Non-Simultaneous Kidney Exchange Cycles in India: new design, in Transplant International by Kute and Rees et al.

 Perhaps the biggest part of the ongoing design of kidney exchange around the world involves adapting to constantly changing local conditions in patient and donor populations, and the prevailing laws, regulations and medical situation.  In India, where non-directed donation is illegal (except in Kerala), this means that some patients can be transplanted only if long exchange cycles are possible.  In most of the world, the requirement that the surgeries in a cycle be performed simultaneously has prevented this.

The paper below, organized by two of the world's most innovative transplant doctors, Vivek Kute and Mike Rees (first and last authors, in the medical manner), demonstrates a path forward in India. The paper reports 17 very carefully arranged and conducted non-simultaneous (and non-anonymous) kidney exchange cycles, accomplishing 67 transplants. These were performed at the  Trivedi Institute of Transplantation Sciences  (using our software:).

Vivek B. Kute, Himanshu V. Patel, Pranjal R. Modi, Sayyad J. Rizvi, Pankaj R. Shah, Divyesh P Engineer, Subho Banerjee, Hari Shankar Meshram, Bina P. Butala, Manisha P. Modi, Shruti Gandhi, Ansy H. Patel, Vineet V. Mishra, Alvin E. Roth, Jonathan E. Kopke, Michael A. Rees, “Non-simultaneous kidney exchange cycles in resource-restricted countries without non-directed donation,” Transplant International, February 2021.

Abstract: Recent reports suggest that bridge-donor reneging is rare (1.5%) in non-simultaneous kidney exchange chains. However, in developing countries, the non-directed donors who would be needed to initiate chains are unavailable, and furthermore, limited surgical space and resources restrain the feasibility of simultaneous kidney exchange cycles. Therefore, the aim of this study was to evaluate the bridge-donor reneging rate during non-simultaneous kidney exchange cycles (NSKEC) in a prospective single-center cohort study (n=67). We describe the protocol used to prepare co-registered donor-recipient pairs for non-simultaneous surgeries, in an effort to minimize the reneging rate. In addition, in order to protect any recipients who might be left vulnerable by this arrangement, we proposed the use of standard criteria deceased-donor kidneys to rectify the injustice in the event of any bridge-donor reneging.  We report 17 successful NSKEC resulting in 67 living-donor kidney transplants (LDKT) using  23 bridge-donors without donor renege  and  no intervening pairs became unavailable. We propose that NSKEC could increase LDKT, especially for difficult-to-match sensitized pairs (25 of our 67 pairs) in countries with limited transplantation resources. Our study confirms that NSKEC can be safely performed with careful patient-donor selection and non-anonymous kidney exchanges.

**************

Some previous posts:

Saturday, February 1, 2020

Long kidney exchange in Ahmedabad, India

Wednesday, May 22, 2019

Kidney exchange in India: the legal framework

Tuesday, May 21, 2019

Robot-assisted kidney transplantation in Ahmedabad, India.

Vaccination (and mask wearing) as repugnant transactions

 If a repugnant transaction is one that some people want to participate in, and other people think they shouldn't be allowed to (even those others aren't harmed by the participation of those who want to), then both vaccination and mask wearing are repugnant transactions, as Trumpism continues to work its way through the body politic.

Here's a story from the LA Times:

Dodger Stadium’s COVID-19 vaccination site temporarily shut down after protesters gather at entrance By MARISA GERBER, IRFAN KHAN

"Dodger Stadium’s mass COVID-19 vaccination site was temporarily shut down Saturday afternoon when about 50 protesters gathered at the entrance, frustrating hundreds of motorists who had been waiting in line for hours.

...

"The demonstrators included members of anti-vaccine and far-right groups. While some carried signs decrying the COVID-19 vaccine and shouting for people not to get the shots, there were no incidents of violence.

...

"A post on social media described the demonstration as the “Scamdemic Protest/March.” It advised participants to “please refrain from wearing Trump/MAGA attire as we want our statement to resonate with the sheeple. No flags but informational signs only.

“This is a sharing information protest and march against everything COVID, Vaccine, PCR Tests, Lockdowns, Masks, Fauci, Gates, Newsom, China, digital tracking, etc.”

...

"Protesters carried signs that read “Save Your Soul TURN BACK NOW,” “CNN IS LYING TO YOU,” “RECALL GAVIN NEWSOM” and “TAKE OFF YOUR MASK.”

...

“Unbelievable,” Los Angeles City Council President Nury Martinez tweeted. “If you don’t want the vaccine fine, but there are millions of Angelenos that do. 16,000 of your neighbors have died, so get out of the way.”

