Airport technical efficiency: Evidence of privatised airports in Latin America

This paper uses both the stochastic and nonstochastic production function approach to measure technical efficiency in public education in Utah.The stochastic specification estimates technical efficiency, assuming half normal and exponential distributions.The nonstochastic specification uses two-stage DEA to separate the effects of fixed inputs on the measure of technical efficiency.The empirical analysis shows substantial variation in efficiency among school districts.While these measures are insensitive to the specific distributional assumptions about the one-sided component of the error term in stochastic specification, they are sensitive to the treatment of fixed socioeconomic inputs in the two-stage DEA.

Impacts of the COVID-19 Pandemic on Assessment of M-Protein and Free Light Chain Levels in Patients with Multiple Myeloma

Little is known about how COVID-19 affects the incidence or outcomes of out-of-hospital cardiac arrest (OHCA), and it is possible that more generalized factors beyond SARS-CoV-2 infection are primarily responsible for changes in OHCA incidence and outcome. To assess whether COVID-19 is associated with OHCA incidence and outcomes. This retrospective cohort study was conducted in Seattle and King County, Washington. Participants included persons aged 18 years or older with nontraumatic OHCA attended by emergency medical services (EMS) between January 1, 2018, and December 31, 2021. Data analysis was performed from November 2022 to March 2023. Prepandemic (2018-2019) and pandemic (2020-2021) periods and SARS-CoV-2 infection. The primary outcomes were OHCA incidence and patient outcomes (ie, survival to hospital discharge). Mediation analysis was used to determine the percentage change in OHCA incidence and outcomes between prepandemic and pandemic periods that was attributable to acute SARS-CoV-2 infection vs conventional Utstein elements related to OHCA circumstances (ie, witness status and OHCA location) and resuscitation care (ie, bystander cardiopulmonary resuscitation, early defibrillation, and EMS response intervals). There were a total of 13 081 patients with OHCA (7102 dead upon EMS arrival and 5979 EMS treated). Among EMS-treated patients, the median (IQR) age was 64.0 (51.0-75.0) years, 3864 (64.6%) were male, and 1027 (17.2%) survived to hospital discharge. The total number of patients with OHCA increased by 19.0% (from 5963 in the prepandemic period to 7118 in the pandemic period), corresponding to an incidence increase from 168.8 to 195.3 events per 100 000 person-years. Of EMS-treated patients with OHCA during the pandemic period, 194 (6.2%) were acutely infected with SARS-CoV-2 compared with 7 of 191 EMS-attended but untreated patients with OHCA (3.7%). In time-series correlation analysis, there was a positive correlation between community SARS-CoV-2 incidence and overall OHCA incidence (r = 0.27; P = .01), as well as OHCA incidence with acute SARS-CoV-2 infection (r = 0.43; P < .001). The survival rate during the pandemic period was lower than that in the prepandemic period (483 patients [15.4%] vs 544 patients [19.2%]). During the pandemic, those with OHCA and acute SARS-CoV-2 infection had lower likelihood of survival compared with those without acute infection (12 patients [6.2%] vs 471 patients [16.0%]). SARS-CoV-2 infection itself accounted for 18.5% of the pandemic survival decline, whereas Utstein elements mediated 68.2% of the survival decline. In this cohort study of COVID-19 and OHCA, a substantial proportion of the higher OHCA incidence and lower survival during the pandemic was not directly due to SARS-CoV-2 infection but indirect factors that challenged OHCA prevention and treatment.

