#ICTD Part 1 Resources

[i-cast-teatus-deletus]

TW for a picture of a pretty gnarly almost-certainly-infected nipple graft.

I came across a handful of similar blog posts about taking care of someone post-surgery, but this one was by far the most informative. Most of them were, no offense, largely complaining about how difficult the day of surgery was for them (and, no offense, often due to their own lack of understanding and preparation for surgery day. That sort of thing is what this neuroticism is all about, making sure I am not stuck in a bad situation based on things I could have avoided had I thought clearly for 7 minutes at SOME point).

This one got me seriously thinking about getting a hotel room close to the surgical site, even though we don't live extremely far away. But the drive they are describing is nearly identical to the drive we would be experiencing and they did not have a great time.

This blog post also links to a resource for JP Drain care, which is always useful.

[cay-kahve-blog]

Case for Integrating Computational Thinking and Science in a Low-Resource Setting Aakash Gautam Virginia Tech Blacksburg, Virginia aakashg@vt.edu Whitney Elaine Wall Bortz Virginia Tech Blacksburg, Virginia whitney8@vt.edu Deborah Tatar Virginia Tech Blacksburg, Virginia dtatar@cs.vt.edu ABSTRACT There is a growing need to use computers to formulate problems and their solutions across domains. It has thus become imperative that students across the globe be able to work with computing to express themselves. However, teaching computer science in a traditional way may not be possible in all settings. We studied a method to integrate computational thinking, the ability to express problems and their solutions to a computing device, into an existing science classroom with the goal of deepening learning in both science and computational thinking in a low-resource setting in Nepal. In this note, we present findings from the study. The proposed curricular method acknowledges local differences and presents a way to adapt to those differences through adaptable multiple layers of activities and representational variability. We hope that interested educators and development practitioners would try our method in classrooms. CCS CONCEPTS • Social and professional topics→Computational thinking; K-12 education; • Applied computing → Interactive learning environments; KEYWORDS ICTD; ICT4D; educational technology; computational thinking; CT; agent-based simulation, NetLogo ACM Reference Format: Aakash Gautam, Whitney Elaine Wall Bortz, and Deborah Tatar. 2017. Case for Integrating Computational Thinking and Science in a Low-Resource Setting. In Proceedings of ICTD ’17. ACM, New York, NY, USA, Article 4, 4 pages. https://doi.org/10.1145/3136560.3136601 1 INTRODUCTION Many prior works on ICTD have focused on access to infrastructural resources, including computers. As famously demonstrated by the One Laptop Per Child (OLPC) project [13], from a learning perspective, infrastructure alone is not enough to produce meaningful learning. Additional key ingredients include both usable software Permission to make digital or hard copies of all or part of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage and that copies bear this notice and the full citation on the first page. Copyrights for components of this work owned by others than the author(s) must be honored. Abstracting with credit is permitted. To copy otherwise, or republish, to post on servers or to redistribute to lists, requires prior specific permission and/or a fee. Request permissions from permissions@acm.org. ICTD ’17, November 16–19, 2017, Lahore, Pakistan © 2017 Copyright held by the owner/author(s). Publication rights licensed to Association for Computing Machinery. ACM ISBN 978-1-4503-5277-2/17/11. . . $15.00 https://doi.org/10.1145/3136560.3136601 and the match between the affordances of the software, the instructional purposes of the unit, and other supporting materials and student activities [4, 10]. These elements and the matches between them, that is, the way the underlying infrastructural resources can be used, constitute the prospects for attaining success [1, 6]. Some prior ICTD work has focused on enabling the use of the underlying infrastructure, for example, by providing educational games in mobile phones outside of schools [5], delivering content through mobile phones [2], blending online and in-person instruction [3], and exploring a technology-centered tutoring system [8]. This note takes the exploration of the use of technology in context to a deeper level. It presents a method of introducing computers with the joint goals of (1) deepening understanding of science and (2) promoting computational thinking. Computational thinking (CT) is the ability to “formulate problems and their solutions so that the solutions are represented in a form that can effectively be carried out by an information-processing agent" [15]. In a simplified form, CT is being able to think like a computer scientist. There is a growing