Economics and Engineering (and market design): some history and prehistory, at Stanford and elsewhere

The  December 2020 issue of History of Political Economy is devoted to Economics and Engineering.

Here's an account of Stanford and Bob Wilson (among others), written before the most recent Nobel prize to Wilson and Milgrom.

A Century of Economics and Engineering at Stanford by Beatrice Cherrier and Aurélien Saïdi

History of Political Economy (2020) 52 (S1): 85–111.  https://doi.org/10.1215/00182702-8717936

"This article documents the disciplinary exchanges between economists and engineers at Stanford throughout the twentieth century. We outline the role of key scholars such as Kenneth Arrow and Robert Wilson, as well as engineers turned administrators like Frederick Terman. We show that engineers drew upon economic theories of decision and allocation to improve practical industrial management decisions. Reciprocally, economists found in engineering the tools that they needed to rethink production and growth theory (including linear programming, optimal control theory, an epistemology of “application” that emphasized awareness to institutional details, trials and errors and experiments). By the 2000s, they had turned into economic engineers designing markets and other allocation mechanisms. These cross-disciplinary exchanges were mediated by Stanford’s own institutional culture, notably its use of joint appointments, the development of multidisciplinary “programs” for students, the ability to attract a variety of visitors every year, the entrepreneurial and contract-oriented vision of its administrators, and the close ties with the industrial milieu that came to be called the Silicon Valley.

..

"This article should not be read as a history of economics, engineering, or management science at Stanford and their idiosyncrasies.4  None of the research programs or institutional arrangements we describe were unique to Stanford. Rather, we document how some of the engineering and economics theories, tools, and epistemologies developed elsewhere were recombined in a specific institutional setting and entrepreneurial culture, and thus came to infuse the vision that some Stanford economists developed and spread in the last decades."

************

The pdf to the full article appears to be ungated, and will be especially rewarding to old Stanford hands, who will recognize a lot of names from Operations Research as well as from Econ.

************

And here's the introduction to the whole December special issue, by its editors:

Introduction: From “Economics as Engineering” to “Economics and Engineering”  by Pedro Garcia Duarte and Yann Giraud

History of Political Economy (2020) 52 (S1): 10–27.  https://doi.org/10.1215/00182702-8717898

"Economists such as Alvin Roth and Esther Duflo have recently argued that economics in the late twentieth century has evolved from (social) science to engineering. On the other hand, historians such as Mary Morgan and Michel Armatte have argued that the transformation of economics into an engineering science has been a century-long development. Turning away from the “economics as engineering” analogy, our introduction suggests an alternative approach to account for the presumed transformation of economics into an engineering science. We encourage the development of a history of “economics and engineering,” which depicts how these two types of knowledge–and the communities who produce them–have interacted in various institutional and national contexts. Drawing on the contributions to this 2020 annual supplement of HOPE, we show how these narratives may help change the historiography of twentieth-century economics."

*************

As it happens, I had the privilege of discussing some of these papers  in Atlanta in  2019 at the ASSA meetings, in a session sponsored by  the History of Economics Society, and chaired by Pedro Garcia Duarte.

Another paper from that session that appears in this issue of HOPE is 

Engineering the “Statistical Control of Business”: Malcolm Rorty, Telephone Engineering, and American Economics, 1900–1930  by Thomas A. Stapleford

History of Political Economy (2020) 52 (S1): 59–84.  https://doi.org/10.1215/00182702-8717924

"Malcolm Rorty is best known to historians of economics as the primary organizer and founder of the National Bureau of Economic Research. This article situates Rorty’s interest in economics against the backdrop of his early career in telephone engineering at American Telephone & Telegraph. I argue that distinct structural features of telephone engineering in general, and AT&T in particular, created overlaps between the practices of engineering and economics, and also opened space for Rorty to craft a broader vision for the “statistical control of business” through quantitatively informed management."

Paying employees to be vaccinated against Covid. (Is that repugnant? Could it be illegal??)

 Apparently paying workers to get vaccinated (even giving them paid time off to get vaccinated) may face some legal complications.

The Washington Post has the story:

Why grocery chains are paying workers to get vaccinated, but other industries are lagging   by By Jena McGregor and Taylor Telford

"A number of leading grocery chains are offering small cash bonuses and other incentives to encourage employees to get the coronavirus vaccine, in an effort that experts say could help speed protection of some of the country’s most vulnerable workers: low-paid, hourly retail workers.