This paper aimed to evaluate the effects of the COVID-19 pandemic on healthcare-associated infections (HAIs), antibiotic resistance and consumption rates in intensive care units (ICUs) of a tertiary care university hospital. Between 1 January 2018 and 31 December 2021, adult patients diagnosed with HAIs in ICUs were investigated retrospectively. Patients were divided into pre-pandemic (2018-2019) and pandemic periods (2020-2021). Antibiotic consumption index was calculated via using the formula of (total dose (grams)/defined daily dose (DDD) x total patient days) x1000. A p value below 0.05 was accepted as statistically significant. The incidence of HAIs (per 1000 patient days) in the ICU of COVID-19 patients was 16.59, while it was 13.42 in the other ICUs during the pandemic period (p=0.107). The bloodstream infection (BSI) incidence was 3.32 in the pre-pandemic period and 5.41 in the pandemic period in ICUs other than the ICU of COVID-19 patients (p<0.001). In the pandemic period, the BSI incidence rate was significantly higher in the ICU of COVID-19 patients than in the other ICUs (14.26 vs 5.41, p<0.001). Central venous catheter bloodstream infections incidence rate was 4.72 in the pre-pandemic and 7.52 in the pandemic period in ICUs other than the ICU of COVID-19 patients (p=0.0019). During the pandemic period, the bacteraemia episode rates of Acinetobacter baumannii (5.375 vs 0.984, p<0.001), Enterococcus spp. (1.635 vs 0.268, p<0.001) and Stenotrophomonas maltophilia (3.038 vs 1.297, p=0.0086) in the ICU of COVID-19 patients were significantly found higher than others. The extended-spectrum beta-lactamase (ESBL) positivity rates for Klebsiella pneumoniae and Escherichia coli were 61% and 42% in the pre-pandemic period; 73% and 69% in the pandemic period in ICUs other than the ICU of COVID-19 patients (p>0.05). In the pandemic period, the ESBL positivity rates for K. pneumoniae and E. coli were 83% and 100% in the ICU of COVID-19 patients, respectively. Meropenem (p<0.001), teicoplanin (p<0.001) and ceftriaxone (p<0.001) consumptions were increased while ciprofloxacin (p=0.003) consumption was decreased in all ICUs after the pre-pandemic period. BSI and CVCBSI incidence rates were significantly increased in all ICUs after the COVID-19 pandemic in our hospital. Bacteraemia episode rates of A. baumannii, Enterococcus spp. and S. maltophilia in ICU of COVID-19 patients were significantly found higher than others. In addition, meropenem, teicoplanin and ceftriaxone consumptions were increased in all ICUs after the COVID-19 pandemic.

Leibenstein has suggested that losses from Xor technical inefficiency may be far more important than losses from allocative inefficiency., Several recent studies have attempted to measure the magnitude of these former losses, while Timmer and Miiller2 have noted that invocation of the term "technical efficiency" may imply an admission of the analyst's incomplete understanding of the production process. Improved specification of the model may relate interfirm productivity variability to input variability, rather than to the somewhat enigmatic technical efficiency. This improved specification may be extremely helpful to policymakers in developing nations, where the list of proposed programs often includes many that aim at improving management. For example, in the area of agricultural development there are frequent proposals related to extension services, farmer training centers, model farmer programs, best-farmer awards, field days, mass-media programs, and the like. The specific content of such programs may vary considerably: teaching specific farm skills, teaching general skills such as literacy and arithmetic, exhorting farmers to work harder, stimulating demand for cash goods, and attempting to develop a generally more modern, change-oriented outlook. If policymakers know why some farmers are better managers (i.e., why there are technical efficiency differentials), they might have firmer grounds for

Relative efficiency in the branch network of a UK bank: An empirical study

To investigate the effect of coronavirus disease 2019 restrictions on ultrasound (US) screening of developmental dysplasia of the hip (DDH) in a children's hospital. The records of US screening of DDH were retrospectively evaluated in the pandemic period (April 2020 to July 2021) and the pre-pandemic period (January 2019 to February 2020). The monthly US number, sex, radiologist number, and age at the initial examination were recorded. A total of 6107 US scans were performed during the pre-pandemic period, which significantly decreased to 3340 during the pandemic. The number of monthly US scans performed did not change between the pre-pandemic (142.7/month) and pandemic (128.2/month) periods. The number of delayed examinations in the total population did not significantly change between the two periods. However, the number of delayed examinations in patients with abnormal hips was significantly increased during the pandemic compared with that in the pre-pandemic period. Coronavirus disease 2019 restrictions decreased the US screening rate of DDH by almost half, but the number of US scans performed by each radiologist was unchanged. The compliance with follow-up recommendations was reduced by half, which may lead to an increase in the incidence of delayed and untreated DDH cases.

