Effects of the information-driven awareness on epidemic spreading on multiplex networks.

In this study, we examine the impact of information-driven awareness on the spread of an epidemic from the perspective of resource allocation by comprehensively considering a series of realistic scenarios. A coupled awareness-resource-epidemic model on top of multiplex networks is proposed, and a Microscopic Markov Chain Approach is adopted to study the complex interplay among the processes. Through theoretical analysis, the infection density of the epidemic is predicted precisely, and an approximate epidemic threshold is derived. Combining both numerical calculations and extensive Monte Carlo simulations, the following conclusions are obtained. First, during a pandemic, the more active the resource support between individuals, the more effectively the disease can be controlled; that is, there is a smaller infection density and a larger epidemic threshold. Second, the disease can be better suppressed when individuals with small degrees are preferentially protected. In addition, there is a critical parameter of contact preference at which the effectiveness of disease control is the worst. Third, the inter-layer degree correlation has a "double-edged sword" effect on spreading dynamics. In other words, when there is a relatively lower infection rate, the epidemic threshold can be raised by increasing the positive correlation. By contrast, the infection density can be reduced by increasing the negative correlation. Finally, the infection density decreases when raising the relative weight of the global information, which indicates that global information about the epidemic state is more efficient for disease control than local information.

Cross-cultural differences in early expectations about third party resource distribution.

Research using non-verbal looking-time methods suggests that pre-verbal infants are able to detect inequality in third party resource allocations. However, nothing is known about the emergence of this capacity outside a very narrow Western context. We compared 12- to 20-month-old infants (N = 54) from one Western and two non-Western societies. Swedish infants confirmed the pattern from previous Western samples by looking longer at the unequal distribution, suggesting that they expected the resources to be distributed equally. Samburu infants looked longer at the equal distribution, suggesting an expectation of unequal distribution. The Kikuyu infants looked equally at both distributions, and did not show any specific exactions. These results suggest that expectations of equal distributions in third party allocations are affected by experience of cultural variations of distributive norms and social interaction early in development.

Evaluation of Length of Stay, Care Volume, In-Hospital Mortality, and Emergency Readmission Rate Associated With Use of Diagnosis-Related Groups for Internal Resource Allocation in Public Hospitals in Hong Kong.

Importance: Hong Kong's internal resource allocation system for public inpatient care changed from a global budget system to one based on diagnosis-related groups (DRGs) in 2009 and returned to a global budget system in 2012. Changes in patient and hospital outcomes associated with moving from a DRG-based system to a global budget system for inpatient care have rarely been evaluated. Objective: To examine associations between the introduction and discontinuation of DRGs and changes in length of stay, volume of care, in-hospital mortality rates, and emergency readmission rates in the inpatient population in acute care hospitals overall, stratified by age group, and across 5 medical conditions. Design, Setting, and Participants: This cross-sectional study included data from patients aged 45 years or older who were hospitalized in public acute care settings in Hong Kong before the introduction (April 2006 to March 2009), during implementation (April 2009 to March 2012), and after discontinuation (April 2012 to November 2014) of the DRG scheme. Data analysis was conducted from January to June 2021. Exposures: Public hospitals transitioned from a global budget payment system to a DRG-based system in April 2009 and returned to a global budget system in April 2014. Main Outcomes and Measures: The main outcome was the association of use of DRGs with patient-level length of stay, in-hospital mortality rate, 1-month emergency readmission rate, and population-level number of admissions per month. An interrupted time series design was used to estimate changes in the level and slope of outcome variables after introduction and discontinuation of DRGs, accounting for pretrends. Results: This study included 7 604 390 patient episodes. Overall, the mean (SD) age of patients was 68.97 (13.20) years, and 52.17% were male. The introduction of DRGs was associated with a 1.77% (95% CI, 1.23%-2.32%) decrease in the mean length of stay, a 2.90% (95% CI, 2.52%-3.28%) increase in the number of patients admitted, a 4.12% (95% CI, 1.89%-6.35%) reduction in in-hospital mortality, and a 2.37% (95% CI, 1.28%-3.46%) decrease in emergency readmissions. Discontinuation of the DRG scheme was associated with a 0.93% (95% CI, 0.42%-1.44%) increase in the mean length of stay and a 1.82% (95% CI, 1.47%-2.17%) reduction in the number of patients treated after adjusting for covariates; no statistically significant change was observed in in-hospital mortality (-0.14%; 95% CI, -2.29% to 2.01%) or emergency readmission rate (-0.29%; 95% CI, -1.30% to 0.71%). Conclusions and Relevance: In this cross-sectional study, the introduction of DRGs was associated with shorter lengths of stay and increased hospital volume, and discontinuation was associated with longer lengths of stay and decreased hospital volume. In-hospital mortality and emergency readmission rates did not significantly change after discontinuation of DRGs.

