Lower-middle Income Economies Research Articles

Comprehensive disaster resilience index: Pathway towards risk-informed sustainable development

The occurrence of natural hazards on the earth is as universal as this universe. Though difficult to avoid or control, however, increasing resilience remains a crucial coping mechanism for disasters. This study focuses on the first target (SDG-13.1) of “Climate Action” which entails strengthening country-specific resilience and adaptive capacity towards natural disasters. Thus, we develop a novel comprehensive disaster resilience index that captures economic stability, emergency workforce, agricultural development, human capital, digitalization, infrastructure, governance, social capital, and women empowerment. We apply IMF index-making methodology using panel data of 62 indicators from 1995 to 2019 across 24 developed and 67 developing countries. Resilience index was higher in high-income countries (0.674) followed by upper-middle (0.463), lower-middle (0.372), and low (0.314) income economies. The top 5 countries with high resilience scores include Switzerland (0.789), Germany (0.777), France (0.751), New Zealand (0.749), and Australia (0.733). Disaster resilience score in 2019 was (a) greater than 0.7 for 9 countries, (b) between 0.5 and 0.7 for 31 countries, (c) between 0.3 and 0.5 for 44 countries, and (d) less than 0.3 for 7 countries. Our study recommends improvement in disaster resilience through risk-informed strategies (i.e., rescue and medical care services, early warning systems, training, and the latest technologies). It is recommended for low resilience countries to (a) increase the health budget and upgrade hospitals, (b) ensure economic stability and food security through agricultural growth and financial development, (c) enhance social and human capital, (d) introduce institutional reforms, and (e) empower women. Thus, improving resilience for preparedness, restoration, and loss minimization underpin the pathway towards risk-informed sustainable development.

Liquidity Shocks and The Bank Lending Channel: Evidence from Lower-Middle Income Economies

This paper examines the impacts of central banks’ liquidity injections on commercial banks’ credit supply in thirty-two lower-middle income economies over the period 1990 until 2020. We use a SVAR panel model to analyze the dynamic interactions between the central bank balance sheet policy, bank liquidity, and bank lending. The results show that liquidity injections have a non-significant impact on the credit to the private sector and a persistent positive impact on banks’ liquid reserves. These results confirm the inefficiency of the bank lending channel in transmitting the central bank balance sheet monetary policy to the real economy in the considered LMIC’s.

Feedback trading in global stock markets under uncertainty of COVID-19

PurposeAlthough some research has been carried out on feedback trading in different asset classes, there have been few empirical investigations that consider both major and emerging stock markets (Koutmos, 1997; Antoniou et al., 2005; Kim, 2009) stock index futures (Salm and Schuppli, 2010). In this study, the author examines positive/negative feedback trading in both developed-emerging-frontier-standalone (51) stock markets for 2010–2020 and sub-periods including COVID-19 period.Design/methodology/approachThe hypothesis “feedback trading behaviour led the price boom/bust in the stock markets during the first quarter of COVID-19 pandemic” is tested by employing the Sentana and Wadhwani (1992) framework and using asymmetrical GARCH models (GJRGARCH, EGARCH) in accordance with the empirical literature.FindingsThe following conclusions can be drawn from the present study; (1) There is no evidence to support a significant distinction between developed, emerging, frontier or standalone markets or high/upper middle, lower middle income economies in the case of feedback trading. It is more likely to be a general phenomenon reflecting the outcomes of general human psychology (2) in the long term (2010–2020) based on the feedback trading results Asian stock markets appear to be far from efficiency.Research limitations/implicationsStock markets are selected based on data availability.Practical implicationsSeveral inferences can be drawn about overall results. First, investors and portfolio managers should beware of their investment decisions during bearish market conditions where volatility is on the rise and also when there is a strong reaction to bad news/negative shocks in the market. Moreover, investing in Asia stock markets may require more attention since those markets are reputed to be more “idiosyncratic”, less reliant on economic and corporate fundamentals in their pricing. Moreover, the impact of foreign investors on stock market volatility and returns and weaker implementation of regulations also affect the efficiency of the markets (Lipinsky and Ong, 2014).Originality/valueTo the best of the author’s knowledge, most studies in the field of feedback trading in stock markets have only focused on a small sample of countries and second, the effect of COVID-19 uncertainty on the stock markets have not been addressed in the literature with respect to feedback trading. This paper fills these literature gaps. This study is expected to provide useful insights for understanding the instabilities in stock markets particularly under conditions of high uncertainty and to fill the gap in the literature by comparing the results for a large sample of countries both in the long term and in the pandemic.Highlights for reviewThis study has shown that feedback trading is more prevalent in Asian stock markets in the long run in Europe, America or Middle East for the period 2010–2020.Positive feedback traders generally dominated most of the stock markets during the early period of COVID-19 pandemic.Another major finding was that the stock markets in Malaysia, Japan, the Philippines, Estonia, Portugal and Ukraine are dominated by negative feedback traders which may be interpreted as “disposition effect” meaning that they sell the “past winners”.In Indonesia, New Zealand, China, Austria, Greece, UK, Finland, Spain, Iceland, Norway, Switzerland, Poland, Turkey, Chile and Argentina neither positive nor negative feedback trading exists even under uncertain conditions.