consensus among educators about CT as a necessary skill permeating many domains [15]. Likewise, studies have posited the importance placed on computers and their perceived value by public in rural settings [9]. Despite these interests in computing, little is known about how to adapt materials and practices to create conditions of receptivity. Barriers include highlevel “wicked problems" [11] like gender bias [9], the benefit of connecting abstract computational ideas to actual life experiences [7], and the need to avoid implying that the only path to learning is through regular access to computer technology. An overly computer-centric perspective on learning may be discouraging to those who do not and cannot have regular access. Students’ varying backgrounds, interests and aspirations require teaching high-order thinking like CT with local adaptation in low-resource settings. The curricular approach we advocate utilizes multiple representations, both on and off the computer, combining the introduction of CT with recognizable components of education, in this case, Biology/Chemistry, that give students access to different facets of knowledge required to have deep understandings. In doing this, we also focus on the strengths of in-classroom, face-to-face instruction. We have designed an integrated curriculum in which the teacher moves students through experiences with multiple representations of a science phenomenon. As shown in Table 1, some of the representations are on paper, some are student created or modified, some represent science through animated, playable simulations, and some represent science through programming code. The instruction is governed by a driving question, in this case, “where does the carbon go" during photosynthesis and carbohydrate catabolism. Modeling and simulation are by themselves important aspects of ICTD ’17, November 16–19, 2017, Lahore, Pakistan Aakash Gautam, Whitney Elaine Wall Bortz, and Deborah Tatar Table 1: Layered activity used in the instructional module Kinds of Representations Pedagogical affordance(s) Objects and Processes Macroscopic digital representation Introduced students to a science phenomenon similar to the real-life world they had experienced. Dynamic objects and processes that were recognized as “reallife" such as cows, plants, sun, eating, dying, and growing. Microscopic overlay Introduced the idea that macroscopic objects and processes are influenced by microscopic, chemical objects and processes. Contextualized dynamic digital representations of molecules and molecular processes interacting with the macroscopic objects. Group poster creation Conveyed that science can be understood by different kinds of representations of objects and phenomena, highlighting different facets of knowledge. Static student drawings and their explanations of the observed phenomena, and explanatory mechanisms. Science fact sheet Helped students connect the knowledge in the other representations with more standard scientific representations, such as chemical formulas. Static written text, images, and chemical formulas to explain the phenomena like in a textbook. Codebased representations Introduced the idea that representations are made to serve particular purposes, that the student can create, change or modify representations and that science may be represented at different levels of granularity and accuracy. Text based code defining objects, properties and procedures that can be edited and uploaded to change the simulation. CT, but the introduction to CT is furthered by creating a context in which students can use programmatic representations to change and explore the phenomenon. The curriculum directs the students towards inquiry about the chemical basis of biological processes. 2 STUDY 2.1 School Setting We conducted our study in a school, established in 2013, 14 kms from Kathmandu, Nepal, that aims to provide interest-based education1. Despite a focus on STEM (Science, Technology, Engineering and Mathematics), the school adheres to the central government’s syllabus, with instruction primarily delivered in English. The school recruits and boards students from several rural areas of the country, most of them from families with limited financial resources. During the 2016-17 school year, 125 co-ed students ranging from 6-16 years 1http://news.mit.edu/2015/help-rebuild-bloom-nepal-school-destroyed-earthquakes-0612 old were enrolled. Sixteen (9 female, 7 male) were enrolled in the 7th grade and participated in this study. Although the setting is rural, from a Nepalese point of view, the school is fairly accessible through public transport and has Internet connectivity. The school had three functioning computers in a room with battery backup, access to which was restricted to students in 9th and 10th grade. 