Academic literature on the topic 'Dynamic Performance Measurement'

With the development of gears towards high temperature, high pressure, high speed and high stress, gear measurement, in which only the static geometric accuracy is considered, is unable to meet the current application requirements. While, the low precision and single function gear tester constrains the measurement of gear dynamic performance. For the resolution of this problem, based on the principle of gear system dynamics and several precision mechanical design techniques, a gear dynamic testing machine has been developed, providing new instruments for gear testing. On the basis of research of the principle of dynamic performance test, the primary measurement items of the testing machine have been determined. The measuring principles of each item and the driving and loading form of the testing machine have been examined. The measurement and control system of the testing machine and its corresponding software have been developed. The instrument can not only obtain the static precision index of the gear, but also obtain the dynamic performance index of the gear in variable working conditions. According to the actual test, the uncertainty of instrument is 3.8 μm and the external disturbance caused by the shaft vibration is less than 0.6 μm, which can meet the 5–6 grade precision gear testing requirement.

With the characteristic of low carbon emission and sustainability, the development of rural tourism becomes one of the key parts to achieve mutual carbon target in Chinese tourism industry. However, previous research on China's rural tourism has largely ignored the quantitative examination of rural tourism initiatives. This paper aims to quantify and measure the efficiency as well as efficiency variation of rural tourism in 25 provinces of China using data envelopment analysis (DEA) and Malmquist productivity index (MPI). The results reveal that the overall efficiency of rural tourism in China is still low, and there exists an obvious regional difference in rural tourism in China. The result not only identify the leading and following regions in Chinese rural tourism, but also reveal how their position in the group changes over time. This is valuable information for managers having to take strategic and tactical decisions to better achieve the low-carbon and sustainable development of China's tourism industry.

Purpose The purpose of this paper is to present how complexity on retail supply chains should be recognized and its relationship with the performance. Different supply chain structures and planning horizons have been analyzed to support practitioners taking action on the short, mid and long terms. Confronted complexity in the supply chain has been categorized as system, perceived and value adding. This would also help practitioners to understand the sources of the complexity and if the complexity is useful for the system or not. Design/methodology/approach Three different retail supply chain scenarios – each concentrating on different planning horizons – have been simulated on system dynamics software STELLA. Using the new classification scheme for complexity and suggested performance metrics, a multi-perspective analysis has been performed on the STELLA output. Findings The results and the methodology can be easily applicable in practice to support decision-making process and to answer “what-if” type scenario analysis on systems design and configuration. Using the selected complexity metrics, complexity of the system considering time factor – static and dynamic – and different information levels – system, perceived and value adding – has been evaluated. Used complexity metrics indicate the problematic areas in the systems to be distinguished. Originality/value This paper uses system dynamics modeling in retail supply chains to derive insight about dynamic behavior and to represent the complex interactions and a new classification scheme for system complexity.

Abstract The Bayesian theorem is the most used instrument for stochastic inferencing in nonlinear dynamic systems and also the fundament of measurement uncertainty evaluation in the GUM. Many powerful algorithms have been derived and applied to numerous problems. The most widely used algorithms are the broad family of Kalman filters (KFs), the grid-based filters and the more recent particle filters (PFs). Over the last 15 years, especially PFs are increasingly the subject of researches and engineering applications such as dynamic coordinate measurements, estimating signals from noisy measurements and measurement uncertainty evaluation. This is rooted in their ability to handle arbitrary nonlinear and/or non-Gaussian systems as well as in their easy coding. They are sampling-based sequential Monte-Carlo methods, which generate a set of samples to compute an approximation of the Bayesian posterior probability density function. Thus, the PF faces the problem of high computational burden, since it converges to the true posterior when number of particles NP→∞. In order to solve these computational problems a highly parallelized C++ library, called Parallel Bayesian Toolbox (PBT), for implementing Bayes filters (BFs) was developed and released as open-source software, for the first time. In this paper the PBT is presented, analyzed and verified with respect to efficiency and performance applied to dynamic coordinate measurements of a photogrammetric coordinate measuring machine (CMM) and their online measurement uncertainty evaluation.

The purpose of this report is to single out and apply the most critical factors for dynamic performance meausrement systems. The report concludes that the existence in practice of theoretically important aspects are diverse and that the most appropriate way of governing the aspects are through the creation of a performance management process.

The theoretical chapter is established for dual purposes. The first is to give the reader a comprehensive understanding of what has been done in the field of performance measurement and management so far and the second is to answer the first research question imposed.

The empirical chapter investigates to what degree the existence of factors singled out in theory are present in practice. Further, the chapter also answers research question two.

Finally the result and analysis chapters focuses on cross-analysing the case studies made and generate a recommendation. Research question three is answered under these headings.

