The moral imperative of money: what investments in science say about a nation's priorities and ethical compass.

The era dominated by the liberal world order, dating back to the end of World War II in 1945 and gaining unchallenged dominance with the fall of the Berlin Wall in 1989, is now coming to an end. Yet the universal principles that the era personified in its rhetoric, and in the best of its actions, lives on. The global community has a moral obligation to continue on its journey to build a more equitable, secure and prosperous world for all of its citizens and must devise investment strategies that enable progress to both endure and accelerate. "The Declaration on Science and the Use of Scientific Knowledge," issued at the conclusion of the inaugural World Conference on Science in 1999, contained a broad range of insights and recommendations that remain as significant today as they did 20 years ago. We would be wise to heed the challenges that the declaration conveyed by recognizing that the journey for equity in science, technology and innovation (STI) is by no means over and, in fact, remains as relevant now as it did then-both as an economic and social necessity and as a moral obligation. This paper seeks to explore how patterns of investment in STI have changed over the past 2 decades-and how they have not.

Deployment optimization of multi-stage investment portfolio service and hybrid intelligent algorithm under edge computing.

The purposes are to improve the server deployment capability under Mobile Edge Computing (MEC), reduce the time delay and energy consumption of terminals during task execution, and improve user service quality. After the server deployment problems under traditional edge computing are analyzed and researched, a task resource allocation model based on multi-stage is proposed to solve the communication problem between different supporting devices. This model establishes a combined task resource allocation and task offloading method and optimizes server execution by utilizing the time delay and energy consumption required for task execution and comprehensively considering the restriction processes of task offloading, partition, and transmission. For the MEC process that supports dense networks, a multi-hybrid intelligent algorithm based on energy consumption optimization is proposed. The algorithm converts the original problem into a power allocation problem via a heuristic model. Simultaneously, it determines the appropriate allocation strategy through distributed planning, duality, and upper bound replacement. Results demonstrate that the proposed multi-stage combination-based service deployment optimization model can solve the problem of minimizing the maximum task execution energy consumption combined with task offloading and resource allocation effectively. The algorithm has good performance in handling user fairness and the worst-case task execution energy consumption. The proposed hybrid intelligent algorithm can partition tasks into task offloading sub-problems and resource allocation sub-problems, meeting the user's task execution needs. A comparison with the latest algorithm also verifies the model's performance and effectiveness. The above results can provide a theoretical basis and some practical ideas for server deployment and applications under MEC.

Performance measurement of ESG-themed megatrend investments in global equity markets using pure factor portfolios methodology.

ESG factors are becoming mainstream in portfolio investment strategies, attracting increasing fund inflows from investors who are aligning their investment values to Sustainable Development Goals (SDG) declared by the United Nations Principles for Responsible Investments. Do investors sacrifice return for pursuing ESG-aligned megatrend goals? The study analyses the risk-adjusted financial performance of ESG-themed megatrend investment strategies in global equity markets. The analysis covers nine themes for the period 2015-2019: environmental megatrends covering energy efficiency, food security, and water scarcity; social megatrends covering ageing, millennials, and urbanisation; governance megatrends covered by cybersecurity, disruptive technologies, and robotics. We construct megatrend factor portfolios based on signalling theory and formulate a novel measure for stock megatrend exposure (MTE), based on the relative fund flows into the corresponding thematic ETFs. We apply pure factor portfolios methodology based on constrained WLS cross-sectional regressions to calculate Fama-French factor returns. Time-series regression rests on the generalised method of moments estimator (GMM) that uses robust distance instruments. Our findings show that each environmental megatrend, as well as the disruptive technologies megatrend, yielded positive and significant alphas relative to the passive strategy, although this outperformance becomes statistically insignificant in the Fama-French 5-factor model context. The important result is that most of the megatrend factor portfolios yielded significant non-negative alphas; which supports our assumption that megatrend investing strategy promotes SDGs while not sacrificing returns, even when accounting for transaction costs up to 50bps/annum. Higher transaction costs, as is the case for some of these ETFs with expense ratios reaching 80-100bps, may be an indication of two things: ESG-themed megatrend investors were willing to sacrifice ca. 30-50bps of annual return to remain aligned with sustainability targets, or that expense ratio may well decline in the future.

Cost-effectiveness of Investment in End-of-Life Home Care to Enable Death in Community Settings.