Understanding the socio-economic and environmental impacts of Ghana's change in economic status on the upstream cocoa supply chain

PurposeChange in the economic status of a low-income country is accompanied by an expected increase in investment and economic activities along with land degradation and biodiversity loss. This study aims to explore Ghana's transition from a low-income to a lower-middle income economy, and the impact of the accompanying rise in extractive activities on the upstream cocoa supply chain (CSC) and its supporting ecosystem.Design/methodology/approachThe author conducted interviews and made critical observations on Ghana's upstream CSC. Grounded theory (GT) and system dynamics (SD) methodologies were employed to extract and analyze themes from the data gathered. Causal loop diagrams were derived from the analyzed data to provide insight into the possible long-term structural behavior of the upstream CSC due to the change in Ghana's economic status.FindingsThe findings suggest that continuous increase in land capture by open-cast mining and logging concessionaires, poor environmental law enforcement and farmer discontentment could cause a decline in cocoa production and biodiversity.Originality/valueThis research could stimulate the identification of a most effective alternative policy (such as agroecological farming) to improve the living standards of upstream CSC partners and reduce biodiversity loss. The models herein could serve as a learning/demonstration tool for researchers, academia and policymakers when brainstorming students, or during stakeholder (community/society) engagement/consultation sessions, to discuss policy decisions and their consequences. The model approach could also be helpful when designing strategic land-use policies. This could improve understanding of the complex interdependent relationships and the consequences of land degradation, loss of biodiversity and rural livelihood from a system thinking perspective.

Exploring the Relationship between Energy Consumption and Economic Growth in Lower Middle and High Income Economies using Panel data Techniques

In this paper, the panel relationship between energy consumption (ECP) and economic growth (GDP), is investigated for the thirty-one countries from 1971 to 2014. These countries are divided into two panels based on lower-middle-income and high-income-level economies. Traditional ADF unit root test is used to confirm the stationarity at first difference. Also, four panel unit root tests, namely LLC (2000), IPS (1997, 2003), Fisher (1999), and Hadri (2000) tests confirmed the stationarity of variables for both panels at first difference. Furthermore, the long-run relationship between ECP and GDP is explored by four advanced panel cointegration techniques, i.e., Kao (1999), Pedroni (1999, 2004), Fisher (1999), and Westerlund (2007). Moreover, the pairwise panel causality test is used to identify the Granger causality between ECP and GDP. Lastly, the dynamic OLS (DOLS) estimator of Saikkonen (1991) and the fully modified OLS (FMOLS) estimator of Phillips and Hansen (1990) is used to estimate the parameters of the cointegration relationship. According to the empirical results, ECP and GDP are cointegrated for both panels. Long-run Granger causality running from GDP to ECP for both income level economies is also revealed. The energy conservation policies can play a vital role in boosting economic growth, especially for lower-middle-income economies.

Export Dynamics and Income Inequality: New Evidence on Export Quality.