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In today’s business climate permeated by Big Data, an opportunity to drive performance lies in analysing consumer behaviour from user data. In particular for online content providers, user data is available in abundance and logged continuously. This leads to new possibilities for design and usage of metrics, as businesses can benefit from smart and timely decision-making. However, in order to profit from user data in performance measurement (PM), it is critical to identify metrics that truly guide decisions. Thus, an effective and efficient PM process is imperative. Despite its promise, Big Data’s role in PM has been scarcely researched. Research has studied user behaviour from data, for instance in the context of video or audio streaming and web search, but primarily with a focus on technical performance. In addition, the research on online content providers’ PM is fragmented, and has mainly been conducted by practitioners. Thus, the PM field needs to be updated to reflect today’s dynamic and digital business climate. Therefore, the purpose of this research was to explore how online content providers, generating a large amount of user data, work with PM, and also practically illustrate how metrics can be designed from user data. The research was carried out as a case study at an audio streaming company, but empirics was also gathered from other online content providers with the aim to increase the generalisability. The illustration of metric design was based on quantitative analysis of commuters’ in-car audio streaming. For commuters’ audio streaming it was found that suitable metrics should capture the habitual nature. Therefore engagement metrics were found to be applicable, for instance the fraction having sessions both in the morning and afternoon, and the fraction having more than one day commuting with the streaming service per week. In regard to online content providers’ PM process, this research contributes with a proposed framework, which was developed from three existing frameworks; HEART reflected as important measurement dimensions and translation of goals to metrics, OKR which sets the focus in terms of high-level goals, and design-implement-use reflected as the process’ phases. It was found that insights from user data and explicit user feedback are complementary and can arise throughout the whole process, and that mutual communication between data scientists and product managers is crucial. Further, four types of iterations were identified in the process; modifying a metric, designing new metrics, completely changing a metric, and starting new initiatives. Moreover, metrics were found to be highly context dependent. Additionally, four important aspects were identified in metric design; data availability and proxy assessment, characteristics and form of metric, metric trade-offs, and metric movement interpretation.
I dagens affärsklimat genomsyrat av Big Data finns en möjlighet att driva resultat framåt genom analys av kundbeteenden från användardata. I synnerhet för online-tjänsteföretag samlas användardata kontinuerligt och finns tillgänglig i en oerhörd mängd. Detta skapar nya möjligheter för design och användande av mätetal då företag kan utveckla smartare och snabbare beslutsfattande. För att verkligen dra fördel av användardata i prestationsmätning (PM) är det dock kritiskt att identifiera mätetal som faktiskt bistår beslutsfattande, vilket följaktligen kräver en effektiv PM-process. Trots potentialen är forskning på Big Data inom PM begränsad. Studier har analyserat kundbeteenden från användardata, exempelvis i kontexten av strömmad video eller audio och webbsökningar, men primärt med fokus på tjänstens tekniska prestanda. Vidare är forskning på PM hos online-tjänsteföretag fragmenterad, och huvudsakligen genomförd av företag inom industrin. Följaktligen bör fältet aktualiseras för att reflektera dagens digitala och dynamiska affärsklimat. Därför var syftet med denna studie att utforska hur online-tjänsteföretag, som besitter stora mängder användardata, arbetar med PM, men även praktiskt illustrera hur mätetal kan designas från denna data. Studien genomfördes som en fallstudie på ett ljud-strömningsföretag, men empiri insamlades även från andra online-tjänsteföretag med avsikt att öka generaliserbarheten. Den praktiska illustrationen av mätetals-design baserades på en kvantitativ analys av pendlares audio-strömning i bil. För pendlares audio-strömning i bil fann denna studie att lämpliga mätetal bör fånga den vanemässiga aspekten associerad med pendling. Därmed anses mätetal som reflekterar engagemang lämpliga, exempelvis andelen som har sessioner både på förmiddagen och eftermiddagen och andelen som har mer än en dag med pendlar-sessioner i veckan. Gällande PM-processen hos online-tjänsteföretag bidrar denna studie med ett föreslaget ramverk som utvecklades från tre existerande ramverk; HEART som reflekteras i form av viktiga mätetalsdimensioner samt översättning av mål till mätetal, OKR vilket sätter fokus för processen i termer av mål på högre nivå, och designa-implementera-använda som reflekterar processens faser. I studien kom det fram att insikter från användardata och explicit användaråterkoppling kompletterar varandra, och att dessa kan uppkomma under hela processen. Vidare konstaterar denna studie att ömsesidig kommunikation mellan dataforskare och produktchefer är essentiellt. Dessutom identifierades fyra typer av iterationer som kan förekomma vid användning av mätetal; modifiera mätetal, designa nya mätetal, fullständigt förändra mätetal samt påbörja nya initiativ. Därutöver kan studien konstatera att mätetal är högst kontextberoende, och att det finns fyra viktiga aspekter att ta hänsyn till i mätetals-design; data-tillgänglighet och proxy-utvärdering, karaktäristik och form på mätetal, trade-off mellan mätetal, samt tolkning av mätetals-förändringar.

