation of the structure of a In2O3 bottom-gate transistor and the viologen charge transfer process. b) The transfer characteristics of In2O3 transistors repeatedly treated and removed of OHV for four cycles. References (1) Si, M.; Lin, Z.; Chen, Z.; Sun, X.; Wang, H.; Ye, P. D. Scaled Indium Oxide Transistors Fabricated Using Atomic Layer Deposition. Nat. Electron. 2022, 5 (3), 164-170. DOI: 10.1038/s41928-022-00718-w.(2) Kiriya, D.; Tosun, M.; Zhao, P.; Kang, J. S.; Javey, A. Air-Stable Surface Charge Transfer Doping of MoS2 by Benzyl Viologen. J. Am. Chem. Soc. 2014, 136 (22), 7853-7856. DOI: 10.1021/ja5033327.(3)Kim, S. M.; Jang, J. H.; Kim, K. K.; Park, H. K.; Bae, J. J.; Yu, W. J.; Lee, I. H.; Kim, G.; Loc, D. D.; Kim, U. J.; Lee, E.-H.; Shin, H.-J.; Choi, J.-Y.; Lee, Y. H. Reduction-Controlled Viologen in Bisolvent as an Environmentally Stable n-Type Dopant for Carbon Nanotubes. J. Am. Chem. Soc. 2009, 131 (1), 327-331. DOI: 10.1021/ja807480g.(4) Takei, K.; Kapadia, R.; Li, Y.; Plis, E.; Krishna, S.; Javey, A. Surface Charge Transfer Doping of III–V Nanostructures. J. Phys. Chem. C 2013, 117 (34), 17845-17849. Figure 1

Ecosystem restoration coupled with poverty alleviation in eThekwini Municipality, KwaZulu‐Natal Province, South Africa

Ecosystem restoration is a necessity for addressing socio‐ecological challenges by improving ecosystem resilience and alleviating poverty through local community involvement. Here, we review a community‐based, large‐scale ecosystem restoration program, Working for Ecosystems, implemented by eThekwini Municipality in KwaZulu‐Natal, South Africa, between 2007 and 2022. For this study, we interrogated monthly and annual reports generated by the program between 2011 and 2021 to describe how the program worked to suppress invasive alien plants (IAPs) and provided employment opportunities to marginalized groups (women, youth, military veterans, and people living with disabilities). Annual budget was positively correlated with the area cleared of IAPs and effort (person‐days in the field). The program successfully incorporated marginalized groups, but military veterans and people living with disabilities remained in smaller numbers and were not well quantified. Participants were encouraged to constitute companies—Small, Medium, and Micro Enterprises—that were then subcontracted to the program or could progress to other endeavors, allowing other community members to enter the program. A steady increase in the implementation budget emphasized the need for a long‐term plan to ensure accountability and sustainability of restoration and socio‐ecological systems.

Financial Health Analysis and Bankruptcy Prediction of BUMN Karya Listed on IDX in The Midst of Increasing Government Infrastructure Projects Based on The National Medium-Term Development Planning (RPJMN 2020 - 2024)

Concerning the increase in the national infrastructure budget by 6% from the previous year, as well as the emphasis on infrastructure reflected in the RPJMN 2020 – 2024 document, the government has once again appointed construction State-Owned Enterprises (BUMN Karya) as the drivers of national development. Unfortunately, over the past five years, the financial condition of BUMN Karya has deteriorated. Additionally, several directors within these companies have been implicated in corruption cases, damaging the public image and trust in BUMN Karya. This led the IDX to suspend trading in one of its stocks in May 2023. This study aims to evaluate the financial performance and health condition of BUMN Karya listed on the IDX, namely WSKT, WIKA, PTPP, and ADHI. The research methodology is based on the Ministry of SOEs No decree. KEP-100/MBU/2002. Furthermore, this study predicts the financial distress faced by these BUMN Karya from 2019 to 2023 using four methods: Altman Z-Score, Ohlson O-Score, Zmijewski, and Springate The findings indicate the health conditions of each company from 2019 to 2023 as follows: WSKT (BB, CCC, B, BB, B), WIKA (AA, BB, BB, B, CCC), PTPP (BBB, BB, BBB, B), and ADHI (BBB, B, BB, BB, BBB). Among the four predictive methods, the Altman Z-Score model most closely approximates the actual condition in 2024 with an accuracy rate of 65%. The results show that all four SOEs experienced a decline in their Altman Z-Score in 2023. This study complements previous research with a different approach and provides additional insights into the government’s push for infrastructure development and efforts to improve and strengthen the financial condition of BUMN Karya.