This paper uses both the stochastic and nonstochastic production function approach to measure technical efficiency in public education in Utah. The stochastic specification estimates technical efficiency assuming half normal and exponential distributions. The nonstochastic specification uses two‐stage data envelopment analysis (DEA) to separate the effects of fixed inputs on the measure of technical efficiency. The empirical analysis shows substantial variation in efficiency among school districts. Although these measures are insensitive to the specific distributional assumptions about the one‐sided component of the error term in the stochastic specification, they are sensitive to the treatment of fixed socioeconomic inputs in the two‐stage DEA.

<b>Objective:</b> To analyse whether the COVID-19 pandemic (2020) resulted in differences in the characteristics of hospital admissions for a respiratory infection in adults with bronchiectasis compared to the pre-COVID-19 period. <b>Methods:</b> An observational, retrospective study enrolling all adults admitted to the hospital between Jan 2009 and Dec 2020 for a respiratory infection with a computed-tomography-confirmed bronchiectasis. Admissions for COVID-19 were excluded. Sociodemographic data, clinical data and admission characteristics were compared between pre-pandemic (2019) and pandemic (2020) period. <b>Results:</b> In 2019, 35 patients were admitted with a mean age of 77y (11), classified the 60% of them as severe according to the Bronchiectasis Severity Index (BSI). Three of these patients had to be readmitted in the same year. During this period, the proportion of admissions tested for viral infection was 28% and for bacterial infection was 72% of hospitalizations. A total of 25 patients were admitted in 2020, with a mean age of 74y (12), being the 76% severe. Readmissions in the same period were observed in four of these patients. Of the admissions, 57% were tested for viral infection and 73% for bacterial infection. The only difference observed for admission characteristics between both periods was the number of test for virus detection (11 (28%) in 2019 <i>vs.</i> 19 (57%) in 2020; p=0.02) (table 1). <b>Conclusions:</b> The number of viral infection test seems to increase during the pandemic period in comparison with pre-pandemic period during admissions for an exacerbation in adult patients with bronchiectasis.

This article examines the association between levels of compassion fatigue and work engagement with COVID-19 in nursing professionals. A longitudinal, before-and-after study was conducted with nursing professionals working in the frontline in the pre-pandemic and pandemic periods. Our study applied the Brazilian versions of the Professional Quality of Life Scale and the Utrecht Work Engagement Scale. High levels of compassion satisfaction (≥43.0), low levels of burnout (&lt;23.0) and secondary traumatic stress (&lt;23.0), as well as high levels of vigor (≥4.0 and ≤4.99), absorption (≥4.0 and ≤4.99), and overall score (≥4.0 and ≤4.99) were observed. Moderate, negative, and significant correlations of burnout with vigor (r: -0.505; p-value: &lt;0.001), in the pre-pandemic period; and with overall score, in the pre-pandemic (r: -0.543; p-value: &lt;0.001) and pandemic periods (r: -0.458; p-value: &lt;0.001), were also observed. No changes in levels of work engagement were found. Professionals with compassion fatigue showed decreased vigor, absorption, and overall score, rated as medium in the pandemic period (≥2.0 and ≤3.99), and an increased dedication, which was low (≥1.0 and ≤1.99) in the pre-pandemic period. It was concluded that there is no harmful association between compassion fatigue and work engagement with COVID-19 in nursing professionals.

The COVID-19 pandemic burdens hospitals, but consequences for quality of care outcomes such as healthcare-associated infections are largely unknown. This cohort included all adult hospital episodes (n=186 945) at an...