Opportunities and constraints in women's resource security amid climate change: A case study of arid-living Namibian agro-pastoralists.

OBJECTIVE: We describe the composition and variation of women's resource strategies in an arid-living Southern African agro-pastoralist society to gain insights into adaptation to climate-change-induced increased aridity. METHODS: Using cross-sectional data from 210 women collected in 2009 across 28 agro-pastoralist villages in Kaokoveld Namibia, we conducted principal-component (PC) analysis of resource variables and constructed profiles of resource strategies from the major PCs. Next, we explored associations between key resource strategies and demographic measures and fitness proxies. RESULTS: The first two PCs accounted for 43% of women's overall resource variation. PC1 reflects women's ability to access market resources via livestock trading, while PC2 captured women's direct food access. We found that market strategies were more common among married women and less common among women who have experienced child mortality. Women with higher subsistence security were more likely to be from the OvaHimba tribe and had a higher risk of gonorrhea exposure. We also qualitatively explored drought-induced pressure on women's livestock. Finally, we show that sexual networks were attenuated during drought, indicating strain on social support. CONCLUSIONS: Our results highlight how agro-pastoralist women manage critical resources in unpredictable environments, and how resource strategies distribute among the women in our study. Goats as a commodity to obtain critical resources suggests that some women have flexibility during drought when gardens fail and cattle die. However, increased aridity and drought may eventually overwhelm husbandry practices in this region.

Validation of a Crisis Standards of Care Model for Prioritization of Limited Resources During the Coronavirus Disease 2019 Crisis in an Urban, Safety-Net, Academic Medical Center.

OBJECTIVES: The coronavirus disease 2019 pandemic has overwhelmed healthcare resources even in wealthy nations, necessitating rationing of limited resources without previously established crisis standards of care protocols. In Massachusetts, triage guidelines were designed based on acute illness and chronic life-limiting conditions. In this study, we sought to retrospectively validate this protocol to cohorts of critically ill patients from our hospital. DESIGN: We applied our hospital-adopted guidelines, which defined severe and major chronic conditions as those associated with a greater than 50% likelihood of 1- and 5-year mortality, respectively, to a critically ill patient population. We investigated mortality for the same intervals. SETTING: An urban safety-net hospital ICU. PATIENTS: All adults hospitalized during April of 2015 and April 2019 identified through a clinical database search. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 365 admitted patients, 15.89% had one or more defined chronic life-limiting conditions. These patients had higher 1-year (46.55% vs 13.68%; p < 0.01) and 5-year (50.00% vs 17.22%; p < 0.01) mortality rates than those without underlying conditions. Irrespective of classification of disease severity, patients with metastatic cancer, congestive heart failure, end-stage renal disease, and neurodegenerative disease had greater than 50% 1-year mortality, whereas patients with chronic lung disease and cirrhosis had less than 50% 1-year mortality. Observed 1- and 5-year mortality for cirrhosis, heart failure, and metastatic cancer were more variable when subdivided into severe and major categories. CONCLUSIONS: Patients with major and severe chronic medical conditions overall had 46.55% and 50.00% mortality at 1 and 5 years, respectively. However, mortality varied between conditions. Our findings appear to support a crisis standards protocol which focuses on acute illness severity and only considers underlying conditions carrying a greater than 50% predicted likelihood of 1-year mortality. Modifications to the chronic lung disease, congestive heart failure, and cirrhosis criteria should be refined if they are to be included in future models.

