Cuando se piensa en África subsahariana es muy difícil desligarse de la noción de caos, sea éste político, económico o social. Esta idea es incluso reforzada por la presencia en la prensa internacional de los casos de Estados fallidos como la República Democrática del Congo, Sudán, Somalia y Chad, entre otros. Lo cierto es que ignorando a estas entelequias estatales, el resto de los países que integran este continente están muy lejos de alcanzar estadios aceptables de desarrollo y bienestar para sus nacionales.Los Estados africanos tienen grandes problemas de corte institucional que no les permiten ser el principal vehículo de desarrollo en sus territorios. Los dos mayores obstáculos a la institucionalización son: por un lado el dominio irrestrictivo de las materias primas exportables por parte de una elite selecta y aislada del resto de la población. El poder económico que implica el control de los recursos naturales y, el poder político a través de las armas, imposibilita que los gobernados tengan espacios para ejercer algún tipo de influencia sobre quienes gobiernan. La accountability de parte de la sociedad local en este caso es nula. Por otro lado, la falta de necesidad del gobierno de su población lo aísla de la misma y tiene como resultado que el Estado como tal carezca de los canales apropiados para ser capaz de mejorar la calidad de vida de sus habitantes por carecer de la infraestructura física y social para llevarlo a cabo.Una vez dicho esto se debe rescatar que son pocos los Estados que escapan de este círculo vicioso de subdesarrollo. Ghana es uno de ellos. Ghana ha sido siempre un país que ha sobresalido en el concierto africano. Fue, si no la más, una de las colonias más prósperas de Gran Bretaña en África. Ghana también fue el primer país de África negra en obtener su independencia en 1957. Su principal líder independentista, Kwame Nkrumah, también fue un importante representante del panafricanismo y un ferviente luchador por la independencia de todo el continente.Para poder contextualizar la realidad de la política ghanesa hay que brindar información sobre su escenario. Ghana es un país con un territorio de 230.940 km2 que cuenta con una población de aproximadamente 22,5 millones de habitantes y más de 100 grupos etnolingüísticos, donde los Akan, Ewe, Gur y Ga-Adangbe son los principales.Las claves para entender el fortalecimiento institucional de Ghana son varias y a continuación serán presentadas. En primer lugar es importante destacar las características propias de la población. En este sentido sobresalen dos rasgos. El primero de ellos es la inexistencia de una etnia absolutamente dominante. Cuando un grupo étnico aventaja en números de manera desproporcionada a la minoría, los derechos de la minoría no son respetados y el proceso por incorporarlos a la política local es conflictivo. En el caso de Ghana los Akan son el 45% de la población - pero entre ellos no hay homogeneidad, lo que lleva a que este grupo se disgregue y políticamente no mantenga la unidad. Esto es beneficioso para el sistema político-partidario, porque los partidos para poder ganar en todo el país deben ser partidos nacionales propiamente dicho y partidos regionales o étnicos. La otra característica a remarcar es la existencia de la institución de la cacicaturas. Previo a la colonia los caciques fueron la máxima autoridad política en las comunidades locales. Los Asante sobresalen porque tuvieron el sistema político más desarrollado de Ghana, contando con un monarca o Asantehene cuyo espacio de influencia fue muy similar al presente territorio ghanés. Esto último es un dato no menor, porque da a entender que previo a la colonia lo que hoy es Ghana había sido (aunque difusamente) un espacio político dominado por un grupo étnico y no un territorio sin identidad concedido a Gran Bretaña al momento del reparto de África entre los europeos. Hoy en día la autoridad política no recae sobre los caciques. De todos modos la prevalencia de las cacicaturas es indiscutible y está arraigada en la cultura política local. En la actualidad, los caciques mantienen la autoridad moral frente a sus seguidores y se han convertido en agentes de desarrollo y compañeros de las instituciones políticas modernas que buscan el bienestar en Ghana.Entre las características económicas de este país se puede afirmar que su base productiva ha girado en torno a la cocoa, la madera y el oro. La ubicación estratégica de estos recursos en el sur del país hizo que los británicos desplegaran una infraestructura física y social capitalista destinada únicamente a la extracción de estas materias primas. No obstante todo lo antedicho, son quizás particularidades políticas las que más llaman la atención de todo este proceso. En Ghana desde la independencia existen altas expectativas políticas para el país. Ser la "Estrella Negra" de África era el objetivo de Ghana. En una primera instancia, la sustitución de importaciones con el respectivo proceso de industrialización local fue la estrategia de desarrollo ghanesa. La falta de experiencia, el clientelismo, el patronazgo, la corrupción y el bajo precio de las materias primas exportables terminaron tiraron por los suelos el sueño ghanés. A partir de aquel momento el país caería en una sucesión de golpes de Estado y de intentos fallidos por restablecer el orden democrático. Para 1980 la realidad era apremiante, más de la mitad de la población vivía en la pobreza, un número muy similar era analfabeta, el PBI había caído 20% de 1972 a 1983, la producción también había disminuido y la poca cocoa exportable era sacado en contrabando por Togo o Costa de Marfil.En ese contexto Jerry Rawlings se hizo con el poder luego de un golpe de Estado en 1981. Luego de intentar políticas socialistas fallidas, Rawlings acudió antes los organismos multilaterales de crédito y a partir de 1983 Ghana empezó el proceso de ajuste estructural y de estabilización de su economía. La dictadura de Rawlings fue muy peculiar: mientras al interior de su país se presentaba como un populista, en el exterior fue visto como un reformista. Esta fue la combinación que permitió que Rawlings y el grupo de tecnócratas económicos pudieran estabilizar la economía. En sus primeros años de gobierno Rawlings contó con el apoyo incondicional de los Comités de Defensa de la Revolución. Estos grupos fueron los responsables de hacer operativas las políticas económicas del régimen. A partir de allí sendas reformas económicas fueron tomando lugar en Ghana durante la década de los 90. La ayuda financiera principalmente del Fondo Monetario Internacional (FMI) y del Banco Mundial (BM), así como de países capitalistas, fue esencial para apuntalar la economía ghanesa. La relación que en un primer momento había empezado con mucho recelo con el probado compromiso del país africano se fue transformando en una relación afianzada, donde ahora Ghana goza de mejores condiciones de crédito y se ha convertido en un aliado estratégico en África occidental.Finalmente, en cuanto al sistema político, el gran desafío para los jóvenes Estados africanos es aprender a aceptar las minorías políticas y étnicas. En el caso de Ghana, la existencia de una tradición de partidos políticos cuya presencia se remonta hasta la independencia y las progresivas victorias del sistema para dotar de pesos y contrapesos el juego partidario hizo posible que luego de la vuelta a la democracia en 1992 existiera la competencia electoral que permitió por primera vez en la historia de Ghana haya un cambio de gobierno hacia un partido opositor luego de su victoria en las urnas en el año 2000. Esta competencia electoral hace que mientras mayor sea la posibilidad de ganar las elecciones, menor será la tentación de los partidos a recurrir a medios no democráticos.Aun son muchos los desafíos que Ghana debe superar para contar con un sistema político y económico maduro y estable respectivamente, que permita potenciar las capacidades de desarrollo que tiene este país. No obstante, la evolución de los últimos 20 años ha permitido que un país en ruinas hoy sea capaz de tener un futuro prometedor y que cuenta con su Ghana Poverty Reduction Strategy I and II, sus propios programas de desarrollo a mediano plazo que pretenden convertir a Ghana en un país de ingreso medio para el año 2015. * Candidato a la Licenciatura en Estudios Internacionales. Universidad ORT- Uruguay
La investigación se propuso analizar el "regreso" del Estado en la escena del desarrollo en los países latinoamericanos en medio de un persistente escenario capitalista global de raigambre neoliberal. Centrándose en la experiencia argentina reciente (2003-2015), el trabajo analiza la estructura y la implicación estatal en el ámbito industrial-pyme. Sistematiza los recursos institucionales que se pusieron en movimiento (financieros, humanos, organizativos) para dinamizar el desarrollo industrial, entendiendo a este como un proceso de transformación de la matriz productiva y de los actores dominantes. Este trabajo aborda al Estado, y a las políticas públicas que implementa, como un objeto disputado en un marco histórico y espacial amplio de hegemonía e intereses neoliberales. En ese carácter disputado se expresa la presencia de redes políticas y económicas globales que buscan deshabilitar y fragmentar las estructuras estatales y con ello el poder del Estado como actor estratégico para dinamizar el desarrollo industrial. La dinámica y trayectoria doméstica son importantes en su configuración, pero bajo la globalización los actores globales han ganado mayor influencia con el objetivo de ampliar la dinámica global de acumulación capitalista. Desde esta perspectiva, si bien el Estado condensa y estructura recursos (financieros, humanos, organizacionales) que resultan estratégicos para concretar el desarrollo industrial, la influencia de las dinámicas y actores globales se aprecia en la adopción de determinada la modalidad de implicación o posicionamiento estatal que configura esa estructuración. El análisis se propuso dos objetivos. Por un lado, uno de carácter teórico referido a analizar la estructura estatal y la implicación estatal en el desarrollo y la incidencia de las redes políticas globales. Como un área donde las reformas neoliberales afectaron con mayor profundidad, el ámbito industrial-pyme se presenta como una particular arena de política pública para estudiar el modo en que organismos internacionales tales como BM, BID, o PNUD, incidieron la modalidad de implicación y configuración estructural del Estado nacional. Por otro lado, como objetivo práctico referido al análisis empírico, se evalúa una de las experiencias neodesarrollistas latinoamericanas. Tomando la experiencia argentina como ejemplo, el período kirchnerista (2003-2015) (Néstor Kirchner y Cristina Fernández) fue un campo fértil para analizar las instancias estatales específicas, y buscar allí alguna explicación sobre la continuidad de ciertos rasgos heredados (concentrada, extranjerizada y centrada en los recursos naturales) que impidieron avances en materia de complejidad y densidad industrial y acentuaron las restricciones propias de la dinámica de desarrollo en los países periféricos. Desde el lente teórico planteado y frente a un regreso estatal que culminó resultando poco satisfactorio, ¿cuál fue la centralidad que asumió la el Ministerio de Industria para direccionar a los actores productivos industriales-pyme hacia dinámicas y sectores más avanzados y complejos? ¿cómo incidieron los organismos internacionales en su estructura o en alguno de sus componentes? Combinando una metodología cualitativa y cuantitativa en donde se analizaron fuentes documentales y se realizaron entrevistas a funcionarios y gestores estatales, la investigación se centró en examinar el Ministerio de Industria de la Nación creado en 2009, y los canales por los cuales los organismos internacionales incidieron en su configuración. El análisis giró en torno a la trayectoria del ministerio, sus competencias, su organización, los recursos financieros y humanos disponibles en sus secretarías, políticas y programas, así como en la implementación del Plan Estratégico Industrial 2020. Así mismo, se profundizó el análisis en dos programas pyme vinculados a organismos internacionales: el Programa de Acceso al Crédito y Competitividad (PACC) (BID), y el Programa Sistemas Productivos Locales (SPL) (PNUD). Los hallazgos de la investigación muestran que la jerarquización del ámbito industrial, no obstante constituirse en un acontecimiento institucional relevante, se presentó también como un proceso de ahuecamiento de competencias y recursos, lo que redundó en la ausencia de centralidad como instancia estratégica para el desarrollo industrial. Se observó la pérdida del control y coordinación de la gestión del comercio exterior en 2011, como un bajo nivel de financiamiento e incentivo al sector industrial, el cual tendió a reproducir la matriz sectorial y actoral preexistente. Además, fue el ministerio con menor cantidad de personal y un índice de contratación superior a otras instancias estatales. Al mismo tiempo, al focalizar en el ámbito pyme, se observó un proceso de fragmentación basado en la profundización de la modalidad de implicación por programas vinculada a los organismos internacionales, donde la implementación del Plan Estratégico Industrial 2020 en 2011 con su impronta de cadena de valor y con escasos recursos asignados, no introdujo cambios significativos. ; The research proposed to analyse the "return" of the State in the development scene in Latin American countries amid a persistent global capitalist scenario with neoliberal roots. Focusing on the recent Argentine experience (2003-2015), the work analyses the structure and state involvement in the industrial-SME sector. It systematizes the institutional resources that were set in motion (financial, human, organizational) to boost industrial development, understanding this as a process of transformation of the productive matrix. This work to examine the State, and the public policies it implements, as an object contested within a broad historical and spatial framework of neoliberal hegemony and interests. Under this contested character is expressed the presence of global political and economic networks that seek to disable and fragment state structures and with it the power of the State as a strategic actor to boost industrial development. The dynamics and domestic trajectory are important in their configuration, but under globalization, global actors have gained greater influence to expand the global dynamics of capitalist accumulation. From this perspective, although the State condenses and structures resources (financial, human, organizational) that are strategic to achieve industrial development, the influence of global dynamics and actors can be seen in the adoption of certain modalities of state involvement or positioning. that configures that structuring. The analysis