Unconditional Grant Research Articles

Partial normalisation of cardiac mechanics with active CRT in patients with chronic failure: a novel application of 3.0T CMR

Abstract Introduction Cardiac resynchronisation therapy (CRT) is a routine treatment for chronic heart failure (CHF) with reduced ejection fraction and conduction delay to improve prognosis. Cardiac mechanics in patients with CHF are believed to be altered from controls based on invasive and echocardiographic based data. Technological advancements in cardiac magnetic resonance (CMR) and devices enable investigation of the cardiac response to CRT over a range of heart rates. Methods Patients with a CRT-D device were enrolled from heart failure clinics at Leeds General Infirmary, UK. After a MRI safety assessment, a baseline device check was conducted by a cardiac physiologist. Left ventricular (LV) volumes and systolic BP were measured at baseline and heart rates of 75, 90, 100, 115, 125, and 140 (randomised order) with CRT active and intrinsic conduction. All scans were conducted using a 3.0 T Siemens Prisma MRI scanner. Analysis of the scans used commercially available software. LV contractility was derived as a ratio of the LV end systolic volume and systolic BP. A post scan device interrogation was conducted to assess for scanning safety. Control participants with a 3.0T MR-conditional dual chamber pacemakers completed a similar protocol. Results Scanning was conducted in 17 CRT patients and 13 controls with a pre and post device and lead interrogation. No patient experienced symptoms related to scanning or device failure. The mean LV ejection fraction at baseline in the CRT cohort was 33.7±12.9%. Left ventricular ejection fraction fell across both cohorts as paced heart rate increased with reduced deterioration in control patients and those with CRT active. Peak LV cardiac output was significantly higher during active CRT (p<0.05). LV contractility was relatively static with CRT disabled (r2=0.13, p=0.38) and improved with CRT active (r2=0.91, p=0.01) and in controls (r2=0.74, p=0.01). Peak LV strain occurred at 100bpm during active CRT and in control patients whereas CRT disabled resulted in earlier deterioration. Conclusion We have demonstrated improvements in cardiac output and contractility consequent to active CRT using 3.0T CMR and subsequently validated via strain analysis. CRT appears to partially normalise cardiac mechanics across the range of heart rates studied. Further work is required to explore this phenomenon on a cellular or metabolic level. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): AK is supported by an unconditional grant provided by Medtronic

Differential effect of anticoagulation therapy in patients older versus younger than 80 years with atrial fibrillation and severe chronic kidney disease

Abstract Introduction In non-valvular atrial fibrillation (NVAF) patients, advanced age and chronic kidney disease (CKD) raise the thrombotic and bleeding rates, making the decision of antithrombotic therapy a challenge. Therefore, we conducted an analysis to explore the efficacy and safety of anticoagulation therapy in this population (AF patients ≥80 years) in comparison with younger AF patients (<80 years). Methods For these results we have analyzed data from FIBRA, a multicentric Spanish retrospective registry on patients with CKD-EPI <30 ml/min/1.73 m2 and newly diagnosed NVAF. For death, multivariable Cox regression analysis was developed. For embolic and bleeding events, competing-risks regression based on Fine and Gray's proportional subhazards model was performed, being death the competing event Results We analyzed 405 patients with CKD-EPI <30 ml/min/1.73 m2. 232 were ≥80 years-old (57.3%). Median of CHA2DS2-VASC and HASBLED scores were 5 and 3 in patients ≥80 years, respectively, and 3 and 2 in patients <80 years, respectively. The prescription of antithrombotic therapies in elderly versus younger patients is shown in Figure 1. During a follow-up of 4.6±2.5 years, 205 died (50.6%), 34 had embolic events (8.4%) and 85 had bleeding outcomes (21.0%). After multivariate analysis, no benefit of anticoagulation therapy was found for mortality in both, older and younger patients. In patients ≥80, anticoagulation was associated with higher rates of bleeding events without a decrease in embolic outcomes. Conclusion In our registry, anticoagulation has not shown benefit in NVAF patients ≥80 years with glomerular filtrate rate <30 ml/min/1.73 m2, increasing the risk of bleeding events without reducing embolic outcomes. Figure 1 Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): BMS-Pfizer alliance unconditional grant