Shifts in behavioral allocation patterns as a natural recovery mechanism: Postresolution expenditure patterns.

BACKGROUND: Behavioral economics predicts that recovery from Alcohol Use Disorder involves shifts in resource allocation away from drinking, toward valuable nondrinking rewards that reinforce and stabilize recovery behavior patterns. Further, these shifts should distinguish nonproblem drinking (moderation) outcomes from outcomes involving abstinence or relapse. To evaluate these hypotheses, 5 prospective studies of recent natural recovery attempts were integrated to examine changes in monetary spending during the year following the initial cessation of heavy drinking as a function of 1-year drinking outcomes. METHODS: Problem drinkers from Southeastern U.S. communities (N = 493, 67% male, 65% white, mean age = 46.5 years) were enrolled soon after stopping heavy drinking without treatment and followed prospectively for a year. An expanded Timeline Followback interview assessed daily drinking and monetary spending on alcohol and nondrinking commodities during the year before and after recovery initiation. RESULTS: Longitudinal associations between postresolution drinking and spending were evaluated using MPlus v.8. Initial models evaluated whether changes in spending at 4-month intervals predicted drinking outcomes at 1 year and showed significant associations in 6 commodity categories (alcohol, consumable goods, gifts, entertainment, financial/legal affairs, housing/durable goods/insurance; ps < 0.05). Cross-lagged models showed that the moderation outcome group shifted spending mid-year to obtain large rewards with enduring benefits (e.g., housing), whereas the abstinent and relapsed groups spent less overall and purchased smaller rewards (e.g., consumable goods, entertainment, and gifts) throughout the year. CONCLUSIONS: Dynamic changes in monetary allocation occurred during the postresolution year. As hypothesized, compared to the groups who abstained or relapsed, the moderation group shifted spending in ways that, overall, yielded higher value alcohol-free reinforcement that should reinforce recovery while they enjoyed some limited nonproblem drinking below heavy drinking thresholds. These findings add to evidence that moderation entails different behavioral regulation processes than abstinent and relapse outcomes, which were more similar to one another.

Patient Mix Optimization in Admission Planning under Multitype Patients and Priority Constraints.

Hospital beds are one of the most critical medical resources. Large hospitals in China have caused bed utilization rates to exceed 100% due to long-term extra beds. To alleviate the contradiction between the supply of high-quality medical resources and the demand for hospitalization, in this paper, we address the decision of choosing a case mix for a respiratory medicine department. We aim to generate an optimal admission plan of elective patients with the stochastic length of stay and different resource consumption. We assume that we can classify elective patients according to their registration information before admission. We formulated a general integer programming model considering heterogeneous patients and introducing patient priority constraints. The mathematical model is used to generate a scientific and reasonable admission planning, determining the best admission mix for multitype patients in a period. Compared with model II that does not consider priority constraints, model I proposed in this paper is better in terms of admissions and revenue. The proposed model I can adjust the priority parameters to meet the optimal output under different goals and scenarios. The daily admission planning for each type of patient obtained by model I can be used to assist the patient admission management in large general hospitals.

When Scarcity Meets Disparity: "Resources Allocation and COVID-19 Patients with Diabetes".

The COVID-19 pandemic raised distinct challenges in the field of scarce resource allocation, a long-standing area of inquiry in the field of bioethics. Policymakers and states developed crisis guidelines for ventilator triage that incorporated such factors as immediate prognosis, long-term life expectancy, and current stage of life. Often these depend upon existing risk factors for severe illness, including diabetes. However, these algorithms generally failed to account for the underlying structural biases, including systematic racism and economic disparity, that rendered some patients more vulnerable to these conditions. This paper discusses this unique ethical challenge in resource allocation through the lens of care for patients with severe COVID-19 and diabetes.

