Mean Efficiency Score Research Articles

Technical efficiency analysis of advanced medical centers in Burkina Faso

IntroductionBurkina Faso faces many challenges in the health domain, with no real opportunity for an increase in public health expenditures. In Burkina Faso, as in all low-income countries, health spending efficiency is crucial. The objective of this paper is to assess the efficiency of Advanced Medical Centers (AMCs)—which correspond to district hospitals—in Burkina Faso over the 2017–2020 period and identify the factors that promote—or, on the contrary, limit—the efficiency of these health structures.MethodWe first assessed the efficiency level of the 45 AMCs running in the country between 2017 and 2020 using a bootstrap Data Envelopment Analysis (DEA) methodology. Inputs include the number of doctors, nurses, other medical staff, non-medical staff, and beds, while output variables correspond to the number of inpatients, surgeries, outpatients, and inpatient days. In a second step, determinants of AMC’s efficiency levels were explored using a double-bootstrap procedure. The roles of AMCs’ internal and environmental factors were both considered.ResultsWe found a mean efficiency score of 0.51 over the study period, indicating that AMCs could have almost doubled their healthcare production without needing additional resources. The size, education level, and health status of the covered population and the density of the healthcare supply in the district appeared to be the driving factors of AMCs’ efficiency.ConclusionOur results indicate that improving the efficiency of AMCs should be a high-level priority for the Burkinabe health policy. Resources could be reallocated across AMCs to increase the overall efficiency of the health system.

Holistic Evaluation of the Gut Microbiota through Data Envelopment Analysis: A Cross-Sectional Study

BackgroundThe gut microbiome plays a crucial role in human health, but maintaining a healthy gut microbiome remains challenging. Current approaches often focus on individual components rather than providing a holistic assessment. ObjectivesTo introduce and evaluate a novel approach using data envelopment analysis (DEA) for assessing gut microbiota efficiency and identifying potential targets for personalized interventions. MethodsWe conducted a cross-sectional analysis of 577 participants from the Kanagawa “ME-BYO” Prospective Cohort Study. Lifestyle factors and gut microbiota composition were assessed. DEA was employed to calculate an efficiency score for each participant, incorporating multiple inputs (lifestyle factors) and outputs (gut microbiotas). This score represents how efficiently an individual’s lifestyle factors contribute to their gut microbiota composition. Tobit regression analysis was used to assess associations between efficiency scores and demographic and health-related factors. ResultsThe mean efficiency score was 0.86, with 14.2% of participants classified as efficient. Efficiency scores showed positive correlations with alcohol intake and Faith's phylogenetic diversity. Tobit regression analysis revealed significant associations between efficiency scores and sex, fat intake, and yogurt consumption. DEA identified specific targets for improving gut microbiota composition in inefficient individuals. ConclusionsThis study demonstrates the potential of DEA as a tool for evaluating gut microbiota efficiency and providing personalized recommendations for microbiota optimization. This approach could lead to more effective strategies for optimizing gut health across diverse populations.

Technical Efficiency of Artisanal Fishing Households in Malawi

This study assesses the technical efficiency of artisanal fishing households in Malawi using the stochastic production frontier model, particularly, the Cobb-Douglas model. The specific objectives of the study were two-fold: to measure the productivity of the artisanal fishers in Malawi and to find the determinants of their technical efficiency. The study used data obtained from the Malawi’s Fifth Integrated Household Survey (IHS-5), and results indicate that artisanal fishers are highly productive as the Cobb-Douglas stochastic frontier production function exhibited increasing returns to scale. The study also found that the artisanal fishers are technically efficient as their mean technical efficiency score is about 99 percent, implying that on average, a typical artisanal fisher operates only 1 percent below the maximum potential output. Furthermore, the study findings indicate that amount of money a household pays as rent for a fishing gear, the number of fishers hired, and the number of fishing gears operated by a household are positive determinants of technical efficiency among artisanal fishers; whereas the payment to hired fishers on credit is a negative determinant of technical efficiency among the artisanal fishing households in Malawi. Hence, two-fold policy implications emanate from the study as follows: Firstly, in order to promote technical efficiency of the artisanal fishing households in Malawi, policymakers need to intensify efforts aimed at encouraging spawning of fish by, strictly, prohibiting fishing in the fish spawning months. Secondly, policymakers need to encourage the artisanal fishers to subsidize the productive inputs in the artisanal fisheries sub-sector such as fishing gears and boats, and improve fishers access to credit.

