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Deep limit order book forecasting: a microstructural guide
No full textWe exploit cutting-edge deep learning methodologies to explore the predictability of high-frequency Limit Order Book mid-price changes for a heterogeneous set of stocks traded on the NASDAQ exchange. In so doing, we release ‘LOBFrame’, an open-source code base to efficiently process large-scale Limit Order Book data and quantitatively assess state-of-the-art deep learning models' forecasting capabilities. Our results are twofold. We demonstrate that the stocks' microstructural characteristics influence the efficacy of deep learning methods and that their high forecasting power does not necessarily correspond to actionable trading signals. We argue that traditional machine learning metrics fail to adequately assess the quality of forecasts in the Limit Order Book context. As an alternative, we propose an innovative operational framework that evaluates predictions' practicality by focusing on the probability of accurately forecasting complete transactions. This work offers academics and practitioners an avenue to make informed and robust decisions on the application of deep learning techniques, their scope and limitations, effectively exploiting emergent statistical properties of the Limit Order Book
When does industrial policy fail and when can it succeed? Case studies from Europe
No full textWhen does industrial policy succeed and fail in advanced economies? Most approaches to these questions concentrate on policy design and state power. Instead, we draw attention to the historical legacies, industrial structures, and institutional arrangements that shape industrial policy outcomes. We use insights from historical institutionalism and international business to develop a relational argument based on two first-order conditions: a critical mass of firms with sufficient capabilities to leverage the resources resulting from industrial policy, and the alignment between industrial policy goals and national institutional systems. Industrial policy could succeed, given the important second-order conditions that many have examined, when one of these conditions is present and public intervention produces the other. But industrial policy is certain to fail when both conditions are absent. Using a most different systems design, we assess our framework through short case-studies of industrial policy success and failure in Europe in the past 6 decades
COVID-19 pandemic and access to mental healthcare: a qualitative study of the experiences of mental healthcare providers and caregivers in Ghana
No full textThe COVID-19 pandemic created enormous additional demand for already weak mental health systems in many countries that were severely impacted, as evidence showed that new mental health disorders were triggered while those with pre-existing mental health conditions worsened. Yet, we know little about the extent to which the pandemic impacted the provision of care by frontline mental health care providers and access to mental health care among caregivers. This study describes the experiences of frontline mental health care providers and caregivers during the COVID-19 pandemic in Ghana. A qualitative study employing a phenomenological approach and semi-structured interview methods was undertaken among caregivers of people living with any kind of mental illness and mental health care providers. We used a purposive sampling technique to select study participants who were available and consented to share their experiences. An interview guide facilitated the data collection process. We used an inductive approach through open coding to generate codes. We then grouped codes into emergent categories and further into themes of experiences of accessing mental health services by users and provision of mental health services by providers. Our analysis identified six themes regarding frontline mental health care providers’ experiences at the primary health care level during the COVID-19 pandemic: a) interrupted home visits b) lack of government support c) lack of medication d) low clinic attendance e) disruptions in service delivery f) extended medication supply and g) patient aggression and attacks. Four themes emerged that characterize the experiences of caregivers of people living with mental health conditions, namely a) denial and withdrawal of facility-based care b) medication refill challenges c) disruption in outreach and follow-up calls and d) isolation and limited community support. The study highlights the challenges experienced by frontline mental health care providers and caregivers of people living with mental health conditions. It brought to light specific gaps that require urgent attention for people living with mental health conditions, their caregivers, and frontline workers. Institutional additional support systems to ensure fewer disruptions and address access-based gaps through outreach and community support would help improve their experiences in future pandemics
Supporting antiretroviral therapy uptake and adherence: the SUPA research programme and RCT