Consensus prevails that performance measurement systems should reflect the strategic direction of a company. Strategies are dynamic in nature while existing measurement systems are stable and predictable. The paradox of combining strategies with measurement systems has created problems for companies as the strategic context alters. Even though the literature surrounding the field is vast and dense there is a gap regarding how to keep measurement system up to date and dynamic. With the existing problem in mind, the objective of this research is to develop a framework that will support the realisation of dynamic performance measurement systems in manufacturing organisations. The research in this thesis has adopted a systems approach and is built around four case studies and two literature studies. The case studies have been conducted at manufacturing organisations on three different continents. The first literature study focused on the general literature in the field whilst the second literature study focused on the characteristics of dynamic performance measurement system in particular. The end-result of this research is a framework based on 19 factors systemised under five sub-headings: review process, IT system, management, employees and culture. In excess of the 19 factors, an additional two factors focalising on the realisation of the framework in practice finalises the end-result. As the research is derived from an industrial problem, this thesis provides an insight for academics of the contemporary struggles of manufacturing organisations with their performance measurement systems. Moreover, this framework provides practitioners with a foundation for making their performance measurement systems compatible and suitable for ever-changing content.

In this thesis we proposed and tested a new method for creating synthetic workloads. Our method takes the dynamic behaviour into consideration, whereas previous studies only consider the static behaviour. This was done by recording performance monitor counters (PMC) events from a reference application. These events were then used to calculate the hardware load characteristics, in our case cache miss ratios, that were stored for each sample and used as input to a load regulator. A signalling application was then used together with a load regulator and a cache miss generator to tune the hardware characteristics until they were similar to those of the reference application. For each sample, the final parameters from the load regulator were stored in order to be able to simulate it. By simulating all samples with the same sampling period with which they were recorded, the dynamic behaviour of the reference application could be simulated. Measurements show that this was successful for L1 D$ miss ratio, but not for L1 I$ miss ratio and only to a small extent for L2 D$ miss ratio. We were also able to show that the total convergence time for the regulator could be reduced by using case-based reasoning to select the initial parameters from similar samples.

Research on situational constraints has overlooked a number of important issues relevant to the generalizability of current findings, including the construct validity of current constraint measures, and an account of the role coping might play in mitigating the effects of constraints. Data from a two-wave panel design with college students as participants was used to investigate the above issues. The data indicated that the current conceptualization and measurement of constraints seems suitable to the task of testing substantive hypotheses. Furthermore, constraints measured with reference to a specific performance domain had greater predictive validity than those representing a general performance domain. The data did not support the contention that problem-focused coping and the perceived controllability of constraints would interact in the prediction of constraints, satisfaction, and performance. Several alternative explanations for the latter findings are offered. Finally, a number of suggestions for the conduct of future research using constraint, controllability, and coping constructs are outlined.
Ph. D.
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Measurements of intraoral pressure (IOP) and sound pressure level (SPL) were taken of four oboists as they performed two sets of musical exercises: (1) crescendo-decrescendo from pp to ff and back to pp on the pitches D4, G4, C5 and A5, and (2) straight and vibrato performances of the same four pitches at mf. Video images of the vocal tract were also made using flexible fiberoptic nasoendoscopy (FFN). IOP and SPL data were captured in real time by the WinDaq®/Lite software package, with the dB meter located 8-9 inches in directly front of the oboe bell. The study yielded minimum and maximum values from 21.04 to 57.81 mm Hg and from 65.53 to 100.89 dB across all pitches examined. Discussion is included for the following topics: (1) the oboe’s sound envelope, or functional range of IOP and SPL values at different pitch levels, including the nonlinearity in the relationship between IOP and SPL on the oboe, (2) the static activation and kinetic maintenance thresholds for reed vibration, (3) the effect of vibrato on IOP/SPL, (4) the utilization of the vocal tract during execution of dynamic changes and vibrato, and (5) the impact of player experience on control of physical variables.