Hospital Nursing Staff Perceptions of Resources Provided by Their Organizations During the COVID-19 Pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has profoundly impacted the health and psychological well-being of hospital nursing staff. While additional support is needed to better cope with increased job stressors, little is known about what types of hospital resources have been provided and how nursing staff perceive them. This study addressed this gap by describing nursing staff perceptions of resources provided by hospitals during the COVID-19 pandemic in the United States. METHODS: Registered nurses and nursing assistants who were working in hospitals during the pandemic were recruited to an online survey via social media posts and emails between May and June 2020. A total of 360 free-text responses to an open-ended survey question were analyzed using content analysis. RESULTS: Over half of participants reported being provided with hospital resources. "Basic needs" resources that included food on-site, groceries, and childcare support were the most frequently reported compared with four other types of resources (personal health and safe practice, financial support, managerial support, communication). Four themes emerged related to staff perceptions of support: community support, unequal benefits, decreasing resources, and insufficient personal protective equipment. CONCLUSION: Our findings can assist organizational leaders in the planning and allocation of different types of resources that are meaningful to nursing staff and thus ensure sustainability, optimal performance, and worker well-being during crises.

Racial Disparities at Mixed-Race and Minority Hospitals : Treatment of African American Males With High-Grade Splenic Injuries.

INTRODUCTION: Racial and socioeconomic disparities in health access and outcomes for many conditions is well known. However, for time-sensitive high-acuity diseases such as traumatic injuries, disparities in access and outcomes should be significantly diminished. Our primary objective was to characterize racial disparities across majority, mixed-race, and minority hospitals for African American ([AA] vs White) males with high-grade splenic injuries. METHODS: Data from the National Trauma Data Bank were utilized from 2007 to 2015; 24 855 AA or White males with high-grade splenic injuries were included. Multilevel mixed-effects regression analysis was used to evaluate disparities in outcomes and resource allocation. RESULTS: Mortality was significantly higher for AA males at mixed-race (OR 1.6; 95% CI 1.3-2.1; P < .001) and minority (OR 2.1; 95% CI 1.5-3.0; P < .001) hospitals, but not at majority hospitals. At minority hospitals, AA males were significantly less likely to be admitted to the intensive care unit (OR 0.7; 95% CI, 0.49-0.97; P = .04) and experienced a significantly longer time to surgery (IRR 1.5; P = .02). Minority hospitals were significantly more likely to have failures from angiographic embolization requiring operative intervention (OR 2.2, P = .009). At both types of nonmajority hospitals, AA males with penetrating injuries were more likely to be managed with angiography (mixed-race hospitals: OR 1.7; P = .046 vs minority hospitals: OR 1.6; P = .08). DISCUSSION: While multiple studies have shown that minority hospitals have increased mortality compared to majority hospitals, this study found this disparity only existed for AAs.

Supply and Demand of Domestic Corneal Tissue and Its Implications on Export Potential-Using Australia as an Example.

PURPOSE: Corneal tissue importation is only possible if another country is able to export corneas without impacting its own domestic demand. Currently, there is little evidence to indicate whether export nations have such surplus capacity and in a position to export. To explore this concept, we examined our nation, Australia, which is reported to routinely decline donations because of its ability to meet domestic corneal transplant demand. Our research offers insights and opportunities for Australia and other nations to evaluate their domestic and international supply and allocation of corneal tissue in this space. METHOD: We collated 12 months of data on collected and noncollected donations, through participating Australian Eye Banks. The explanation of why some known donors were declined or not pursued indicated if demand was met and potential surplus-for-export levels. RESULTS: There were 7.5% (n = 11,889) of deaths in Australia that were notified to Australian Eye Banks during our reporting period. Of those, 9.3% (n = 1106/11,889) were recovered and allocated, 15.7% (n = 1863/11,889) were known but declined, and 75% (n = 8920/11,889) were not pursued. Of those that were declined, 64.3% (n = 1197/1863) were declined because of limitations with service/manpower at the eye bank, whereas 35.7% (n = 666/1863) were declined because demand was met. CONCLUSIONS: Australia did not meet demand all the time, during our data period. There were adequate quantities of potential donors to support increasing recovery for domestic allocation and provide for exportation without hindrance to Australian demand. Further examination of domestic supply and demand cycles and the export process is required before routine exportation.