No full textBackground Antiretroviral therapy has transformed human immunodeficiency virus infection intoa chronic condition associated with normal life expectancy. In the United Kingdom, the uptake of antiretroviral therapy is generally high, but a delay in starting antiretroviral therapy and non-adherence compromise the health and well-being of people living with human immunodeficiency virus, increase the risk of transmission of human immunodeficiency virus and increase National Health Service costs. Objectives The overall aim was to improve antiretroviral therapy uptake and adherence by addressing perceptual and practical barriers. The objectives were to (1) identify culturally specific beliefs and other factors influencing uptake of and adherence to antiretroviral therapy that have not emerged in previous research; (2) refine existing methods for assessing perceptual and practical barriers to antiretroviral therapy uptake and adherence; (3) develop an intervention to increase antiretroviral therapy uptakeand adherence; (4) determine intervention feasibility and acceptability; (5) evaluate intervention efficacy;(6) assess the short- and long-term costs and cost-effectiveness of the interventions and (7) prepare for implementation within the National Health Service. Design Objective 1 – in-depth interviews with Black African and Black Caribbean people living with human immunodeficiency virus (n = 52); objective 2 – adaptation of the Beliefs about Medicines Questionnaire; objective 3 – development of the Supporting UPtake and Adherence to antiretroviral therapy service intervention; objective 4 – feasibility study (n = 213) and acceptability/process interviews (n = 24); objective 5 – observational study (n = 484) and randomised controlled trial (n = 143); objective 6 – systematic review, cost-effectiveness analysis (n = 210) and economic modelling; and objective 7 – preparatory implementation work with people living with human immunodeficiency virus and human immunodeficiency virus clinic staff. Setting National Health Service human immunodeficiency virus clinics in England with a high proportion of ethnic minority populations. Participants People living with human immunodeficiency virus. Interventions Adherence support – cognitive–behavioural therapy plus care as usual. Main outcome measures Workstream 1 – adapted Beliefs about Medicines Questionnaire–antiretroviral therapy. Workstream 2 – feasibility study: participant recruitment and withdrawal rates. Workstream 3 – randomised controlled trial – primary outcome: medication event monitoring system adherence. Workstream 4 – incremental cost-effectiveness ratio. Results Workstream 1 – qualitative studies were used to refine the Beliefs about Medicines Questionnaire – antiretroviral therapy and, together with our preparatory research, to inform the cognitive–behavioural therapy-based intervention. Workstream 2 – recruitment to the randomised controlled trial and observational study was deemed feasible. Thematic analysis of exit interviews with recipients of the SUPA intervention demonstrated that the intervention was acceptable and addressed perceptual and practical barriers to antiretroviral therapy. In Workstream 3, we did not meet the recruitment targets and our trial was underpowered for the primary outcome: 143 participants met the inclusion criteria and were randomised (care as usual, n = 72; care as usual plus cognitive–behavioural therapy, n = 71). There was no significant effect of cognitive–behavioural therapy on the primary end point. Of the 112 participants (care as usual, n = 55; cognitive–behavioural therapy, n = 57) for whom sufficient data for primary end-point analysis were available, 17 (15.2%) met the primary end point (> 80% of months with an average monthly adherence of ≥ 90%) [9 (16.4%) in the care-as-usual group and 8 (14.0%) in the cognitive–behavioural therapy group (p = 0.94)]. Secondary end points: median Medication Event Monitoring System adherence at 12 months was 61.9% in the care-as-usual group and 66.5% in the cognitive–behavioural therapy group (p = 0.40), representing a 7.5% uplift in adherence. Participants who were randomised to receive the intervention, based on perceptions of antiretroviral therapy at baseline (low antiretroviral therapy necessity beliefs, and/or high antiretroviral therapy concerns), experienced a greater decrease in antiretroviral therapy concerns [care as usual −0.9 (95% confidence interval −1.4 to −0.5) vs. cognitive–behavioural therapy −0.6 (95% confidence interval −0.8 to −0.3); p = 0.03], treatment intrusiveness [median change in highly active antiretroviral treatment (antiretroviral therapy) Intrusiveness Scale scores: care as usual −0.5 (95% confidence interval −5.6 to 18.0) vs. cognitive–behavioural therapy −5.6 (95% confidence interval −20.4 to 1.2); p = 0.03] and depression scores [median change in depression score: care as usual 0 (95% confidence interval −1.5 to 2.0) vs. cognitive–behavioural therapy −1 (95% confidence interval −3 to 0); p = 0.02] between baseline and 12 months. Workstream 4 – cognitive–behavioural therapy resulted in 0.056 more quality-adjusted life-years than care as usual (95% confidence