The amplification of demand variation up a supply chain widely termed ‘the Bullwhip Effect’ is disruptive, costly and something that supply chain management generally seeks to minimise. Originally attributed to poor system design; deficiencies in policies, organisation structure and delays in material and information flow all lead to sub-optimal reorder point calculation. It has since been attributed to exogenous random factors such as: uncertainties in demand, supply and distribution lead time but these causes are not exclusive as academic and operational studies since have shown that orders and/or inventories can exhibit significant variability even if customer demand and lead time are deterministic. This increase in the range of possible causes of dynamic behaviour indicates that our understanding of the phenomenon is far from complete. One possible, yet previously unexplored, factor that may influence dynamic behaviour in supply chains is the application and operation of supply chain performance measures. Organisations monitoring and responding to their adopted key performance metrics will make operational changes and this action may influence the level of dynamics within the supply chain, possibly degrading the performance of the very system they were intended to measure. In order to explore this a plausible abstraction of the operational responses to the Supply Chain Council’s SCOR® (Supply Chain Operations Reference) model was incorporated into a classic Beer Game distribution representation, using the dynamic discrete event simulation software Simul8. During the simulation the five SCOR Supply Chain Performance Attributes: Reliability, Responsiveness, Flexibility, Cost and Utilisation were continuously monitored and compared to established targets. Operational adjustments to the; reorder point, transportation modes and production capacity (where appropriate) for three independent supply chain roles were made and the degree of dynamic behaviour in the Supply Chain measured, using the ratio of the standard deviation of upstream demand relative to the standard deviation of the downstream demand. Factors employed to build the detailed model include: variable retail demand, order transmission, transportation delays, production delays, capacity constraints demand multipliers and demand averaging periods. Five dimensions of supply chain performance were monitored independently in three autonomous supply chain roles and operational settings adjusted accordingly. Uniqueness of this research stems from the application of the five SCOR performance attributes with modelled operational responses in a dynamic discrete event simulation model. This project makes its primary contribution to knowledge by measuring the impact, on supply chain dynamics, of applying a representative performance measurement system.

The book takes on a systematic treatment of dynamic decision making and performance measurement. The analytical foundations of the dynamic production technology are introduced and developed in detail for several primal representations of the technology with an emphasis on dynamic directional distance functions. Dynamic cost minimization and dynamic profit maximization are developed for primal and dual representations of the dynamic technology. A dynamic production environment can be characterized as one where current production decisions impact future production possibilities. Consequently, the dynamic perspective of production relationships necessarily involves the close interplay between stock and flow elements in the transformation process and how current decisions impact the changes in future stocks. Stock elements in the production transformation process can involve physical elements that can be effectively employed in the transformation process, which can include the stock of technical knowledge and expertise available to the decision maker during the decision period. The dynamic generalization of concepts measuring the production structure (e.g., economies of scale, economies of scope, capacity utilization) and performance (e.g., allocative, scale and technical inefficiency, productivity) are developed from primal and dual perspectives. As an important source of productivity growth, production efficiency analysis is the subject of countless studies. Yet, theoretical and empirical studies focusing on production efficiency have ignored typically the time interdependence of production decisions and the adjustment paths of the firm over time. The empirical implementation of these production and performance measures is developed at length for both nonparametric and econometric approaches.

AbstractThe research spans several application areas, including biotechnology, medical imaging, and environmental monitoring. Precise and specialized processing techniques are often required for measurements of signal parameters with high efficiency, for example, in terms of resolution and count rate, such as time of occurrence of events. Digital solutions have thus received the most significant attention since they are the most effective at enabling flexible, application-oriented elaboration systems. The research is finalized to develop high-resolution time measurement systems in Field Programmable Gate Array (FPGA) devices. The goal is to optimize resolution, linearity, and processing speed at the state-of-the-art in modern, most dynamic branches of very high-efficiency time measurement. To maximize the number of events handled in real-time, the research is also concentrated on developing cutting-edge communication and data transfer methods for performing multiple measures in parallel.

This project objective evaluated the potential of improving linked weather-and-mobility model predictions by blending soil moisture observations from a Cosmic-ray Soil Moisture Observing System (COSMOS) sensor with weather-informed predictions of soil moisture and soil strength from the Geospatial Weather-Affected Terrain Conditions and Hazards (GeoWATCH). Assimilating vehicle-borne COSMOS observations that measure local effects model predictions of soil moisture offered potential to produce more accurate soil strength and vehicle mobility forecast was the hypothesis. This project compared soil moisture observations from a COSMOS mobile sensor driven around an area near Iowa Falls, IA, with both GeoWATCH soil moisture predictions and in situ probe observations. The evaluation of the COSMOS rover data finds that the soil moisture measurements contain a low measurement bias while the GeoWATCH estimates more closely matched the in situ data. The COSMOS rover captured a larger dynamic range of soil moisture conditions as compared to GeoWATCH, capturing both very wet and very dry soil conditions, which may better flag areas of high risk for mobility considerations. Overall, more study of the COSMOS rover is needed to better understand sensor performance in a variety of soil conditions to determine the feasibility of assimilating the COSMOS rover estimates into GeoWATCH.