2.2 Curricular Approach We conducted a two-week long intervention, involving 35 instructional hours. A Nepali author of this note led the instruction, with support from the local science teacher. There were four computers in the class including one of the author’s laptop, which meant each computer was to be shared by four students. To mitigate inequality in engagement and learning experience when sharing a computer [10], students discussed their plans in groups prior to working on the computer. We also asked students to rotate their position while working on the computer. The science content in the module adhered to the national 7th science curriculum to teach photosynthesis and the natural carbon cycle. The left-most part of Figure 1 shows the level of instruction students had received. Our module tied that level of representation to the chemical processes involved in photosynthesis and carbohydrate catabolism in animals. This approach opens up the idea of conservation of matter which can lead to the introduction and balancing of related chemical equations. The representations utilized during the intervention, their affordances, and the objects and processes they illustrated are listed in Table 1. Students first worked on an introductory simulation that had simple representation of familiar, macroscopic real-world phenomenon. In this representation, plants grew, cows moved around, and the sun shined. The cows ate plants and died if there were no plants. By changing sliders and buttons, students could explore the relationship between the number of plants, the number of cows, and longevity. They moved into exploration of the microscopic phenomena by displaying hugely exaggerated representations of carbon forms and their transformation through different chemical processes (see the center image in Figure 1). Students worked in groups of four to create their own representations: posters they drew and described what they thought was going on in the simulation. They presented the poster to the class for discussion. Other, more standard scientific representations were presented via the “science fact sheet", a single-page document with verbal descriptions, chemical formulas and illustrative pictures that highlighted some of the science concepts. A last set of representations were introduced through exposure to the code that implemented the simulation. This enabled the important idea that the expression of objects could be modified by writing commands and blocks of code. Students studied snippets of the code to understand the model, and subsequently discussed and implemented an extension of the model by writing code. 2.3 System Description A central part of the curriculum involves working with an animated digital simulation of the natural carbon cycle, and interacting with the macroscopic and microscopic representations of the natural carbon cycle implemented using agent-based modeling in NetLogo Case for Integrating Computational Thinking and Science in a Low-Resource Setting ICTD ’17, November 16–19, 2017, Lahore, Pakistan Figure 1: Textbook representation of the phenomenon (left), the overlay of microscopic and macroscopic representations that we presented during our intervention (center), and one group’s drawing of the science phenomena (right) [14]. The simulation runs in any Internet browser and therefore does not require local software installation. In general, the system is a single page web application in which the simulation and modeling are executed on the client side once the first page loads. Therefore, the system is established through a simple local HTTP server and does not depend on Internet connectivity. However, for the study, we recorded log entries of student interaction with the computer so we served the web application through a remote server and this required Internet connectivity. 2.4 Data Collection and Analysis After engaging in an IRB-approved consent process at the beginning of the intervention, we conducted an attitudinal assessment to evaluate students’ self-confidence with, interest in, values for, and identification with computing. Use of the simulation was logged including keystrokes and interface-based changes. Student worksheets and posters were collected for analysis. We also conducted a post-performance assessment. Posters and free-text comments about attitudes were analyzed using a grounded theory approach [12] by researchers familiar with the project, including the authors. Themes emerging from the content and pictorial depiction were identified and discussed, and possible alternative conceptions were identified as well. Variation in student activity with the computers was analyzed through log data. Furthermore, post-performance assessment was evaluated against an established rubric to measure the students’ understanding of science and CT. A few emergent findings are reported here. 3 FINDINGS 3.1 Interest in Computing and Apprehension Students had played mobile games but were unfamiliar with the concepts of simulation and modeling. Previous use of computers was confined to two students who had typed in Microsoft Word and drawn in Microsoft Paint a few times. Most had seen others use computers but had never actively used one. Despite the limited exposure to computing, most students held it in esteem. A student ([S7]) wrote, “I think computing is very important for all of us because now days [nowadays] most of the people depends [depend] on computing for their work." While students were interested and excited, they were also initially apprehensive. Three groups hesitated to change slider values during the initial exploration out of fear of “making the system go bad". 