proposed two objectives. On the one hand, one of a theoretical nature referred to analyse the state structure and the state involvement in the development and incidence of global political networks. As an area where the neoliberal reforms affected in greater depth, the industrial-SME sector is presented as a public policy arena to study the way in which international organizations such as the World Bank, IDB, or UNDP, influenced the modality of involvement and configuration structural of the State. On the other hand, as a practical objective referred to the empirical analysis, one of the Latin American neo-developmental experiences is evaluated. Taking the Argentine experience as an example, the Kirchner period (2003-2015) (Néstor Kirchner and Cristina Fernández) was a fertile ground to analyse the specific state instances, and to find there some explanation about the continuity of certain inherited traits (concentrated, foreignized and focused on natural resources) that impeded progress in terms of complexity and industrial density and accentuated the constraints of the dynamics of development in peripheral countries. From this framework and in front of a state return that ended up being unsatisfactory, what was the centrality that the Ministry of Industry assumed to direct the productive industrial-SME actors towards more advanced and complex dynamics and sectors? How did international organizations influence its structure or any of its components? The research combining a qualitative and quantitative methodology in which documentary sources were analysed and interviews were conducted with officials and state managers. It focused on examining the Ministry of Industry of the Nation created in 2009, and the channels through which the international organizations had an impact on your configuration. The analysis focused on the ministry's trajectory, its competencies, its organization, the financial and human resources available in its secretariats, policies and programs, as well as the implementation of the Strategic Industrial Plan 2020. Likewise, the analysis was deepened in two SME programs linked to international organizations: Access to Credit and Competitiveness Program (ACCP) (DIB), and the Local Productive Systems Program (SPL) (UNDP). The research shows that the hierarchy of the industrial sphere, despite becoming a relevant institutional event, was also presented as a process of hollowing out competencies and resources, which resulted in the absence of centrality as a strategic instance for industrial development. The loss of control and coordination of foreign trade management was observed in 2011, as a low level of financing and incentive to the industrial sector, which tended to reproduce the pre-existing sector matrix. In addition, it was the ministry with the least amount of personnel and a hiring index superior to other state agencies. At the same time, by focusing on the SME area, a fragmentation process was observed based on the deepening of the program implication modality linked to international organizations. Here, the implementation of the Strategic Industrial Plan 2020 in 2011 with its chain value approach and with scarce resources allocated, did not introduce significant changes. ; Fil: Seiler, Cristhian Rubén. Universidad Nacional de Entre Ríos; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
The research activity carried out during the three years of the PhD course attended, at the Engineering Department of the University of Palermo, was aimed at the identification of an alternative predictive model able to solve the traditional building thermal balance in a simple but reliable way, speeding up any first phase of energy planning. Nowadays, worldwide directives aimed at reducing energy consumptions and environmental impacts have focused the attention of the scientific community on improving energy efficiency in the building sector. The reduction of energy consumption and CO2 emissions for heating and cooling needs of buildings is an important challenge for the European Union, because the buildings sector contributes up to 36% of the global CO2 emissions [1] and up to 40% of total primary energy consumptions [2]. Despite the ambitious goals set by the Energy Performance of Buildings Directive (EPBD) at the European level [1], which states that, by 2020, all new buildings and existing buildings undergoing major refurbishments will have to be Nearly Zero Energy Buildings (NZEB) [3,4], the critical challenge remains the improvement of the efficiency when upgrading the existing building stock to standards of the NZEB level [5]. The improvement of the energy efficiency of buildings and their operational energy usage should be estimated early in the design phase to guarantee a reduction in energy consumption, so buildings can be as sustainable as possible [6]. While a newly constructed NZEB can employ the "state of the art" of available efficient technologies and design practices, the optimization of existing buildings requires better efforts [7]. One way or the other, the identification of the best energy retrofit actions or the choice of a better technological solution to plan a building is not so simple. It has become one of the main objectives of several research studies, which require deep knowledge in the field of the building energy balance. The building thermal balance includes all sources and sinks of energy, as well as all energy that flows through its envelope. More in detail, the energy demand in buildings depends on the combination of several parameters, such as climate, envelope features, occupant behaviour and intended use. Indeed, the assessment of building energy performance requires substantial input data describing structures, environmental conditions [8], thermo-physical properties of the envelope, geometry, control strategies, and several other parameters. From the first design phases designers and researchers, which are trying to respect the prescriptions of the EPBD directive and to simultaneously ensure the thermal comfort of the occupants, must optimize all possible aspects that represent the key points in the building energy balance. As will be shown in Chapter A, the literature offers highly numerous complex and simplified resolution approaches [9]. Some are based on knowledge of the building thermal balance and on the resolution of physical equations; others are based on cumulated building data and on implementations of forecast models developed by machine-learning techniques [10]. Several numerical approaches are most widespread; these have undergone testing and implementing in specialised software tools such as DOE-2 [11], Energy Plus [12], TRNSYS [13] and ESP-r [14]. Such building modelling software can be employed in several ways on different scales; they can be simplified [15,16] or detailed comprehensively by different methods and numerical approaches [17]. Nevertheless, they are often characterised by a lack of a common language, which constitutes an obstacle for making a suitable choice. It is often more convenient to accelerate the building thermal needs evaluation and use the simplified methods and models. For example, a steady state approach for the evaluation of thermal loads is characterised by a good level of accuracy and low computational costs. However, its main limitation is that some phenomenon, such as the thermal inertia of the building envelope/structure, may be completely neglected. On the other hand, the choice of a more complex solution, such as the dynamic approach, uses very elaborate physical functions to evaluate the energy consumption of buildings. Although these dynamic simulation tools are effective and accurate, they have some practical difficulties such as collecting detailed building data and/or evaluating the proper boundary conditions. The use of these tools normally requires an expert user and a careful calibration of the model and do not provide a generalised response for a group of buildings with the same simulation, because they support a specific answer to a specific problem. Meanwhile the lack of precise input can lead to low-accuracy simulation. Anyway, in all cases it is necessary to be an expert user to implement, solve and evaluate the results, and these phases are not fast and not always immediately provide the correct evaluation, conducting the user to restart the entire procedure. In the field of energy planning, in order to identify energy efficiency actions aimed at a particular context, could be more convenient to speed up the preliminary assessment phase resorting to a simplified model that allows the evaluation of thermal energy demand with a good level of accuracy and without excessive computational cost or user expertise. The aim of this research, conducted during the three years of the PhD studies, is based on the idea of overcoming the limits previously indicated developing a reliable and a simple building energy tool or an evaluation model capable of helping an unskilled user at least in the first evaluation phase. To achieve this purpose, the first part of the research was characterised of an in-depth study of the sector bibliography with the analysis of the most widespread and used methods aimed at solving the thermal balance of buildings. After a brief distinction of the analysed methods in White, Black and Grey Box category, it was possible to highlight the strengths and weaknesses of each one [9]. Based on the analysis of this study, some alternative methods have been investigated. In detail, the idea was to investigate several Black-Box approaches; mainly used to deduce prediction models from a relevant database. This category does not require any information about physical phenomena but are based on a function deduced only by means of sample data connected to each other and which describes the behaviour of a specific system. Therefore, it is fundamental the presence of a suitable and well-set database that characterise the problem, so that the output data are strongly related to one or more input data. The completely absence of this information and the great difficulty in finding data, has led to the creation of a basic energy database which, under certain hypotheses, is representative of a specific building stock. For this reason, in the first step of this research was developed a generic building energy database that in a reliable way, and underlining the main features of the thermal balance, issues information about the energy performances. In detail, two energy building databases representative of a non-residential building-stock located in the European and Italian territory have been created. Starting from a well-known and calibrated Base-Case dynamic model, which simulates the actual behaviour of a non-residential building located in Palermo, it was created an Ideal Building representative of a new non-residential building designed with high energy performances in accordance whit the highest standard requirements of the European Community. Taking into consideration the differences existing in the regulations and technical standards about the building energy performance of various European countries, several detailed dynamic simulation models were developed. Moreover, to consider different climatic characteristics, different locations were evaluated for each country or thermal zone which represent the hottest, the coolest and the mildest climate. The shape factor of buildings, which represents the ratio between the total of the loss surfaces to the gross heated volume of a building, was varied from 0.24 to 0.90. To develop a representative database where the data that identify the building conditions are the inputs of the model linked to an output that describes the energy performances it was decided to develop a parametric simulation. In detail different transmittance values, boundary conditions, construction materials, and energy carriers were chosen and employed to model representative building stocks of European and Italian cities for different climatic zones, weather conditions, and shape factor; all details and the main features are described in Chapter B. These two databases were used to investigated three alternative methods to solve the building thermal balance; these are: • Multi Linear Regression (MLR): identification of some simple correlations that uses well known parameters in every energy diagnosis [18–20]; • Buckingham Method (BM): definition of dimensionless numbers that synthetically describe the relationships between the main characteristic parameters of the thermal balance [21]; and • Artificial Neural Network (ANN): Application of a specific Artificial Intelligence (AI) to determine the thermal needs of a [22] building. These methods, belonging to the Black-Box category, permit solving a complex problem easier with respect to the White-Box methods because they do not require any information about physical phenomena and expert user skills. Only a small amount of data on well-known parameters that represent the thermal balance of a building is required. The first analysed alternative method was the MLR, described in Chapter C. This approach allowed to develop a simple model that guarantees a quick evaluation of building energy needs [19] and is often used as a predictive tool. It is reliable and, at the same time, easy to use even for a non-expert user since an in-depth knowledge in the use phase is not needed, and computational costs are low. Moreover, the presence of an accurate input analysis guarantees greater speed and simplicity in the data collection phase [23]. The basis for this model is the linear regression among the variables to forecast and two or more explanatory variables. The feasibility and reliability of MLR models is demonstrated by the publication of the main achieved results in international journals. At first, the MLR method was applied on a dataset that considered heating energy consumptions for three configurations of non-residential buildings located in seven European countries. In this way, it was developed a specific equation for each country and three equations that describe each climatic region identified by a cluster analysis; these results were published in [19]. In a second work [18], it was applied the same methodology to a set of data referring to buildings located in the Italian peninsula. In this case, three building analysed configurations, in accordance to Italian legislative requirements regarding the construction of high energy performance buildings, have been employed. The achievement of the generalised results along with a high level of reliability it was achieved by diversifying each individual model according to its climate zone. It was provided an equation for each climate zone along with a unique equation applicable to the entire peninsula, obviously with different degrees of reliability. An improved version of the latest work