interval 0.0029 to 0.083). The incremental cost-effectiveness ratio was £11,189 per quality-adjusted life-year. At a threshold of £20,000 per quality-adjusted life-year, there was > 90% likelihood that the intervention would be more cost-effective than care as usual. There was a 13% likelihood that the intervention would produce more quality-adjusted life-years and result in lower health and social care costs than care as usual. A Markov model showed that, over the longer term, cognitive–behavioural therapy results in fewer quality-adjusted life-years and higher costs and, therefore, care as usual would be the more cost-effective option. Limitations Our primary outcome of full Medication Event Monitoring System adherence was problematic, our randomised controlled trial was underpowered and we were unable to demonstrate a significant difference in our primary outcome. Conclusions Patients who received the Supporting UPtake and Adherence to antiretroviral therapy service intervention benefited from a reduction in antiretroviral therapy concerns, a reduction in antiretroviral therapy intrusiveness and reduced depressive symptoms, and from improved quality of life. The intervention was likely to be cost-effective for the National Health Service within 12 months. Future work Given the difficulty in recruiting people at a high risk of non-engagement with human immunodeficiency virus care, future work assessing the effectiveness of adherence interventions may require alternative, non-standard randomised controlled trial designs. Further studies are necessary to recalibrate our understanding of the levels of antiretroviral therapy adherence necessary to achieve viral load suppression. Study registration The trial is registered as ISRCTN35514212 and the study is registered as CRD42019072431. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research Programme (NIHR award ref: RP-PG-0109-10047) and is published in full in Programme Grants for Applied Research; Vol. 13, No. 8. See the NIHR Funding and Awards website for further award information
Evaluating health and social care integration in England’s Pioneer programme: the challenges of undertaking research in service delivery and research regulatory systems that are not fit for purpose
No full textObjectives Better integrated health and social or long-term care is high on government policy agendas in many countries. In England, successive pilot programmes, with related national evaluations, have been introduced to better integrate care to meet the needs of people requiring multi-agency help. However, researchers evaluating such programmes both in England and internationally face a daunting number of challenges produced by service delivery and research regulatory systems. This paper analyses the challenges encountered in seeking to undertake a prospective quasi-experimental evaluation of the impacts of community based multi-disciplinary teams (MDTs) on patient experience and outcomes, as part of a wider evaluation of the Integrated Care and Support Pioneers programme. The paper also identifies a number of general lessons for research commissioners, study site participants, and those tasked with undertaking such evaluative research. Methods We reviewed our research activities and timelines from the start of the evaluation. We created a narrative history - using reports to the funder, applications to research and ethics regulatory bodies and correspondence with Pioneer sites, regulatory bodies and data providers - to describe the challenges faced and our approaches to attempting to mitigate them. Results We experienced four key challenges: (1) unrealistic commissioner research specifications; (2) negotiating with and recruiting multiple organisations and services at potential study sites; (3) navigating research ethics and governance systems; and (4) recruiting participants for primary data collection and obtaining (with their consent) their linked routine service use data. The first two challenges resulted from the lack of shared understanding of evaluation feasibility and constraints between local health and care system actors and national level commissioners of evaluation, plus no clear incentive for local sites to participate. The third and fourth challenges were the product of multiple, protracted, and unnecessarily risk-averse research approval processes which affected both the nature and quantity of the data we could collect. Conclusions We recommend that major changes are made to the regulation of policy research to enable more robust evaluation to take place and that disproportionately high levels of risk aversion in approval processes for non-interventional, low-risk studies are addressed. In addition, the evaluation commissioning process needs to be far better informed at an early stage about which elements in programmes can feasibly be evaluated before research specifications are advertised
Frontline staff perspectives on multi-disciplinary team working and the effectiveness of integrated service delivery: findings from the evaluation of the Integrated Care and Support Pioneers in England