Previous literature has highlighted the relationship between export diversification and income inequality. The present study attempts to explore the influence of export quality on income inequality. A global sample of 92 economies consisting of 30 low- and lower-middle-income economies (LMEs), 21 upper-middle-income economies (UMEs), and 41 high-income economies (HIEs) over the period 2002–2014, is collected to create a balanced set of panel data. Using econometric techniques for balanced panel data to deal with cross-sectional dependence, heteroscedasticity, and endogeneity, we first find that the effect of export quality is negative and significant on the Gini index pre-tax and pre-transfer in LMEs and UMEs, implying that export quality reduces income inequality. Second, export quality has a positive and significant impact on income inequality in HIEs. Our findings imply that different economic policies should be considered for dealing with income inequality among different income groups of economies.

Does economic complexity matter for the shadow economy?

Reflecting the geography of economic activities, economic complexity may be important for the shadow economy . This study is the first attempt to analyse the influence of economic complexity on the shadow economy. Analyses are carried out for 115 economies and three subsamples ( i.e., 45 low- and lower-middle-income economies (LMEs); 32 upper-middle-income economies (UMEs); and 38 high-income economies (HIEs)) from 1995 to 2017. Several estimates are applied to panel data, providing robust results. First , increases in economic complexity are found to ( i ) reduce the relative size of the shadow economy (% official GDP); while ( ii ) increasing the absolute size of the shadow economy (constant USD). This implies that economic complexity might have benefits for both the official and shadow economies, but the benefits for the official economy are likely dominant over the shadow economy. Second , economic complexity appears to have a negative influence on both the relative and absolute size of the shadow economy in the long run. Third , the analyses for the three subsamples add further findings. The influence of economic complexity on the shadow economy is found to be consistent in HIEs and LMEs, while economic complexity has a negative influence on both the relative and absolute size of the shadow economy in UMEs.

Validity of tourism-led growth hypothesis in Asia: new insight from a heterogeneous income group analysis

The paper investigates the validity of tourism-led growth hypothesis in 37 Asia economies with annual time series data spanning between 1995 and 2018. The region was disaggregated into three income groups (high-income economies, upper middle-income economies, and lower middle-income economies) respectively. In different sublets, the outcome of tourism receipts was positive and significant on economic growth for high income economies and lower middle-income economies respectively. Also, tourism expenditures appeared significant in high-income economies only. Overall, tourism-led growth hypothesis is valid in all the income classifications. Therefore, it is recommended that Asian economies across the income groups respectively should advance more policies that will stimulate sustainable economic growth. Second, policymakers in the upper middle-income countries should strengthen the link between the tourism industry and sustainable economic growth by building strong governance framework for proper accountability and remittance.

Measuring Early Impact of COVID-Pandemic Across Lower Middle Income Economies in South Asia Using Volatility Spillover Convergence Model with n-Phase Approach

Measuring Early Impact of COVID-Pandemic Across Lower Middle Income Economies in South Asia Using Volatility Spillover Convergence Model with n-Phase Approach

Results-based Monitoring and Evaluation of the Building Resilience to Climate-related Hazards Project: A Legendary Good Practice towards Climate Hazards Resilience

Nepal is a small landlocked country with complex topography and fragile geology which coupled with its lower-middle income economy, natural resources dependent population, and weak institutional capacity, all combine to rank it as the 4th most climate-vulnerable country in the world (http://maplecroft.com). A climate risk assessment carried out specifically for the Strategic Program for Climate Resilience (SPCR) at the sector, district and community levels identified the following critical risks: i) water quantity and quality, ii) food security, iii) ecosystem health, iv) animal and human health, v) vulnerable groups, and vi) economic growth and sustainability. Realizing this potential, the Government of Nepal (GoN) with support from the World Bank (WB) launched the Building Resilience to Climate-related Hazards (BRCH) Project in June 2013 with the aim to minimize overall climate risks in Nepal under the global initiatives of Pilot Program for Climate Resilience (PPCR). It is designed to demonstrate ways that developing countries can make climate risk and resilience part of their core development planning. The results-based monitoring adopted by the BRCH project is a legendary good practice in Nepal, an effective measure towards addressing climate hazards – the ultimate goal of the project and it could be instrumental for the South Asia as well.