concerning the Italian case study appeared in the paper published in [20]. The revised model provided an ability to predict the energy needs for both heating and cooling. Furthermore, to simplify the data retrieval phase that is required for the use of the developed MLR tool, an input selection analysis based on the Pearson coefficient has been performed. In this way the explanatory variables, needful for an optimal identification of thermal loads, have been identified. Finally, a comprehensive statistical analysis of errors ensured high reliability. The second analysed alternative method represents an innovative approach in developing a flexible and efficient tool in the building energy forecast framework. This tool predicts the energy performance of a building based some dimensionless parameters implemented through the application of the Buckingham theorem. A detailed description of the methodology and results is discussed in the Chapter D and is also published in [21]. The Buckingham theorem represents a key theorem of the dimensional analysis since it is able to define the dimensionless parameters representing the building balance [24]. These parameters define the relationships between the descriptive variables and the fundamental dimensions. Such a dimensional analysis guarantees that the relationship between physical quantities remains valid, even if there is a variation of the magnitudes of the base units of measurement [25]. The dimensional analysis represents a good model to simplify a problem by means of the dimensional homogeneity and, therefore, the consequent reduction in the number of variables. Therefore, this model works well with different applications such as forecasting, planning, control, diagnostics and monitoring in different sectors. The application of the BM for predicting the energy performance of buildings determined nine ad hoc dimensionless numbers. The identification of a set of criteria and a critical analysis of the results allowed to immediately determine thought the dimensionless numbers and without using any software tool, the heating energy demand with a reliability of over 90%. Furthermore, the validation of the proposed methodology was carried out by comparing the heating energy demand that was calculated by a detailed and accurate dynamic simulation. The last Black-Box examined model was the application of Artificial Neural Networks. The ANNs are the most widely used data mining models, characterised by one of the highest levels of accuracy with respect to other methods but generally have higher computational costs in the developing phase [26]. The design of a neural network, inspired by the behaviour of the human brain, involves the large number of suitably connected nodes (neurons) that, upon applications of simple mathematical operations, influence the learning ability of the network itself [27]. Also in this case, as described in Chapter E, this methodology was applied at the two different energy databases. In [22], the ANN was used to predict the demand for thermal energy linked to the winter climatization of non-residential buildings located in European context, while in another work under review, the ANN was used to determine the heating and cooling energy demand of a representative Italian building stock. The validation of the ANNs was carried out by using a set of data corresponding to 15% of the initial set which were not used to train the ANNs. The obtained good results (determination coefficient values higher than 0.95 and Mean Absolute Percentage Error lower than 10%) show the suitability of the calculation model based on the use of adaptive systems for the evaluation of energy performance of buildings. Simultaneously, a deep analysis of the investigated problem, underlines how to determine the thermal behaviour of a building trough Black-Box models, particular attention must be paid to the choice of an accurate climate database that along with thermophysical characteristics, strongly influence the thermal behaviour of a building [9]. In detail, to develop a predictive model of thermal needs, it is also necessary to pay close attention to the climate aspects. In the literature, many studies use the degree day (DD) to predict building energy demand, but this assessment, through the use of a climatic index, is correct only if its determination is a function of the same weather data used for the model implementation. Otherwise, the predictive model is generally affected by a greater evaluation error; all these aspects are deeply discussed analysing a specific Italian case study in Chapter F, and the main results are published in [8]. The results achieved during the three years of PhD research, make it possible to affirm that each model can be used to solve thermal building balance by knowing merely a few parameters representative of the analysed problem. Nonetheless, some questions may be asked: Which of these models can be identified as the most efficient solution? Is it possible to compare the performances of these models? Is it possible to choose the most efficient model based on some specific phase in the evaluation? To attempt to answer these questions, during the research period it was decided to compare the three selected alternative models by applying a Multi Criteria Analysis (MCA), that explicitly evaluates multiple criteria in decision-making. It is a useful decision support tool to apply to many complex decisions by choosing among several alternatives. The idea rising thanks to the scientific collaboration with the VGTU University of Vilnius, Lithuanian, in the person of Prof. A. Kaklauskas and Prof. L. Tupènaitè, experts in the field of multi-criteria analysis. At the first time a multi-criteria procedure was applied to determine the most efficient alternative model among some resolution procedures of a building's energy balance. This application required extra effort in defining the criteria and identifying a team of experts. To apply the MCA, it was necessary to identify the salient phases of the evaluation procedure to explain the most sensitive criteria for acquiring conscious, truthful answers that only a pool of experts in the field can provide. Details of this work were carried out during the period of one-month research in Vilnius, from April to May 2019, where it was possible to improve the application of the Multiple Criteria Complex Proportional Evaluation (COPRAS) method for identifying the most efficient predictive tool to evaluate building thermal needs. These results are collected in Chapter G and the main results are explained in a paper under review in the Journal "Energy" from September. The identification of the most efficient alternative model to solve the building energy balance through the application of a specific MCA, allowed to deepen the identified methodology and improve research. In particular, the most efficient alternative resolution model was the subject of the research that took place during the research period at the RWTH in Aachen University, Germany with Prof. M. Traverso, Head of the INaB Department, from September 2018 to March 2019. The experience in the field of LCA and the possibility of identifying the environmental impacts linked to the building system, has led the research to investigate neural networks for a dual and simultaneous environmental-energy analysis. The results confirm that the application of ANNs is a good alternative model for solving the energy and environmental balance of a building and for ensuring the development of reliable decision support tools that can be used by non-expert users. ANNs can be improved by upgrading the training database and choosing the network structure and learning algorithm. The results of this research are collected in Chapter H and published in [28].
The PGC was funded by National Institute of Mental Health (NIMH) Grant Nos. MH085520 (to PFS) and MH080403. Statistical analyses were carried out on the Genetic Cluster Computer (http://www. geneticcluster.org) hosted by SURFsara and financially supported by the Netherlands Scientific Organization Grant No. NWO 480-05-003 (to D. Posthuma) and the department of Psychology, Vrije Universiteit Amsterdam along with a supplement from the Dutch Brain Foundation. The Bonn/Mannheim GWAS was supported by the German Federal Ministry of Education and Research (BMBF) through the Integrated Genome Research Network Systematic Investigation of the Molecular Causes of Major Mood Disorders and Schizophrenia Grant Nos. 01GS08144 and 01GS08147, under the auspices of the National Genome Research Network plus, and through the Integrated Network Integrated Understanding of Causes and Mechanisms in Mental Disorders, under the auspices of the e:Med Programme Grant Nos. 01ZX1314A and 01ZX1314G. The Bonn/Mannheim GWAS was also supported by the German Research Foundation (DFG) Grant Nos. FOR2107, RI908/11-1, and NO246/10-1. The GenRED GWAS project was supported by NIMH R01 Grant Nos. MH061686 (to DFL), MH059542 (to W.H. Coryell), MH075131 (W.B. Lawson), MH059552 (JBP), MH059541 (W.A. Scheftner), and MH060912 (MMW). Max Planck Institute of Psychiatry MARS study was supported by the BMBF Program Molecular Diagnostics: Validation of Biomarkers for Diagnosis and Outcome in Major Depression by Grant No. 01ES0811. Genotyping was supported by the Bavarian Ministry of Commerce, and the BMBF in the framework of the National Genome Research Network by Grant Nos. NGFN2 and NGFN-Plus, FKZ 01GS0481 and 01GS08145. The Netherlands Study of Depression and Anxiety and the Netherlands Twin Register contributed to Genetic Association Information Network (GAIN)-MDD and to MDD2000. Funding for NTR/NESDA was from the following: the Netherlands Organization for Scientific Research (MagW/ZonMW Grant Nos. 904-61-090, 985-10-002, 904-61-193, 480-04004, 400-05-717, 912-100-20; Spinozapremie Grant No. 56-464-14192; Geestkracht program Grant No. 10-000-1002); the Center for Medical Systems Biology (NWO Genomics), Biobanking and Biomolecular Resources Research Infrastructure, Vrije Universiteit's Institutes for Health and Care Research and Neuroscience Campus Amsterdam, BIC/BioAssist/RK (Grant No. 2008.024); the European Science Foundation (Grant No. EU/QLRT-200101254); the European Community's Seventh Framework Program (Grant No. FP7/2007-2013); ENGAGE (Grant No. HEALTH-F4-2007-201413); and the European Science Council (Grant No. ERC 230374). Genotyping was funded in part by the GAIN of the Foundation for the US National Institutes of Health, and analysis was supported by grants from GAIN and the NIMH (Grant No. MH081802). Funding for the QIMR samples was provided by the Australian National Health and Medical Research Council (Grant Nos. 241944, 339462, 389927, 389875, 389891, 389892, 389938, 442915, 442981, 496675, 496739, 552485, 552498, 613602, 613608, 613674, 619667), the Australian Research Council (Grant Nos. FT0991360, FT0991022), the FP-5 GenomEUtwin Project (Grant No. QLG2-CT-2002-01254), and the US National Institutes of Health (Grant Nos. AA07535, AA10248, AA13320, AA13321, AA13326, AA14041, MH66206, DA12854, DA019951), and the Center for Inherited Disease Research (Baltimore, MD). RADIANT was funded by the following: a joint grant from the UK Medical Research Council and GlaxoSmithKline (Grant No. r G0701420); the National Institute for Health Research Specialist Biomedical Research Centre for Mental Health at the South London and Maudsley National Health Service Foundation Trust and the Institute of Psychiatry, King's College London; the UK Medical Research Council (Grant No. G0000647), and the Marie Curie Industry-Academia Partnership and Pathways (Grant No. 286213). The GENDEP study was funded by a European Commission Framework 6 grant (EC Contract Ref.: LSHB-CT2003- 503428). Genotyping of STAR* D was supported by NIMH Grant No. MH072802 (to SPH). STAR* D was funded by NIMH Grant No. N01MH90003 to the University of Texas Southwestern Medical Center at Dallas (to A.J. Rush). The CoLaus/PsyCoLaus study was supported by research grants from GlaxoSmithKline, the Faculty of Biology and Medicine of Lausanne, and the Swiss National Science Foundation (Grant Nos. 3200B0-105993, 3200B0-118308, 33CSCO-122661, 33CS30-139468, 33CS30-148401) and two grants from GlaxoSmithKline Clinical Genetics. SHIP is part of the Community Medicine Research net of the University of Greifswald, Germany, which is funded by the Federal Ministry of Education and Research (Grant Nos. 01ZZ9603, 01ZZ0103, 01ZZ0403), the Ministry of Cultural Affairs, and the Social Ministry of the Federal State of Mecklenburg-West Pomerania. Genome-wide data have been supported by the Federal Ministry of Education and Research (Grant No. 03ZIK012) and a joint grant from Siemens Healthcare, Erlangen, Germany, and the Federal State of Mecklenburg-West Pomerania. SHIP-LEGEND is funded by the DFG (Grant No. GR 1912/5-1). The TwinGene study was supported by the Swedish Ministry for Higher Education, the Swedish Research Council (Grant No. M-2005-1112), GenomEUtwin (Grant Nos. EU/QLRT2001-01254,QLG2-CT-2002-01254), the Swedish Foundation for Strategic Research and the US National Institutes of Health (Grant No. U01 DK066134). The collection of PRISME control subjects and genotyping of the 883 Danish control subjects was supported by grants from The Danish Strategic Research Council, The Stanley Research Foundation, and H. Lundbeck A/S. The Muenster Depression cohorts were supported by the European Union (Grant No. N Health-F2-2008-222963) and by grants from the DFG (Grant Nos. FOR 2107 and DA1151/5-1 [ to UD]), Innovative Medizinische Forschung of the Medical Faculty of Munster (Grant Nos. DA120903, DA111107, and DA211012 [ all to UD]). Generation Scotland is supported by a Wellcome Trust Strategic Award "Stratifying Resilience and Depression Longitudinally" (Reference No.: 104036/Z/14/Z) and core support from the Chief Scientist Office of the Scottish Government Health Directorates (Grant No. CZD/16/6) and the Scottish Funding Council (Grant No. HR03006).r The NIMH Cell Repository at Rutgers University and the NIMH Center for Collaborative Genetic Studies on Mental Disorders made essential contributions to this project. Genotyping was carried out by the Broad Institute Center for Genotyping and Analysis with support from Grant No. U54 RR020278 (which partially subsidized the genotyping of the GenRED cases). Collection and quality control analyses of the control dataset were supported by grants from NIMH and the National Alliance for Research on Schizophrenia and Depression.r We acknowledge the contributions of Dr. George S Zubenko and Dr. Wendy N Zubenko, Department of Psychiatry, University of Pittsburgh School of Medicine, to the GenRED I project. We are grateful to Knowledge Networks (Menlo Park, CA) for assistance in collecting the control dataset. We express our profound appreciation to the families who participated in