To assess the impact of COVID-19 pandemic on moral distress (MD) among healthcare professionals (HCPs) (physicians and nurses) in Spanish ICUs. Cross-sectional, prospective study. ICUs in Spain. HCPs currently working in Spanish ICUs. Data were collected via electronic survey with the use of a 50-item questionnaire in two different periods: prepandemic (October-December 2019) and during the second wave of COVID-19 (September-November 2020). During the prepandemic and pandemic periods, 1,065 (57.1% nurses) and 1,115 (58.5% nurses) HCPs completed the questionnaire, respectively. Higher MD levels were reported during COVID-19 pandemic, particularly among ICU nurses, when compared with the prepandemic period. Before COVID-19, physicians reported significantly higher levels of MD than ICU nurses (80.0 [interquartile range {IQR}, 40.0-135.0] vs 61.0 [IQR, 35.0-133.0]; p = 0.026). These differences disappeared during the pandemic period (81.0 [IQR, 39.0-138.5] vs 74.0 [IQR, 41.0-143.0]; p = 0.837). During the pandemic, younger and less experienced HCPs working in hospital areas that were converted in ICU or in ICUs with multiple occupancy rooms reported higher MD levels. In addition, HCPs who were off work for psychologic burden reported higher MD levels (108.0 [IQR, 66.0-139.0] vs 76.0 [IQR, 40.0-141.0]; p < 0.05). In the prepandemic period, patient-level root causes were the most morally distressing for nurses, whereas physicians reported higher MD on system-level root causes. During the pandemic, both groups reported higher MD on system-level root causes. During COVID-19, significantly more HCPs considered leaving their job due to MD. MD has increased among ICU HCPs in Spain during COVID-19 pandemic. Physicians reported higher MD levels than nurses in the prepandemic period, whereas both HCPs groups reported similar MD levels in the pandemic period. Strategies are needed and should be implemented to mitigate MD among HCPs.

Birthweight is a strong determinant of a neonate’s health. The SARS-CoV-2 pandemic’s impact on birthweight has not been investigated in-depth, with inconsistent conclusions from initial studies. To assess changes in preterm birth and inappropriate birthweight between the SARS-CoV-2 pandemic and pre-pandemic periods. A nationwide birth micro-data consisted with exhaustive census of all births in 2011–2020 in South Korea was accessed to examine whether the mean birthweight and rates of under/overweight births changed significantly during the SARS-CoV-2 pandemic year (2020) compared to those of the pre-pandemic period (2011–2019). A total of 3,736,447 singleton births were analyzed. Preterm birth was defined as < 37 weeks of gestation. Low birthweight (LBW) and macrosomia were defined as birthweights < 2.5 kg and ≥ 4.0 kg, respectively. Small for gestational age (SGA) and large for gestational age (LGA) were defined as birthweights below the 10th and above 90th percentiles for sex and gestational age, respectively. Inappropriate birthweight was defined as one or more LBW, macrosomia, SGA, or LGA. Generalized linear models predicted birth outcomes and were adjusted for parental age and education level, marital status, parity, gestational age, and months from January 2011. There were 3,481,423 and 255,024 singleton births during the pre-pandemic and pandemic periods, respectively. Multivariable generalized linear models estimated negative associations between the pandemic and preterm birth (odds ratio [OR], 0.968; 95% confidence interval [CI] 0.958–0.978), LBW (OR: 0.967, 95% CI 0.956–0.979), macrosomia (OR: 0.899, 95% CI 0.886–0.912), SGA (OR: 0.974, 95% CI 0.964–0.983), LGA (OR: 0.952, 95% CI 0.945–0.959), and inappropriate birthweight (OR: 0.958, 95% CI 0.952–0.963), indicating a decline during the pandemic compared to pre-pandemic period. An 8.98 g decrease in birthweight (95% CI 7.98–9.99) was estimated during the pandemic. This is the largest and comprehensive nationwide study to date on the impact of the SARS-CoV-2 pandemic on preterm birth and inappropriate birthweight. Birth during the pandemic was associated with lower odds of being preterm, underweight, and overweight. Further studies are required to understand the dynamics underlying this phenomenon.