No full textObjectives Horizontal integration of health and social care in England is frequently supported by multi-disciplinary (MDT) case management focused on high-risk older people with multiple chronic conditions living in the community. This paper analyses MDT working in two of the 25 areas participating in the Integrated Care and Support Pioneer Programme in England. The analysis aims to understand the experience of frontline staff in such MDTs of working with professionals and staff from multiple sectors, and their perceptions of their roles and the benefits of integrated working. Methods We conducted semi-structured interviews with a purposive sample of 54 frontline staff from a range of professional backgrounds working in 11 community-based MDTs in two Integrated Care and Support Pioneers. A largely inductively developed coding frame was used to thematically code and guide analysis of verbatim interview transcripts from audio recordings. Findings Staff conceptualised the team as a cohesive yet ‘porous’ entity, able to evolve a shared sense of purpose to deliver holistic care that helped to level traditional professional hierarchies, enable collective problem-solving and share responsibility for patient care. MDT working was seen as benefiting staff and patients. Despite strong similarities between the MDTs in members’ understandings of the role and purpose of a MDT, each MDT was adapted to its context and the needs of the population served. The process of working through inter-professional tensions seemed to strengthen relationships within the team and enhance its ability to work effectively in the local health and care system. However, without performance or outcome measures, these perceptions were driven by ‘soft’ intelligence alone. Conclusions Frontline staff accounts of MDT working demonstrate their strong commitment to this way of working, as a mechanism enabling them to deliver more holistic care with perceived benefits to patients
What are the unmet needs in people affected by dementia? A scoping review of reviews
No full textObjectives To examine through a social health lens the unmet needs of people affected by dementia, which includes people with dementia, their informal and formal (or professional) caregivers. ‘Unmet needs’ was conceptualised as inaccessible or a lack of appropriate interventions to address identified problems. Method A scoping review of reviews was conducted. Five electronic databases were searched, followed by a two-stage-screening process. Data were extracted into a standardised sheet comprising study characteristics and domains from the Camberwell Assessment of Needs for the Elderly (CANE), and narratively synthesised. Unmet needs of people with dementia were mapped onto a social health framework. Results Eighty-five reviews were included. The most frequently reported unmet needs of people with dementia were related to psychological distress, lack of daytime activities, and company, all of which contribute to poorer social health. Informal caregivers most frequently reported a lack of information about the disease trajectory, post-diagnostic care, and home-based practical support. Formal caregivers had related information needs; their psychological distress stemmed from a range of sources. Conclusion This review of reviews provides a high-level synthesis of the unmet needs of people affected by dementia. It underscores fundamental knowledge gaps and shortcomings in existing interventions and services particularly for formal and informal caregivers
Promoting a transition with inclusion in India the role of Business Responsibility and Sustainability Reporting (BRSR)
No full textThis report highlights key indicators relevant to the just transition from the homegrown Business Responsibility Sustainability Reporting (BRSR) in India and creates a tool that investors and companies can use to signal just transition activities. Based on 2023–24 BRSR disclosures by companies, the report applies its methodology to companies in the steel, cement, power and mining sectors. It analyses how each company demonstrates actions and achievements against the International Labour Organization’s just transition indicators, and where they could make improvements, mapped against the relevant BRSR principles. This illustrates how investors and companies could use information from the BRSR to assess relevant corporate just transition-related activities
Zee, Jerry C. Continent in dust experiments in a Chinese weather system. 312 pp., bibliogr. Berkeley: University of California Press, 2022. £25.00 (paper)
No full textIntegrating nature into the IMF-World Bank’s Debt Sustainability Framework for Low Income Countries: a new systematic approach to nature-economy risk assessment
No full textThis report investigates the rationale, feasibility, and implications of integrating nature-related risks into the Low-Income Country Debt Sustainability Framework (LIC-DSF). The LIC-DSF is a core tool for assessing debt vulnerabilities in low-income countries (LICs), with significant influence on IMF-World Bank surveillance, concessional financing terms, and broader macroeconomic policy frameworks, as well as private investment and costs of capital