The efficiency evaluation of traditional Chinese medicine hospitals by data envelopment analysis in Zhengzhou, China.

This study aimed to evaluate the operational efficiency of traditional Chinese medicine (TCM) hospitals in China. Pearson's analysis was used to test the correlation between the input and output variables. Data envelopment analysis (DEA) was utilized to analyze the input and output variables of 16 TCM hospitals, and each hospital efficiency score was computed by Deap 2.1, assuming variable return to scale (VRS), which is an input-oriented model. t tests were conducted to confirm the significant difference of efficiency scores at the hospital level and by hospital type, and ANOVA was used to test for significant differences in efficiency scores according to hospitals' size. The correlation coefficient of the input and output indicators was between 0.613 and 0.956 (p < 0.05). The difference in number of doctors (ND) and numbers of pharmacists (NP) were statistically significant (p < 0.05) at the hospital level. The mean efficiency scores for technical efficiency (TE), pure technical efficiency (PTE), and scale efficiency (SE) in secondary TCM hospitals were 0.766, 0.919, and 0.838, respectively. Additionally, the lowest TE, PTE, and SE were 0.380, 0.426, and 0.380, respectively. Eight TCM hospitals in this study were DEA efficient, with an efficiency score of 1. There were no statistically significant differences in TE, PTE, and SE among hospital levels, hospital types or hospital sizes groups (p > 0.05). This study revealed that tertiary TCM hospitals had a greater level of efficiency than secondary TCM hospitals. In our study, 50% of TCM hospitals had inefficient management. Therefore, to activate the new development power of TCM hospitals, it is necessary to reform and improve the management system and mechanism of TCM hospitals, optimize the development environment of TCM hospitals and formulate development plans and measures based on local conditions.

Efficiency evaluation, regional technological heterogeneity and determinant of total factor productivity change in China’s healthcare system

Enhancing efficiency and productivity in countries’ healthcare systems is a global challenge. The Chinese government invested huge resources to improve the efficiency and productivity of the healthcare system across the country. To assess the success of the mission above, this research utilized DEA-SBM Meta frontier analysis alongside the Malmquist Productivity Index. These methodologies were employed to gauge Efficiency, production technology heterogeneity, and productivity of healthcare systems change across 31 mainland Chinese provinces and four distinct geographical regions throughout the study period spanning from 1997 to 2022. Results revealed that the mean efficiency score of China’s healthcare system is 0.7672. It indicates a growth potential of 23.28 percent in the operational efficiency of healthcare systems. The eastern region’s efficiency level (0.86917) is higher among all four regions. Zhejiang, Shandong, and Guangdong are the top three healthcare-efficiency performers. The technology gap ratio indicates that eastern regions witnessed a high TGR (0.9909), showing the country’s attainment of superior healthcare technologies. Beijing, Guangdong, Shanghai, Tianjin, and Zhejiang witnessed higher TGR values among all 31 mainland Chinese provinces. The total factor productivity index of the healthcare system witnessed a slight growth of 0.33%, with an average MI score of 1.0033. Efficiency change (EC) was found to be the main determinant of TFPC as technology change TC is less than EC. Moreover, the MI score of the Western region (1.033) is higher than the corresponding Eastern, northeastern, and central regions. Guizhou, Anhui, and Yunnan were found to be the top three performers in TFPC growth. Finally, the Kruskal–Wallis test confirmed the statistically significant difference among 4 Chinese regions for the healthcare system’s efficiency, TFPC, and TGR.

Can performance-based financing improve efficiency of health centers in Ethiopia? A Malmquist Productivity Index analysis