this project, and to the many clinicians who facilitated the referral of participants to the study. We thank the twins and their families registered at the Australian Twin Registry for their participation in the many studies that have contributed to this research. We thank V. Mooser, G. Weaber, and P. Vollenweider who initiated the CoLaus project. We express our gratitude to the Lausanne inhabitants who volunteered to participate in the PsyCoLaus study. We would like to acknowledge the PRISME-study group, Denmark, for collection of the PRISME samples. We thank David M. Hougaard, Section of Neonatal Screening and Hormones, Statens Serum Institute, Copenhagen, Denmark; Preben Bo Mortensen, National Centre for Register-based Research, Aarhus University, Denmark; Merete Nordentoft, Mental Health Centre, Copenhagen, Denmark; and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark. Funding from the BBSRC and MRC is gratefully acknowledged.r Data used in the preparation of this article were obtained from the Genetic and Environmental Risk for Alzheimer's disease (GERAD1) Consortium. As such, the investigators within the GERAD1 consortia contributed to the design and implementation of GERAD1 and/or provided data but did not participate in analysis or writing of this report.r SS, HS, KS, and TET are employees of deCODE Genetics/Amgen. VA received funds from the German Federal Ministry of Education and Research, from the European Union (FP 7), and from the Interdisciplinary Center for Clinical Research Munster, and he has served on the advisory boards of, or has given presentations on behalf of the following companies: Astra-Zeneca, Janssen-Organon, Lilly, Lundbeck, Servier, Pfizer, Otsuka, and Trommsdorff. BTB has received funding from the National Health and Medical Research Council Australia and honoraria from Lundbeck, BristolMeyers Squibb, Sanofi, Servier, Astra-Zeneca, Pfizer. IJD is supported by the MRC-BBSRC, Centre for Cognitive Ageing and Cognitive Epidemiology, part of the cross council Lifelong Health and Wellbeing Initiative (Grant No. MR/K026992/1). HJG has received funding from German Research Foundation and Federal Ministry of Education and Research Germany and speakers honoraria from Eli Lilly and Servier. CH acknowledges support from the Medical Research Council (MRC) and the Biotechnology and Biological Sciences Research Council (BBSRC). DJM is supported by an , funded by the Chief Scientist Office. AMM is supported by a Scottish Funding Council Senior Clinical Fellowship and by the Dame Theresa and Mortimer Sackler Foundation and has received research support from Pfizer, Janssen, and Lilly. CMM was supported by the Netherlands Organization for Scientific Research (Grant No. NOW VENI 916-76-125). BM- M has consulted for Affectis Pharmaceuticals. MP has served on the advisory boards of Lundbeck and Eli Lilly ; BACKGROUND: Major depressive disorder (MDD) is a disabling mood disorder, and despite a known heritable component, a large meta-analysis of genome-wide association studies revealed no replicable genetic risk variants. Given prior evidence of heterogeneity by age at onset in MDD, we tested whether genome-wide significant risk variants for MDD could be identified in cases subdivided by age at onset. METHODS: Discovery case-control genome-wide association studies were performed where cases were stratified using increasing/decreasing age-at-onset cutoffs; significant single nucleotide polymorphisms were tested in nine independent replication samples, giving a total sample of 22,158 cases and 133,749 control subjects for subsetting. Polygenic score analysis was used to examine whether differences in shared genetic risk exists between earlier and adult-onset MDD with commonly comorbid disorders of schizophrenia, bipolar disorder, Alzheimer's disease, and coronary artery disease. RESULTS: We identified one replicated genome-wide significant locus associated with adult-onset (.27 years) MDD (rs7647854, odds ratio: 1.16, 95% confidence interval: 1.11–1.21, p 5 5.2 3 10-11). Using polygenic score analyses, we show that earlier-onset MDD is genetically more similar to schizophrenia and bipolar disorder than adult-onset MDD. CONCLUSIONS: We demonstrate that using additional phenotype data previously collected by genetic studies to tackle phenotypic heterogeneity in MDD can successfully lead to the discovery of genetic risk factor despite reduced sample size. Furthermore, our results suggest that the genetic susceptibility to MDD differs between adult- and earlier-onset MDD, with earlier-onset cases having a greater genetic overlap with schizophrenia and bipolar disorder. ; United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute of Mental Health (NIMH) MH085520 MH080403 ; SURFsara ; Netherlands Scientific Organization NWO 480-05-003 ; Department of Psychology, Vrije Universiteit Amsterdam ; Dutch Brain Foundation ; Federal Ministry of Education & Research (BMBF) 01GS08144 01GS08147 ; National Genome Research Network plus, and through the Integrated Network Integrated Understanding of Causes and Mechanisms in Mental Disorders ; e:Med Programme 01ZX1314A 01ZX1314G ; German Research Foundation (DFG) FOR2107 RI908/11-1 NO246/10-1 ; United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute of Mental Health (NIMH) MH061686 MH059542 MH075131 MH059552 MH059541 MH060912 ; Federal Ministry of Education & Research (BMBF) 01ES0811 ; Bavarian Ministry of Commerce ; Federal Ministry of Education & Research (BMBF) NGFN2 NGFN-Plus FKZ 01GS0481 01GS08145 ; Netherlands Organization for Scientific Research (MagW/ZonMW) 904-61-090 985-10-002 904-61-193 480-04004 400-05-717 912-100-20 ; Spinozapremie 56-464-14192 ; Geestkracht program 10-000-1002 ; Center for Medical Systems Biology (NWO Genomics) ; Biobanking and Biomolecular Resources Research Infrastructure ; Vrije Universiteit's Institutes for Health and Care Research and Neuroscience Campus Amsterdam ; BIC/BioAssist/RK 2008.024 ; European Science Foundation (ESF) EU/QLRT-200101254 ; European Union (EU) FP7/2007-2013 ; ENGAGE HEALTH-F4-2007-201413 ; European Science Council ERC 230374 ; United States Department of Health & Human Services National Institutes of Health (NIH) - USA ; GAIN ; United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute of Mental Health (NIMH) MH081802 MH072802 N01MH90003 ; National Health and Medical Research Council of Australia 241944 339462 389927 389875 389891 389892 389938 442915 442981 496675 496739 552485 552498 613602 613608 613674 619667 ; Australian Research Council FT0991360 FT0991022 ; FP-5 GenomEUtwin Project QLG2-CT-2002-01254 ; United States Department of Health & Human Services National Institutes of Health (NIH) - USA AA07535 AA10248 AA13320 AA13321 AA13326 AA14041 MH66206 DA12854 DA019951 U01 DK066134 ; Center for Inherited Disease Research (Baltimore, MD) ; UK Medical Research Council and GlaxoSmithKline G0701420 ; National Institute for Health Research (NIHR) ; Maudsley National Health Service Foundation Trust ; Institute of Psychiatry, King's College London ; Medical Research Council UK (MRC) G0000647 ; European Union (EU) 286213 ; European Commission Framework 6 grant (EC) LSHB-CT2003- 503428 ; GlaxoSmithKline ; Faculty of Biology and Medicine of Lausanne ; Swiss National Science Foundation (SNSF) 3200B0-105993 3200B0-118308 33CSCO-122661 33CS30-139468 33CS30-148401 ; GlaxoSmithKline Clinical Genetics ; Federal Ministry of Education & Research (BMBF) 01ZZ9603 01ZZ0103 01ZZ0403 03ZIK012 ; Ministry of Cultural Affairs ; Social Ministry of the Federal State of Mecklenburg-West Pomerania ; Siemens Healthcare, Erlangen, Germany ; German Research Foundation (DFG) GR 1912/5-1 FOR 2107 DA1151/5-1 ; Swedish Ministry for Higher Education ; Swedish Research Council M-2005-1112 ; GenomEUtwin QLG2-CT-2002-01254 EU/QLRT2001-01254 ; Swedish Foundation for Strategic Research ; Danske Strategiske Forskningsrad (DSF) ; Stanley Research Foundation ; European Union (EU) N Health-F2-2008-222963 ; Innovative Medizinische Forschung of the Medical Faculty of Munster DA120903 DA111107 DA211012 ; Wellcome Trust Strategic Award "Stratifying Resilience and Depression Longitudinally" 104036/Z/14/Z ; Chief Scientist Office of the Scottish Government Health Directorates CZD/16/6 ; Scottish Funding Council HR03006 ; Broad Institute Center for Genotyping and Analysis U54 RR020278 ; NARSAD ; Biotechnology and Biological Sciences Research Council (BBSRC) ; Medical Research Council UK (MRC) ; Federal Ministry of Education & Research (BMBF) ; Interdisciplinary Center for Clinical Research Munster ; National Health and Medical Research Council of Australia ; MRC-BBSRC, Centre for Cognitive Ageing and Cognitive Epidemiology, part of the cross council Lifelong Health and Wellbeing Initiative MR/K026992/1 ; German Research Foundation (DFG) ; Federal Ministry of Education ; Research Germany and speakers honoraria from Eli Lilly and Servier ; Medical Research Council UK (MRC) ; Biotechnology and Biological Sciences Research Council (BBSRC) ; NRS Career Fellowship - Chief Scientist Office ; Scottish Funding Council Senior Clinical Fellowship ; Dame Theresa and Mortimer Sackler Foundation ; Netherlands Organization for Scientific Research (NWO) NOW VENI 916-76-125 ; Lundbeckfonden R155-2014-1724 ; Medical Research Council UK (MRC) MR/K026992/1 MC_PC_U127561128 1292844 ; Chief Scientist Office CZD/16/6/4
En Democracy in Capitalist Times, John Dryzek (1996) reflexiona sobre la tensión inminente entre la democracia y la economía política capitalista. Socias virtuosas durante la vigencia del relato de la modernidad, las vinculaciones entre estas dos ideas y/o fuerzas fueron horadándose de forma progresiva. Conforme sostiene el autor, si bien el capitalismo ha sido históricamente siempre bueno para la democracia, no ocurre lo propio en la actualidad. En el transcurrir de los últimos años, en efecto, el capitalismo ha dejado de identificar en su asociación con la democracia un factor clave para su desarrollo. Por lo consecuente, en los tiempos presentes, democracia y capitalismo no constituyen procesos necesariamente convergentes. De hecho, en determinadas circunstancias operan de modo contrapropuesto. A modo de ejemplo, baste señalar que los Estados, apremiados por las necesidades de competir y prosperar en la economía internacional, deben de adoptar crecientemente políticas públicas que los vuelven menos democráticos (Dryzek, 1996:3).Según el autor, cuatro son los desafíos que la economía política capitalista de hogaño impone a la democracia. En primer término, se presentan los condicionamientos a las funciones del Estado. Al respecto, es de notar que, en las sociedades capitalistas contemporáneas, los Estados no pueden alejarse de una ingeniería político-funcional estructuralmente determinada. En palabras de Dryzek, "en el momento actual, todos los Estados deben mantener el orden civil, gestionar las vicisitudes de la vida económica operando como Estados de bienestar (al menos aquellos cuyas condiciones económicas se lo permiten) y asegurar un sistema capitalista de mercado el cual provea de bienes para ganancia y soporte de los gobiernos" (Dryzek, 1996:10). En segundo término, se plantea el desafío inherente al racionalismo económico, promotor de un individualismo "agresivo" y del repliegue de los hombres/ciudadanos de lo público/democrático. El tercer desafío remite a la ideología liberal soporte de las democracias capitalistas. Advierte Dryzek, en este punto, que tal ideología -su elemento liberal en particular- ha asimilado y desarticulado todas críticas potenciales al sistema, incluso las formuladas desde la teoría democrática. El último de los desafíos interpuesto por la economía capitalista a la democracia se vincula a las demandas provenientes del escenario económico internacional. Tal cual explica el autor, el orden económico trasnacional emergente requiere la adopción políticas (liberalización y desregulación del movimiento de bienes, servicios, finanzas, capital y personas) que limitan, constriñen iniciativas democráticas. Es propósito del presente trabajo escrutar los caracteres de estos últimos constreñimientos. Explora, en términos concretos, las limitaciones que el proceso de globalización implicó -e implica, desde luego- para la democracia. El indagar sobre los alcances de tales constreñimientos conlleva un propósito en paralelo: advertir las oportunidades para la democracia en el marco del (des)orden económico correspondiente al proceso globalizador.En relación con esto último, resulta importante remarcar que si bien Dryzek repara sobre la magnitud de las limitaciones de la democracia en la coyuntura actual, su obra –insiste en reiteradas oportunidades- apela a la lectura y a la acción en positivo. Es que, conforme expone, detrás de cada uno de los desafíos se identifica una serie de oportunidades para propiciar el proceso de democratización. Subyacen ciertamente bajo cada desafío un complejo de contradicciones que el desarrollo capitalista no puede contener. Considérese como muestra de ello la crisis ecológica en ciernes provocada por el incremento en la demanda de recursos naturales y el agotamiento progresivo de los mismos.Tras esta introducción, el artículo se desarrolla en tres secciones. En la primera de ellas, se identifican las derivaciones del proceso de globalización sobre la democracia. Especial atención se pone en este apartado a los constreñimientos interpuestos por tres agentes claves de la escena económica mundial: los organismos multilaterales de crédito; las empresas multinacionales y el capital financiero transnacional. En la seccón siguiente, en tanto, se ensaya sobre las oportunidades para la democratización del espacio económico internacional. Finalmente, y conforme las convenciones de rigor, se presentan unas reflexiones conclusivas.La democracia frente a las demandas de la economía globalIniciado en los primeros setenta, en concomitancia con la profundización del proceso de integración de la economía mundial y el desarrollo de vastos avances tecnológicos –particularmente en el ámbito de las comunicaciones-, el fenómeno globalizador acarreó importantes derivaciones sobre el actuar y el pensar político. De tales derivaciones, el debilitamiento del Estado resulta sin dudas una de las más significativas. Lejos de presentarse como aquella entidad capaz de reivindicar "con éxito el monopolio del uso legítimo de la fuerza física y simbólica en un territorio determinado y sobre el conjunto de la población correspondiente" (Bourdieu, 1996:9), el Estado se encuentra atravesado en la actualidad por una crisis que asesta los basamentos de su propia naturaleza. La soberanía y la autonomía, principios constitutivos del Estado nación westfaliano, reportan ciertamente múltiples desafíos asociados a fuerzas y movimientos que ignoran fronteras territoriales y desdibujan consecuentemente las demarcaciones históricas entre lo interno y lo externo.Las contrariedades incrementales de los Estados para definir y ejecutar políticas en el ámbito económico dan cabal cuenta de estas mudanzas contextuales. Tras la multiplicación exponencial de los flujos internacionales y el ascenso del capital financiero como actor rector de la economía global, los Estados comprueban crecientes limitaciones para definir su relación con el mercado. Tal relación, otrora objeto de decisiones debatidas y adoptadas al interior de los Estados conforme la correlación de fuerzas e ideas socio-políticas, se conoce progresivamente influenciada por actores económicos internacionales, indiferentes, en lo general, a las demandas de las comunidades política y territorialmente organizadas.En este contexto, se inscriben las limitaciones de las sociedades para gobernarse democráticamente. Al imponerse la supuestamente ascética lógica de los mercados como el lineamiento rector de la vida social, los ciudadanos se repliegan de la vida pública desencantados de las capacidades arquitectónicas de la política y del régimen democrático.Con la despolitización como telón de fondo, los gobernantes -y dirigentes, en general- experimentan crecientes dificultades para agenciar representatividad. Es que, enfrentados ante un escenario signado por la complejidad, los gobernantes se hallan desbordados por las demandas de contexto, mostrándose incapaces de atender los mandatos primigenios de sus representados. Pero no es ésta la única problemática que perjudica a la dinámica de la democrática representación. No deben descuidarse al respecto las importantes derivaciones de la globalización sobre los propios representados. Se señala en este punto al deterioro y/o desarticulación de grupos sociales sobre los cuales se habían estructurado instituciones estables de representación -partidos políticos, sindicatos, etc.