"Dollar General, Trader Joe’s, Aldi and Lidl, as well as Instacart, have announced plans to promote the vaccine among employees, including flexible work schedules, paid time off to visit a vaccination site and bonuses of up to $200.

"The restaurant industry may also be moving toward incentives. On Tuesday, Darden Restaurants, which employs more than 175,000 workers across Olive Garden, LongHorn Steakhouse and many more brands, said it would offer up to four hours of paid time off to get the vaccine.

"However, few other companies have followed suit, potentially in part because of legal uncertainties involved with health screening questionnaires leading up to vaccination.

...

"Some lawyers believe companies will be able to successfully argue that the required screening questions for the coronavirus vaccine meet the standard of being needed for the business. 

...

"But others say the screening questions could complicate things if they’re seen as being part of a “voluntary wellness program,” which may limit the incentives companies can offer. If the employer contracts with an outside firm to vaccinate employees or has its own staff inoculate workers, new proposed rules from the U.S. Equal Employment Opportunity Commission, which says incentives can only be “de minimus” in size, might apply. The proposed rules give examples like a water bottle or gift card of “modest value.”

**********

Update: here's a related story from the Financial Times, focusing on the fact that there may be a shortage of vaccinated employees for some time:

Should Covid vaccines be mandatory at work? A few companies have introduced ‘no jab, no job’ policies, but it is unclear if such steps are lawful by Pilita Clark and Emma Jacobs

Mechanism design conference (virtually) at Pitt, April 15-17, with keynotes by Tuomas Sandholm and Utku Unver

 Here's the announcement: the conference is sponsored by the NBER

Mechanism Design for Vulnerable Populations

Thurs Apr 15- Sat Apr 17, 2021

Graduate School of Public and International Affairs (GSPIA)

University of Pittsburgh

"We are delighted to share that the NSF/CEME Decentralization 2021 conference, which had to be postponed from 2020 due to COVID-19, will take place virtually on April 15-17 this year! This conference series is funded by the National Science Foundation and is administered through the National Bureau of Economic Research (NBER). This is the 50th anniversary of the Decentralization conference - the first Decentralization Conference was held at UC Berkeley in 1971.

"The goal of this year's conference is to apply and extend mechanism design to the practical needs of institutions that serve vulnerable populations. These populations pose conceptual and technical challenges for the designer due to the high stakes decision making environments, complex constraints on agents’ action space, and the cumulative effects of disadvantaged participation in previous mechanisms. We are excited to have Tuomas Sandholm (Carnegie Mellon University) and M. Utku Unver (Boston College) as keynote speakers.

"Talks (including discussions) are 30-45 minutes and spans general mechanism design theory as well as topics such as matching and assignment problems in foster care, refugee resettlement, low-income housing, affirmative action, and criminal justice. Each talk will be followed by an open chat with the audience and two discussants - for session #2-5 this will be an academic and a practitioner. Breakout groups at the end of each module allows for more substantial engagement with each topic."

 

Vaccine delivery in the U.S. continues to be congested

As of today, congestion is still competing with short supply to limit vaccination in the US.

Some doses are being wasted or delayed in the name of fairness,  to better honor the priority orderings being used in each state, some doses are being sequestered for second vaccinations rather than being used now for first vaccinations, and some regions and/or providers have too little vaccine on hand, or too little predictability of supply to plan efficient distribution.

 USA today has the story:

Amid sputtering COVID-19 vaccine rollout, 16 states have used less than half of distributed doses  by Ken Alltucker

"The Biden administration has vowed drug companies will make enough vaccine to immunize 300 million Americans by the end of the summer.

But getting the vaccine from the factory to the arms of people has been anything but smooth. Of 47.2 million doses shipped to states and nursing homes, 24.6 million doses have been administered, the Centers for Disease Control and Prevention reported Thursday. 

The nation's slow rollout has boiled over from California, which tapped Blue Shield of California to allocate vaccines, to Maryland where Gov. Larry Hogan implored the federal government to send more doses of the potentially life-saving vaccine.

An Arlington, Virginia, hospital canceled 10,000 vaccine appointments, citing the state's decision to send doses to county health departments rather than directly to hospitals and other health providers.  In Minnesota, a vaccine lottery offered just 8,000 appointments to more than 226,000 people who signed up over a 24-hour period this week."