The Indiana Department of Transportation (INDOT) completed a total of 25 high friction surface treatment (HFST) projects across the state in 2018. This research study attempted to investigate the durability and performance of HFST in terms of its HFST-pavement system integrity and surface friction performance. Laboratory tests were conducted to determine the physical and mechanical properties of epoxy-bauxite mortar. Field inspections were carried out to identify site conditions and common early HFST distresses. Cyclic loading test and finite element method (FEM) analysis were performed to evaluate the bonding strength between HFST and existing pavement, in particular chip seal with different pretreatments such as vacuum sweeping, shotblasting, and scarification milling. Both surface friction and texture tests were undertaken periodically (generally once every 6 months) to evaluate the surface friction performance of HFST. Crash records over a 5-year period, i.e., 3 years before installation and 2 years after installation, were examined to determine the safety performance of HFST, crash modification factor (CMF) in particular. It was found that HFST epoxy-bauxite mortar has a coefficient of thermal expansion (CTE) significantly higher than those of hot mix asphalt (HMA) mixtures and Portland cement concrete (PCC), and good cracking resistance. The most common early HFST distresses in Indiana are reflective cracking, surface wrinkling, aggregate loss, and delamination. Vacuum sweeping is the optimal method for pretreating existing pavements, chip seal in particular. Chip seal in good condition is structurally capable of providing a sound base for HFST. On two-lane highway curves, HFST is capable of reducing the total vehicle crash by 30%, injury crash by 50%, and wet weather crash by 44%, and providing a CMF of 0.584 in Indiana. Great variability may arise in the results of friction tests on horizontal curves by the use of locked wheel skid tester (LWST) due both to the nature of vehicle dynamics and to the operation of test vehicle. Texture testing, however, is capable of providing continuous texture measurements that can be used to calculate a texture height parameter, i.e., mean profile depth (MPD), not only for evaluating friction performance but also implementing quality control (QC) and quality assurance (QA) plans for HFST.

Objectives. Diagnostic errors are a known patient safety concern across all clinical settings, including the emergency department (ED). We conducted a systematic review to determine the most frequent diseases and clinical presentations associated with diagnostic errors (and resulting harms) in the ED, measure error and harm frequency, as well as assess causal factors. Methods. We searched PubMed®, Cumulative Index to Nursing and Allied Health Literature (CINAHL®), and Embase® from January 2000 through September 2021. We included research studies and targeted grey literature reporting diagnostic errors or misdiagnosis-related harms in EDs in the United States or other developed countries with ED care deemed comparable by a technical expert panel. We applied standard definitions for diagnostic errors, misdiagnosis-related harms (adverse events), and serious harms (permanent disability or death). Preventability was determined by original study authors or differences in harms across groups. Two reviewers independently screened search results for eligibility; serially extracted data regarding common diseases, error/harm rates, and causes/risk factors; and independently assessed risk of bias of included studies. We synthesized results for each question and extrapolated U.S. estimates. We present 95 percent confidence intervals (CIs) or plausible range (PR) bounds, as appropriate. Results. We identified 19,127 citations and included 279 studies. The top 15 clinical conditions associated with serious misdiagnosis-related harms (accounting for 68% [95% CI 66 to 71] of serious harms) were (1) stroke, (2) myocardial infarction, (3) aortic aneurysm and dissection, (4) spinal cord compression and injury, (5) venous thromboembolism, (6/7 – tie) meningitis and encephalitis, (6/7 – tie) sepsis, (8) lung cancer, (9) traumatic brain injury and traumatic intracranial hemorrhage, (10) arterial thromboembolism, (11) spinal and intracranial abscess, (12) cardiac arrhythmia, (13) pneumonia, (14) gastrointestinal perforation and rupture, and (15) intestinal obstruction. Average disease-specific error rates ranged from 1.5 percent (myocardial infarction) to 56 percent (spinal abscess), with additional variation by clinical presentation (e.g., missed stroke average 17%, but 4% for weakness and 40% for dizziness/vertigo). There was also wide, superimposed variation by hospital (e.g., missed myocardial infarction 0% to 29% across hospitals within a single study). An estimated 5.7 percent (95% CI 4.4 to 7.1) of all ED visits had at least one diagnostic error. Estimated preventable adverse event rates were as follows: any harm severity (2.0%, 95% CI 1.0 to 3.6), any serious harms (0.3%, PR 0.1 to 0.7), and deaths (0.2%, PR 0.1 to 0.4). While most disease-specific error rates derived from mainly U.S.-based studies, overall error and harm rates were derived from three prospective studies conducted outside the United States (in Canada, Spain, and Switzerland, with combined n=1,758). If overall rates are generalizable to all U.S. ED visits (130 million, 95% CI 116 to 144), this would translate to 7.4 million (PR 5.1 to 10.2) ED diagnostic errors annually; 2.6 million (PR 1.1 to 5.2) diagnostic adverse events with preventable harms; and 371,000 (PR 142,000 to 909,000) serious misdiagnosis-related harms, including more than 100,000 permanent, high-severity disabilities and 250,000 deaths. Although errors were often multifactorial, 89 percent (95% CI 88 to 90) of diagnostic error malpractice claims involved failures of clinical decision-making or judgment, regardless of the underlying disease present. Key process failures were errors in diagnostic assessment, test ordering, and test interpretation. Most often these were attributed to inadequate knowledge, skills, or reasoning, particularly in “atypical” or otherwise subtle case presentations. Limitations included use of malpractice claims and incident reports for distribution of diseases leading to serious harms, reliance on a small number of non-U.S. studies for overall (disease-agnostic) diagnostic error and harm rates, and methodologic variability across studies in measuring disease-specific rates, determining preventability, and assessing causal factors. Conclusions. Although estimated ED error rates are low (and comparable to those found in other clinical settings), the number of patients potentially impacted is large. Not all diagnostic errors or harms are preventable, but wide variability in diagnostic error rates across diseases, symptoms, and hospitals suggests improvement is possible. With 130 million U.S. ED visits, estimated rates for diagnostic error (5.7%), misdiagnosis-related harms (2.0%), and serious misdiagnosis-related harms (0.3%) could translate to more than 7 million errors, 2.5 million harms, and 350,000 patients suffering potentially preventable permanent disability or death. Over two-thirds of serious harms are attributable to just 15 diseases and linked to cognitive errors, particularly in cases with “atypical” manifestations. Scalable solutions to enhance bedside diagnostic processes are needed, and these should target the most commonly misdiagnosed clinical presentations of key diseases causing serious harms. New studies should confirm overall rates are representative of current U.S.-based ED practice and focus on identified evidence gaps (errors among common diseases with lower-severity harms, pediatric ED errors and harms, dynamic systems factors such as overcrowding, and false positives). Policy changes to consider based on this review include: (1) standardizing measurement and research results reporting to maximize comparability of measures of diagnostic error and misdiagnosis-related harms; (2) creating a National Diagnostic Performance Dashboard to track performance; and (3) using multiple policy levers (e.g., research funding, public accountability, payment reforms) to facilitate the rapid development and deployment of solutions to address this critically important patient safety concern.