3.2 Summary of Key Science Learning Observations • The students used mechanistic phrases like “throw out carbon dioxide" and “take in oxygen" but weren’t familiar with the random motion of molecules. The simulation encouraged students to inquire about movement of molecules and the right conditions necessary for reactions to occur. • Students knew that air contained carbon-dioxide and that its chemical formula was CO2. However, none of the students could use the formula to conclude that carbon-dioxide contains one carbon atom and two oxygen atoms. The microscopic representation of carbon-dioxide molecule that showed atoms in CO2 drove students to connect the subscripts with the atomic count. • Students described carbon-dioxide gas as containing CO2 (rather than being CO2) and therefore initially identified the carbon atoms in the simulation as carbon-dioxide and the depiction of the molecule with all three atoms as representing the gas. The question “what are the blacks and red dots?" led to a class-wide discussion on Day 3, clarifying the misconception. • They knew about photosynthesis but not about breakdown of glucose in animals. Three of the four groups studied the graph, which showed carbon amounts in atmosphere, plants, and cows to hypothesize the transformation of carbon forms in animals. • Fifteen of the sixteen students identified that water was missing from the simulation. This created the opportunity for this class of students to build into the simulation based on their own understanding of what was important about the science. 3.3 Summary of Key CT Observations • None of the students were familiar with simulation or modeling at the start of the intervention. As we progressed through the activities, students evaluated and critiqued in terms of things that were accurate, inaccurate, and missing from the model. • Students expressed their lived experiences through single-lined commands by modifying shapes of objects. The most common changes involved changing cows to people, plants to flags and tree, and the sun to hills and mountains. ICTD ’17, November 16–19, 2017, Lahore, Pakistan Aakash Gautam, Whitney Elaine Wall Bortz, and Deborah Tatar • Because the students thought that it was important to represent water, they undertook a project they thought was important: extending the code to implement clouds and rainfall. • Students were able to implement clouds and rainfall by identifying and discussing elements in the simulation that were similar to the extension they wanted to create. They abstracted common properties and methods from the existing code. • With the instructor’s support, the students divided the task into smaller tasks, and planned and discussed ways to complete those tasks. The planning and discussion occurred without a computer and pushed the idea that CT is not just about computers. • By the end of the task, students had created two new objects and three methods which highlighted their understanding science and understanding of CT concepts such as method call sequences, operators, and abstraction. 4 DISCUSSION AND CONCLUSION 4.1 Deepening Science Learning Under the conditions in the study, students appeared to learn quite a lot of important science. The students were familiar with a single form of representation i.e. the textbook depiction of the process. Although the students had read about concepts such as atomic composition, molecular movement and necessary conditions for reactions to occur, the representations in the text book were static and separated each idea into an isolated unit. As shown in Figure 1, the representation of photosynthesis in the book showed a single molecule with arrows labeled oxygen and carbon-dioxide. It did not show the atomic structure of oxygen or carbon-dioxide. Our dynamic representation containing atomic structure of carbon-dioxide made it easier for students to connect different ideas. Furthermore, the multiple representations presented through layered activities pushed students to further explore the science phenomenon such as by using graphs alongside the simulation. 4.2 Deepening Computational Thinking Students moved from initial apprehension to considerable sophistication in the two-weeks of instruction. They certainly learned something about programming (because they were able to implement changes), but they were actively engaged in discussing elements of the models, and formulating and expressing solutions. In some sense, the low-resource setting, with only four computers for 16 students makes it abundantly clear that only some access is required. Most of the pedagogical challenge is provoking a computational way of thinking. 