Financial Inclusion between Financial Innovation and Economic Growth: A Study of Lower Middle Income Economies

Purpose: Financial inclusion is a key concern that has achieved much impulsion in the last two decades internationally. It has the scope of reporting of financial scheme and institutions to the underserved community in the economy. This study examined the effect of financial innovation on economic growth with the mediation of financial inclusion.
 Design/Methodology/Approach: To address the relationship researchers in this study have used measures from a dataset of low and lower middle income group economies over a sample period from 2010-2017.
 Findings: The results of this study shows that financial innovation creates opportunities for financially excluded segment of the society which results in financial inclusion that leads to economic growth of low and lower middle economies.
 Implications/Originality/Value: Study will provide new evidence that contributes new ways to improve low and lower middle economies towards economic growth by promoting financial innovation and financial inclusion.

The pesticide health risk index - An application to the world's countries

While the use of pesticides continues to rise worldwide, our understanding of the pervasiveness of associated contamination and the health risks humans may be exposed to remain limited to small samples size, and based on small geographic scales, the exposed population, or the pesticide types. Using our recent mapping of global pesticide use, we quantify three complementary health risk metrics for 92 active ingredients: (i) the pesticide hazard load (PHL); (ii) the population exposure (PE); and (iii) the human intake relative to the acceptable dose (INTR). We integrated these metrics into the pesticide health risk index (PHRI) to assess the standing of 133 nations against the global averages of PHL and PE and the acceptable levels of INTR using data of 2015 (PHRI > 1 indicates a concern). We found that some low-toxicity ingredients have PHL values equivalent to high-toxicity ones, and hence neglecting low-toxicity ingredients may cause biases in risk assessments. The geography of PHL, PE, and INTR show hotspots across the Americas, East and South Asia, and Europe, but with the EU27 countries generally showing lower PHL than other countries possibly due to strict governance on pesticide use. By our measure, about 1.7 billion people (24% of the world population) reside in close proximity to where pesticide applications are greater than 100 kg-a.i. km−2 year−1; about 2.3 billion people (32% of the world population) may exceed the acceptable pesticide intake and about 1.1 billion (15% of the world population) may exceed this by 10 fold. We identified 36 countries with PHRI > 1 and 6 countries with PHRI > 5; of these countries, 10 belong to lower-middle and low income economies. Our analyses show that proximity exposure to pesticides may be more widespread than revealed in occupational studies, and therefore assessments of potential health effects over wider scales may be needed.

The Vulnerability Effect of International Tourism on a Destination’s Economy

ABSTRACT This study investigates how international tourism influences economic vulnerability for 69 economies, consisting of 36 low- and lower-middle-income economies (LMEs), and 33 upper-middle-income and high-income economies (UHEs). By applying assorted panel data estimations, the study finds that, first, international tourism increases the economic vulnerability of destination countries, and second, an analysis of two subsamples confirms the increasing effect of international tourism on economic vulnerability for UHEs. Surprisingly, the ratio of visitor spending to GDP impacts economic vulnerability negatively in LMEs, while the effect of the ratio of visitor spending to exports is positive. Some important policy implications have been raised. Lastly, the results have been checked for robustness by different estimators and strategies.

Determinants of COVID-19 vaccine acceptance in the Arab world: a cross-sectional study

BackgroundThe Arab region is highly affected by the COVID-19 pandemic. Local governments have already started to act against the disease. However, only a few countries provided COVID-19 vaccination. Compliance with vaccination is a major topic affecting proper coverage. Thus, we aim to explore vaccine acceptance among Arab populations, and compare it with the global numbers.MethodsAn internet-based survey using social media platforms was conducted, targeting adults who were able to read and understand Arabic, had access to the internet, and from all 22 Arab league countries. Due to the response rate variation between participants, the countries were grouped into four categories based on their income: Low income, Lower-middle income, Upper-middle income, and High-income economies. Data about demographics, previous COVID-19 infection, and vaccine acceptance tendency were collected and analyzed using Chi-squared (χ2) test and Logistic regression.ResultsA total of 870 participants completed the survey. 59.3% of the participants were male, 53.3% were between 25 and 44 years, and 69.9% were Arabs who live inside of their home country. The COVID-19 vaccine acceptance rate was 62.4%. A significant higher tendency toward vaccination was identified in males (65.4%, P = 0.04) and people living outside their home countries (67.9%, P = 0.02). However, age group, level of education, and previous COVID-19 infection were all factors with insignificant effect. Citizens of High-income countries were more likely to accept the vaccine (70.2%).ConclusionsLess than two-thirds of Arabs are compliant with COVID-19 vaccination. This proportion is relatively lower than the global rate. It is important to develop strategies to promote vaccine acceptance and reach the ideal coverage needed to achieve efficient immunization.