1.1 Macroeconomic summary Economic recovery has consistently outperformed the technical staff’s expectations following a steep decline in activity in the second quarter of 2020. At the same time, total and core inflation rates have fallen and remain at low levels, suggesting that a significant element of the reactivation of Colombia’s economy has been related to recovery in potential GDP. This would support the technical staff’s diagnosis of weak aggregate demand and ample excess capacity. The most recently available data on 2020 growth suggests a contraction in economic activity of 6.8%, lower than estimates from January’s Monetary Policy Report (-7.2%). High-frequency indicators suggest that economic performance was significantly more dynamic than expected in January, despite mobility restrictions and quarantine measures. This has also come amid declines in total and core inflation, the latter of which was below January projections if controlling for certain relative price changes. This suggests that the unexpected strength of recent growth contains elements of demand, and that excess capacity, while significant, could be lower than previously estimated. Nevertheless, uncertainty over the measurement of excess capacity continues to be unusually high and marked both by variations in the way different economic sectors and spending components have been affected by the pandemic, and by uneven price behavior. The size of excess capacity, and in particular the evolution of the pandemic in forthcoming quarters, constitute substantial risks to the macroeconomic forecast presented in this report. Despite the unexpected strength of the recovery, the technical staff continues to project ample excess capacity that is expected to remain on the forecast horizon, alongside core inflation that will likely remain below the target. Domestic demand remains below 2019 levels amid unusually significant uncertainty over the size of excess capacity in the economy. High national unemployment (14.6% for February 2021) reflects a loose labor market, while observed total and core inflation continue to be below 2%. Inflationary pressures from the exchange rate are expected to continue to be low, with relatively little pass-through on inflation. This would be compatible with a negative output gap. Excess productive capacity and the expectation of core inflation below the 3% target on the forecast horizon provide a basis for an expansive monetary policy posture. The technical staff’s assessment of certain shocks and their expected effects on the economy, as well as the presence of several sources of uncertainty and related assumptions about their potential macroeconomic impacts, remain a feature of this report. The coronavirus pandemic, in particular, continues to affect the public health environment, and the reopening of Colombia’s economy remains incomplete. The technical staff’s assessment is that the COVID-19 shock has affected both aggregate demand and supply, but that the impact on demand has been deeper and more persistent. Given this persistence, the central forecast accounts for a gradual tightening of the output gap in the absence of new waves of contagion, and as vaccination campaigns progress. The central forecast continues to include an expected increase of total and core inflation rates in the second quarter of 2021, alongside the lapse of the temporary price relief measures put in place in 2020. Additional COVID-19 outbreaks (of uncertain duration and intensity) represent a significant risk factor that could affect these projections. Additionally, the forecast continues to include an upward trend in sovereign risk premiums, reflected by higher levels of public debt that in the wake of the pandemic are likely to persist on the forecast horizon, even in the context of a fiscal adjustment. At the same time, the projection accounts for the shortterm effects on private domestic demand from a fiscal adjustment along the lines of the one currently being proposed by the national government. This would be compatible with a gradual recovery of private domestic demand in 2022. The size and characteristics of the fiscal adjustment that is ultimately implemented, as well as the corresponding market response, represent another source of forecast uncertainty. Newly available information offers evidence of the potential for significant changes to the macroeconomic scenario, though without altering the general diagnosis described above. The most recent data on inflation, growth, fiscal policy, and international financial conditions suggests a more dynamic economy than previously expected. However, a third wave of the pandemic has delayed the re-opening of Colombia’s economy and brought with it a deceleration in economic activity. Detailed descriptions of these considerations and subsequent changes to the macroeconomic forecast are presented below. The expected annual decline in GDP (-0.3%) in the first quarter of 2021 appears to have been less pronounced than projected in January (-4.8%). Partial closures in January to address a second wave of COVID-19 appear to have had a less significant negative impact on the economy than previously estimated. This is reflected in figures related to mobility, energy demand, industry and retail sales, foreign trade, commercial transactions from selected banks, and the national statistics agency’s (DANE) economic tracking indicator (ISE). Output is now expected to have declined annually in the first quarter by 0.3%. Private consumption likely continued to recover, registering levels somewhat above those from the previous year, while public consumption likely increased significantly. While a recovery in investment in both housing and in other buildings and structures is expected, overall