An Analyses of Formula-Based Intergovernmental Transfer Using A Comprehensive Model

In this paper we analyze the tactics used by the central government during the allocation of grants toward local governments, by implementing the guidelines of the comprehensive model of Fiorillo and Merkaj (FM’s model) (2020)*. We apply the model to investigate a formula-based unconditional grant in a post-socialist economy, namely Albania, by assuming the value of three key structural parameters of the model. Using panel data for the period 2004-2011, we find that in Albania although the central government appears to follow the principles of equity and efficiency, political and electoral objectives of the incumbents do influence the allocation of transfers. Results confirm the predictions of the FM model: in a country with weak local government, where central government is perceived as the true policy maker even of local policies, in the presence of a proportional electoral rule, the incumbent tends to shape tactical allocation in favour of supporters. *Fiorillo Fabio and Merkaj Elvina A Comprehensive Approach to Intergovernmental Grants’ Tactical Allocation. Theory And Estimation Guidelines, submitted to International Tax and Public Finance (2020)

P507Cumulative comorbidity and survival in out-of-hospital cardiac arrest

Abstract Funding Acknowledgements EU Horizon 2020 - 733381, CVON2017-15 RESCUED, CVON2018-30 Predict2, an unconditional grant from Physio-Control Inc., Redmond, WA USA. OnBehalf ARREST Introduction Multiple chronic health conditions have been associated with survival after out-of-hospital cardiac arrest (OHCA). The influence of cumulative disease burden on survival rates at successive stages of post-resuscitation care is unknown. Purpose To study the relationship between cumulative disease burden (Charlson Comorbidity Index [CCI]) and survival rates in the course of post-resuscitation care. Methods From a prospective community-based OHCA registry, 2544 OHCA patients aged ≥18y with presumed cardiac cause in 2010-2014 were included. CCI was determined using medical histories from general practitioners and hospital correspondence, and categorized into: no (CCI = 0), moderate (CCI = 1-2) or high (CCI≥3) disease burden. The following stages of post-resuscitation care were defined: (1) pre-hospital: from OHCA to hospital admission, (2) in-hospital: from hospital admission to hospital discharge. The association between CCI and overall survival and survival at successive stages of care was assessed using logistic regression analyses. Results were stratified according to sex. Results In the pre-hospital stage, no association between CCI and survival to hospital admission was found (OR 0.93, 95%CI 0.73-0.1.18, P = 0.61) (Figure 1). In contrast, during the in-hospital stage high CCI was significantly associated with lower survival rate (OR 0.41, 95% CI 0.27-0.61, P < 0.01) (Figure 1), but, when stratified according to sex (pinteraction= <0.01), this association was only statistically significant in men (OR 0.34; 95%CI 0.21-0.55; P < 0.01), and not in women (OR 0.68; 95%CI 0.31-1.50; P = 0.33). When assessed individually, OHCA patients with congestive heart failure (24.8% vs. 12.0%, P < 0.01), peripheral vascular disease (11.7% vs. 5.4%, P < 0.01), diabetes (22.0% vs. 13.2%, P < 0.01), renal disease (17.1% vs. 5.9%, P < 0.01), malignancy (17.8% vs. 9.6%, P < 0.01), chronic pulmonary disorder (19.9% vs. 13.7%, P < 0.01), or dementia (0.3% vs. 3.0%, P < 0.01), were less likely to survive during the in-hospital stage. Conclusion Pre-existing comorbidity burden plays a significant role in OHCA survival, but only during the in-hospital stage. In order to ultimately improve survival after OHCA, in-hospital care needs further study taking pre-existing comorbidity burden into account. Abstract Figure 1