4.3 Integrating Science and CT This paper presents initial evidence of student learning drawn from a study in which we taught both Science and CT in a low-resource environment. The method that we used prioritized representations both on and off the computer that moved fluently between science and CT and back again. We believe that this method worked because students were continually able to draw on elements that they already understood to make sense of novel elements. In this case, the students were highly motivated and had quite a bit of textbook knowledge. It remains to be seen whether the method could be successful in environments with less motivated students. However, some optimism may be drawn from the fact that the underlying system is attentive to a range of conditions that prevail in low-resource schools. It does not require many computers or much investment in creating access. Even devices that simply give browser access could be used. Furthermore, these layered representations can provide different learning opportunities for students who bring different strengths and knowledge bases to the learning task. These students thought it was important to implement clouds and rainfall; others might consider it important to implement detritivores, showing more orientation towards the underlying chemistry or lions, showing more orientation towards ecology. A classroom teacher may not use our system the way we did during the intervention. They may not focus on the code-based model and instead focus on the static representation through the science fact sheet or focus solely on the visual simulation. However, evidence from our intervention in Nepal suggests that the richness in the learning environment, particularly through variability in the representations, supports students at different levels to explore and discover while providing flexibility for instructors to use the tool as they need for their class. REFERENCES [1] Paul Braund and Anke Schwittay. 2006. The missing piece: Human-driven design and research in ICT and development. In Information and Communication Technologies and Development, 2006. ICTD’06. International Conference on. IEEE, 2–10. [2] Cynthia Breazeal, Robin Morris, Stephanie Gottwald, Tinsley Galyean, and Maryanne Wolf. 2016. Mobile devices for early literacy intervention and research with global reach. In Proceedings of the Third (2016) ACM Conference on Learning@ Scale. ACM, 11–20. [3] Edward Cutrell, Jacki O’Neill, Srinath Bala, B Nitish, Andrew Cross, Nakull Gupta, Viraj Kumar, and William Thies. 2015. Blended learning in Indian colleges with massively empowered classroom. In Proceedings of the Second (2015) ACM Conference on Learning@ Scale. ACM, 47–56. [4] Paul DiMaggio, Eszter Hargittai, Coral Celeste, and Steven Shafer. 2004. From unequal access to differentiated use: A literature review and agenda for research on digital inequality. Social inequality (2004), 355–400. [5] Matthew Kam, Anuj Kumar, Shirley Jain, Akhil Mathur, and John Canny. 2009. Improving literacy in rural India: Cellphone games in an after-school program. In Information and Communication Technologies and Development (ICTD), 2009 International Conference on. IEEE, 139–149. [6] Patrick J McEwan. 2015. Improving learning in primary schools of developing countries: A meta-analysis of randomized experiments. Review of Educational Research 85, 3 (2015), 353–394. [7] Na’ilah S Nasir, Ann S Rosebery, BethWarren, and Carol D Lee. 2006. Learning as a cultural process: Achieving equity through diversity. The Cambridge handbook of the learning sciences (2006), 489–504. [8] Benjamin D Nye. 2015. Intelligent tutoring systems by and for the developing world: a review of trends and approaches for educational technology in a global context. International Journal of Artificial Intelligence in Education 25, 2 (2015), 177–203. [9] Joyojeet Pal, Meera Lakshmanan, and Kentaro Toyama. 2007. “My Child will be Respected": Parental perspectives on computers in rural India. In Information and Communication Technologies and Development, 2007. ICTD 2007. International Conference on. IEEE, 1–9. [10] Udai Singh Pawar, Joyojeet Pal, and Kentaro Toyama. 2006. Multiple mice for computers in education in developing countries. In Information and Communication Technologies and Development, 2006. ICTD’06. International Conference on. IEEE, 64–71. [11] Horst WJ Rittel and Melvin M Webber. 1973. Dilemmas in a general theory of planning. Policy sciences 4, 2 (1973), 155–169. [12] Anselm Strauss and Juliet Corbin. 1994. Grounded theory methodology. Handbook of qualitative research 17 (1994), 273–85. [13] Mark Warschauer and Morgan Ames. 2010. Can One Laptop per Child save the world’s poor? Journal of international affairs (2010), 33–51. [14] Uri Wilensky and I Evanston. 1999. NetLogo: Center for connected learning and computer-based modeling. Northwestern University, Evanston, IL 4952 (1999). [15] Jeannette M Wing. 2006. Computational thinking. Commun. ACM 49, 3 (2006), 33–35.