BACKGROUND: Many people with terminal illness prefer to die in home-like settings-including care homes, hospices, or palliative care units-rather than an acute care hospital. Home-based palliative care services can increase the likelihood of death in a community setting, but the provision of these services may increase costs relative to usual care. OBJECTIVE: The aim of this study was to estimate the incremental cost per community death for persons enrolled in end-of-life home care in Ontario, Canada, who died between 2011 and 2015. METHODS: Using a population-based cohort of 50,068 older adults, we determined the total cost of care in the last 90 days of life, as well as the incremental cost to achieve an additional community death for persons enrolled in end-of-life home care, in comparison with propensity score-matched individuals under usual care (ie, did not receive home care services in the last 90 days of life). RESULTS: Recipients of end-of-life home care were nearly 3 times more likely to experience a community death than individuals not receiving home care services, and the incremental cost to achieve an additional community death through the provision of end-of-life home care was CAN$995 (95% confidence interval: -$547 to $2392). CONCLUSION: Results suggest that a modest investment in end-of-life home care has the potential to improve the dying experience of community-dwelling older adults by enabling fewer deaths in acute care hospitals.

Return on investment: a practical calculation tool to convince your institution.

Introduction: The significant investments necessary to integrate a new technology or service often create a financial barrier. To convince a hospital board to invest, it is important to demonstrate a return on investment (ROI). As many pharmacists are not used to estimating an ROI, this short report proposes a simple methodology and a free practical tool to download. Methods: Determining an ROI requires a calculation of all the expenses linked to the initial investments and the annual running costs of the equipment or service. When possible, real costs must be used in this calculation, but the costs of some parameters can only be estimated. The methodology involves three steps: (A) calculation of the initial balance (on shot costs and savings), (B) calculation of the annual balance (valid in the years after the investment) and (C) final calculation of time to recovery (duration until the initial investments are reimbursed by the annual savings) and ROI (the net benefit in euros at the end of the amortisation period). Results: This methodology was applied to the installation of automated dispensing cabinets in our hospital. The initial balance (€32 500±€4200) included equipment acquisition costs, installation costs and initial savings (stock-value reduction and non-investment in traditional ward pharmacy). The annual balance (€8622±3564) included amortisation and maintenance costs as well as human resources, medication, logistics and safety savings. We estimated a 3.8-year (min 2.7-max 6.4) time to recovery and an ROI of €36 476 (min €7964-max €64 988) after 8 years. Conclusions: Large investments for innovative equipment or service will be harder and harder to obtain if no economic evaluation is provided. The method proposed here is simple and provides useful input for discussions with a hospital board. The case study highlights a positive ROI related to automated dispensing cabinets.

Assessing return on investment in health libraries requires lateral thinking.

This study considers the status of trends in value and impact research in health libraries and discusses how return on investment approaches such as social value analysis could be used. It uses an example, based on the Health Education England evaluation framework for health library and knowledge services, to outline how a theory of change can be developed. Health libraries now work more closely with health care staff and researchers in co-creating value and impact for improving patient care. Therefore, collection of data to assess social value should be drawn not only from performance data already collected by libraries, but also data collection by and for the health care organisation on evaluation of care quality and professional competence.

Subcategorizing the Expected Value of Perfect Implementation to Identify When and Where to Invest in Implementation Initiatives.

Purpose. Clinical practice variations and low implementation of effective and cost-effective health care technologies are a key challenge for health care systems and may lead to suboptimal treatment and health loss for patients. The purpose of this work was to subcategorize the expected value of perfect implementation (EVPIM) to enable estimation of the absolute and relative value of eliminating slow, low, and delayed implementation. Methods. Building on the EVPIM framework, this work defines EVPIM subcategories to estimate the expected value of eliminating slow, low, or delayed implementation. The work also shows how information on regional implementation patterns can be used to estimate the value of eliminating regional implementation variation. The application of this subcategorization is illustrated by a case study of the implementation of an antiplatelet therapy for the secondary prevention after myocardial infarction in Sweden. Incremental net benefit (INB) estimates are based on published cost-effectiveness assessments and a threshold of SEK 250,000 (£22,300) per quality-adjusted life year (QALY). Results. In the case study, slow, low, and delayed implementation was estimated to represent 22%, 34%, and 44% of the total population EVPIM (2941 QALYs or SEK 735 million), respectively. The value of eliminating implementation variation across health care regions was estimated to 39% of total EVPIM (1138 QALYs). Conclusion. Subcategorizing EVPIM estimates the absolute and relative value of eliminating different parts of suboptimal implementation. By doing so, this approach could help decision makers to identify which parts of suboptimal implementation are contributing most to total EVPIM and provide the basis for assessing the cost and benefit of implementation activities that may address these in future implementation of health care interventions.

Future time perspective drives younger and older adults to continue investing in failing activities.