Diagnostic Power of Chest CT for COVID-19: To Screen or Not to Screen

Background: Chest CT is increasingly used for COVID-19 screening in healthcare systems with limited SARS-CoV-2 PCR capacity. Its diagnostic value was supported by studies with methodological concerns and its use is controversial. Here we investigated its potential to diagnose COVID-19 in symptomatic patients and to screen asymptomatic patients in a prospective study with minimal selection bias. Methods: From March 19, 2020 to April 20, 2020 we performed parallel SARS-CoV-2 PCR and CT with categorization of COVID-19 suspicion by CO-RADS, in 859 patients with COVID-19 symptoms and 1138 controls admitted to the hospital for COVID-19 unrelated medical urgencies. CT-CORADS was categorized on a 5-point scale from 1 (very low suspicion) to 5 (very high suspicion). AUC under ROC curve were calculated in symptomatic versus asymptomatic patients to predict positive SARS-CoV-2 positive PCR and likelihood ratios for each CO-RADS score were used for rational selection of diagnostic thresholds. Findings: CT-CORADS had significant (PInterpretation: CT-CORADS has meaningful diagnostic power in symptomatic patients, supporting its application for time-sensitive triage. Sensitivity in asymptomatic patients is insufficient to justify its use as screening approach. Incidental detection of CO-RADS ≥ 3 in asymptomatic patients should trigger reflex testing for respiratory pathogens.Funding Statement: This work was supported by a donation from board members of Fagron (Nazareth, Belgium), a healthcare company, to RADar, the teaching and education initiative of AZ Delta General Hospital, to be used as unconditional research grant for data collection, collaborative collaboration and open access publication.Declaration of Interests: The authors declare no conflict of interest.Ethics Approval Statement: The study was approved by the AZ Delta Institutional Review Board with a waiver of informed consent from study participants considering the study is based on secondary analysis of existing data (Clinical Trial Number: B1172020000008).

Home- or hospital-based monitoring to time frozen embryo transfer in the natural cycle? Patient-reported outcomes and experiences from the Antarctica-2 randomised controlled trial.