National Academies committee on Donor Organ Procurement, Allocation, and Distribution

The National Academies of Science, Engineering, and Medicine have formed a committee on

A Fairer and More Equitable, Cost-Effective, and Transparent System of Donor Organ Procurement, Allocation, and Distribution

"Challenges exist in ensuring deceased donor organs are allocated to individuals on the transplant recipient waitlist in a fair, equitable, cost-effective and transparent manner. In response to the Consolidated Appropriations Act, 2020, the National Academies of Sciences, Engineering, and Medicine will establish an ad hoc committee to conduct a study to examine the economic (costs), ethical, policy, regulatory, and operational issues relevant to organ allocation policy decisions involving deceased donor organs. "

"On February 4-5, 2021, the committee will host a public workshop that will bring together stakeholders to explore gaps, barriers, and opportunities for improving deceased donor organ procurement, allocation, and organ distribution. Workshop presentations and discussions will examine the organ procurement process, opportunities and challenges for transplant centers, data collection and modeling, disparities and access issues, perspectives from deceased donor families and transplant recipients, and cost and economic factors."

Register here.

Committee

Basketball is still adjusting to the three-point field goal

Rules are an important part of the design of marketplaces, and also of games and competitive sports. And it can take time for participants to adjust to changes in the rules and settle into a new equilibrium. Here's some history of 3-point rules in Wikipedia.

The WSJ has the story of the growth of 3-point baskets in professional basketball:

The One Number That Explains the NBA’s 3-Point Revolution--No team had ever taken 40% of its shots as 3-pointers until 2017. Now half the league is doing it.    By Ben Cohen

"When the NBA slapped a 3-point line on the court and declared certain shots worth more than other shots, the single most consequential rule change in modern sports, it would take years for basketball teams to realize they had different incentives. Slowly at first, and then with astonishing speed, they shot more and more 3-pointers. But for almost four decades, there was a limit. No team attempted 40% of its shots as threes. 

"Then it happened in 2017. It happened again in 2018—but with two teams above the 40% threshold. That number would balloon to five in 2019 and nine in 2020. 

"But what’s happening this season is a rapid acceleration of a trend that has reshaped the game. There are currently 15 teams with 3-point rates above 40%. Half the league is now doing something that until recently no team in the history of the league had ever done.

...

"At last year’s MIT Sloan Sports Analytics Conference, an event where many bold predictions about the future of basketball have turned out to be prescient, some NBA team executives felt the 3-point boom was only beginning. 

“The people entering the league today started playing still before this 3-point explosion,” said Mike Zarren, the Boston Celtics’ assistant general manager. “There’s a lot of kids now who are learning to shoot a lot of threes—so there ought to be more good shooters coming.” 

...

"One shot is worth 50% more than another shot a few inches away. In the NBA, a ruthless, zero-sum industry with billions of dollars at stake, that’s incredible value. It’s the type of glaring inefficiency that teams would have to be foolish to ignore. 

“I don’t think we’ve reached the upper limit yet,” said Haralabos Voulgaris, the Mavericks’ director of quantitative research and development. “I think when you start getting into around 60 to 65% 3-point rate, that’s probably where you’re getting toward more diminishing returns.”

Removing disincentives from kidney donation: pro and con in the American Journal of Kidney Diseases

 Two dueling papers in the American Journal of Kidney Diseases consider the effects of compensating kidney donors to remove disincentives from kidney donation.  The first (by McCormick et al.) suggests that including payments to compensate for risk would increase donation. The second paper (by Danovitch et al.) agrees, but says that this is what would make  compensation unethical, since it is unethical to pay for risk, as that might convince some to donate who otherwise would not.

Reducing the Shortage of Transplant Kidneys: A Lost Opportunity for the US Health Resources and Services Administration (HRSA)

Frank McCormick, Philip J. Held, Glenn M. Chertow, Thomas G. Peters, John P. Roberts   DOI:https://doi.org/10.1053/j.ajkd.2020.10.007 

"If the government removes all of these disincentives, it would not only be a major step toward economic fairness, but it would also significantly increase the number of living donors. "

The True Meaning of Financial Neutrality in Organ Donation

Gabriel M. Danovitch, Alexander M. Capron, Francis L. Delmonico, DOI:https://doi.org/10.1053/j.ajkd.2020.11.006

"Although McCormick et al discuss this principle  in the accompanying Policy Forum Editorial,4 it is our opinion that they distort the meaning of financial neutrality.5 The authors expand the legitimate costs of donation, including travel, lodging, lost work, and other verifiable expenses, to reach a $38,000 fixed payment to donors by including a dollar value for wholly subjective factors such as pain, fear, risk, and quality of life. For example, “risk” is assigned a value of $6,500. These factors are intrinsic to the process of organ donation, and it is disingenuous to include them under the rubric of financial neutrality.