Research on hot rolling scheduling problem based on Two-phase Pareto algorithm.

Under the background of excess capacity and energy saving in iron and steel enterprises, the hot rolling batch scheduling problem based on energy saving is a multi-objective and multi constraint optimization problem. In this paper, a hybrid multi-objective prize-collecting vehicle routing problem (Hybrid Price Collect Vehicle Routing Problem, HPCVRP) model is established to ensure minimum energy consumption, meet process rules, and maximize resource utilization. A two-phase Pareto search algorithm (2PPLS) is designed to solve this model. The improved MOEA/D with a penalty based boundary intersection distance (PBI) algorithm (MOEA/D-PBI) is introduced to decompose the HPCVRP in the first phase. In the second phase, the multi-objective ant colony system (MOACS) and Pareto local search (PLS) algorithm is used to generate approximate Pareto-optimal solutions. The final solution is then selected according to the actual demand and preference. In the simulation experiment, the 2PPLS is compared with five other algorithms, which shows the superiority of 2PPLS. Finally, the experiment was carried out on actual slab data from a steel plant in Shanghai. The results show that the model and algorithm can effectively reduce the energy consumption in the process of hot rolling batch scheduling.

Decision-making approaches used by UK and international health funding organisations for allocating research funds: A survey of current practice.

Innovations in decision-making practice for allocation of funds in health research are emerging; however, it is not clear to what extent these are used. This study aims to better understand current decision-making practices for the allocation of research funding from the perspective of UK and international health funders. An online survey (active March-April 2019) was distributed by email to UK and international health and health-related funding organisations (e.g., biomedical and social), and was publicised on social media. The survey collected information about decision-making approaches for research funding allocation, and covered assessment criteria, current and past practices, and considerations for improvements or future practice. A mixed methods analysis provided descriptive statistics (frequencies and percentages of responses) and an inductive thematic framework of key experiences. Thirty-one responses were analysed, representing government-funded organisations and charities in the health sector from the UK, Europe and Australia. Four themes were extracted and provided a narrative framework. 1. The most reported decision-making approaches were external peer review, triage, and face-to-face committee meetings; 2. Key values underpinned decision-making processes. These included transparency and gaining perspectives from reviewers with different expertise (e.g., scientific, patient and public); 3. Cross-cutting challenges of the decision-making processes faced by funders included bias, burden and external limitations; 4. Evidence of variations and innovations from the most reported decision-making approaches, including proportionate peer review, number of decision-points, virtual committee meetings and sandpits (interactive workshop). Broadly similar decision-making processes were used by all funders in this survey. Findings indicated a preference for funders to adapt current decision-making processes rather than using more innovative approaches: however, there is a need for more flexibility in decision-making and support to applicants. Funders indicated the need for information and empirical evidence on innovations which would help to inform decision-making in research fund allocation.

Allocation of pharmaceutical resources in maternal and child healthcare institutions during the COVID-19 pandemic.

Since the outbreak of a cluster of patients with pneumonia of unknown cause in Wuhan, Hubei Province, China, in December 2019, the disease was later officially named coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2), quickly spreading globally. Pregnant women and children are particularly vulnerable during disasters and emergencies. Comprehensive and applicable emergency preparedness and response are definitely important methods to prevent and contain the COVID-19 pandemic. The rational allocation of pharmaceutical resources plays an important role in the medical emergency plan. This paper aimed to share experiences for the allocation of pharmaceutical resources in hospitals focusing primarily on women and children during the COVID-19 pandemic.