The Impact of General Elections on Stock Market Volatility in Indonesia (2004–2023)

Elections are events that play an important role in the economic aspects of a country. Elections create uncertainty and potentially affect investor sentiment, causing fluctuations in Indonesian stock prices. A few months before the election, stock prices in Indonesia showed a significant increase in the Indonesia Composite Stock Price Index (IHSG). This occurs due to an increase in purchasing power for campaign needs and an increase in the government budget. The ARCH/GARCH model is a relevant analysis instrument in looking at market volatility. This study forecasts the close value of IHSG in the election year 2024 and analyzes the effect of elections on stock price volatility in Indonesia. This research resulted in the best model is GARCH (1,1) with RMSE 604.74, MAE 484.27, and MAPE 13.37. The forecasting results from November 23, 2023 - February 29, 2023 tend to increase, the average increase is 0.097%, the biggest increase from the end of November to the beginning of the first week of December 2023 by 0.229%. The relationship between IHSG value and political month is positive. The regression equation shows the IHSG value in months containing political events is 743,53 greater than in non-political months.

ინტეგრაციისა და რეინტეგრაციის ბენეფიციარების საჭიროების კვლევა

Georgia faces significant challenges, the main of which is the rapid and sustainable development of the country's economy in adherence to the principles of the free market, the establishment of institutions relevant to the modern European and universal democratic values system, the provision of social welfare, and integration into the European and Euro-Atlantic space. Overcoming these challenges and building a modern democratic state requires systemic changes in the management and implementation of state policy. Despite the legislative reforms implemented in the field of migration in recent years, the improvement of legal mechanisms for regulating this area remains a challenge, while certain issues still require legal regulation due to the needs of the beneficiaries. Based on the results of the survey, it is advisable to implement the following measures in order to better integrate internationally protected persons: promoting the teaching of the Georgian language, improving access to public services, employment assistance, budget increase of integration programs.

State budget system improvement for informed decision-making in Latvia

The study aims to improved the state budget system to ensure informed decision-making, which will contribute to more efficient use of budget funds and increase national financial stability. A comparative analysis of successful budget planning practices in other countries, such as Sweden, Canada and Estonia, was conducted, and the legal framework for coordination between government agencies in the budget management process in Latvia was reviewed. The methodological approach was based on the analysis of statistical data from official sources and regulations, as well as the use of information from government and ministerial websites. The results of the study showed that the analysis of revenues and expenditures of the Latvian state budget for the period from 2019 to August 2024 revealed a steady increase in revenues, with the exception of a decline in 2020 due to the pandemic, and an increase in expenditures, which requires optimisation and better coordination between government agencies. The study determined that the existing legal framework of Latvia regulating coordination between state institutions in budget management needs to be improved to increase the efficiency of this interaction. A comparison of Latvia's budget management systems with the successful practices of Sweden, Canada and Estonia demonstrated management improvement potential by introducing long-term strategic planning, as in Sweden, integrating results into the budget process, as in Canada, and increasing transparency and public involvement, as in Estonia. Based on the data obtained, recommendations were developed to integrate new technologies into the budget process and increase transparency, contributing to a more efficient use of public resources. The results indicate the need to reform the state budget system to ensure informed decision-making in Latvia. This will make it possible to use budget funds more rationally, increase the transparency of financial processes and strengthen public confidence in government decisions

Eight years into the horizon of aspirational maternal and newborn health pledges: a nationwide cross-sectional exploration of the Burundian EmONC network capacity and budget deficits

ObjectiveThe Burundian emergency obstetric and neonatal care (EmONC) programme, which was initiated in 2017 and supported by a specific policy, does not appear to reverse maternal and newborn mortality trends....

Assessing health plan payer's budget impact of etranacogene dezaparvovec for the treatment of hemophilia B in the United States.