What are the patient-reported outcomes (PROs) and patient-reported experiences (PREs) in home-based monitoring compared to those in hospital-based monitoring of ovulation for scheduling frozen-thawed embryo transfer (FET)? Women undergoing either home-based or hospital-based monitoring experience an increase in anxiety/sadness symptoms over time, but women undergoing home-based monitoring felt more empowered during the treatment and classified the monitoring as more discreet compared to hospital-based monitoring. FET is at the heart of modern IVF. The two types of FET cycles that are mainly are used are artificial cycle FET, using artificial preparation of the endometrium with exogenous progesterone and oestrogen, and natural cycle FET (NC-FET). During a natural cycle FET, women visit the hospital repeatedly and receive an ovulation trigger to time FET (i.e. modified NC-FET or hospital-based monitoring). The previously published Antarctica randomised controlled trial (NTR 1586) showed that modified NC-FET is more cost-effective compared to artificial cycle FET. From the women's point of view a more natural approach using home-based monitoring of ovulation with LH urine tests to time FET may be desired (true NC-FET or home-based monitoring). Currently, the multicentre Antarctica-2 randomised controlled trial (RCT) is comparing the cost-effectiveness of home-based monitoring of ovulation with that of hospital-based monitoring of ovulation. The Antarctica-2 RCT enables us to study PROs, defined as the view of participating women of their healthcare status, and PREs, defined as the perception of the received care of participating women, in both FET strategies. PROs and PREs were assessed alongside the Antarctica-2 RCT. PROs were assessed using the validated EuroQol-5D-5L questionnaire. Currently, there are no guidelines for assessing PREs in this population. Therefore, members of the Dutch Patient Organisation for Couples with Fertility Problems (FREYA) filled out an online survey and selected the following PREs to assess (i) anxiety about missing ovulation, (ii) perceived level of partner participation, (iii) level of discretion, (iv) feeling of empowerment and (v) satisfaction with treatment. Women participating in the RCT also participated in PRO and PRE assessment. We assessed PROs and PREs at three time points: (i) before randomisation, (ii) at the time of the FET and (iii) at the time of the pregnancy test. A sample size of 200 participants was needed to find a difference of 0.3 with a standard deviation in both groups of 0.7, an alpha of 5%, power of 80% and a drop-out rate of 10%. We performed mixed model analysis for between-group comparison of treatment and time effects. A total of 260 women were randomised. Of these, 132 women were treated with home-based monitoring and 128 women were treated with hospital-based monitoring. Data before randomisation were available for 232 women (home-based monitoring n= 116, hospital-based monitoring n= 116). For the PROs, we found a significant increase in anxiety/sadness symptoms over time (P< 0.001) in both groups. We found no treatment effect of home-based versus hospital-based monitoring for the PROs (P= 0.8). Concerning the PRES, we found that women felt more empowered during home-based monitoring (P= 0.001) and classified the home-based monitoring as more discreet (P= 0.000) compared to the hospital-based monitoring. The results are applicable only to women undergoing NC-FET and not to women undergoing artificial cycle FET. Apart from clinical outcomes, PROs and PREs are also of importance in clinical decision-making and to support tailoring treatment even more specifically to the wishes of patients. Measurement of PROs and PREs should therefore be incorporated in future clinical research. The Antarctica-2 RCT is supported by a grant of the Netherlands Organisation for Health Research and Development (ZonMw 843002807). J.B. receives unconditional educational grants from Merck Serono and Ferring and is a member of the medical advisory board of Ferring. C.L. reports that his department receives unrestricted research grants from Ferring, Merck and Guerbet. E.G. receives personal fees from Titus Health Care outside submitted work. The remaining authors have no conflicts of interest. Trial NL6414 (NTR6590). 23 July 2017. 10 April 2018.

The Links Between Fiscal Federalism, Political Alignment and Elections

Does economic dependence of small towns on federal grants lead to electoral support? To answer this question, we use an exogenous rule of distribution to estimate the effects of the main federal transfer to Brazilian small towns on the results of elections throughout 20 years, when two rival parties succeeded in power. We find that more dependence on unconditional grants benefits the central government party, whereas the main opposition party loses votes in races to president and National Congress. The hypothesis is that enforcing economic dependence of small towns on the central government's unconditional grants can be a channel of political alignment - they need federal deputies aligned to the federal government to ask for budget amendments. On the other hand, larger cities can be a resilient place of opposition, once the size of government is smaller and where average income fluctuates more, especially in periods of low economic growth.

Switching Patients with Type 1 Diabetes to Insulin Degludec from Other Basal Insulins: Real-World Data of Effectiveness and Safety.