Modelling allocation of resources in prevention and control of obstetric fistula in Ugandan women.

In spite of reliable and skilled healthcare resources, the prevalence rate of obstetric fistula in Uganda is high. The risk factors for obstetric fistula cut across due to high poverty rates and cultural barriers. The main objective of this study was to assess the impact of inability to access skilled healthcare at delivery and implications to the economy. The specific objective was to determine the best way of investment in getting women access to skilled healthcare before, during and after child birth. The question to be answered was whether it was more economical to invest in getting women access to skilled healthcare, or in expanding healthcare. The study was conducted using data from the Uganda Demographic Health Survey 2016. The data was from 18,506 women in the age group of 15-49 in 15 regions around the country. Results show that the highest investment in providing access to skilled healthcare is required when there are few skilled healthcare centres. On the other hand, if there is little investment in providing access to skilled healthcare during child birth, many skilled healthcare centres are required. Results show further that the minimum time taken to reduce fistula prevalence is attained when there are many women accessing skilled healthcare in the few equipped health centres. However, if there are many skilled healthcare centres but a few women treated for obstetric fistula, then it will take longer to reduce fistula prevalence. Fitting the model to data suggested that Uganda has a big backlog of women to treat for obstetric fistula as in all skilled healthcare centres, there were less women treated than expected. Although still under the expected figure, the benefit of these treatments for obstetric fistula is that for every one woman treated, 8 more would seek treatment for the condition. This would however cost the country a great deal in that the treatment funds would perhaps give more returns if diverted to outreach activities aimed to get women seek skilled healthcare during child birth.

COVID-19 and food and nutritional (in)security: action by the Brazilian Federal Government during the pandemic, with budget cuts and institutional dismantlement. / COVID-19 e (in)segurança alimentar e nutricional: ações do Governo Federal brasileiro na pandemia frente aos desmontes orçamentários e institucionais.

The COVID-19 pandemic poses one of this century's greatest public health challenges, with impacts on the health and living conditions of populations worldwide. The literature has reported that the pandemic affects the hegemonic food system in various ways. In Brazil, the pandemic amplifies existing social, racial, and gender inequalities, further jeopardizing the Human Right to Adequate Food (HRAF) and the attainment of food and nutritional security, especially among more vulnerable groups. In this context, the article aims to analyze the first measures by the Brazilian Federal Government to mitigate the pandemic's effects and that may have repercussions on food and nutritional security, considering the recent institutional changes in policies and programs. A narrative literature review was performed, and the information sources were the bulletins of the Center for Coordination of Operations by the Crisis Committee for Supervising and Monitoring the Impacts of COVID-19 and homepages of various government ministries, from March to May 2020. The actions were systematized according to the guidelines of the National Policy for Food and Nutritional Security. The analysis identified the creation of institutional crisis management arrangements. The proposed actions feature those involving access to income, emergency aid, and food, such as authorization for food distribution outside schools with federal funds from the National School Feeding Program. However, the setbacks and dismantlement in food and nutritional security may undermine the Federal Government's capacity to respond to COVID-19.

A pandemia por COVID-19 representa um dos maiores desafios da saúde pública deste século, causando impactos na saúde e nas condições de vida das populações em todo o mundo. Tem sido apontado pela literatura que a pandemia afeta de diversas formas o sistema alimentar hegemônico. No Brasil, a pandemia amplifica as desigualdades sociais, raciais e de gênero já existentes, comprometendo ainda mais a garantia do Direito Humano à Alimentação Adequada (DHAA) e a concretização da segurança alimentar e nutricional, especialmente entre os mais vulneráveis. Nesse contexto, este artigo tem como objetivo analisar as primeiras ações, em âmbito federal, do governo brasileiro para a mitigação dos efeitos da pandemia que podem repercutir na segurança alimentar e nutricional, considerando as recentes mudanças institucionais das políticas e programas. Foi realizada uma revisão narrativa da literatura e utilizado como fontes de informação os boletins do Centro de Coordenação de Operações do Comitê de Crise para Supervisão e Monitoramento dos Impactos da COVID-19 e homepages de ministérios setoriais, de março a maio de 2020. As ações foram sistematizadas segundo as diretrizes da Política Nacional de Segurança Alimentar e Nutricional. Foi identificada a criação de arranjos institucionais para o gerenciamento da crise. Dentre as ações propostas, destacam-se aquelas relacionadas ao acesso à renda, como o auxílio emergencial, e a alimentos, como a autorização para a distribuição de alimentos fora do ambiente escolar com os recursos federais do Programa Nacional de Alimentação Escolar. No entanto, os retrocessos e desmontes na área de segurança alimentar e nutricional podem comprometer a capacidade de resposta do Governo Federal no contexto da COVID-19.