[khalilhumam]

COVID-19 and Seizing the Opportunity for Reforming Tax Expenditures in Africa

New Post has been published on http://khalilhumam.com/covid-19-and-seizing-the-opportunity-for-reforming-tax-expenditures-in-africa/

COVID-19 and Seizing the Opportunity for Reforming Tax Expenditures in Africa

The resources needed for financing the Sustainable Development Goals (SDGs) are estimated at US$ 2.5 to 3 trillion per year. According to the IMF, low-income countries (LICs) will need, on average, additional resources amounting to 15.4 percent of GDP to finance the SDGs in education, health, roads, electricity, and water by 2030. Unfortunately, the COVID-19 pandemic has made mobilization of resources for financing the SGDs almost impossible. In this blog post, we argue that the COVID-19 crisis has made it imperative for developing countries to begin reforming their tax systems to generate more resources domestically—reforms which they have postponed until now because of vested interests. One area where reform has been resisted is tax expenditures (TEs). Reforming TEs would not only generate additional revenues, but it would also improve taxpayer perception of the fairness of the tax system and enhance budget transparency.

The background

As developing countries face a growing need for additional resources to respond to the pandemic, their domestic revenues have actually taken a hit with the collapse in economic activity. Consumption taxes, for instance, are likely to plummet even more than during the global financial crisis. Hence, tax revenues could be significantly affected for a number of years. Moreover, tax compliance is likely to suffer, since households and businesses under economic stress may simply stop paying taxes. Some tax administrations have already reduced their audit and arrears collection activities to ease the severe financial pressure that many businesses and individuals are facing. Resource flows from external sources are also projected to decline in 2020 and beyond.  Global foreign direct investment (FDI) in general is expected to shrink by more than 30 percent in 2020, and the impact is likely to be even larger for developing countries. Moreover, global remittances are expected to decline by 20 percent, the sharpest decline in recent history. The outlook for official development assistance (ODA) is bleak, with budgetary pressures in donor countries stemming from the adoption of policies to mitigate the economic and social effects of the pandemic on their citizens. In addition, access to international markets is particularly tough for poor countries. During the first two months of the pandemic, more than US$ 100 billion flew out of emerging markets—more than three times than during the 2008 crisis.

Tax expenditures in Africa

TEs, also known as tax incentives, include exemptions, reduced rates, deductions, and tax credits that reduce the taxpayer's liability as well as the government's revenue collection. While these provisions are used widely to pursue different policy goals, they are costly and often ineffective in reaching their objectives. Estimates show that TEs in Latin America account for slightly more than 4 percent of GDP on average, ranging from 1.3 percent of GDP in Bolivia and Paraguay to 8 percent of GDP in Colombia. The average share of TEs at 2.9 percent of GDP in Africa is significantly lower than in Latin America. At the same time, the fiscal cost of TEs is above 4 percent of GDP in Tanzania, Rwanda, and Liberia, and can be as high as 7.8 percent in Senegal (see Figure 1). As a share of tax revenues, they exceed 20 percent in five countries and are estimated to be as high as 40 percent in Senegal. Figure 1. Tax expenditures as a percentage of GDP and total tax revenue, latest available year