IntroductionReal-world evidence on the effectiveness and safety of insulin degludec (IDeg) in patients with diabetes is a priority. We have therefore evaluated the effectiveness and safety of IDeg, including impact on metabolic control, glycemic variability, weight gain and hypoglycemia, in patients with type 1 diabetes under routine clinical practice conditions.MethodsThis was an observational longitudinal multicenter study. A retrospective chart review of all patients with type 1 diabetes who were switched from basal insulin to IDeg was performed, and temporal trends in clinical outcomes were assessed.ResultsData obtained from 195 patients, with a median age of 42.8 [interquartile range (IQR) 24.6–56.4] years and a median diabetes duration of 16 (IQR 10.0–28) years, were analyzed. Median follow-up was 9.5 (IQR 7.7–11.3) months. Improvements were found in glycated hemoglobin (− 0.34%; p < 0.0001), fasting blood glucose (− 24.82 mg/dL; p < 0.0001), post-prandial glucose (− 17.23 mg/dL; p = 0.0009), glycemic variability as indicated by standard deviation of blood glucose (− 5.67 mg/dL; p < 0.0001) and high blood glucose index (− 3.77; p < 0.0001). Body weight and body mass index remained substantially stable during the follow-up (− 0.18 kg; p = 0.56 and − 0.12; p = 0.42, respectively). Risk of nocturnal hypoglycemia decreased by 52% [incidence rate ratio 0.48; 95% confidence interval (CI) 0.29–0.77] and risk of total hypoglycemic episodes by 41% (incidence ratio 0.59; 95% CI 0.45–0.83). Basal and short-acting insulin doses decreased by − 1.4 and − 3.1 IU, respectively.ConclusionSwitching patients with type 1 diabetes to IDeg from other basal insulins was associated with relevant improvements in metabolic control and glycemic variability without weight gain; the risk of hypoglycemic episodes also significantly declined.FundingNovo Nordisk S.p.A. unconditional grant.Electronic Supplementary MaterialThe online version of this article (10.1007/s13300-019-00722-y) contains supplementary material, which is available to authorized users.

Earthquakes, grants, and public expenditure: How municipalities respond to natural disasters

AbstractWe analyze the response of municipalities to the occurrence of natural disasters in terms of spending behavior, use of upper‐tier transfers and recovery, using balance sheet data of about 8,000 Italian municipalities for the period 2000–2015, and the universe of earthquakes events. We find evidence of increasing expenditure for about 12 years after the shocks, with asymmetric responses between earthquake‐related and unconditional grants, and heterogeneous flypaper effects across the country. While in northern municipalities expenditure tends to regress to pre‐earthquake levels, southern municipalities stick to higher expenditure levels when grants drop. This evidence is coupled with a faster recovery of private income and housing prices in northern municipalities.

FLYPAPER EFFECT DANA ALOKASI UMUM (DAU)DAN PENDAPATAN ASLI DAERAH (PAD) TERHADAP BELANJA DAERAH DI KOTA PAREPARE

Unconditional grants that are proxied by the General Allocation Fund are determined based on the fiscal space, namely the fiscal needs minus the regional fiscal capacity and the basic allocation allocated as a lump (lump sum) from the central government. This study aims to determine the Flypaper Effect on General Allocation Fund (GAF) and Local Own Source Revenue (LOSR) towards regional expenditure of Parepare City. This research uses descriptive method, the research is conducted to find out the value of the independent variable, either one or more variables (independent) without making comparisons, or connecting with other variables.To find out the value of variables without making comparisons or connecting with other variables, where the variables in the study are regional income sourced from regional expenditure based on GAF and LOSR. The results showed that the Flypaper Effect occurred in the General Allocation Fund and Local Own-Source Revenue toward Regional Expenditure in the Regional Government of Parepare City in the 2014-2018 period. The Flypaper Effect occurs because in this case the General Allocation Fund is used first for Regional Expenditure rather than Local Own-Source Revenue.

Household-level effects of providing forecast-based cash in anticipation of extreme weather events: Quasi-experimental evidence from humanitarian interventions in the 2017 floods in Bangladesh

In 2017, Bangladesh experienced the worst floods in recent decades. Based on a forecast and pre-defined trigger level, a Red Cross Red Crescent project distributed an unconditional cash grant of BDT 5000 (USD 60 equivalent) to 1039 poor households in highly vulnerable, flood-prone communities in the Brahmaputra river basin before an early flood peak. Systems that can deliver forecast-based cash grants are a potential adaptation strategy to deal with changes in extreme events linked to climate change. This paper presents the results of a mixed-methods, quasi-experimental study, based on a post-disaster household survey. The research assesses the effectiveness of the forecast-based cash distribution in helping beneficiaries to take preparatory early actions and reduce the negative impacts of the flood on their health, well-being, assets and livelihoods. The assessment shows that the cash grants contributed to improving households' access to food, a reduction in high-interest debt accrual of vulnerable households, and reduced psychosocial stress during and after the flood period, compared to a control group of similarly vulnerable and flood-affected communities that did not receive the forecast-based cash assistance. The intervention may also have prevented households from being forced to make destitution sales of valuable assets, as indicated by qualitative data collected in July, but we do not see these benefits sustained after a second flood peak in August 2017. There is a need for further research to assess the longer-term effects of forecast-based cash on the socio-economic development and well-being of the most vulnerable.