Etranacogene dezaparvovec is a recently approved gene therapy for people with hemophilia B (PwHB). Current standard of care is prophylaxis with factor IX (FIX) to prevent bleeding. Etranacogene dezaparvovec increases blood FIX levels such that FIX prophylaxis could be eliminated. To estimate the budgetary impact of etranacogene dezaparvovec adoption and utilization in a commercial health plan of the United States. A budget impact model was developed to evaluate the introduction of etranacogene dezaparvovec to treat severe or moderately severe hemophilia B. The model considered a hypothetical 1-million-member plan over a 5-year horizon. FIX therapy prophylaxis use was estimated based on a weighted average of relevant brands using US market share data. A scenario of etranacogene dezaparvovec adoption/utilization was compared with one without etranacogene dezaparvovec utilization. Two etranacogene dezaparvovec uptake (market share growth) analyses were performed: one with gradual uptake and alternatively assuming all eligible PwHB received etranacogene dezaparvovec in year 1. The one-time cost of etranacogene dezaparvovec was assumed to be $3.5 million. Other costs (FIX prophylaxis, disease monitoring, bleed management, and adverse events) were estimated from published literature. All costs were in 2022 US dollars. Bleed and adverse event rates were sourced from the HOPE-B trial comparing etranacogene dezaparvovec to previous FIX therapy prophylaxis. The model estimated annual and per-member per-month costs over 5 years. Secondary analyses were performed considering a 10-year horizon. In the 1-million-member health plan, an estimated 1.8 PwHB were eligible for treatment with etranacogene dezaparvovec. Gradual uptake of etranacogene dezaparvovec resulted in cumulative 5-year budget impact of $848,509 compared with a scenario without etranacogene dezaparvovec. In years 1-5, the incremental annual and per-member per-month costs ranged from $79,824 to $271,435 and from $0.007 to $0.023, respectively. In the alternative uptake analysis, etranacogene dezaparvovec became cost saving annually beginning in year 2 and cumulatively beginning in year 5, for a 5-year savings of $754,844. Secondary analyses over 10 years found both uptake analyses cost saving. Other scenarios considered did not affect results substantially. Introducing etranacogene dezaparvovec as treatment for PwHB would have a modest budget increase within 5 years after treatment but may become cost saving if all eligible PwHB were treated in year 1. Initiating PwHB on etranacogene dezaparvovec sooner may produce greater overall savings and earlier annual savings. Etranacogene dezaparvovec is a treatment option that may provide overall cost savings for US commercial health plans, which would increase as the plan size increases.

Decomposition algorithms for the robust unidirectional quay crane scheduling problems

Our study focuses on a two-stage robust optimization model for the unidirectional quay crane scheduling problem with uncertain handling times at container terminals. We first implement two classical algorithms adopted in Li and Zhang (2021), the Benders decomposition algorithm and the column-and-constraint generation algorithm, to solve the robust model. Based on analytical and numerical comparisons of them, we design an exact hybrid algorithm to leverage capabilities of both algorithms by alternatively adding cuts of both kinds. Extensive experiments validate the effectiveness of this mechanism. Numerical experiments also reveal that the benefit and the cost of robustness fade away as the uncertainty budget increases and highlight the advantage of our robust approach to deal with uncertainty over a two-stage stochastic program under extreme situations.

Quantum Computing Approach to Realistic ESG-Friendly Stock Portfolios

Finding an optimal balance between risk and returns in investment portfolios is a central challenge in quantitative finance, often addressed through Markowitz portfolio theory (MPT). While traditional portfolio optimization is carried out in a continuous fashion, as if stocks could be bought in fractional increments, practical implementations often resort to approximations, as fractional stocks are typically not tradeable. While these approximations are effective for large investment budgets, they deteriorate as budgets decrease. To alleviate this issue, a discrete Markowitz portfolio theory (DMPT) with finite budgets and integer stock weights can be formulated, but results in a non-polynomial (NP)-hard problem. Recent progress in quantum processing units (QPUs), including quantum annealers, makes solving DMPT problems feasible. Our study explores portfolio optimization on quantum annealers, establishing a mapping between continuous and discrete Markowitz portfolio theories. We find that correctly normalized discrete portfolios converge to continuous solutions as budgets increase. Our DMPT implementation provides efficient frontier solutions, outperforming traditional rounding methods, even for moderate budgets. Responding to the demand for environmentally and socially responsible investments, we enhance our discrete portfolio optimization with ESG (environmental, social, governance) ratings for EURO STOXX 50 index stocks. We introduce a utility function incorporating ESG ratings to balance risk, return and ESG friendliness, and discuss implications for ESG-aware investors.

Diagnosing the Causes of Failing Waste Collection in Belize, Bolivia, the Dominican Republic, Ecuador, Panama, and Paraguay Using Dynamic Modeling

Most developing countries fail to provide waste collection services to all their citizens, which leads to many adverse effects. Nevertheless, research has not yet succeeded in explaining the underlying causes. We drew up a quantitative system dynamics model that can be used to diagnose the complex societal system that is leading to poor waste collection. The model describes demographic, social, economic, financial, participatory, and governance processes that may play a role. It is calibrated against real-life datasets for six Latin American countries. The calibration shows adequate performance of the model. Strong population growth appears to have a dual effect. It leads to an increase in available budgets for collection but also tends to dilute the available budget per inhabitant. Processes on the growth of GDP, government revenues, and quality of governance strongly improve access of citizens to waste collection. They do so separately but also because they reinforce each other. But, there are differences per country. Progress in Belize seems to be hampered mostly by low governance quality. For Bolivia, the hurdle seems to consist of an inability to increase public revenues and absorb new urban citizens. Ecuador and Paraguay would also benefit from increased revenues along with an ability to increase public participation. The Dominican Republic and Panama reveal an overall passivity to improve their services. This model may be useful for decision makers globally to develop effective interventions.