-. Este complejo de desafíos interpuesto a la democracia se configura, se canaliza mediante la estructura y el desempeño de los actores claves del orden económico global. A continuación, un repaso por las limitaciones postuladas por tres de ellos: los organismos multilaterales de crédito, las empresas multinacionales y el capital financiero trasnacional.Constituidos para garantizar la estabilidad de los intercambios económicos internacionales, los organismos multilaterales de créditos se constituyen -en no pocas oportunidades- en cortapisas para el desarrollo democrático. Como bien observa Dryzek, las instituciones del orden económico internacional -el Fondo Monetario Internacional (FMI) o el Banco Mundial (BM) imponen constreñimientos masivos respecto a lo que los Estados (y no sólo los deudores) pueden hacer o no (Dryzek, 1996:11). Las condicionalidades del FMI son tal vez la expresión más acabada de este planteo. So pretexto de observar los principios constitutivos y resguardar en paralelo los recursos del organismo, el FMI condicionó históricamente su asistencia a la ejecución de políticas que en los hechos resultaban contrarias al desarrollo democratizador. Los excesos del FMI sobre democracias con economías en desarrollo durante el manejo de las crisis financieras de la década del noventa fueron oportunamente explicitados por Stiglitz (2003). Conforme el economista, en la gestión de sucesivas las crisis, el organismo exigió a los Estados la adopción de políticas que condujeron a un empobrecimiento general de la población y niveles crecientes de inequidad social. De seguro, son las condicionalidades exigidas a Argentina durante y tras la salida inmediata del régimen de la convertibilidad muestra cabal de tales excesos. Durante este período, el FMI requirió medidas que forzaban abiertamente los mecanismos democráticos (piénsese al respecto el condicionamiento de asistencia a la sanción de leyes con plazos y contenidos determinados, tal cual lo sucedido en 2002 con la exigencia de la derogación de la ley de subversión económica). Las empresas multinacionales configuran otros importantes desafíos para la democracia. Conforme explica Guéhenno (1995), al distribuir en varios países las diferentes fases de la producción, las multinacionales dificultan la localización del valor añadido. Significativas consecuencias tiene esta situación para la definición de una política impositiva progresiva. Tal como expone el precitado autor: "el impuesto ya no es una decisión soberana desde el momento en que ya no existe una necesidad territorial, que el lugar de la residencia y la inversión ya no son un dato sino una opción y que el valor añadido se forma de una manera demasiado abstracta para que pueda asignarse a un lugar preciso" (Guéhenno, 1995:26). Urgidos entonces por atraer y propiciar la radicación de las multinacionales en sus territorios, los Estados estipulan una miríada de concesiones que termina por debilitar aún más sus márgenes de maniobra política. Apremiados por esta lógica, se encomiendan a una competencia con otros Estados, la cual los coloca en una situación cada vez más desventajosa (proceso de "carrera hacia abajo" o race-to-bottom, conforme la literatura económica). En este escenario de concesiones incrementales a las compañías multinacionales, los Estados resignan recursos, harto necesarios para garantizar las condiciones estructurales del desarrollo democrático. Finalmente, han de considerarse los constreñimientos planteados por el capital financiero transnacional. En virtud de su movilidad y volumen, ostenta este actor la capacidad de influir de modo cuasi instantáneo sobre la suerte de la(s) política(s) de los Estados. La posibilidad de trasladarse de un mercado a otro de manera repentina hace del capital financiero internacional un actor "escurridizo" a las decisiones por las sociedades democráticas adoptadas. Sin compromiso alguno con tales sociedades, los flujos internacionales de capital activan y censuran políticas públicas lo cual lo convierte en no pocas circunstancias en los grandes electores nacionales. Ratifican así su carácter "absentista", tal cual lo advertido por Bauman (1999:10). La erosión en las potestades impositivas reporta mayor dimensión en relación con lo formulado con las empresas multinacionales. Además de las concesiones estatales derivadas de las urgencias de financiamiento, deben de sumarse las dificultades técnico-administrativas para la aplicación de medidas impositivas.Los senderos para la democratizaciónAdvertidos los desafíos derivados del escenario económico global, se procede en este apartado a escrutar las oportunidades para la democratización por éstos habitadas. En consonancia con lo planteado en las líneas introductorias del trabajo, se sostiene que detrás de cada uno de los constreñimientos se descubren contradicciones y/o fallas que habilitan senderos hacia la democratización de los ámbitos inherentes a cada desafío particular (el Estado; la economía; la sociedad civil y el sistema internacional). En el ámbito del orden económico internacional, varias son las contradicciones que habilitaron -y habilitan- cauces para el proceso de democratización. En concomitancia a la acentuación del proceso de globalización y de sus desafíos a la democracia, asoman en la escena económica trasnacional ciertos indicios inherentes al proceso de democratización. En tal sentido, puede corroborarse en el campo de la economía internacional –y en los actores arriba analizados- indicios, expresiones de una creciente participación (franchise), alcance (scope) y autenticidad (authenticity) democrática; los tres criterios considerados por Dryzek para identificar un proceso de democratización.Se formulan a continuación algunos comentarios sobre este incipiente proceso de democratización en la economía global.En relación con el criterio de participación es de señalarse la progresiva gravitación de actores otrora marginados, desvalorados, en la estructura y las decisiones de los organismos multilaterales de crédito. Durante los últimos años, en efecto, estos actores han ampliado el número de interlocutores. A modo ilustrativo, se menciona que el Centro Internacional de Arreglo de Diferencias relativas a Inversiones (CIADI) -institución constitutiva del Grupo Banco Mundial- ha aceptado recientemente la participación de organizaciones no gubernamentales (organismos vinculados al trabajo en Derechos Humanos, en defensa de usuarios de servicios públicos) en algunos procedimientos arbitrales incoados contra la República Argentina mediante la figura del amicus curae.También pudo comprobarse en últimos años esfuerzos incrementales por subsumir el accionar de la economía internacional y de estos actores, en particular, bajo el control democrático. Piénsese en las regulaciones medioambientales que, orientadas compatibilizar la satisfacción de necesidades presentes con la habilidad de las generaciones futuras a satisfacer las suyas propias (tal cual la definición de desarrollo sustentable), condicionan los procesos industriales de producción. Promovida por la paulatina concientización de las sociedades sobre la relevancia de la preservación de los recursos naturales, la incorporación de la problemática ambiental en la agenda democrática ha implicado modificaciones en el diseño y ejecución de los procesos industriales. Puede ilustrase también el avance de este criterio con la preocupación de no pocas empresas e inversores en la actualidad por encauzar acciones inscriptas en el concepto de Responsabilidad Social Corporativa (RSC).Entendido por Dryzek como "el grado por el cual el control democrático es sustantiva más que simbólico, informado más que ignorante", el criterio de la autenticidad reporta indicios más sutiles. La razón de ello se vincula al hecho de que el control democrático de la economía política global remite más a los esfuerzos y acciones de los actores e instituciones internacionales que de las sociedades nacionales. En continuidad con el ejemplo de la incorporación de la problemática medioambiental en la agenda democrática, puede identificarse al Protocolo de Kyoto (aún con sus profusas deficiencias) como un mecanismo de control al desarrollo de la producción industrial.Reflexiones finalesIdeas y/o fuerzas claves de una historia compartida –esto es, la historia de la modernidad-, la democracia y la economía política capitalista empezaron, en el transcurrir de los últimos tiempos, a operar en tensión. Tal cual lo ensayado por Dryzek, el desarrollo del capitalismo se disoció poco a poco del proceso de democratización. En este contexto, la economía capitalista dejó de identificar en su asociación con la democracia un elemento capital para su dinamización.Cuatro son para Dryzek los desafíos que el capitalismo impone actualmente a la democracia: (a) los condicionamientos en funciones al Estado, (b) el racionalismo económico; (c) la ideología liberal de la democracia capitalista y (d) las demandas provenientes del orden económico internacional.Fue propósito del trabajo centrar atención en el último de estos desafíos. De este modo, se encauzó a identificar los caracteres y alcances de los desafíos a la democracia provenientes de la economía internacional.Conforme se advirtió, no son pocos los desafíos que la economía política global impone al proceso de democratización. La constitución de un espacio global crecientemente integrado supone vastas limitaciones al desempeño democrático de las sociedades y los Estados en los tiempos contemporáneos. Especial énfasis se puso a los constreñimientos interpuestos por los organismos multilaterales de crédito, las empresas multinacionales y el capital financiero trasnacional.No obstante su número y dimensión, las limitaciones a la democracia provenientes del sistema económico internacional no deben ser interpretadas cual fenómenos o procesos forzosos. En tal sentido, se comparte con Dryzek la necesidad de una lectura en clave optimista. Haciendo propias sus palabras ha de remarcarse que: "cuando la teoría democrática se encuentra con el mundo real, debería devenir fortalecida y corregida. El propósito básico de identificar constreñimientos es el de identificar oportunidades" (Dryzek, 1996:9).La interpretación en términos positivos permite identificar algunos indicios respecto al avance del proceso de democratización en el ámbito propio de la economía internacional. Se advirtió, específicamente, la paulatina manifestación de los criterios de participación, alcance y autenticidad en el accionar de los actores promotores del sistema económico global. La democracia, en términos de Downs, no es una construcción institucional estática. Se trata, al contrario, de un proceso dinámico de gobierno y de vida, inclusive. Así pues, "los defensores de la democracia deben de cambiar sus formas y significados específicos" (citado por Dryzek, 1996:5). En la actualidad, el Estado nacional, cual espacio referencial para la organización política en tiempos de la modernidad, ha dejado de representar un articulador resuelto de solidaridades políticas. "El Estado nacional es mucho menos que antes un marco general de identificación colectiva", en palabras de Touraine (2006:50). En este contexto, se ha de advertir que la democracia no adentró en un proceso de cesión sino en uno orientado a la búsqueda de nuevas formas y significación. El proceso de democratización, en breve, ha de desarrollarse en nuevos espacios, distintos a los del Estado nación. De aquí, entonces nuestra perspectiva positiva en la resolución de la tensión entre democracia y la economía capitalista en tiempos de la globalización. Sobre el autor Doctor en Relaciones Internacionales. Docente de Economía Internacional en la Facultad de Ciencia Política y Relaciones Internacionales de la Universidad Nacional de Rosario (UNR). Becario Postdoctoral del Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET). Referencias bibliográficasBAUMAN, Zygmut (1999), La Globalizacón: Consecuencias humanas, México, Fondo de Cultura Económica.BOURDIEU, Pierre (1996), "Espíritus de Estado. Génesis y estructura del campo burocrático", en Revista Sociedad, Facultad de Ciencias Sociales, UBA, Número 8, abril.DRYZEC, John (1996), Democracy in Capitalist Times. 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BACKGROUND: Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015. METHODS: For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification. FINDINGS: Global HIV incidence reached its peak in 1997, at 3·3 million new infections (95% uncertainty interval [UI] 3·1-3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5-2·8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38·8 million (95% UI 37·6-40·4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1·8 million deaths (95% UI 1·7-1·9 million) in 2005, to 1·2 million deaths (1·1-1·3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections. INTERPRETATION: Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030. FUNDING: Bill & Melinda Gates Foundation, and National Institute of Mental Health and National Institute on Aging, National Institutes of Health.