The impact of unconditional child cash grant on child malnutrition and its immediate and underlying causes in five districts of the Karnali Zone, Nepal \u2013 A trend analysis

BackgroundThe impact of unconditional cash transfers on child malnutrition and its determinants remains poorly understood. The aim of this study was evaluate the impact of an unconditional child cash grant on children’s nutritional status and its immediate (infant and young child feeding, dietary diversity, food consumption, and child infection and care) and underlying (household food security; Water, Hygiene and Sanitation (WASH) determinants among children younger than five years in the Karnali Zone, Nepal.MethodsThe five districts of the Karnali Zone received standard social welfare services in the form of targeted resource transfers for eligible families, plus an unconditional child cash payment, augmented by a capacity building and behavioural change education. Repeated cross-sectional surveys, with measures taken at baseline (2009, N=3750), midline (2013, N=3750) and endline (2015, N=3647), were carried out using a two-stage cluster sampling method. Multi-level Generalized Linear Mixed Models (GLMMs) with normal, binomial, Poisson, or multinomial link were performed to detect the unadjusted and adjusted trends.ResultsThere was a linear growth among children, with a corresponding increase of 0.41 height-for-age Z-scores (p < 0.001), 0.50 weight-for-age Z-scores (p<0.001), and 0.34 weight-for-height Z-scores (p<0.001) between the study period, equating to a decline in child undernutrition of 9.4, 16.5, and 5.1 percentage points (p<0.001) for stunting, underweight, and wasting respectively. Improvements were also observed in WASH outcomes, care and health seeking behaviours, and food availability.ConclusionUnconditional child cash grant embedded within a government sponsored cash transfer program for families and complemented by capacity building and behavioural change strategies improves child nutritional status and its determinants.

Inputs, Incentives, and Complementarities in Education: Experimental Evidence from Tanzania*

AbstractWe present results from a large-scale randomized experiment across 350 schools in Tanzania that studied the impact of providing schools with (i) unconditional grants, (ii) teacher incentives based on student performance, and (iii) both of the above. After two years, we find (i) no impact on student test scores from providing school grants, (ii) some evidence of positive effects from teacher incentives, and (iii) significant positive effects from providing both programs. Most important, we find strong evidence of complementarities between the programs, with the effect of joint provision being significantly greater than the sum of the individual effects. Our results suggest that combining spending on school inputs (the default policy) with improved teacher incentives could substantially increase the cost-effectiveness of public spending on education.

An Empirical Analysis on the Flypaper Effect of Unconditional Grants: Focusing on Spatial Regression Analysis

An Empirical Analysis on the Flypaper Effect of Unconditional Grants: Focusing on Spatial Regression Analysis

Tubal flushing with oil- or water-based contrast medium: can we identify markers that indicate treatment benefit?