IntroductionThe Ethiopian government has introduced several healthcare financing reforms intending to improve efficiency. Piloting implementation of performance-based financing is one of these actions. The purpose of this research is to assess the efficiency of healthcare facilities that have implemented performance-based financing compared to those that have not.MethodsEfficiency was measured using a nonparametric data envelopment analysis and the Malmquist Productivity Index technique. Total factor productivity change, technical change, and technological change are compared across eight sampled healthcare facilities that are implementing performance-based financing and eight that are not in Ethiopia.ResultsHealth facilities implementing performance-based financing have a mean technical efficiency score of 64%, allowing for a potential 36% reduction in inputs without affecting outputs. Their scale efficiency is 88%, indicating a potential 12% increase in total outputs without expanding facilities. In contrast, facilities not implementing performance-based financing have a mean technical efficiency score of 62%, with a potential for 38% input reduction without affecting outputs. Their scale efficiency is 87%, suggesting a potential 13% increase in total outputs without scaling up facilities. Among the 16 healthcare facilities observed, seven experienced a decline in the mean total productivity, while one remained stagnant. The remaining eight facilities witnessed an increase in productivity. The healthcare facilities implementing performance-based financing showed a 1.3% decrease in mean total productivity during the observed period. Among them, five showed an increase and three showed a decrease in the total factor of productivity. The mean total factor of productivity of all healthcare facilities not implementing performance-based financing remained stagnant over the three-year period (2019–2021), with four showing an increase and four showing a decrease in total productivity.ConclusionsThe study concludes that implementing performance-based financing did not improve productivity levels among healthcare facilities over three years. In fact, productivity decreased among the facilities implementing performance-based financing, while those not implementing it remained stagnant. This shows health facilities that implement performance-based financing tend to utilize more resources for similar outputs, contradicting the anticipated efficiency improvement.

Profit Efficiency of Milk Producers in Ethiopia: Empirical Evidence from Western Shewa Milk Shade, Walmara District

The study assessed the profit efficiency and the responsible factors for the inefficiency of dairy farmers in West Shewa milkshed, central Ethiopia. A multistage random sampling method was employed to select sample households. The primary data were collected using structured questionnaires with computer-assisted personal interviews (CAPI). Descriptive and econometric data analysis were performed, and the stochastic frontier model was the model used. The result disclosed that the dairy business is profitable, and the mean efficiency score is 71%, indicating the existence of 29% inefficiency in dairy farming. This result indicates that enhancement of all the efficiencies will enable households to attain a potential profit of 88428.25 birrs. Sex, the price of milk, and the number of cows owned were the main factors that affected the profit inefficiency of the dairy farmers. This study suggests that the profit efficiency of dairy farmers will be enhanced if they choose their dairy farm sizes based on the production resources they have, and if the milk collection centers are availed in all villages.

Optimising nutrition and consumption for better health: An analysis of noncommunicable disease strategies in the organisation for economic co‐operation and development nations

AbstractThe role of nutrition in promoting health and reducing the prevalence of noncommunicable diseases (NCDs) is vital, yet both inadequate and excessive food consumption can be detrimental. Moreover, excessive smoking and alcohol consumption contribute to higher mortality rates. Countries have implemented policies, strategies, and awareness campaigns to combat NCD‐related deaths. Within this context, the study aims to assess the relative efficiency of Organisation for Economic Co‐operation and Development (OECD) countries in preventing chronic NCDs by considering nutritional supply and smoking and alcohol consumption as inputs. It also seeks to identify countries' best policies and strategies to reduce regular NCD‐related death rates, emphasizing the importance of selecting and implementing adaptive strategies locally. This study employs slack‐based measurement (SBM) data envelopment analysis (SBM‐DEA). The mean efficiency score across the countries is 0.95, with a standard deviation of 0.09, indicating a generally high‐efficiency level. Twenty‐nine countries with an efficiency score of 1 are deemed relatively efficient. Austria, Belgium, Germany, Greece, Ireland, Korea, Luxembourg, the United Kingdom, and the United States did not achieve relative efficiency in NCD management. The findings highlight the importance of considering the unique context of each country when designing and implementing NCD prevention and management strategies. The study emphasizes the need for regular evaluation and appropriate measurement methods to assess the achievement of targets and address implementation challenges. Furthermore, it highlights the significance of adopting a comprehensive, coordinated approach to ensure the effectiveness of NCD policies and underscores the need for flexibility and adaptability in addressing NCDs.