...

"Critically, HRSA explicitly rejects the suggestion that payment be made for “undertaking a ‘risk,’ whether it be a long-term health risk or surgical risk.”

******************

I have to assume that people who reject payments for risk live in rural parts of America where we have volunteer fire departments, rather than in cities, where we pay fire fighters, partly for the risk they take.

In a different context, here's a recent post about a paper in the Journal of Medical Ethics that considers payments for risk in vaccine trials:

Thursday, October 29, 2020

Paying participants in challenge trials of Covid-19 vaccines, by Ambuehl, Ockenfels, and Roth

"we note that increasing hourly pay by a risk-compensation percentage ... provides compensation proportional to risk only if the risk increases proportionally with the number of hours worked. (Some risky tasks take little time; imagine challenge trials to test bulletproof vests.) To ensure that equal consequences are compensated with equal amounts across a wide variety of studies, we instead recommend a three-part contract consisting of: (1) salary for time involvement that is adjusted to account for the amount of discomfort experienced during participation, (2) insurance against ex post adverse outcomes and (3) ex ante compensation for risks that cannot be compensated ex post (such as death). Such a scheme also increases transparency about what is requested from participants and thus contributes to high-quality participation decisions."

Congestion in vaccine delivery, and shortage of overall supply: latest news, and a call for increased production

Covid vaccines in many parts of the U.S. are being distributed only slowly, while other places are experiencing shortages.

 The NY Times brings us up to date:

New Pandemic Plight: Hospitals Are Running Out of Vaccines.  Health officials are frustrated that available doses are going unused while the virus is killing thousands of people each day. Many vaccine appointments have been canceled.   By Simon Romero and Giulia McDonnell Nieto del Rio

"In the midst of one of the deadliest phases of the pandemic in the United States, health officials in Texas and around the country are growing desperate, unable to get clear answers as to why the long-anticipated vaccines are suddenly in short supply. Inoculation sites are canceling thousands of appointments in one state after another as the nation’s vaccines roll out through a bewildering patchwork of distribution networks, with local officials uncertain about what supplies they will have in hand.

...

"Health officials trying to piece together why this is happening are puzzled by reports that millions of available doses are going unused. As of Friday morning, nearly 39.9 million doses of the Pfizer-BioNTech and Moderna vaccines had been distributed to state and local governments, but only about 19.1 million doses had been administered to patients, according to the Centers for Disease Control and Prevention....

...

"“Right now, in many cities and counties when an announcement of available vaccinations is made, website sign-up pages crash and phone calls go unanswered"

...

"The public health department in San Francisco and hospitals in the city were “caught by surprise” by the lack of doses, Dr. Rutherford said, and by the eligibility expansion to those 65 and older, which likely strained the system. Varying vaccine distribution channels — such as Kaiser Permanente and the University of California, San Francisco — receive the doses on their own, he said, further complicating an already convoluted distribution system.

“So it’s a little hard for the city to understand exactly what’s left over, what they need to do, where the holes are to fill,” Dr. Rutherford said. Still, new vaccination sites are opening in San Francisco, which Dr. Rutherford said would help speed the process along once more doses become available. “There’s this tension between efficiency and equity,” he said. “It’s never easy.”

*****************

Here's a paper that points out that getting people vaccinated fast would have enormous benefits in terms of saving lives and reopening the economy, and that once we get the kinks out of vaccine distribution, it makes sense to invest in production facilities much faster than the pharma companies might feel it was necessary to do on their own.

Preparing for a Pandemic: Accelerating Vaccine Availability  By AMRITA AHUJA, SUSAN ATHEY, ARTHUR BAKER, ERIC BUDISH, JUAN CAMILO CASTILLO, RACHEL GLENNERSTER, SCOTT DUKE KOMINERS, MICHAEL KREMER, JEAN LEE, CANICE PRENDERGAST, CHRISTOPHER M. SNYDER, ALEX TABARROK, BRANDON JOEL TAN, WITOLD WIECEK

Abstract: Vaccinating the world’s population quickly in a pandemic has enormous health and economic benefits. We analyze the problem faced by governments in determining the scale and structure of procurement for vaccines. We analyze alternative approaches to procurement, arguing that buyers should directly fund manufacturing capacity and shoulder most of the risk of failure, while maintaining some direct incentives for speed. We analyzed the optimal portfolio of vaccine investments for countries with different characteristics as well as the implications for international cooperation. Our analysis, considered in light of the experience of 2020, suggests lessons for future pandemics.