STUDY QUESTIONCan we identify patient characteristics that distinguish which ovulatory infertile women undergoing hysterosalpingography (HSG) benefit more or less from flushing with oil-based contrast medium compared to water-based contrast medium?SUMMARY ANSWERIn ovulatory infertile women, HSG with oil-based contrast medium resulted in higher 6-month ongoing pregnancy and live birth rates as compared to HSG with water-based contrast medium and this treatment effect was independent of characteristics of the couple.WHAT IS KNOWN ALREADYWe recently showed that in infertile women undergoing HSG, flushing with oil-based contrast medium resulted in more ongoing pregnancies than flushing with water-based contrast medium.STUDY DESIGN, SIZE, DURATIONWe used data from our randomized clinical trial (RCT) in which 1,119 ovulatory infertile women undergoing HSG during fertility work-up were randomized for use of oil-based (N = 557) or water-based (N = 562) contrast medium.PARTICIPANTS/MATERIALS, SETTING, METHODSWe built logistic regression models to predict ongoing pregnancy and live birth (secondary outcome) as a function of the specific contrast, the specific marker, and marker-by-contrast-interaction. Markers considered were female age, maternal ethnicity, female smoking, body mass index (BMI), duration of infertility, infertility being primary or secondary, sperm quality, and previous appendectomy.MAIN RESULTS AND THE ROLE OF CHANCEThe 6-month ongoing pregnancy rates in the overall population were 39.7% after use of oil-based contrast versus 29.1% after use of water-based contrast medium [relative risk (RR), 1.37; 95% confidence interval (CI), 1.16–1.61; P < 0.001]. Among the studied baseline characteristics, BMI (P = 0.002) and semen volume (P = 0.02) were statistically significant prognosticators. The treatment effect of oil-based contrast was stronger in women with a BMI ≤30 kg/m2 [RR, 1.54; 95% CI, 1.23–1.92; P = 0.002], and in women whose partner had a semen volume >3 ml [RR, 1.77; 95% CI, 1.28–2.46; P = 0.02]. Also, in women who smoked, the treatment effect of flushing with oil was stronger, but this interaction did not reach statistical significance (P = 0.066). We found no positive effect of oil-based contrast in obese women. We found similar but weaker associations for live birth, which was probably due to lower number of events resulting in less power.LIMITATIONS, REASONS FOR CAUTIONThe RCT was restricted to infertile ovulatory women younger than 39 years of age without endocrinological disorders and at low risk for tubal pathology. Our results should not be generalized to infertile women who do not share these features.WIDER IMPLICATIONS OF THE FINDINGSAll infertile, ovulatory women younger than 39 years with a low risk for tubal pathology will benefit from an HSG with oil-based contrast; therefore, this should be offered to them after fertility work-up.STUDY FUNDING/COMPETING INTEREST(S)The original H2Oil RCT was an investigator-initiated study that was funded by the two academic institutions (AMC and VUmc) of the Amsterdam UMC. The study displayed in this paper was funded by an unconditional research grant from Guerbet. B.W.M. is supported by an NHMRC Practitioner Fellowship (GNT1082548). K.D. reports consultancy for Guerbet, during the conduct of the study, and also reports research grants from Guerbet. C.B.L. reports grants from Guerbet, during the conduct of the study, and grants from Ferring, grants from Merck, and personal fees from Ferring, outside the submitted work. P.H. reports grants from Guerbet, during the conduct of the study, and grants from Ferring and Merck, outside the submitted work. V.M. reports receiving travel and speakers fee as well as research grants from Guerbet. B.W.M. reports consultancy for ObsEva, Merck, Merck KGaA, and Guerbet, and research grants from Guerbet and Merck. The other authors have no conflict of interest to declare.TRIAL REGISTRATION NUMBERNTR 3270 www.trialregister.nlTRIAL REGISTRATION DATE1 February 2012.DATE OF FIRST PATIENT’S ENROLMENT3 February 2012.

Government of Malawi's unconditional cash transfer improves youth mental health

We explore the impacts of Malawi's national unconditional cash transfer program targeting ultra-poor households on youth mental health. Experimental findings show that the program significantly improved mental health outcomes. Among girls in particular, the program reduces indications of depression by about 15 percentage points. We investigate the contribution of different possible pathways to the overall program impact, including education, health, consumption, caregiver's stress levels and life satisfaction, perceived social support, and participation in hard and unpleasant work. The pathways explain from 46 to 65 percent of the program impact, advancing our understanding of how economic interventions can affect mental health of youth in resource-poor settings. The findings underline that unconditional cash grants, which are used on an increasingly large scale as part of national social protection systems in Sub-Saharan Africa, have the potential to improve youth mental wellbeing and thus may help break the vicious cycle of poverty and poor mental health.