Level of technical efficiency and associated factors among health centers in East Gojjam Zone, Northwest Ethiopia: an application of the data envelopment analysis

BackgroundBesides the scarcity of resources, inefficient utilization of available health service resources has been the bottleneck to deliver quality health services in Ethiopia. However, Information regarding the efficiency of health service providers is limited in the country. Health service managers and policy makers must be well informed about the efficiency of health service providers and ways of using limited resources efficiently to make evidence-based decisions. This study aimed to assess the level of technical efficiency and associated factors among health centers in East Gojjam Zone, Northwest Ethiopia.MethodsA facility-based cross-sectional study was conducted among 27 randomly selected health centers in East Gojjam zone, Northwest Ethiopia, from October 30, 2022, to April 30, 2023. Using an interviewer-administered questionnaire and document review checklist, health centers’ data was collected and entered to Epi-Data version 4.6. The data was exported to Microsoft office excel and Stata version 14 for analysis. A two-stage output-oriented data envelopment analysis with a variable return to scale assumption was employed to determine the level of technical efficiencies. Finally, the tobit regression model was applied to identify the associated factors at 5% level of significance.ResultsIn this study, 59.3% of the health centers were technically efficient. The mean technical efficiency score of the health centers was 0.899 ± 0.156. Inefficient health centers could provide more 22, 433 outpatient visits, 1,351 family planning visits, 155 referral services, 206 skilled deliveries and 385 fully vaccinations of children if they were technically efficient as their peer health centers for the same year. From the tobit regression, the catchment population and number of administrative staffs were statistically significant determinants of the technical efficiency of health centers.ConclusionsThe mean technical efficiency of the health centers in East Gojjam zone, Northwest Ethiopia was high. However, nearly half of the health centers were technically inefficient, which indicates the exitance of a space for further improvements in the productivity of these health centers. Employing excess number administrative staffs (above the optimal level) should be discouraged and selecting appropriate sites where the health centers to be constructed (to have large catchment population coverage) could improve the productivity of health centers.

The Effects of Body-Worn Cameras on Police Efficiency: A Study of Local Police Agencies in the United States

Research on body-worn cameras (BWCs) has burgeoned in recent years. However, much of this research has not examined the effects of this technology on police performance. In this study, we created a novel dataset on police organizational inputs and outputs and assessed the effects that BWCs have on police efficiency. Using a multiple-stage approach, in the first stage, we estimated the efficiency of local police agencies using a robust order- m efficiency model. In the second stage, we assessed the effects of BWCs using a range of matching estimators and an instrumental variable (IV) model. The first-stage results show that police agencies could improve their efficiency by 2% (from a mean efficiency score of 0.98 to 1). The second-stage matching and IV estimates suggest BWC effects on efficiency range between four and six percentage points in our preferred model. The introduction of this significant technological advance has brought many benefits to police agencies. Our findings show that BWCs can help improve police efficiency, yielding significant cost savings to law enforcement.

Determinants of Technical Efficiency in Cow Milk Production in Kurunegala District: An Application of Data Envelopment Analysis

The aim of this study was to determine the level of technical efficiency scores under the assumptions of both constant returns and variable returns to scales on a sample of 150 cow milk producers in Kurunegala District, Sri Lanka. A structured questionnaire was used to gather the data during 2022 in the study and those data were analysed by Data Envelopment Analysis and Tobit regression model. Results of the data envelopment analysis based on input - oriented reveal that, mean technical efficiency scores estimated for constant returns and variable returns to scales were 0.782 and 0.887, respectively, indicating that substantial inefficiencies occurred in operations among the sample farmers. Further, with respect to returns to scale, out of the 150 dairy farmers, 21 were found to be operating at the constant returns to scale while, 122 and 7 were operating at an increasing return to scale and decreasing returns to scale respectively. Tobit regression model was applied to examine the factors influencing the technical efficiency under the specifications of constant returns to scale, variable returns to scale, and scale effects. The study found that age, sex, family size, credit accessibility, and milking frequency were significantly influence the technical efficiencies in dairy farming. These findings could help to increase the milk production and technical efficiency of cow milk production in the study area.