The pandemic of COVID-19 has afflicted every individual and has initiated a cascade of directly or indirectly involved events in precipitating mental health issues. The human species is a wanderer and hunter-gatherer by nature, and physical social distancing and nationwide lockdown have confined an individual to physical isolation. The present review article was conceived to address psychosocial and other issues and their aetiology related to the current pandemic of COVID-19. The elderly age group has most suffered the wrath of SARS-CoV-2, and social isolation as a preventive measure may further induce mental health issues. Animal model studies have demonstrated an inappropriate interacting endogenous neurotransmitter milieu of dopamine, serotonin, glutamate, and opioids, induced by social isolation that could probably lead to observable phenomena of deviant psychosocial behavior. Conflicting and manipulated information related to COVID-19 on social media has also been recognized as a global threat. Psychological stress during the current pandemic in frontline health care workers, migrant workers, children, and adolescents is also a serious concern. Mental health issues in the current situation could also be induced by being quarantined, uncertainty in business, jobs, economy, hampered academic activities, increased screen time on social media, and domestic violence incidences. The gravity of mental health issues associated with the pandemic of COVID-19 should be identified at the earliest. Mental health organization dedicated to current and future pandemics should be established along with Government policies addressing psychological issues to prevent and treat mental health issues need to be developed. References World Health Organization (WHO) Coronavirus Disease (COVID-19) Dashboard. 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Open Peer Review reports Background Perinatal mental health problems affect up to one in five women worldwide [1, 2]. Stress, anxiety and depression in pregnancy affect not only the mother but can also have long-term adverse effects on her child via biological mechanisms in utero [3]. Along with the impact on the mother and her developing infant, antenatal depression and anxiety are the most common predictors of postnatal depression [4, 5]. Postnatal depression can reduce her ability to provide sensitive and responsive caregiving that can potentially impair child development [6]. Mental health problems in the perinatal period are a particular challenge in low- and middle-income countries (LMICs) where they can be at least twice as frequent as in higher-income countries [1]. Our geographical context for this work will be The Gambia, in West Africa, where mental health services are minimal, services for perinatal mental health are non-existent and high levels of stigma associated with mental health issues, as well as specific local attitudes and beliefs, impede recognition and prevent help-seeking behaviour. It is thus of high priority to develop new low-cost, low-resource, non-stigmatising and culturally appropriate approaches to reduce symptoms of anxiety and depression perinatally, for the benefit of both the mother and child. The current project will test the hypothesis that the creative arts—in particular group-singing—will show special promise in alleviating perinatal mental distress in The Gambia. In high-income countries, such as the UK and the USA, singing in groups has been shown to be a powerful modulator of mood and emotion, evoking positive effects on mental health, well-being and social affiliation [7] via mechanisms involving synchrony and entrainment [8], the saliency of relational communicative features in musical interaction [9] and significant effects on the endocrine system [10]. In addition, the mother's voice is a key channel through which meaningful, sensitive and contingent interactions between the caregiver and infant can take place [11]. Recent studies have found that music and its use specifically during the perinatal period can reduce women's stress levels and depressive symptoms and increase women's attachment to their infant [12,13,14,15]. Music-centred approaches may be particularly fruitful in The Gambia as there are already a range of musical practices that specifically engage pregnant women and new mothers [16]. For instance, infant naming ceremonies occur 7 days after birth and are musical celebrations to recognise the new mother and her family [16]. Performances by Kanyeleng groups are closely associated with pregnancy and motherhood and are important in health communication [17]. These pre-existing cultural and creative practices provide an excellent context from which to explore, co-design and ultimately evaluate culturally situated, music-centred interventions that aim to reduce symptoms of anxiety and depression perinatally and facilitate mother-infant caregiving. Study aims This is a feasibility study which aims to inform the design of a larger trial to investigate a Community Health Intervention through Musical Engagement (CHIME) to help reduce symptoms of anxiety and depression in pregnant women compared to standard care. This article describes the trial protocol (version 1.0, 11/11/18). The protocol was prepared in accordance with the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidance. The trial SPIRIT checklist can be viewed in Additional file 1. Objectives Our primary objective is to test (a) the feasibility of delivering a group-singing intervention to a sample of pregnant women in The Gambia using a stepped wedge design and (b) the feasibility of using standardised tools to measure the impact of this intervention on anxiety and depression symptoms, before and after the intervention. This objective can be broken down into five specific feasibility objectives: 1) To obtain demographic information on the eligible population 2) To determine if our measurement tools, the Edinburgh Postnatal Depression Scale (EPDS) and the Self-Reporting Questionnaire (SRQ-20), are useable 3) To determine if the intervention is deliverable 4) To determine if the stepped wedge trial design is deliverable and obtain information that will inform the definitive study. Specifically to: a. Assess recruitment and acceptability of randomising clinics b. Assess the recruitment rate of women to control and intervention groups c. Assess participants' adherence to the intervention group and follow-up in both arms d. Test the feasibility of data collection 5) To determine if this type of intervention is culturally appropriate and well received by the community and health workers. Methods/design We will be testing the feasibility of a stepped wedge cluster design, which differs from a parallel arm cluster design in that all clinics involved in the study receive the intervention [18]. Advantages over a parallel arm cluster trial include the requirement of a smaller sample size due to the availability of a within group comparison and prevention of potential disappointment for health clinics who are not randomised into the intervention. Study setting This multi-site study will recruit from four antenatal clinics in western Gambia. Study population All participants will be Mandinka or Wolof Gambian women who are pregnant. Inclusion criteria Pregnant (14–24 weeks gestation) Speak Wolof or Mandinka fluently Exclusion criteria At least one previous late term miscarriage Current psychosis or history of psychosis Withdrawal criteria If the participant develops any serious medical condition or the participant's mental health significantly declines (as assessed by the care team), and the care team deem it necessary, then she may be withdrawn from the study. Intervention The intervention will be delivered on the community level, meaning that it will include women with a range of anxiety and depression symptoms. Our primary aim is to reduce symptoms in those experiencing them (whether these are at a high level or a medium or low level). We anticipate this may also help to reduce their symptoms into the postnatal period. By including those with low and high levels of symptoms, rather than screening and including only those with high levels of symptoms, we will aim to avoid stigma and increase acceptability. The intervention has been developed following focus groups with various stakeholders including health professionals (midwives and community birth companions), pregnant women and musicians (griots and Kanyeleng groups). Four groups of 20 women between 14 and 24 weeks gestation will attend six 60-min group-singing sessions at their local antenatal clinic. This will take place in the morning as this is the time deemed to best suit the majority of women and clinics. Local Kanyeleng groups who specialise in musical practices to support women's health will lead the sessions. The content of the six sessions will be co-designed with the Kanyeleng groups via two extended workshops with the research team. All sessions will begin with a welcome song and end with a closing song. Some of the songs used during the main body of the session will cover topics including the (a) importance of the singing group in supporting each other, (b) importance of other positive relationships in their lives, (c) resilience to challenges and empowerment and (d) importance of being open, removing stigma to discuss challenges. One lullaby will be introduced at each session. Kanyeleng leaders will also be encouraged to ensure that all the women feel comfortable and are participating when they can. The nature of the intervention will necessarily vary somewhat across the four settings, especially as Wolof speaking groups and Mandinka groups have different and distinct cultural beliefs, practices and language. By using the Kanyeleng groups local to each of the four clinics involved, the sessions will be contextually appropriate, while the workshop with all four Kanyeleng groups before the intervention begins will ensure that the overarching goals, content and approach to session delivery are broadly standardised. Over the course of the 6-week intervention period, a research assistant will observe and video and audio record two singing sessions (the first and the fourth sessions) from each of the four clinics to ascertain, using a checklist, the extent to which the sessions conform to our articulated goals. A community health nurse at each clinic will be engaged to take attendance data and report any issues of concern to the research team. The control group will consist of four groups of 20 women between 14 and 24 weeks gestation from the same four clinics. These women will receive only standard care without any additional intervention. Randomisation and blinding As we will be testing the feasibility of delivering a stepped wedge cluster design, the four different antenatal clinics will be randomised with two sites starting first (creating the first sequence) and two starting 6 weeks later (the second sequence). Randomisation will be performed by the study statistician who will generate a randomisation list using software and apply it to the pre-concealed list of clinics. The researchers and participants will not be blinded to whether they are in the intervention or the control cohort. Outcome measurements Two local research assistants (RAs) will collect all measures orally as there is a high rate of illiteracy among the target population. All scales have been translated into Mandinka and Wolof. The translation method used was based on suggestions by the World Health Organisation, Hanlon et al. [19] and Cox, Holden and Henshaw [20]. First, the scales were translated into Mandinka and Wolof. An expert panel discussion then refined the translation before back translating it into English. The expert panel came together once more to resolve any remaining issues before finalising the translation. Two questionnaires will measure antenatal anxiety and depression symptoms. The Edinburgh Postnatal Depression Scale (EPDS) [21] is a ten-item scale that was developed to screen for postnatal depression. It has subsequently been validated to be used during pregnancy [22]. This measurement tool has been used and validated in other African contexts; however, there is no avaliable validated version of the EPDS in Mandinka or Wolof even though it has been used in The Gambia before [23]. The Self-report Questionnaire (SRQ-20) [24] is a 20-item scale developed by the World Health Organization to measure anxiety and depression symptoms in a variety of cultural contexts. It has been used in many different African contexts such as Ethiopia [19], South Africa [25] and Rwanda [26] and as a way to measure perinatal mental health [23]. However, the SRQ-20 has never been used in the Gambian context nor has it been translated into Wolof or Mandinka. Demographic outcomes We will collect demographic information about all participants. The data we will collect is as follows: date of birth, gestational age, time taken to get to the health centre, parity, gravida, place of birth, current place of residence, ethnic group, history of serious illness, occupation, husband's occupation, marital status, educational background and amount of regular musical engagement. Feasibility outcomes The feasibility outcomes are as follows: Recruitment rate Retention and attrition rates of participants Clinics' adherence to stepped wedge schedule Completeness of data by site and over time Video and audio recording of sessions to determine fidelity of the intervention at each site, i.e. whether key content emphasised in training workshops was being delivered at each site. Qualitative interviews with participants after the intervention to capture enjoyment and perceived benefit. Recruitment Four antenatal clinics will be chosen to take part in the study based on three criteria: (1) availability of a local Kanyeleng group to deliver the intervention, (2) the language group predominantly spoken in the area (with at least one clinic being in a predominantly Wolof speaking area) and (3) the type of community the clinic serves (with at least one within an urban area). The health professionals working at the health centre will first approach participants for the study. If they meet the criteria, they will be given information about the study and asked if they would like to be referred to the RAs. They will then be put in contact with one of the RAs who will meet them privately face to face. The information sheet will be read out in their native language verbatim to ensure participants' ability to give informed consent. Consent will be taken orally by the RAs and recorded by signature or thumbprint. If participants do not choose to take part we will record their reason, if it is given, to help understand why women might not want or be able to participate. Incentive and participant retention Participants in both groups will be offered a total of 600 Dalasi (about 12 USD) for their time, 200 Dalasi for each of the three data collection time points (baseline, post, follow-up). All participants will be reminded of the data collection and the group-singing sessions by phone call. Calls will be made by the RAs 3 days and 1 day before as well as on the day of these appointments. Where possible, a record will be kept of the reasons women give for failing to join the intervention or data collection session. Sample size As this is a feasibility study, it is not designed to assess the efficacy of the intervention, although pilot data on this will be collected. We will evaluate the feasibility of study design, data collection and whether the intervention is deliverable and acceptable to the participants. In the study, we will gather information to be used in the design of the future definitive study including an estimate of the standard deviation of potential primary outcomes to inform the sample size. We aim to collect data from a total of 120 pregnant women, 60 in the control condition and 60 in the intervention condition [27]. This number will be sufficient to provide estimates of binary feasibility outcomes with precision of at least ± 9 percentage points for the 95% confidence interval. Trial schedule This trial design involves a sequential crossover of clusters whereby each cluster (antenatal clinic) receives the control condition followed by the intervention condition. The four chosen clinics will be randomised to two sequences of a 12-week phase. A separate cohort of participants will be recruited to the control group and the intervention (singing) group. Each cohort will be recruited around 4–6 months into their pregnancy. The 12-week phase for both the control and intervention cohort will include data collection at week 1 ("baseline") and week 7 ("post") after either group-singing (intervention) or standard care (control) as well as at week 11 ("follow-up"), 4 weeks after the intervention finished. Contamination will be avoided by having data for the control group collected before the intervention groups start at each clinic. See Fig. 1 for a schematic for the study. Fig. 1 figure1 Schematic of the study Full size image Assessment and management of risk There are no high risks within our study compared to standard care. We have identified three areas of ethical concern and have outlined how each of these issues will be managed. 