Pediatric acute hepatitis of unknown etiology (AHUE) has been reported globally since April 2022. The purpose of the present study was to investigate the impact of coronavirus disease 2019 (COVID-19) pandemic on the incidence of AHUE in Japan. A nationwide survey of AHUE was conducted in 2510 pediatric hospitals by the Japan Pediatric Society. We retrospectively reviewed AHUE cases, defined by the World Health Organization's working case definition, and compared the incidence, clinical characteristics, and causative pathogens before the COVID-19 pandemic period (pre-pandemic, January 2017 to December 2019) and during the pandemic period (pandemic, January 2020 to June 2022). In total, 707 cases (450 pre-pandemic, 257 pandemic) were reported. The median age was 3years (interquartile range (IQR): 1-9years), and 43.8% were female. The number of AHUE cases decreased significantly in the pandemic period (102.8 cases/year) compared with the pre-pandemic period (150.0 cases/year). Investigations of pathogens causing AHUE demonstrated that the most common cause was unknown, accounting for 64% and 75% of cases in the pre-pandemic and pandemic periods, respectively. Among those whose pathogens were identified, the most common pathogens were Epstein-Barr virus (9.6%), cytomegalovirus (6.2%), and influenza (4.0%) in the pre-pandemic, and 7.0%, 3.5%, and 0.4%, respectively, in the pandemic period. SARS-CoV-2 and adenovirus were only 2.7% and 1.9%, respectively, in the pandemic period. The number of AHUE cases decreased during the COVID-19 pandemic compared with the pre-pandemic period, and no increase in adenovirus-associated disease or severe cases was observed in Japan.

BackgroundSevere acute respiratory infection (SARI) is a leading cause of mortality globally, peaking during the COVID-19 pandemic. We analyzed SARI-associated deaths during the pre-and-pandemic periods in Bangladesh to identify the contributing factors.MethodsWe analyzed data from hospital-based influenza surveillance at nine tertiary-level hospitals in Bangladesh. We considered March 2018–February 2020 as the pre-pandemic period and March 2020–February 2022 as the pandemic period and included adult (≥ 18 years) participants in our study. Surveillance physicians identified WHO-SARI case definition meeting inpatients and collected demographics, clinical characteristics, and outcomes at hospital discharge and 30 days post-discharge. We performed rRT-PCR for influenza and SARS-CoV-2 viruses on collected nasopharyngeal and oropharyngeal swabs. We used multivariable Cox's regression models to calculate the hazard ratio (HR) for factors associated with SARI deaths in these adult patients.ResultsWe enrolled 4392 SARI patients during the pre-pandemic and 3824 SARI patients during the pandemic period. Case fatality ratio was higher during the pandemic: 13.62% (521) [in-hospital: 6.45% (247); post-discharge: 7.17% (274)] compared to pre-pandemic, 6.01% (264) [in-hospital: 2.01% (89), post-discharge: 4% (175)] (p < 0.001). Pre-pandemic, influenza was detected in 14% (37/264) of SARI deaths. Influenza was detected during the pandemic in 2.3% (12/521), SARS-CoV-2 in 41.8% (218/521), and both viruses in only one SARI death. History of smoking and the presence of 1 or more co-morbid conditions independently attributed to SARI deaths in adults in the pre-pandemic period. SARI deaths in such patients were also associated with respiratory difficulties on admission in both pre-pandemic (aHR 2.36; 95% CI:1.65–3.36) and pandemic period (aHR 2.30; 95% CI: 1.57–3.35) after accounting for age, sex, smoking status, presence of 1 or more co-morbid conditions, and detection of influenza and SARS-CoV-2 viruses.ConclusionsDuring the pandemic, SARI mortality increased; influenza-associated mortality declined, and SARS-CoV-2 caused over a third of SARI deaths. Post-discharge mortality was higher than in-hospital mortality during both periods. Limiting premature discharge and strengthening post-discharge monitoring and nursing services could reduce unexpected deaths. Formative research to better understand post-discharge mortality is essential to reduce SARI deaths.