Technical Efficiency of Broiler Production in Delta State, Nigeria

Purpose: The study examined the technical efficiency of broiler production in Delta State, Nigeria. Specifically, it determined the effects of socio-economic characteristics of the farmers on production output, determined the profitability of broiler production, and established the levels of technical efficiency attained by the farmers. It also ascertain the socio-economic factors of the farmers that influence their technical efficiency levels; assessed the nature of returns to scale and elasticities of broiler production inputs; and identified the constraints to broiler production in the area. A survey research design approach was used in the study. Multistage random sampling technique was used to select 240 registered broiler farmers. Primary data were collected in the 2019 production season using structured questionnaire administered to the respondents by personal interview. Methodology: Descriptive and parametric statistics such as frequencies, means, percentages, ratios, enterprise budgeting, profit function regression and Cobb-Douglas stochastic frontier regression techniques were used in data analysis. Findings: Findings indicated that broiler production output was significantly influenced by age, household size, farm size, farming experience and cost of feeds while gender, marital status, educational level, access to credit and extension visits were not significant. Mean technical efficiency scores of 0.94 was attained with 0.97 maximum and 0.90 minimum. Output elasticities with respect to farm size, labour, capital and feeds were 0.42, 0.13, 0.13 and 0.17 respectively. Technical efficiency of the farmers was significantly influenced by educational level, farming experience, household size, gender and access to credit, but weakly determined by age. Broiler farms operated at decreasing returns to scale. Major constraints to broiler production in the area arranged in descending order of seriousness were high cost of feeds, inadequate capital, high cost of labour, parasites and diseases, high mortality rate and inadequate feeds. Unique contributor to theory, policy and practice: Policy measures such as increased budgetary allocation to livestock production, subsidization of inputs, provision of soft loans to broiler farmers by relevant institutions, provision of requisite infrastructures and improved funding of extension agencies to enhance information dissemination to broiler farmers are advocated.

An integrated approach for evaluating and improving the performance of hospital ICUs based on ergonomic and work-motivational factors

The intensive care unit (ICU) holds significant importance in hospitals. Primarily concerned with monitoring and providing care to critically ill patients, the ICU has proven effective in reducing mortality rates and minimizing complications of diseases, thanks to the highly complex and specific measures taken within this department. Considering the unique contributions made by the staff in this unit, its performance assessment can help improve patient care and satisfaction. This study presents a framework that utilizes ergonomic and work-motivational factors (WMFs) to assess the performance of various ICUs. Upon the identification of these indicators, a standard questionnaire is developed to collect the required data. The mean efficiency score of the units is then determined using the data envelopment analysis (DEA). The model is validated using the principal component analysis (PCA). Ultimately, the SWOT (strengths, weaknesses, opportunities, and threats) matrix is employed to formulate an appropriate strategy and offer improvement measures to the managerial team to enhance their ICU performance. The proposed framework can be applied to evaluate the performance of other healthcare departments. Among the studied ICU centers, including general ICU, isolation ICU catering to individuals with infectious diseases, cardiac care unit (CCU), and neonatal ICU (NICU). NICU and general ICU have the best and worst performance in terms of macro- and micro-ergonomic and motivational indicators, which are on average 0.826% more elevated and 0.659% lower, respectively. According to the performed sensitivity analysis, the ICUs in question demonstrate the most appropriate and inappropriate performance about the indicators of “knowledge, situation assessment, and situation analysis” and “work stress”, respectively.

A systematic review and meta-regression analysis of technical efficiency in Ethiopian wheat farming

Replications are important for science, both statistically and philosophically. A plethora of empirical studies that have been done so far show that there are always variations, errors and inconclusive findings on the technical efficiency (TE) scores of wheat output in Ethiopia. In this study, we intend to contribute to these controversies by providing the first thorough investigation of the magnitude of mean-effect size and the underlying factors of mean technical efficiency variations in wheat production across studies in Ethiopia. These efficiency scores are retrieved from 31 studies, or a household size of 12,754 over the years 2011–2022. The analysis of meta-regression was done using a random effect model using Comprehensive Meta-analysis (CMA-4) software. The Begg and Mazumdar rank-correlation test, egger test, and funnel plot were used to determine publication bias across studies. Since 2022, we have utilized the classic fail-safe-N test. One issue with publication bias is the omission of some non-significant studies from the analysis, which, if they were included, would cancel out the observed effect. Further, the missing study problem or “file drawer” problem, of the study would also be computed using the “Trim and Fill” estimation approach. To evaluate heterogeneity, a forest plot is used. The effect size is also determined using the random effect model along with the I-squared statistic, the tau-squared and tau, and the Q-test. As a result, a mean effect size of 71.6% with a 95% confidence interval of 67.9%−75.3% is observed. The meta-regression demonstrates that the 31 mean technical efficiency studies included in the research had varying efficiency scores due to variations in sample size, methodologies used, publication status, and study range. It suggests that, with all other factors held constant, a 1% change in these regressors causes a 0.01%, 10.88%, 21.22%, and 6.74% change, respectively, in the mean technical efficiency scores across studies in Ethiopia. In addition, the technical efficiency score across studies is also affected by the location in which the study is conducted.