Does Flypaper Effect Exist? New Evidence from Turkish Municipalities

In this paper, we investigate the phenomenon of flypaper effect and its relation to the local tax effort, by using a new and detailed panel data set that consist of all province and district municipalities’ fiscal data in Turkey between 1997 and 2005. We use fixed effects and dynamic panel data specific GMM estimators to obtain the results. We provide new evidence using an advanced technique which is firstly used to uncover flypaper effect in Turkey. According to our estimations, the flypaper effect does exist for the Turkish municipalities. This result is robust to various model specifications and econometric techniques. Turkish municipalities also experience substitution effect of unconditional grants on the revenue collection efforts.

The Impact of Cash Transfer Programmes on Youth and Adult Labour Supply: Evidence from Lesotho and the Philippines

AbstractThis study analyses the effect of cash transfers, aimed to increase children's human capital, on youth and adult labour supply. We provide novel results from the evaluation of two programmes: the conditional cash transfer Pantawid in the Philippines and the unconditional cash transfer Child Grant Programme in Lesotho. The transfers did not discourage youth and adult work. However, marginal adjustments emerged: the Child Grant Programme decreased youth and adult occasional work, representing the last resort to cope with income vulnerability; the Pantawid did not influence youth work but increase adult wage work, with a reduction of family work, indicating that the transfer decreased transaction costs associated with labour market access. © 2018 John Wiley &amp; Sons, Ltd.

Unconditional cash transfers for clinical and economic outcomes among HIV-affected Ugandan households.

HIV infection has profound clinical and economic costs at the household level. This is particularly important in low-income settings, where access to additional sources of income or loans may be limited. While several microfinance interventions have been proposed, unconditional cash grants, a strategy to allow participants to choose how to use finances that may improve household security and health, has not previously been evaluated. We examined the effect of an unconditional cash transfer to HIV-infected individuals using a 2 × 2 factorial randomized trial in two rural districts in Uganda. Our primary outcomes were changes in CD4 cell count, sexual behaviors, and adherence to ART. Secondary outcomes were changes in household food security and adult mental health. We applied a Bayesian approach for our primary analysis. We randomized 2170 patients as participants, with 1081 receiving a cash grant. We found no important intervention effects on CD4 T-cell counts between groups [mean difference 35.48, 95% credible interval (CrI) -59.9 to 1131.6], food security [odds ratio (OR) 1.22, 95% CrI: 0.47 to 3.02], medication adherence (OR 3.15, 95% CrI: 0.58 to 18.15), or sexual behavior (OR 0.45 95% CrI: 0.12 to 1.55), or health expenditure in the previous 3 weeks (mean difference $2.65, 95% CrI: -9.30 to 15.69). In secondary analysis, we detected an effect of mental planning on CD4 cell count change between groups (104.2 cells, 9% CrI: 5.99 to 202.16). We did not have data on viral load outcomes. Although all outcomes were associated with favorable point estimates, our trial did not demonstrate important effects of unconditional cash grants on health outcomes of HIV-positive patients receiving treatment.

Upping the Ante: The Equilibrium Effects of Unconditional Grants to Private Schools

We assess whether financing can help private schools, which now account for one-third of primary school enrollment in low- and middle-income countries. Our experiment allocated unconditional cash grants to either one (L) or all (H) private schools in a village. In both arms, enrollment and revenues increased, leading to above-market returns. However, test scores increased only in H schools, accompanied by higher fees, and a greater focus on teachers. We provide a model demonstrating that market forces can provide endogenous incentives to increase quality and increased financial saturation can be used to leverage competition, generating socially desirable outcomes. (JEL I21, I22, I25, I28, L22, L26, N75, O15, O16)