1. Mothers may experience an adverse effect such as a miscarriage, difficult birth, still birth, a sudden drastic change in physical or mental health, infant health problems or even a serious adverse effect such as death during the intervention. It is possible that a participant experiencing such an adverse event may attribute a causal link between the adverse event and their involvement in the study. We will mitigate this association being made, firstly, by clearly explaining the nature of the intervention and any possible risks to the women when they are recruited into the study. If, despite this, an association of this nature was still made, we would enlist the help of the Ministry of Health & Social Welfare (our partner on the project) to disseminate information to the women and the community concerning the incidence of such events occurring in the general population in an attempt to reassure those concerned that such adverse events should not be attributed to involvement in the study. 2. It is possible that some of the themes involved in questionnaires could lead to the women revealing episodes of self-harm. If this is the case, the woman will receive in the moment front-line counselling to talk through these issues with the RAs who are trained psychiatric nurses. Then, if needed, she will be referred on to the community mental health team (CMHT) for further management. If the CMHT deems it appropriate, they may then refer her on to the psychiatric team. 3. It is possible that some of the themes involved in questionnaires may also lead the women to reveal domestic abuse. If this is the case, the woman will receive in the moment front-line counselling to talk through these issues with the RAs. For emergencies and cases that require immediate intervention, the RAs will connect with the Gender-Based Violence focal person. For other cases, the RAs will refer the woman to the One Stop Center at Serekunda General Hospital or Edward Francis Small Teaching Hospital. 4. Women throughout the study will be monitored by the RAs, both trained psychiatric nurses. If the RAs feel that at any point a woman's score indicates a high level of symptoms and/or the women reveal that they are particularly struggling, the RAs will refer the woman on to the Community Mental Health Team (CMHT) for further management. If the CMHT deems it appropriate, they may then refer her on to the psychiatric team. Data management All consent forms will be stored in a master file, which will be kept in a locked drawer where only members of the research team have access. All case report forms will not be linked to names, just a participant number, and kept in a separate locked cabinet where only the research team has access. All data, including video and audio recordings, will be held on an encrypted hard drive only members of the research team can access. Data will be stored for 5 years after the study and will then be deleted or destroyed. Analysis All data will be entered into a database by an RA and verified by the second RA using double data entry to ensure data quality. As this is a feasibility study, we will examine missing data as an outcome. Descriptive statistics will be summarised to understand the demographic variables relating to the recruited population. Descriptive statistics and plots will be used to assess the distribution of the measurement tools, repeated at baseline and follow-up and by each arm. We will also examine the distributions of scores in the different language groups to see to what extent item scores and overall distributions differ or are similar. Correlations between our two measurement tools will be calculated. To determine if the intervention is deliverable, we will record the number of sessions that the Kanyeleng groups delivered, aiming to deliver two thirds of the sessions, and the duration of each session, aiming to last between 45 and 75 min. We will also perform a qualitative evaluation, using the video and audio recordings, to determine intervention fidelity at the four sites. Both RAs will watch the video and audio recordings of the first and fourth group-singing sessions at each clinic and complete a checklist to determine if all the necessary elements—as outlined in the training workshops—were included in the intervention. Reliability of the fidelity measure will be ascertained by measuring inter-rater consistency. We will also calculate the proportion of clinics approached that consented, aiming to reach over 50% recruitment rate, and record any scheduling problems in keeping with the stepped wedge timeline. Recruitment, adherence and completeness of data will be calculated for both groups. We aim to achieve a 60% recruitment rate and no more than 30% attrition in both arms. To determine if the intervention was culturally appropriate and well received by the community and health workers, we will collect qualitative data from post-intervention interviews and perform a thematic analysis. Discussion The absence of mental health services in The Gambia, coupled with the stigma associated with mental illness in general, results in high levels of unmet need for pregnant women dealing with mental distress in The Gambia. The development of a low-cost, low-resource intervention, which is rooted in local health and cultural practices, is of high priority, and the feasibility study we intend to carry out will inform a full-scale trial to investigate efficacy of such an approach. By employing local research assistants and creating a partnership with governmental agencies, such as The Ministry of Health & Social Welfare and The National Centre for Arts and Culture, this study brings the understanding of existing health services and access to a network of primary healthcare workers throughout the country as well as the diversity of local musical practices and the meanings attached to them. This valuable knowledge will help us cope with the practical and operational issues that may arise. We hope to disseminate our findings within various scientific publications, during field days in various areas in The Gambia, and during a meeting in London which will bring together the researchers as well community members, academic colleagues and health professionals interested in hearing about this work. Trial status This article describes the protocol for a Community Health Intervention through Musical Engagement (CHIME) for perinatal mental health in The Gambia (version 1.0, 11/11/18). The sponsor for this trial is Goldsmiths, University of London. The project is funded by the MRC and the AHRC. Ethical approval was obtained from the Goldsmiths University Ethics Committee, the Research and Publication Committee (RePubliC) from the University of The Gambia and the Australian National University ethics committee. 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Funding The funders (MRC and AHRC) and sponsor (Goldsmiths) have no roles or responsibilities in the design, conduct, data analysis and interpretation, manuscript writing and dissemination of results. Author information Author notes Katie Rose M. Sanfilippo and Bonnie McConnell are joint first authors. Affiliations Goldsmiths, University of London, London, UK Katie Rose M. Sanfilippo & Lauren Stewart The Australian National University, Canberra, Australia Bonnie McConnell Imperial College London, London, UK Victoria Cornelius & Vivette Glover The Ministry of Health and Social Welfare, Banjul, The Gambia Buba Darboe, Hajara B. Huma & Malick Gaye The National Centre for Arts and Culture, Banjul, The Gambia Hajara B. Huma, Malick Gaye & Hassoum Ceesay University of Cambridge, Cambridge, UK Paul Ramchandani & Ian Cross Contributions LS is the principal investigator and obtained grant funding and conceived of the study. KRMS wrote the first draft of this publication manuscript, helped with the ethics and grant application, the intervention design, and the data monitoring and data collection plan. BM helped with the ethics and grant applications, translations of questionnaires, administration of focus groups and design of the intervention. VC obtained study funding, designed the study and statistical analysis plan, contributed to writing the manuscript. BD helped with the grant and ethics application, translations of questionnaires, administration of focus groups and design of the intervention. HBH and MG helped with the translation of the questionnaires, administration of the focus groups and design of the intervention. HC helped with planning the logistics for running the study as well as with the translation of the questionnaires. IC, VG and PR all helped with the grant application and advised on research and intervention design. All authors reviewed and had input into the final submission. All authors read and approved the final manuscript. Corresponding author Correspondence to Katie Rose M. Sanfilippo. Ethics declarations Ethics approval and consent to participate Ethical approval was obtained from the Goldsmiths University Ethics Committee, the Research and Publication Committee (RePubliC) from the University of The Gambia and the Australian National University ethics committee. Members of the research team will carry out the consenting and conduct of this study orally. It will be emphasised that any participant is able to withdraw from the study at any point without any consequences. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary information Additional file 1. SPIRIT Checklist. Rights and permissions Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Reprints and Permissions About this article Verify currency and authenticity via CrossMark Cite this article Sanfilippo, K.R.M., McConnell, B., Cornelius, V. et al. A study protocol for testing the feasibility of a randomised stepped wedge cluster design to investigate a Community Health Intervention through Musical Engagement (CHIME) for perinatal mental health in The Gambia. Pilot Feasibility Stud 5, 124 (2019) doi:10.1186/s40814-019-0515-5 Download citation Received 22 February 2019 Accepted 15 October 2019 Published 07 November 2019 DOI https://doi.org/10.1186/s40814-019-0515-5 Share this article Anyone you share the following link with will be able to read this content: Get shareable link Keywords Perinatal mental health Feasibility trial The Gambia Music Singing group Kanyeleng Comments By submitting a comment you agree to abide by our Terms and Community Guidelines. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. Please note that comments may be removed without notice if they are flagged by another user or do not comply with our community guidelines.
We thank CERN for the very successful operation of the LHC, as well as the support staff from our institutions without whom ATLAS could not be operated efficiently. We acknowledge the support of ANPCyT, Argentina; YerPhI, Armenia; ARC, Australia; BMWFW and FWF, Austria; ANAS, Azerbaijan; SSTC, Belarus; CNPq and FAPESP, Brazil; NSERC, NRC, and CFI, Canada; CERN; CONICYT, Chile; CAS, MOST, and NSFC, China; COLCIENCIAS, Colombia; MSMT CR, MPO CR, and VSC CR, Czech Republic; DNRF and DNSRC, Denmark; IN2P3-CNRS, CEA-DSM/IRFU, France; GNSF, Georgia; BMBF, HGF, and MPG, Germany; GSRT, Greece; RGC, Hong Kong SAR, China; ISF, I-CORE, and Benoziyo Center, Israel; INFN, Italy; MEXT and JSPS, Japan; CNRST, Morocco; FOM and NWO, Netherlands; RCN, Norway; MNiSW and NCN, Poland; FCT, Portugal; MNE/IFA, Romania; MES of Russia and NRC KI, Russian Federation; JINR; MESTD, Serbia; MSSR, Slovakia; ARRS and MIZŠ, Slovenia; DST/NRF, South Africa; MINECO, Spain; SRC and Wallenberg Foundation, Sweden; SERI, SNSF, and Cantons of Bern and Geneva, Switzerland; MOST, Taiwan; TAEK, Turkey; STFC, United Kingdom; DOE and NSF, United States of America. In addition, individual groups and members have received support from BCKDF, the Canada Council, CANARIE, CRC, Compute Canada, FQRNT, and the Ontario Innovation Trust, Canada; EPLANET, ERC, FP7, Horizon 2020, and Marie Skłodowska-Curie Actions, European Union; Investissements d'Avenir Labex and Idex, ANR, Région Auvergne, and Fondation Partager le Savoir, France; DFG and AvH Foundation, Germany; Herakleitos, Thales and Aristeia programmes cofinanced by EU-ESF and the Greek NSRF; BSF, GIF, and Minerva, Israel; BRF, Norway; Generalitat de Catalunya, Generalitat Valenciana, Spain; the Royal Society and Leverhulme Trust, United Kingdom. The crucial computing support from all WLCG partners is acknowledged gratefully, in particular from CERN, the ATLAS Tier-1 facilities at TRIUMF (Canada), NDGF (Denmark, Norway, Sweden), CC-IN2P3 (France), KIT/GridKA (Germany), INFN-CNAF (Italy), NL-T1 (Netherlands), PIC (Spain), ASGC (Taiwan), RAL (UK), and BNL (USA), the Tier-2 facilities worldwide and large non-WLCG resource providers. Major contributors of computing resources are listed in Ref. [74]
We acknowledge the support of ANPCyT, Argentina; YerPhI, Armenia; ARC, Australia; BMWFW and FWF, Austria; ANAS, Azerbaijan; SSTC, Belarus; CNPq and FAPESP, Brazil; NSERC, NRC and CFI, Canada; CERN; CONICYT, Chile; CAS, MOST and NSFC, China; COLCIENCIAS, Colombia; MSMT CR, MPO CR and VSC CR, Czech Republic; DNRF and DNSRC, Denmark; IN2P3-CNRS, CEA-DSM/IRFU, France; GNSF, Georgia; BMBF, HGF, and MPG, Germany; GSRT, Greece; RGC, Hong Kong SAR, China; ISF, I-CORE and Benoziyo Center, Israel; INFN, Italy; MEXT and JSPS, Japan; CNRST, Morocco; FOM and NWO, Netherlands; RCN, Norway; MNiSW and NCN, Poland; FCT, Portugal; MNE/IFA, Romania; MES of Russia and NRC KI, Russian Federation; JINR; MESTD, Serbia; MSSR, Slovakia; ARRS and MIZŠ, Slovenia; DST/NRF, South Africa; MINECO, Spain; SRC and Knut and Alice Wallenberg Foundation, Sweden; SERI, SNSF and Cantons of Bern and Geneva, Switzerland; MOST, Taiwan; TAEK, Turkey; STFC, United Kingdom; DOE and NSF, United States. In addition, individual groups and members have received support from BCKDF, the Canada Council, CANARIE, CRC, Compute Canada, FQRNT, and the Ontario Innovation Trust, Canada; EPLANET, ERC, FP7, Horizon 2020 and Marie Sklodowska-Curie Actions, European Union; Investissements d'Avenir Labex and Idex, ANR, Région Auvergne and Fondation Partager le Savoir, France; DFG and AvH Foundation, Germany; Herakleitos, Thales and Aristeia programmes co-financed by EU-ESF and the Greek NSRF; BSF, GIF and Minerva, Israel; BRF, Norway; Generalitat de Catalunya, Generalitat Valenciana, Spain; the Royal Society and Leverhulme Trust, United Kingdom.