An integrated policy framework and plan of action to prevent and control plant invasions in India

Biological invasions are a major global challenge for the conservation of biodiversity, maintenance of ecosystem health and sustainable livelihoods. As the number of novel introductions of invasive species is predicted to increase due to rising trade volumes in the emerging economies, regulatory policies to prevent the introduction and spread of invasive species are of paramount importance. However, poor response capacities, lack of coordination between stakeholders, heavy dependence on biological resources and little public awareness are some of the formidable barriers in framing and implementing such policies in developing countries.This study was conceptualized to establish common ground by considering the diverse interests of different actors and design a policy framework to control invasive alien plant species (IAPS) in the lower-middle income economies considering India as a case study. To achieve this objective, we evaluated the introduction pathways and current economic uses of IAPS in India and critically reviewed the infrastructure and current response capacity of the country for regulating pre- and post-border trading of these problematic species. We found that the majority of IAPS were introduced for ornamental purposes and some of them are still actively traded and used for several economic purposes. Despite having a rich legacy of environmental policies, a legal framework exclusively to deal with invasive species is non-existent in India. Here, we propose a set of policy interventions, for international and domestic trading, by integrating trade regulations based on a risk assessment framework with interests of both consumers and traders to ensure effective compliance from all stakeholders. Further, we identify potential hurdles for policy implementation in India and therefore, based on the existing biosecurity infrastructure, we outline an operable and dynamic decentralized system having a standard operating procedure to ensure coordination between different stakeholders, increase public awareness and guide further research direction.

Policy implications of remittances, trade liberalization and Dutch disease – A comparative analysis based on income categorization

Prior research does not provide any consensus on whether Dutch disease can be caused by international remittances. However, remittances cause sectoral imbalances, which may adversely affect the economy. This study's main objective is to determine the impact of remittances on the real exchange rate movement from 1999 to 2019 in 199 countries and territories. This paper will apply the one-step system Generalized Methods of Moment (S-GMM) to the linear dynamic panel data (DPD). This study's main findings indicate that remittances have a depreciating effect on the exchange rate in all countries and in lower-middle-income countries. In comparison, the first lag of remittances has a significant negative impact in high-income countries but a significant positive impact in lower-middle-income countries. The results indicate that lower middle income and low-income economies should adopt macroeconomic policies to neutralize the Dutch disease. From a policy perspective, the imposition of a variable tax or retention on the exports will increase the exporters' cost, and the exchange rate will depreciate accordingly. Such a policy formulation would allow countries to recover from Dutch disease while instigating trade of commodities, which could benefit the economy in the long run. The self-balancing mechanism would also protect the economy against long-run depreciation of currency value.

POS-593 ISN SISTER RENAL CENTRES PROGRAMME: ESTABLISHING AND SUSTAINING TUNNELLED VENOUS DIALYSIS LINE PLACEMENT IN PORT HARCOURT, NIGERIA