Inspired by socioemotional selectivity theory, we investigated age differences in further investment in failing situations by considering goal type and future time perspective. In Experiment 1, 32 younger and 30 older adults reported their likelihood of continued investing following an unsuccessful investment. Older adults were more willing to invest with emotional goals as opposed to knowledge and unspecified goals, while younger adults showed a greater willingness to invest with emotional and knowledge goals rather than unspecified goals. In Experiment 2, another sample of 32 younger and 34 older adults completed the same decision tasks as those in Experiment 1. After future time perspective restriction, the younger adults made decisions resembling Experiment 1's older adults, while after future time perspective expansion, the older adults behaved like Experiment 1's younger adults. These results indicate that future time perspective modification could reverse participants' goal prioritisation, manifesting in differential willingness to pursue further investment in decision scenarios with different goals. Our results represent important steps towards understanding the mechanism of older and younger adults' further investment in failing situations and illustrate that forging connections between the lifespan theory of motivation and further investment decision is critical for understanding adults' decision behaviours.

The predictive ability of the expected utility-entropy based fund rating approach: A comparison investigation with Morningstar ratings in US.

In this paper, we propose an alternative fund rating approach based on the Expected Utility-Entropy (EU-E) decision model, in which the measure of risk for a risky action was axiomatically developed by Luce et al. We examine the ability of this approach as an alternative fund rating approach for its ability to potentially mitigate the drawbacks of the risk measure used in Morningstar ratings, and investigate the ability of the EU-E model based and Morningstar ratings to predict mutual fund performance. Overall, we find that the risk measure used in both models plays a defining role in their ability to predict future fund performance, and that the EU-E model can effectively consider the behavioral decisions of an investor.

Time to Reevaluate the Away Rotation: Improving Return on Investment for Students and Schools.

Away rotations are common among senior medical students preparing to apply for residency. For competitive specialties, multiple away rotations may be viewed as a de facto requirement for a strong application. Although away rotations are often valuable learning experiences, a variety of noneducational factors motivate students to enroll, including the need for letters of recommendation, students' uncertainty regarding their strength as applicants, perceived competitiveness of residency applications, and conflicting guidance from advisors.Students who enroll in away rotations often benefit from a novel educational environment, opportunities for career exploration, and the chance to assess "fit" with a program. Yet away rotations also come at a significant cost. Students must deal with the time and expenses of rotating at multiple institutions. The application process for away rotations is expensive, disjointed, and inefficient. Students must work hard to make an impression on host institution faculty, and risk hurting their residency applications with a negative letter of recommendation.To reduce the burden of away rotations, future research should assess the impact of multiple away rotations on success in the Match. Allowing students limited access to letters of recommendation content would allow students and advisors to make informed decisions regarding additional rotations. Students would benefit from greater standardization of the application process for away rotations, with uniform dates, timely acceptances and rejections, and a cap for the number of applications per student. Students can maximize their returns by targeting away rotations that provide the most diverse educational experiences and valuable letters of recommendation.

Gestión de la innovación en los servicios de salud pública / Innovation management in public health services

Los términos conocimiento, tecnología e innovación cada vez más forman parte del vocabulario empresarial, al reconocerse como pilares para el éxito de cualquier organización en el siglo XXI. Especialmente en la prestación de servicios sociales como la salud pública la gestión de la innovación debe constituir una prioridad para la atención con calidad y efectividad de los acuciantes problemas de salud que afectan a la humanidad. El objetivo del artículo es analizar el desarrollo de la gestión de la innovación en los servicios de salud pública. El análisis bibliográfico realizado incluyó material de los últimos seis años en cuatro bases de datos regionales, acerca de la gestión de la innovación en servicios de salud pública. La investigación ha constituido una preocupación constante en los servicios de salud pública, lo que requiere de la gestión continua de la innovación en sus entidades, con énfasis en los aspectos que la literatura considera más relevantes, como el talento humano, la estrategia y cultura organizacional, la relación con los clientes y entidades colaboradoras, en especial, las educativas. La gestión de la innovación constituye una prioridad para las entidades de salud, en correspondencia con las políticas públicas que promueven la solución continua a los problemas poblacionales de salud(AU)

The terms knowledge, technology and innovation are increasingly part of the business vocabulary, recognizing as pillars for the success of any organization in the twenty-first century. Especially in the provision of social services such as public health, innovation management must be a priority for the quality and effectiveness of the pressing health problems that affect humanity. The objective of this article is to analyze the development of innovation management in public health services. The bibliographic analysis included material from the last six years in four regional databases on the management of innovation in public health services. Research has been a constant concern in the public health services, which requires the continuous management of innovation in its entities, with emphasis on the aspects that literature considers more relevant, such as human talent, strategy and organizational culture, the relationship with clients and collaborating entities, especially educational ones. Innovation management is a priority for health institutions, in accordance with public policies that promote a continuous solution to population health problems(AU)

Financialisation in health care: An analysis of private equity fund investments in Turkey.