Mike Rees wins transplant surgeon excellence award for innovations in kidney exchange

Mike Rees, who founded the Alliance for Paired Kidney Donation (APKD), received The American Association of Kidney Patients (AAKP)  2021 MEDAL OF EXCELLENCE AWARD at the American Society of Transplant Surgeons Winter Symposium (January 16),  during the ASTS Awards Ceremony.  In the two-minute video below, he accepts the award for his introduction of Nonsimultaneous Extended Altruistic Donor Chains, Standard Acquisition Charges, and Global Kidney Exchange (GKE).

Forbes interviews Jennifer Erickson on organ donation

 I met Jennifer Erickson when she was at the White House Office of Science and Technology Policy during the Obama administration, and helped organize the White House Organ Summit in 2016.

Here's a story about her in Forbes:

Why Ending The Organ Donation Waitlist Can Save Countless Lives And Billions Of Dollars  by Rob Dube

“You have no budget,” Jennifer’s boss told her. “What you do have is your desk, a phone, and a period of time where people will take your call. You’re here to hustle. You’re here to make something happen for people around the country.

...

"After speaking with experts, Jennifer chose to focus on ending the waitlist for organ transplants. She was drawn in by the enormous problems within the United States’ current organ donation system. The U.S. has the research, resources, and expertise. Yet, “tens of thousands of organs go unrecovered every year!” says Jennifer. “That’s nuts!”

...

"Once the research was compiled, Jennifer found startling information. She uncovered “really troubling issues with inequality,” Jennifer says. Too often, low-income citizens and people of color were left out-of-loop both as donors and recipients. “Research shows that Black families are less likely to be approached about organ donation, and talked to less about it when they actually are.” 

"And although saving lives is always at the forefront of her mind, Jennifer learned how much money the U.S. could save by ending the organ transplant waitlist. “For every patient who gets a kidney transplant,” Jennifer says, “We save a quarter of a million dollars. 

"Most people care more about saving lives—but what an opportunity to save tens of billions a year while helping Americans at the same time. It’s huge, exciting, and we have every reason to get it right.”

"The conversation with Jennifer Erickson continues on the Leading with Genuine Care podcast. "

HT: Frank McCormick

**********

Related post:

Monday, January 13, 2020

The organization of organ donation: Jennifer Erikson and Abe Sutton call for an Office of Organ Policy

Mike Luca on social media bans

 Mike Luca writes, in Wired, about social media bans as part of their design.

Social Media Bans Are Really, Actually, Shockingly Common--Booting Trump didn’t set a precedent. From Yelp to Uber to Airbnb, platforms regularly ban users and content, but too often behind the scenes.

"DONALD TRUMP’S ACCOUNTS have been banned on Twitter, Facebook, and a host of other platforms. Every last one of @realdonaldtrump’s 47,000 tweets vanished from the site in an instant, from the birther lies and election conspiracy theories to the 2016 taco bowl tweet. In an explanatory blog post, the company cited the attack on the Capitol and “the risk of further incitement of violence” that might occur by permitting further Trump tweets. His multiplatform removal has drawn cheers from many, as well as the ire of more than a few Trump supporters. The bans have also raised concerns that the companies had gone too far in exercising their power to shape what users see.

...

"To combat review fraud, Yelp and other platforms flag reviews they deem spammy or objectionable and remove them from the main listings of the page. Yelp puts these into a section labeled “not currently recommended,” where they are not factored into the ratings you see on a business’s page. The goal of approaches like this is to make sure people can trust the content they do see.

...

"Ultimately, removing content can be valuable for users. People need to feel safe in order to participate in markets. And, it can be hard to trust review websites riddled with fake reviews, housing rental websites rife with racial discrimination, and social media platforms that are megaphones of misinformation. Removing bad content can create healthier platforms in the long run. There is a moral case for banning the president. There is also a business case."

SAT eliminates subject tests

 The portfolio of standardized tests available to college admissions offices is shrinking (or at least changing)...

The WSJ has the story:

College Board Eliminates SAT Subject Tests--Decision takes effect immediately, while many colleges already made the exams optional   By Melissa Korn and Douglas Belkin

"The College Board is eliminating SAT subject tests, as the pandemic accelerates a push for changes in college admissions.

"The 20 subject tests have been offered for decades in areas including math, English literature, world history and physics, but have fallen out of favor as a requirement for college applications. Between 2016 and 2019, registrations for the test fell by 8%—and dropped sharply last year, as test sites were closed due to the coronavirus pandemic.

...