THE FUTURE OF INTERNATIONAL COOPERATION IN THE ARCTIC

The Arctic is a strategically important region for our country, with enormous opportunities, but also with serious global challenges and threats. One such challenge is the erosion of international cooperation. Today, international cooperation in the Arctic is facing the most serious challenge in its history. We argue that today there is a steady trend toward a return to realism in Arctic cooperation, with non-hierarchical goal-setting giving way to the proclamation of national security as the primary goal by most Arctic states. This entails an increase in military budgets, and nation-states are becoming the main actors in Arctic governance. Finally, military power, hitherto largely seen as an "act of desperation", will be increasingly used by the Arctic states in their public rhetoric.

Smooth Nested Simulation: Bridging Cubic and Square Root Convergence Rates in High Dimensions

Nested simulation concerns estimating functionals of a conditional expectation via simulation. In this paper, we propose a new method based on kernel ridge regression to exploit the smoothness of the conditional expectation as a function of the multidimensional conditioning variable. Asymptotic analysis shows that the proposed method can effectively alleviate the curse of dimensionality on the convergence rate as the simulation budget increases, provided that the conditional expectation is sufficiently smooth. The smoothness bridges the gap between the cubic root convergence rate (that is, the optimal rate for the standard nested simulation) and the square root convergence rate (that is, the canonical rate for the standard Monte Carlo simulation). We demonstrate the performance of the proposed method via numerical examples from portfolio risk management and input uncertainty quantification. This paper was accepted by Baris Ata, stochastic models and simulation. Funding: The authors acknowledge financial support from the National Natural Science Foundation of China [Grant NSFC 12101149] and the Hong Kong Research Grants Council [Grants GRF 17201520 and GRF 17206821]. Supplemental Material: The e-companion and data files are available at https://doi.org/10.1287/mnsc.2022.00204 .

The Effect of the 2020 Black Lives Matter Protests on Police Budgets: How “Defund the Police” Sparked Political Backlash

Abstract This article investigates whether a core political demand of the 2020 Black Lives Matter (BLM) protests was realized: “defund the police.” Original hand-compiled data containing budget information on 264 major cities in the United States and comprehensive protest data enable us to assess the effect of protests on changes in city police budgets. We find no evidence that BLM protests led to police defunding. In cities with large Republican vote shares, protest is associated with significant increases in police budgets. We demonstrate that electoral incentives cannot explain this policy backlash. Instead, we provide tentative evidence that backlash in Republican cities might stem from policymakers’ own conservatism and entrenched right-wing influences within city politics. The analysis offers novel evidence on the consequences of the largest protest movement in U.S. history and reveals the importance of backlash in explaining policy outcomes of social movements.

Cost-effectiveness of intervention combinations towards the elimination of vertical transmission of HIV in limited-resource settings: a mathematical modelling study

Since 2000, there has been a substantial global reduction in the vertical transmission of HIV. Despite effective interventions, gaps still remain in progress towards elimination in many low-income and middle-income countries. We developed a mathematical model to determine the most cost-effective combinations of interventions to prevent vertical transmission. We developed a 12-month Markov model to follow a cohort of women of childbearing age (aged 15-49 years) in Zambia (n=1 107 255) who were either pregnant, in delivery, or breastfeeding; the population included in the model reflects the estimated number of pregnant women in Zambia from the 2018 Zambia Demographic and Health Survey. The model incorporated nine interventions: infant prophylaxis; three different HIV retesting schedule options; oral pre-exposure prophylaxis; maternal peer-support groups; regimen shift; tracing of loss to follow-up; and point-of-care viral load testing. We analysed incident HIV infections among mothers and infants, intervention costs, and evaluated 190 scenarios of different combinations of inventions to calculate the incremental cost-effectiveness ratios (ICERs) over 1 year. Three interventions with the greatest reduction in vertical transmission, individually, were support groups for 80% of those in need (35% reduction in infant infections), HIV retesting schedules (6·5% reduction), and infant prophylaxis (4·5% reduction). Of all 190 scenarios evaluated, eight were on the cost-effectiveness frontier (ie, were considered to be cost-effective); all eight included increasing infant prophylaxis, regimen shift, and use of support groups. Excluding the highest-cost scenarios, for a 1-22% increase in total budget, 23-43% of infant infections could be prevented, producing ICERs between US$244 and $16 242. Using the interventions modelled, it is possible to reduce vertical transmission and to cost-effectively prevent up to 1734 infant HIV infections (43% reduction) in Zambia over a period of 1 year. To optimise their effect, these interventions must be scaled with fidelity. Future work is needed to incorporate evidence on additional innovative interventions and HIV risk factors, and to apply the model to other country contexts to support targeted implementation and resource use. The ELMA Foundation.