The 2007-2008 global financial crisis revived interest in the impacts of financial markets and actors on our social and economic life. Nevertheless, research on health care financialisation remains scant. This article presents findings from research on one modality of financial investments in health care: global private equity funds' investments in private hospitals. Adopting a political economy approach, it analyses the drivers and impacts of the upsurge of global private equity investments in the Turkish private hospital sector amid the global financial crisis. The analysis derives from review of research and archival literature, as well as six in-depth interviews held with owners/executive board directors/general managers of the largest private hospital chains in Turkey and the general partners of their PE investors. The interviewing process took place between January and November 2016. All interviews were conducted by the author in Istanbul. The findings point to a mutually reinforcing relationship between neoliberal policies and financialisation processes in health care. The article shows that neoliberal healthcare reforms, introduced under consecutive Justice and Development Party (JDP) governments in Turkey, have been important precursors of private equity investments in healthcare services. These private equity investments, in turn, intensified and broadened the process of marketisation in health care services. Four impacts are identified, through which private equity investments hasten the marketisation of health care services. These relate to the impacts of private equity investments on a) advancing the process of chain formation by large hospital groups, b) spreading financial imperatives into the operations of private hospitals c) fostering internationalisation of capital, and d) augmenting inequities in access to health care services and standards.

Is foreign direct investment good for health in low and middle income countries? An instrumental variable approach.

There is a scarcity of quantitative research into the effect of FDI on population health in low and middle income countries (LMICs). This paper investigates the relationship using annual panel data from 85 LMICs between 1974 and 2012. When controlling for time trends, country fixed effects, correlation between repeated observations, relevant covariates, and endogeneity via a novel instrumental variable approach, we find FDI to have a beneficial effect on overall health, proxied by life expectancy. When investigating age-specific mortality rates, we find a stronger beneficial effect of FDI on adult mortality, yet no association with either infant or child mortality. Notably, FDI effects on health remain undetected in all models which do not control for endogeneity. Exploring the effect of sector-specific FDI on health in LMICs, we provide preliminary evidence of a weak inverse association between secondary (i.e. manufacturing) sector FDI and overall life expectancy. Our results thus suggest that FDI has provided an overall benefit to population health in LMICs, particularly in adults, yet investments into the secondary sector could be harmful to health.

Comparison of two Medication Therapy Management Practice Models on Return on Investment.

OBJECTIVE: To compare the return on investment (ROI) of an integrated practice model versus a "hub and spoke" practice model of pharmacist provided medication therapy management (MTM). METHODS: A cohort retrospective analysis of MTM claims billed in 76 pharmacies in North Carolina in the 2010 hub and spoke practice model and the 2012 "integrated" practice model were analyzed to calculate the ROI. RESULTS: In 2010, 4089 patients received an MTM resulting in 8757 claims in the hub and spoke model. In 2012, 4896 patients received an MTM resulting in 13 730 claims in the integrated model. In 2010, US$165 897.26 was invested in pharmacist salary and $173 498.00 was received in reimbursement, resulting in an ROI of +US$7600.74 (+4.6%). In 2012, US$280 890.09 was invested in pharmacist salary and US$302 963 was received in reimbursement, resulting in an ROI of +US$22 072.91 or (+7.9%). CONCLUSION: The integrated model of MTM showed an increase in number of claims submitted and in number of patients receiving MTM services, ultimately resulting in a higher ROI. While a higher ROI was evident in the integrated model, both models resulted in positive ROI (1:12-1:21), highlighting that MTM programs can be cost effective with different strategies of execution.

We must convince the government to invest in the health workforce.

In New York on 21 September, a potentially game-changing report was submitted to the secretary general of the United Nations.

Assessing the health impact of transnational corporations: its importance and a framework.

BACKGROUND: The adverse health and equity impacts of transnational corporations' (TNCs) practices have become central public health concerns as TNCs increasingly dominate global trade and investment and shape national economies. Despite this, methodologies have been lacking with which to study the health equity impacts of individual corporations and thus to inform actions to mitigate or reverse negative and increase positive impacts. METHODS: This paper reports on a framework designed to conduct corporate health impact assessment (CHIA), developed at a meeting held at the Rockefeller Foundation Bellagio Center in May 2015. RESULTS: On the basis of the deliberations at the meeting it was recommended that the CHIA should be based on ex post assessment and follow the standard HIA steps of screening, scoping, identification, assessment, decision-making and recommendations. A framework to conduct the CHIA was developed and designed to be applied to a TNC's practices internationally, and within countries to enable comparison of practices and health impacts in different settings. The meeting participants proposed that impacts should be assessed according to the TNC's global and national operating context; its organisational structure, political and business practices (including the type, distribution and marketing of its products); and workforce and working conditions, social factors, the environment, consumption patterns, and economic conditions within countries. CONCLUSION: We anticipate that the results of the CHIA will be used by civil society for capacity building and advocacy purposes, by governments to inform regulatory decision-making, and by TNCs to lessen their negative health impacts on health and fulfil commitments made to corporate social responsibility.