"Robyn Lady, director of student services at Chantilly High School in Virginia, applauded the latest move. ...

“Anything that moves us closer to simplifying the process for students and removing barriers is a move in the right direction,” she said, adding that she’d like to see all standardized tests eliminated from college admissions. “This is all about equity and access.”

Vaccine congestion: short planning horizons

 ProPublica has the story:

How Operation Warp Speed Created Vaccination Chaos--States are struggling to plan their vaccination programs with just one week’s notice for how many doses they’ll receive from the federal government. The incoming Biden administration is deciding what to do with this dysfunctional system.       by Caroline Chen, Isaac Arnsdorf and Ryan Gabrielson

"Hospitals and clinics across the country are canceling vaccine appointments because the Trump administration tells states how many doses they’ll receive only one week at a time, making it all but impossible to plan a comprehensive vaccination campaign.

"The decision to go week by week was made by Operation Warp Speed’s chief operating officer, Gen. Gustave Perna, because he didn’t want to count on supplies before they were ready. Overly optimistic production forecasts turned out to be a major disappointment in the rollout of the H1N1 vaccine more than a decade ago, also leading to canceled appointments and widespread frustrations with the government’s messaging.

"This time, however, the most pressing problem isn’t the overpromising of supply. For each of the past three weeks, the federal government got about 4.3 million shots. But the amount that each state is sent has fluctuated as Operation Warp Speed changes the quantities available week by week.

State health officials say the unpredictable shipments have led to chaos on the ground, including the inability to quickly use up all of the doses sent to them. The week-by-week system also makes it hard to plan for the second doses that everyone needs because they come three or four weeks after the initial dose.

...

"The makers of the two authorized vaccines, Pfizer and Moderna, are each contracted to supply 100 million doses by the end of March. But with just 31.2 million delivered as of Jan. 15, according to data from the Centers for Disease Control and Prevention, the companies will need to ramp up their pace to hit their targets."

*********

HT: Peter Cramton

School choice under discussion in Vienna (video, in English and German)

 On Wednesday I spoke about school choice in Vienna.  (Here's the prospectus.)The video is below. (I start speaking around minute 9:30, in English, for 30 minutes, and the subsequent talk and discussion are in German.)

 

(https://www.youtube.com/watch?v=eZgOM6-xdH8&feature=youtu.be)

My understanding is that there will now be some opportunity for the scholars in Vienna to study the current (local) school assignment system used in Vienna, in conjunction with the schools administration.

Congestion in decentralized vaccination

 The news is full of stories of people obsessively refreshing web pages, hoping to get an appointment for a Covid vaccine.

The Washington Post has this story:

Tipsters, tech-savvy kids, pharmacy hopping: How Americans are landing coronavirus vaccines.  ‘It feels like I’m trying to get a Beyoncé ticket,’ said a woman trying to get her mother an appointment  By Fenit Nirappil, Karin Brulliard and Sarah Fowler

"Those searching for a shot face a decentralized system of vaccine distribution operated by cash-strapped public health departments and a disparate network of clinics and medical providers, all crushed by unprecedented demand for a shield against the virus decimating American life.

"While many Americans have had no problem getting shots, others like Cohen have spent hours trying to get vaccinated, to no avail. The challenges in vaccinating people mirror the botched rollout of coronavirus testing as a mix of government and private providers navigate unfamiliar terrain while communicating with the public in different ways.

"Some vaccine appointment websites crashed almost as soon as they launched. Older Americans are enlisting their kids and grandchildren to stay on the phone and keep refreshing websites until they land an appointment. Tiny intelligence networks are forming around the country to scour for morsels of information on how to get a leg up on the vaccine search.

"Claire Hannan, executive director of the Association of Immunization Managers, said these struggles are unavoidable as the federal government defers distribution to localities without the resources to create a centralized sign-up for vaccines or to hold mass inoculation drives.

...

"The Centers for Disease Control and Prevention plans to encourage people to use VaccineFinder as a national resource for finding shots, but a public search function has not launched while supplies are still limited."

A proposed match for English professors, in the Chronicle of Higher Ed

 Here's a proposal for a centralized clearinghouse for new Ph.D.s in English.  It's a thought experiment, unconstrained by considerations of stability.

The Chronicle of Higher Ed 

Medical Residencies Use Automatic Matching. Professorships Should, Too.--A thought experiment in improving a dismal situation.  By Kim Adams

"What would a computerized match look like in faculty hiring? Let’s say that I am applying for a tenure-track assistant professor position in English. I would read job ads from universities and submit the requested application materials, just as I do now. The main difference would be timing. In order for a match to work, all the job ads would need to be posted by a given date, for example, September 1. It would work best if they were all posted in the same place, perhaps the website of the new Faculty Match Program. The application materials would likewise be due at a uniform time, let us say November 1.