Under the auspices of the International Society of Nephrology Sisters Renal Centres programme, Renal centres from Port Harcourt, Nigeria and Salford UK have maintained collaboration in various aspects of kidney care. A key issue in sustaining dialysis care in a lower middle income economy is access for haemodialysis (HD). Before this project all HD access was via temporary femoral vein lines inserted for a single dialysis session. Pre-visit video conferencing provided educational and planning opportunities in the delivery of peritoneal dialysis for acute kidney injury (AKI). A Nigerian kidney doctor in training visited the UK centre to gain first-hand experience of line insertion techniques. An initial visit to the sister hospital was undertaken by UK nephrologists with special interests in dialysis and interventional nephrology. A pop-up dialysis access workshop was undertaken in the dialysis unit over 3 days for junior and senior doctors and members of the multi-disciplinary team: Didactic teaching on dialysis access methods Small group teaching on the basics of HD, PD and prescriptions Simple and sustainable training tools for basic surgical procedures, HD and PD catheter insertion and Seldinger technique Dialysis access ultrasound training with volunteers examining abdominal anatomy and vascular access imaging Hands on training with simple access phantoms, made from accessible materials for ongoing practice. Tunnelled haemodialysis line insertion was achieved by local and visiting nephrologists, unique to the dialysis centre which normally relies on temporary femoral venous access. All three patients achieved successful permanent venous line access without complication. The local nephrologist was able to place catheters with the visiting interventional nephrologist closely supervising. The procedures were recorded to allow analysis and reflection on the procedures. Since the 4 lines have been successfully inserted by the local nephrologist. This has been supported with ongoing video and telephone links. This has allowed continued updates on technique, difficulties and complications. One episode of local exit site bleeding was encountered and managed with follow up calls and advice. Covid 19 has precluded the planned follow up visits. This has highlighted the issues of keeping colleagues up to date and maintaining skills when practice is significantly altered. The collaboration is investing in more robust internet communication to facilitate teaching and mentorship while planning the next part of the project to establish a peritoneal dialysis programme. Significant gains have been made on our journey to establishing long term HD vascular access for the dialysis patients in Port Harcourt Teaching Hospital, despite the major obstacles faced.

Achieving SDG target 8.1 (sustain economic growth) in developing countries: how aid for trade policy and regulations can assist?

PurposeThis study aims to examine how aid for trade policy and regulations (AfTPR) contribute to achieving Sustainable Development Goal (SDG) target 8.1 (sustain per capita economic growth) and whether the effectiveness of AfTPR is conditional to the stable political environment.Design/methodology/approachThis paper uses a widely accepted endogenous growth framework and applies panel data fixed effects and two-step difference and system generalized method of moments estimation strategies on panel data of 50 developing countries over 2005–2017.FindingsThe findings of the study confirm that aid to trade policy promotes sustainable economic growth in developing countries, but this category of development assistance is only effective and significant for low and lower middle-income (LLMI) economies. The positive and significant effect of AfTPR in upper middle-income countries is conditional to their level of political stability. Under a stable political situation, the positive effect of AfTPR on sustainable growth remains almost same for the LLMI countries, whereas for the upper middle-income countries this growth effect reached almost double.Research limitations/implicationsInternational trade is considered as a driver for inclusive and sustainable economic growth, whereas aid for trade is acknowledged for its prospective contribution toward achieving these goals. The findings have dominant policy implications for the international development organizations and donors, which recommend that it is more desirable to transmit aid toward developing and implementing trade policy and regulations as per capita economic growth improves in the aid recipient countries.Originality/valueAccording to the authors’ knowledge, no prior study empirically analyzes the effect of AfTPRs on SDG target 8.1.

Abstract PS7-21: Timelines to initiate an adjuvant phase III trial across the globe: A sub-analysis of the APHINITY trial