Technical Efficiency Difference between Model and Non-Model Smallholder Wheat Producer Farmers in Lode Hetosa Woreda of East Arsi Zone of Oromia Regional State, Ethiopia

The smallholder farming system in Ethiopia is largely dominated by staple food crops which are exposed to managerial inefficiency and factors beyond the control of the farmer. Accordingly, the study aimed to analyze technical efficiency differences between model and non-model smallholder wheat producer farmers and inefficiency determinants in Hetosa Woreda of East Arsi Zone. The Stochastic Production Frontier Cobb-Douglas functional form was used. To analyze cross-sectional data collected from 700(350 model and 350 non-model) farmers for the production year of 2018/19, descriptive and econometrics data analysis techniques were used. The findings of the descriptive analysis showed that model farmers produced an average of 32.82 and non-model farmers produced on average 29.36 quintals of wheat per hectare. The value of the discrepancy ratio (γ) which indicates technical inefficiency variability was 89%, 82%, and 84% for the model, non-model, and overall farmers respectively. The mean technical efficiency score was 81%, 79%, and 80% for the model, non-model, and overall farmers respectively. Land, fertilizer, and labor statistically significantly affected the wheat output of model farmers, whereas all input variables statistically significantly affected the wheat output of non-model farmers. In addition, model farmers' technical inefficiency was statistically significantly determined by the mode of plowing, mode of harvesting, shock, training, and marketing, and that of non-model farmers’ technical inefficiency was statistically significantly affected by mode of harvesting, level of education, land fragmentation, and marketing. Thus, training, market, education, and strategic plan to mitigate factors beyond the control of farmers need to be considered for improvement to make farmers more productive and technically efficient in wheat production in the study area.

A regulatory robust conditional approach to measuring the efficiency of wholesale water supply and wastewater treatment services

A benchmarking evaluation instrument was designed with a European Union country regulatory authority for water supply and wastewater treatment services to determine the efficient operating cost of its service providers that operated in the wholesale market segment in the 2017–2021 period. To this end, the non-parametric Data Envelopment Analysis technique was adapted to a robust and conditional approach. The results point to similar mean efficiency scores between water supply and wastewater services in the five-year period, despite the greater heterogeneity in the latter. Furthermore, the estimated potential cost savings for both services ranged from about 2% to 3%.

Productive efficiency of beef cattle production in Botswana: a latent class stochastic meta-frontier analysis

IntroductionEfficiency in food production is crucial for sustainable agriculture in developing countries. This paper contributes to the existing literature by presenting an innovative approach to modeling productive efficiency in beef cattle production. Treating farm performance across regions as unobserved heterogeneity, we determine technical efficiency of beef cattle production in Botswana. We aim to shed light on the factors influencing efficiency in this sector.MethodsThe study utilized block-level data from various annual agricultural surveys (2006–2014) covering 26 agricultural districts and six agro-ecological regions in Botswana. We employed a latent class stochastic frontier model complemented with the stochastic meta-frontier analysis.ResultsResults show that the best performing farming systems in terms of efficiency are districts with well-developed infrastructure and better access to output and input markets. In contrast, the farming systems that perform poorly consist of agricultural districts without access to livestock advisory centers, with higher average temperatures and foot and mouth disease, limiting access to export markets. The mean technical efficiency scores for beef production for agricultural districts in class one and two were 62 and 59%, respectively, implying high potential to improve beef production using the same level of agricultural inputs through efficiency-enhancing investments.DiscussionBased on our results, it is crucial for agricultural policies to prioritize regionally specific investments that address the needs of the under-performing districts. By targeting the lagging districts, policymakers can help beef producers improve their input efficiency and bridge the technological gaps to the meta-frontier. This can be achieved through investments in infrastructure, access to livestock advisory services, and disease control measures. Such efforts will not only enhance the efficiency of beef production but also contribute to the overall sustainability of the agricultural sector in Botswana.