...

"The algorithm would be designed to ensure a maximum distribution of candidates across openings. While the number of first round interview requests a candidate could receive would be unlimited, the number of campus visits would be limited to three. The process would prefer to provide each candidate with one campus visit before providing any candidates with a second. This would benefit both parties. A greater number of candidates would receive campus visits than in the current system. And the department conducting the search could rest assured that the candidates matched to their campus were actually interested in taking the job.

...

Colleges would then conduct campus visits and complete the hiring process as usual. Because of the imbalance of candidates and positions, the risk of unmatched candidates would be high (but that’s nothing new). The risk of unmatched positions is small, perhaps smaller than in the current system, under which searches not infrequently fail despite the superabundance of job candidates. Stable matches would mean fewer faculty members who go on the market after one or two years in a position, thereby decreasing the quantity of applications that search committees need to wade through in future cycles.

...

"The failure of the academic-job market is evident to all those involved. The madness of the market is subsuming the process of doctoral education. Without substantial changes, the doctoral degree will lose its value and the market will collapse. Collective action among graduate students and contingent faculty members can draw attention to these issues, but only the unified, cooperative action of deans and presidents can solve them.

Covid vaccine causes outbreak of smoking in New Jersey

 Strategy-proofness is an idea that shouldn't be appreciated only by game theorists.

The NY Times has the story:

Smokers in N.J. Are Eligible for Vaccine. No Proof Needed. New Jersey is one of only two states that has included smoking among the high-risk medical conditions that make people eligible for the Covid-19 vaccine.

More on convalescent plasma for treating Covid-19

Early results concerning the effectiveness of convalescent plasma have been mixed.  Here's a new study, in the NEJM, and reported in the NY Times. (see my earlier posts here.)

Here's the Times story:

Blood Plasma Reduces Risk of Severe Covid-19 if Given Early  By Katherine J. Wu

"A small but rigorous clinical trial in Argentina has found that blood plasma from recovered Covid-19 patients can keep older adults from getting seriously sick with the coronavirus — if they get the therapy within days of the onset of the illness.

"The results, published Wednesday in the New England Journal of Medicine, are some of the first to conclusively point toward the oft-discussed treatment’s beneficial effects."

And here's the NEJM article:

Early High-Titer Plasma Therapy to Prevent Severe Covid-19 in Older Adults

List of authors.

Romina Libster, M.D., Gonzalo Pérez Marc, M.D., Diego Wappner, M.D., Silvina Coviello, M.S., Alejandra Bianchi, Virginia Braem, Ignacio Esteban, M.D., Mauricio T. Caballero, M.D., Cristian Wood, M.D., Mabel Berrueta, M.D., Aníbal Rondan, M.D., Gabriela Lescano, M.D., et al., for the Fundación INFANT–COVID-19 Group*

"BACKGROUND: Therapies to interrupt the progression of early coronavirus disease 2019 (Covid-19) remain elusive. Among them, convalescent plasma administered to hospitalized patients has been unsuccessful, perhaps because antibodies should be administered earlier in the course of illness.

METHODS: We conducted a randomized, double-blind, placebo-controlled trial of convalescent plasma with high IgG titers against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in older adult patients within 72 hours after the onset of mild Covid-19 symptoms. The primary end point was severe respiratory disease, defined as a respiratory rate of 30 breaths per minute or more, an oxygen saturation of less than 93% while the patient was breathing ambient air, or both. The trial was stopped early at 76% of its projected sample size because cases of Covid-19 in the trial region decreased considerably and steady enrollment of trial patients became virtually impossible.

RESULTS: A total of 160 patients underwent randomization. In the intention-to-treat population, severe respiratory disease developed in 13 of 80 patients (16%) who received convalescent plasma and 25 of 80 patients (31%) who received placebo (relative risk, 0.52; 95% confidence interval [CI], 0.29 to 0.94; P=0.03), with a relative risk reduction of 48%. A modified intention-to-treat analysis that excluded 6 patients who had a primary end-point event before infusion of convalescent plasma or placebo showed a larger effect size (relative risk, 0.40; 95% CI, 0.20 to 0.81). No solicited adverse events were observed.

CONCLUSIONS: Early administration of high-titer convalescent plasma against SARS-CoV-2 to mildly ill infected older adults reduced the progression of Covid-19. "