We thank CERN for the very successful operation of the LHC, as well as the support staff from our institutions without whom ATLAS could not be operated efficiently. We acknowledge the support of ANPCyT, Argentina; YerPhI, Armenia; ARC, Australia; BMWFW and FWF, Austria; ANAS, Azerbaijan; SSTC, Belarus; CNPq and FAPESP, Brazil; NSERC, NRC and CFI, Canada; CERN; CONICYT, Chile; CAS, MOST and NSFC, China; COLCIENCIAS, Colombia; MSMT CR, MPO CR and VSC CR, Czech Republic; DNRF and DNSRC, Denmark; IN2P3-CNRS, CEA-DSM/IRFU, France; GNSF, Georgia; BMBF, HGF, and MPG, Germany; GSRT, Greece; RGC, Hong Kong SAR, China; ISF, I-CORE and Benoziyo Center, Israel; INFN, Italy; MEXT and JSPS, Japan; CNRST, Morocco; FOM and NWO, Netherlands; RCN, Norway; MNiSW and NCN, Poland; FCT, Portugal; MNE/IFA, Romania; MES of Russia and NRC KI, Russian Federation; JINR; MESTD, Serbia; MSSR, Slovakia; ARRS and MIZŠ Slovenia; DST/NRF, South Africa; MINECO, Spain; SRC and Wallenberg Foundation, Sweden; SERI, SNSF and Cantons of Bern and Geneva, Switzerland; MOST, Taiwan; TAEK, Turkey; STFC, United Kingdom; DOE and NSF, United States of America. In addition, individual groups and members have received support from BCKDF, the Canada Council, CANARIE, CRC, Compute Canada, FQRNT, and the Ontario Innovation Trust, Canada; EPLANET, ERC, FP7, Horizon 2020 and Marie Skłodowska-Curie Actions, European Union; Investissements d'Avenir Labex and Idex, ANR, Région Auvergne and Fondation Partager le Savoir, France; DFG and AvH Foundation, Germany; Herakleitos, Thales and Aristeia programmes co-financed by EU-ESF and the Greek NSRF; BSF, GIF and Minerva, Israel; BRF, Norway; Generalitat de Catalunya, Generalitat Valenciana, Spain; the Royal Society and Leverhulme Trust, United Kingdom. The crucial computing support from all WLCG partners is acknowledged gratefully, in particular from CERN and the ATLAS Tier-1 facilities at TRIUMF (Canada), NDGF (Denmark, Norway, Sweden), CC-IN2P3 (France), KIT/GridKA (Germany), INFN-CNAF (Italy), NL-T1 (Netherlands), PIC (Spain), ASGC (Taiwan), RAL (UK) and BNL (USA) and in the Tier-2 facilities worldwide.
EPJC is an open-access journal funded by SCOAP3. y. We acknowledge the support of ANPCyT, Argentina; YerPhI, Armenia; ARC, Australia; BMWFW and FWF, Austria; ANAS, Azerbaijan; SSTC, Belarus; CNPq and FAPESP, Brazil; NSERC, NRC and CFI, Canada; CERN; CONICYT, Chile; CAS, MOST and NSFC, China; COLCIENCIAS, Colombia; MSMT CR, MPO CR and VSC CR, Czech Republic; DNRF and DNSRC, Denmark; IN2P3-CNRS, CEA-DSM/IRFU, France; GNSF, Georgia; BMBF, HGF, and MPG, Germany; GSRT, Greece; RGC, Hong Kong SAR, China; ISF, I-CORE and Benoziyo Center, Israel; INFN, Italy; MEXT and JSPS, Japan; CNRST, Morocco; FOM and NWO, Netherlands; RCN, Norway; MNiSW and NCN, Poland; FCT, Portugal; MNE/IFA, Romania; MES of Russia and NRC KI, Russian Federation; JINR; MESTD, Serbia; MSSR, Slovakia; ARRS and MIZŠ, Slovenia; DST/NRF, South Africa; MINECO, Spain; SRC and Wallenberg Foundation, Sweden; SERI, SNSF and Cantons of Bern and Geneva, Switzerland; MOST, Taiwan; TAEK, Turkey; STFC, United Kingdom; DOE and NSF, USA. In addition, individual groups and members have received support from BCKDF, the Canada Council, CANARIE, CRC, Compute Canada, FQRNT, and the Ontario Innovation Trust, Canada; EPLANET, ERC, FP7, Horizon 2020 and Marie Skłodowska-Curie Actions, European Union; Investissements d'Avenir Labex and Idex, ANR, Région Auvergne and Fondation Partager le Savoir, France; DFG and AvH Foundation, Germany; Herakleitos, Thales and Aristeia programmes co-financed by EU-ESF and the Greek NSRF; BSF, GIF and Minerva, Israel; BRF, Norway; Generalitat de Catalunya, Generalitat Valenciana, Spain; the Royal Society and Leverhulme Trust, UK. The crucial computing support from all WLCG partners is acknowledged gratefully, in particular from CERN, the ATLAS Tier-1 facilities at TRIUMF (Canada), NDGF (Denmark, Norway, Sweden), CCIN2P3 (France), KIT/GridKA (Germany), INFN-CNAF (Italy), NLT1 (Netherlands), PIC (Spain), ASGC (Taiwan), RAL (UK) and BNL (USA)
We thank CERN for the very successful operation of the LHC, as well as the support staff from our institutions without whom ATLAS could not be operated efficiently. We acknowledge the support of ANPCyT, Argentina; YerPhI, Armenia; ARC, Australia; BMWFW and FWF, Austria; ANAS, Azerbaijan; SSTC, Belarus; CNPq and FAPESP, Brazil; NSERC, NRC and CFI, Canada; CERN; CONICYT, Chile; CAS, MOST and NSFC, China; COLCIENCIAS, Colombia; MSMT CR, MPO CR and VSC CR, Czech Republic; DNRF and DNSRC, Denmark; IN2P3-CNRS, CEA-DSM/IRFU, France; GNSF, Georgia; BMBF, HGF, and MPG, Germany; GSRT, Greece; RGC, Hong Kong SAR, China; ISF, I-CORE and Benoziyo Center, Israel; INFN, Italy; MEXT and JSPS, Japan; CNRST, Morocco; FOM and NWO, Netherlands; RCN, Norway; MNiSW and NCN, Poland; FCT, Portugal; MNE/IFA, Romania; MES of Russia and NRC KI, Russian Federation; JINR; MESTD, Serbia; MSSR, Slovakia; ARRS and MIZŠ Slovenia; DST/NRF, South Africa; MINECO, Spain; SRC and Wallenberg Foundation, Sweden; SERI, SNSF and Cantons of Bern and Geneva, Switzerland; MOST, Taiwan; TAEK, Turkey; STFC, United Kingdom; DOE and NSF, United States of America. In addition, individual groups and members have received support from BCKDF, the Canada Council, CANARIE, CRC, Compute Canada, FQRNT, and the Ontario Innovation Trust, Canada; EPLANET, ERC, FP7, Horizon 2020 and Marie Skłodowska-Curie Actions, European Union; Investissements d'Avenir Labex and Idex, ANR, Région Auvergne and Fondation Partager le Savoir, France; DFG and AvH Foundation, Germany; Herakleitos, Thales and Aristeia programmes co-financed by EU-ESF and the Greek NSRF; BSF, GIF and Minerva, Israel; BRF, Norway; Generalitat de Catalunya, Generalitat Valenciana, Spain; the Royal Society and Leverhulme Trust, United Kingdom. The crucial computing support from all WLCG partners is acknowledged gratefully, in particular from CERN and the ATLAS Tier-1 facilities at TRIUMF (Canada), NDGF (Denmark, Norway, Sweden), CC-IN2P3 (France), KIT/GridKA (Germany), INFN-CNAF (Italy), NL-T1 (Netherlands), PIC (Spain), ASGC (Taiwan), RAL (UK) and BNL (USA) and in the Tier-2 facilities worldwide.
We thank CERN for the very successful operation of the LHC, as well as the support staff from our institutions without whom ATLAS could not be operated efficiently. We acknowledge the support of ANPCyT, Argentina; YerPhI, Armenia; ARC, Australia; BMWFW and FWF, Austria; ANAS, Azerbaijan; SSTC, Belarus; CNPq and FAPESP, Brazil; NSERC, NRC and CFI, Canada; CERN; CONICYT, Chile; CAS, MOST and NSFC, China; COLCIENCIAS, Colombia; MSMT CR, MPO CR and VSC CR, Czech Republic; DNRF, DNSRC and Lundbeck Foundation, Denmark; IN2P3-CNRS, CEADSM/IRFU, France; GNSF, Georgia; BMBF, HGF, and MPG, Germany; GSRT, Greece; RGC, Hong Kong SAR, China; ISF, I-CORE and Benoziyo Center, Israel; INFN, Italy; MEXT and JSPS, Japan; CNRST, Morocco; FOM and NWO, Netherlands; RCN, Norway; MNiSW and NCN, Poland; FCT, Portugal; MNE/IFA, Romania; MES of Russia and NRC KI, Russian Federation; JINR; MESTD, Serbia; MSSR, Slovakia; ARRS and MIZS, ˇ Slovenia; DST/NRF, South Africa; MINECO, Spain; SRC and Wallenberg Foundation, Sweden; SERI, SNSF and Cantons of Bern and Geneva, Switzerland; MOST, Taiwan; TAEK, Turkey; STFC, United Kingdom; DOE and NSF, United States of America. In addition, individual groups and members have received support from BCKDF, the Canada Council, CANARIE, CRC, Compute Canada, FQRNT, and the Ontario Innovation Trust, Canada; EPLANET, ERC, FP7, Horizon 2020 and Marie Sk lodowska-Curie Actions, European Union; Investissements d'Avenir Labex and Idex, ANR, Region Auvergne and Fondation Partager le Savoir, France; DFG and AvH Foundation, Germany; Herakleitos, Thales and Aristeia programmes co-financed by EU-ESF and the Greek NSRF; BSF, GIF and Minerva, Israel; BRF, Norway; the Royal Society and Leverhulme Trust, United Kingdom. The crucial computing support from all WLCG partners is acknowledged gratefully, in particular from CERN and the ATLAS Tier-1 facilities at TRIUMF (Canada), NDGF (Denmark, Norway, Sweden), CC-IN2P3 (France), KIT/GridKA (Germany), INFN-CNAF (Italy), NL-T1 (Netherlands), PIC (Spain), ASGC (Taiwan), RAL (U.K.) and BNL (U.S.A.) and in the Tier-2 facilities worldwide.