investment levels in this case likely continued to be low, and gross fixed capital formation is expected to continue to show significant annual declines. Imports likely recovered to again outpace exports, though both are expected to register significant annual declines. Economic activity that outpaced projections, an increase in oil prices and other export products, and an expected increase in public spending this year account for the upward revision to the 2021 growth forecast (from 4.6% with a range between 2% and 6% in January, to 6.0% with a range between 3% and 7% in April). As a result, the output gap is expected to be smaller and to tighten more rapidly than projected in the previous report, though it is still expected to remain in negative territory on the forecast horizon. Wide forecast intervals reflect the fact that the future evolution of the COVID-19 pandemic remains a significant source of uncertainty on these projections. The delay in the recovery of economic activity as a result of the resurgence of COVID-19 in the first quarter appears to have been less significant than projected in the January report. The central forecast scenario expects this improved performance to continue in 2021 alongside increased consumer and business confidence. Low real interest rates and an active credit supply would also support this dynamic, and the overall conditions would be expected to spur a recovery in consumption and investment. Increased growth in public spending and public works based on the national government’s spending plan (Plan Financiero del Gobierno) are other factors to consider. Additionally, an expected recovery in global demand and higher projected prices for oil and coffee would further contribute to improved external revenues and would favor investment, in particular in the oil sector. Given the above, the technical staff’s 2021 growth forecast has been revised upward from 4.6% in January (range from 2% to 6%) to 6.0% in April (range from 3% to 7%). These projections account for the potential for the third wave of COVID-19 to have a larger and more persistent effect on the economy than the previous wave, while also supposing that there will not be any additional significant waves of the pandemic and that mobility restrictions will be relaxed as a result. Economic growth in 2022 is expected to be 3%, with a range between 1% and 5%. This figure would be lower than projected in the January report (3.6% with a range between 2% and 6%), due to a higher base of comparison given the upward revision to expected GDP in 2021. This forecast also takes into account the likely effects on private demand of a fiscal adjustment of the size currently being proposed by the national government, and which would come into effect in 2022. Excess in productive capacity is now expected to be lower than estimated in January but continues to be significant and affected by high levels of uncertainty, as reflected in the wide forecast intervals. The possibility of new waves of the virus (of uncertain intensity and duration) represents a significant downward risk to projected GDP growth, and is signaled by the lower limits of the ranges provided in this report. Inflation (1.51%) and inflation excluding food and regulated items (0.94%) declined in March compared to December, continuing below the 3% target. The decline in inflation in this period was below projections, explained in large part by unanticipated increases in the costs of certain foods (3.92%) and regulated items (1.52%). An increase in international food and shipping prices, increased foreign demand for beef, and specific upward pressures on perishable food supplies appear to explain a lower-than-expected deceleration in the consumer price index (CPI) for foods. An unexpected increase in regulated items prices came amid unanticipated increases in international fuel prices, on some utilities rates, and for regulated education prices. The decline in annual inflation excluding food and regulated items between December and March was in line with projections from January, though this included downward pressure from a significant reduction in telecommunications rates due to the imminent entry of a new operator. When controlling for the effects of this relative price change, inflation excluding food and regulated items exceeds levels forecast in the previous report. Within this indicator of core inflation, the CPI for goods (1.05%) accelerated due to a reversion of the effects of the VAT-free day in November, which was largely accounted for in February, and possibly by the transmission of a recent depreciation of the peso on domestic prices for certain items (electric and household appliances). For their part, services prices decelerated and showed the lowest rate of annual growth (0.89%) among the large consumer baskets in the CPI. Within the services basket, the annual change in rental prices continued to decline, while those services that continue to experience the most significant restrictions on returning to normal operations (tourism, cinemas, nightlife, etc.) continued to register significant price declines. As previously mentioned, telephone rates also fell significantly due to increased competition in the market. Total inflation is expected to continue to be affected by ample excesses in productive capacity for the remainder of 2021 and 2022, though less so than projected in January. As a result, convergence to the inflation target is now expected to be somewhat faster than estimated in the previous report, assuming the absence of significant additional outbreaks of COVID-19. The technical staff’s year-end inflation projections for 2021 and 2022 have increased, suggesting figures around 3% due largely to variation in food and