Abstract Background:Previous analysis of an adjuvant breast cancer trial (NCT00490139) suggested that geographical location and income affected the time required to set up a clinical trial, being significantly longer in South American and upper-middle income economies, potentially affecting access of innovative therapies in these locations. Understanding that this can be a dynamic process, we performed a similar analysis for the recent global phase III APHINITY trial (NCT01358877), which investigated the addition of pertuzumab to chemotherapy and trastuzumab as adjuvant therapy for patients with HER2-positive primary breast cancer. Methods:Time to regulatory authority (RA) submission to approval, time to ethics committee/institutional review board (EC/IRB) approval, time from study approval by EC/IRB to first randomized patient, and time from first to last randomized patient were collected prospectively. Analyses were conducted by grouping countries either by geographical region or economic income classification as per 2019 World Bank criteria. Descriptive statistics of medians and ranges were calculated for the different timelines evaluated. Differences between geographical regions and economic income classification groups were calculated using one-way analysis of variance (ANOVA) following data normalization on square roots of the time to local RA. Geographical regions represented by only one participating country were not included in the ANOVA calculations. Results:APHINITY randomized 4805 patients between November 2011 and August 2013. Of the 42 participating countries, 41 had data available regarding all relevant timelines. Of those, 21 (51.2%) were located in Europe, 9 (21.9%) in the East Asia-Pacific region, 8 (19.5%) in Latin America and Caribbean, 2 (4.8%) in North America, and 1 (2.4%) in Sub-Saharan Africa. Twenty-seven (65.8%) of the participating countries had high, 11 (26.8%) upper-middle, and 3 (7.3%) had lower-middle income economies. Except for time from first patient to last patient randomized, there was wide variation in timelines within geographical region and across economic income classification. For example, the median time from EC/IRB approval to first recruited patient across all geographical regions was 118 days, but the range was wide (13– 463 days). There was, however, no statistical difference between the time to RA according to geographical region (p=0.47) although there was a trend to longer time to RA in upper-middle income economies compared to the others (p=0.07). Conclusion Our results did not demonstrate a significantly longer time for trial activation in Latin American & Caribbean countries and upper-middle income economies compared to other groups in the APHINITY trial. When compared to a previous report, this may reflect collective work from collaborative research groups, pharmaceutical industry sponsors and regulatory authorities across the globe and is to be welcomed. Variability in timelines within geographical regions and income classifications may exist and should be further investigated. Table 1: Timelines in the activation process of APHINITY across geographical region and economic income classification.Time to RA (days)*Time to EC/IRB (days)Time from EC/IRB approval to first patient (days)Time from first patient to last patient randomized (months)Europe and Central Asia56 (4-135)67 (22-164)109 (13-257)17.6 (13.2-21.7)North America31 (30-32)73 (19-126)126 (86-165)17.6 (13.8-21.5)East Asia and Pacific53 (15-372)67 (31-421)108 (56-147)18 (8.7-19.9)Latin America and Caribbean51 (15-276)43 (19-273)232 (98-463)14.6 (6.5-17.5)Middle East and North Africa-141 (141-141)92 (92-92)13.9 (13.9-13.9)Sub-Saharan Africa103 (103-103)14 (14-14)185 (185-185)18.2 (18.2-18.2)Overall53 (4-372)56 (14-421)118 (13-463)17 (6.5-21.7)High income45 (4-276)60 (19-273)98 (13-257)18.2 (11.9-21.7)Upper middle income92 (15-372)54 (14-421)185 (73-463)14.2 (6.5-18.2)Lower middle income55 (32-111)33 (32-78)201 (147-209)15.1 (13.5-17.4)Overall53 (4-372)56 (14-421)118 (13-463)17 (6.5-21.7)Data are medians (range)*The protocol was not submitted to a country regulatory authority for Israel. The corresponding timelines for Israel cannot be calculated.EC/IRB = ethics committee/institutional review board; RA = regulatory approval Citation Format: Maria Alice Franzoi, Marion Procter, Orianne Emond, Damien Parlier, Noam Pondé, Daniel Eiger, Sebastien Guillaume, Linda Reaby, Christopher Twelves, Emma Clark, Evandro de Azambuja, Jose Bines. Timelines to initiate an adjuvant phase III trial across the globe: A sub-analysis of the APHINITY trial [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-21.

Export quality dynamics: Multidimensional evidence of financial development

AbstractThis study examines the impact of financial development on export quality. Financial development is proxied by the overall financial development index, its two sub‐indices (financial institutions index and financial markets index) and three dimensions of each sub‐index. The study begins by examining the causality between financial development indicators and export quality. The influences of financial development indicators on export quality are then investigated. Econometric techniques are applied for 49 low‐ and lower‐middle‐income economies (LMEs), 31 upper‐middle‐income economies (UMEs) and 48 high‐income economies (HIEs) over the period 2002–14, which was chosen on account of data availability. The predominant finding is significant bidirectional causality between financial development indicators, as well as their dimensions, and export quality. Notably, most financial development indicators and their dimensions are found to have significant positive effects on export quality for both HIEs and LMEs, while two dimensions of the financial institutions indicator have no significant impacts in the case of UMEs.