La pandemia por COVID-19 representa uno de los mayores desafíos de la salud pública de este siglo, causando impactos en la salud y condiciones de vida de las poblaciones en todo el mundo. Se ha señalado por parte de la literatura que la pandemia afecta de diversas formas el sistema alimentario hegemónico. En Brasil, la pandemia amplifica las desigualdades sociales, raciales y de género ya existentes, comprometiendo todavía más la garantía del Derecho Humano a la Alimentación Adecuada (DHAA) y la concretización de la seguridad alimentaria y nutricional, especialmente entre los más vulnerables. En este contexto, el objetivo de este artículo es analizar las primeras acciones, en el ámbito federal, del gobierno brasileño para la mitigación de los efectos de la pandemia que puedan repercutir en la seguridad alimentaria y nutricional, considerando los recientes cambios institucionales de las políticas y programas. Se realizó una revisión narrativa de la literatura y se utilizaron como fuentes de información los boletines del Centro de Coordinación de Operaciones del Comité de Crisis para la Supervisión y Monitoreo de los Impactos de la COVID-19 y homepages de ministerios sectoriales, de marzo a mayo de 2020. Las acciones se sistematizaron según las directrices de la Política Nacional de Seguridad Alimentaria y Nutricional. Se identificó la creación de soluciones institucionales para la gestión de la crisis. Entre las acciones propuestas, se destacan aquellas relacionadas con el acceso a la renta, como el apoyo de emergencia, y de alimentos, como la autorización para la distribución de alimentos fuera del ambiente escolar con los recursos federales del Programa Nacional de Alimentación Escolar. No obstante, los retrocesos y recortes en el área de seguridad alimentaria y nutricional pueden comprometer la capacidad de respuesta del Gobierno Federal en el contexto de la COVID-19.

Optimal Allocation of Research Funds under a Budget Constraint.

Purpose. Health economic evaluations that include the expected value of sample information support implementation decisions as well as decisions about further research. However, just as decision makers must consider portfolios of implementation spending, they must also identify the optimal portfolio of research investments. Methods. Under a fixed research budget, a decision maker determines which studies to fund; additional budget allocated to one study to increase the study sample size implies less budget available to collect information to reduce decision uncertainty in other implementation decisions. We employ a budget-constrained portfolio optimization framework in which the decisions are whether to invest in a study and at what sample size. The objective is to maximize the sum of the studies' population expected net benefit of sampling (ENBS). We show how to determine the optimal research portfolio and study-specific levels of investment. We demonstrate our framework with a stylized example to illustrate solution features and a real-world application using 6 published cost-effectiveness analyses. Results. Among the studies selected for nonzero investment, the optimal sample size occurs at the point at which the marginal population ENBS divided by the marginal cost of additional sampling is the same for all studies. Compared with standard ENBS optimization without a research budget constraint, optimal budget-constrained sample sizes are typically smaller but allow more studies to be funded. Conclusions. The budget constraint for research studies directly implies that the optimal sample size for additional research is not the point at which the ENBS is maximized for individual studies. A portfolio optimization approach can yield higher total ENBS. Ultimately, there is a maximum willingness to pay for incremental information that determines optimal sample sizes.