regulated items prices. The projection for inflation excluding food and regulated items also increased, but remains below 3%. Price relief measures on indirect taxes implemented in 2020 are expected to lapse in the second quarter of 2021, generating a one-off effect on prices and temporarily affecting inflation excluding food and regulated items. However, indexation to low levels of past inflation, weak demand, and ample excess productive capacity are expected to keep core inflation below the target, near 2.3% at the end of 2021 (previously 2.1%). The reversion in 2021 of the effects of some price relief measures on utility rates from 2020 should lead to an increase in the CPI for regulated items in the second half of this year. Annual price changes are now expected to be higher than estimated in the January report due to an increased expected path for fuel prices and unanticipated increases in regulated education prices. The projection for the CPI for foods has increased compared to the previous report, taking into account certain factors that were not anticipated in January (a less favorable agricultural cycle, increased pressure from international prices, and transport costs). Given the above, year-end annual inflation for 2021 and 2022 is now expected to be 3% and 2.8%, respectively, which would be above projections from January (2.3% and 2,7%). For its part, expected inflation based on analyst surveys suggests year-end inflation in 2021 and 2022 of 2.8% and 3.1%, respectively. There remains significant uncertainty surrounding the inflation forecasts included in this report due to several factors: 1) the evolution of the pandemic; 2) the difficulty in evaluating the size and persistence of excess productive capacity; 3) the timing and manner in which price relief measures will lapse; and 4) the future behavior of food prices. Projected 2021 growth in foreign demand (4.4% to 5.2%) and the supposed average oil price (USD 53 to USD 61 per Brent benchmark barrel) were both revised upward. An increase in long-term international interest rates has been reflected in a depreciation of the peso and could result in relatively tighter external financial conditions for emerging market economies, including Colombia. Average growth among Colombia’s trade partners was greater than expected in the fourth quarter of 2020. This, together with a sizable fiscal stimulus approved in the United States and the onset of a massive global vaccination campaign, largely explains the projected increase in foreign demand growth in 2021. The resilience of the goods market in the face of global crisis and an expected normalization in international trade are additional factors. These considerations and the expected continuation of a gradual reduction of mobility restrictions abroad suggest that Colombia’s trade partners could grow on average by 5.2% in 2021 and around 3.4% in 2022. The improved prospects for global economic growth have led to an increase in current and expected oil prices. Production interruptions due to a heavy winter, reduced inventories, and increased supply restrictions instituted by producing countries have also contributed to the increase. Meanwhile, market forecasts and recent Federal Reserve pronouncements suggest that the benchmark interest rate in the U.S. will remain stable for the next two years. Nevertheless, a significant increase in public spending in the country has fostered expectations for greater growth and inflation, as well as increased uncertainty over the moment in which a normalization of monetary policy might begin. This has been reflected in an increase in long-term interest rates. In this context, emerging market economies in the region, including Colombia, have registered increases in sovereign risk premiums and long-term domestic interest rates, and a depreciation of local currencies against the dollar. Recent outbreaks of COVID-19 in several of these economies; limits on vaccine supply and the slow pace of immunization campaigns in some countries; a significant increase in public debt; and tensions between the United States and China, among other factors, all add to a high level of uncertainty surrounding interest rate spreads, external financing conditions, and the future performance of risk premiums. The impact that this environment could have on the exchange rate and on domestic financing conditions represent risks to the macroeconomic and monetary policy forecasts. Domestic financial conditions continue to favor recovery in economic activity. The transmission of reductions to the policy interest rate on credit rates has been significant. The banking portfolio continues to recover amid circumstances that have affected both the supply and demand for loans, and in which some credit risks have materialized. Preferential and ordinary commercial interest rates have fallen to a similar degree as the benchmark interest rate. As is generally the case, this transmission has come at a slower pace for consumer credit rates, and has been further delayed in the case of mortgage rates. Commercial credit levels stabilized above pre-pandemic levels in March, following an increase resulting from significant liquidity requirements for businesses in the second quarter of 2020. The consumer credit portfolio continued to recover and has now surpassed February 2020 levels, though overall growth in the portfolio remains low. At the same time, portfolio projections and default indicators have increased, and credit establishment earnings have come down. Despite this, credit disbursements continue to recover and solvency indicators remain well above regulatory minimums. 1.2 Monetary policy decision In its meetings in March and April the BDBR left the benchmark interest rate unchanged at 1.75%.