0331 Effects of Cognitive Behavioral Therapy for Insomnia (CBTI) on Daytime Cognitive Functioning: A Report from the AIR Trial

Abstract Introduction Prior studies have shown that CBTI improves patient reported outcomes including daytime fatigue, mood status and quality of life, yet there are limited data concerning the effects of therapy on objective measures of daytime function. The current study tested the effects of CBTI on measures derived from the psychomotor vigilance test (PVT) in a sample of patients with comorbid insomnia disorder and sleep apnea. Methods Patients with insomnia and comorbid OSA, who were prescribed PAP therapy (N =155; Mage= 56.8±12.5 yrs.; 58.1% women) were randomized to digital CBTI (dCBTI) or Sleep Hygiene (CTRL). They completed PVT at baseline and after 8 weeks of treatment. Patients in the dCBTI arm who reached remission were offered no additional insomnia treatment, whereas those who did not were randomly assigned to 8 weeks of continued access to dCBTI or to a therapist delivered CBTI. Patients again completed the PVT after this second 8-week treatment phase. PVT outcome measures included mean reaction time, attentional lapses and efficiency scores. Linear mixed models were used to compare the PVT measures of patients receiving either of the CBTI treatment sequences with those assigned to the CTRL. Results Analyses showed significant group x time interactions for PVT attentional lapses (F = 3.04; p &amp;lt; .05) and for efficiency scores (F= 4.06; p&amp;lt; .025). Those who received either of the CBTI treatment sequences showed a greater reduction in attentional lapses and greater improvement in their efficiency scores from baseline to the post-treatment assessments than did those assigned the CTRL. Conclusion Findings indicate that CBTI improves objective indices of daytime cognitive functioning among those with comorbid apnea and insomnia disorder. Further tests of CBTI’s effects on these and other measures of cognitive functioning are warranted in other samples of insomnia patients who do and do not have medical, psychiatric and sleep disorder comorbidities. Support (if any) Funding support from the National Heart, Lung and Blood Institute, Grant # 1R01HL130559-01A1.

Smallholder Tomato Production in Mwanza Region- A Technical Efficiency Analysis Approach.

This study measured technical efficiency and its determinants in maize production by small-scale producers in Mwanza region, using a stochastic frontier production function approach. A randomly selected sample of participants in the two districts was used. The Maximum Likelihood estimation procedure was followed to obtain the determinants of technical efficiency and technical efficiency levels of small-scale tomato producers. The minimum and maximum values of technical efficiency were between 20% and 91%, indicating that the least practices of specific producer operates at a minimum level of 20%, while the best practice producers operate at 91% technical efficiency level respectively. The summary results of the mean technical efficiency was 57%. The results indicate that farmers were not fully technically efficient with a mean technical efficiency score of 0.58. The study also revealed that most of the farmers irrespective of the size of the holdings have shown technical inefficiency problems. Experienced farmers were observed to have good measures of technical efficiency. The findings also indicated that significant variables of technical efficiency included household size, labour, fertilizer, seed, educational level, household size, farming experience, and access to extension services were statistically significant by positively impacted on producers’ technical efficiency in the study area.

Efficiency evaluation of public hospitals in Kuwait: An application of data envelopment analysis

Background: Kuwait overall health expenditure, in 2019, was 5.5% from the gross-domestic product and the state is the biggest healthcare provider in secondary and tertiary hospitals. Hospital efficiency and productivity are, therefore, an important issue to analyse, specifically in terms of number of visits to outpatient clinics, the number of surgical procedures performed, bed turnover and bed occupancy. Data envelopment analysis has been used to provide insights in the understanding of this growth in other countries. Methods: Data envelopment analysis (DEA) was used to estimate technical and scale efficiency scores for seventeen public hospitals in Kuwait from 2015 to 2019 using a two-stage DEA. Technical efficiency scores were regressed against institutional characteristics using Tobit regression to investigate the determinants of efficiency differences amongst hospitals. Results: The mean technical efficiency score for all hospitals was 75%, and it improved by 1% since 2015. The mean pure technical efficiency score was 85% in 2015 and improved to 86% in 2019. The mean scale efficiency score was 89% in 2015 and decreased to 88% in 2019. Only five hospitals were constantly technically and scale efficient. Tobit regression showed that hospital efficiency was significantly associated with the hospital level (secondary or tertiary), number of beds, bed occupancy rate and the average length of stay. Conclusions: Most public hospitals in Kuwait were not technically and scale efficient, but improvements were observed in the overall scores and pure technical efficiencies of these hospitals throughout the study. The identification of the factors influencing efficiency is crucial for hospital managers and policymakers to take evidence-based decisions to improve the technical efficiency of the main health-producing units in the country.