Source: Global Tax Expenditures Database, forthcoming.* Yet, given the striking lack of transparency on TEs in Africa, underreporting is very likely to be an issue.  Therefore, these figures should be interpreted with caution, as a lower bound. Indeed, when it comes to transparency, 26 out of 40 countries currently publish official TE reports on a regular basis in Latin America. By contrast, only 19 African countries reported on their TEs at least once between the years 2000 and 2019. The remaining 64 percent of the countries did not publish any TE reports during this period. In addition, even for those African countries reporting on TEs, the heterogeneity in the scope and detail of information provided is striking. Whereas a few countries such as DR Congo and Morocco provide comprehensive reports with data disaggregated at the TE level, most countries only publish aggregated data (e.g., by tax base) or detailed data for a few TE provisions. TEs have significant fiscal costs and can result in net revenue losses. So far, corporate income tax (CIT) revenues in Africa have held up, but the CIT bases can start to erode, depleting the ability of African countries to pay for development. Tax incentives for investment, which have been used widely to promote industrial production in developing economies, are a case in point. In some African countries (e.g. Burkina Faso, Côte D’Ivoire, Guinea, Madagascar, and Mauritania), businesses account for more than 60 percent of total revenue foregone through TEs. Yet, these provisions have proven to be significantly less effective than envisioned, and there is a strong, negative relationship between the generosity of tax incentives and revenues from corporate taxes. As shown in Figure 2, for each 10-percentage point increase in CIT incentives, CIT revenue decreases by around 0.35 percent of GDP. Figure 2. Corporate income tax incentives and corporate income tax revenue

Source: Kronfol and Steenbergen (2020). “Evaluating the Costs and Benefits of Corporate Tax Incentives.” In addition, TEs often disproportionally benefit better-off population groups such as politically connected firms or multinationals and high-income earners, hence worsening a country’s income distribution.

A proposal for reform

Low-income countries are urged to announce that, as part of their policy reforms, they would re-assess TEs during the next annual budget discussions (or during the discussions on supplementary budgets), with the objective of lowering their annual cost by at least one percentage point of GDP. This would be significant, given the average tax-to-GDP increases witnessed in recent years in developing economies. Figure 3 shows that countries in Asia, Latin America, and sub-Saharan Africa improved their tax collections on average by under 1 percent of GDP in the past decade. An important component of reform would necessarily have to be a commitment by governments to refrain from granting any new tax concessions. The IMF estimates that revenues in sub-Saharan Africa would fall on average by 2.6 percent of GDP in 2020 because of COVID-19, further highlighting the need for TE reform. Figure 3. Tax revenue (% of GDP), 2000-2018

Source: ICTD Government Revenue Dataset. Note: Argentina, Brazil, and Chile are excluded from Latin America. Reforming TEs would trigger the additional benefit of improving tax compliance. It is common for policymakers in developing countries to complain about low tax compliance in their countries. Tax compliance may be low in part because citizens feel they do not receive quality services from the government. It is also low because taxpayers see how unequal the tax system is (i.e. how the well-off—including the beneficiaries of TEs—do not pay their share of taxes). Thus, a rationalization of TEs would have a favourable impact on overall tax compliance in the economy. Donor countries will have to do their share as well. They would have to agree to subject their aid-funded projects in developing countries to custom duties and value-added tax (VAT). The cost of tax exemptions with respect to ODA projects can be as high as 3 percent of GDP for countries that depend heavily on aid. There are some donor countries (Netherlands and Norway) that have renounced the exemption-seeking policy. The COVID-19 crisis presents an opportunity to all donor countries to relinquish exemptions for the aid they provide. Unlike the G20 Debt Service Suspension Initiative, which provides a temporary respite from debt obligations to the poorest countries, elimination of exemptions on aid-funded projects would generate a permanent increase in revenues for countries in need.

Conclusion

The bottom line is that COVID-19 presents an opportunity for policymakers to reform TEs. Widespread support for reform can be gained by highlighting the need for additional resources at this juncture to pay for improved health services and to mitigate the impact of the pandemic. The case becomes even stronger when citizens realize that the ultimate beneficiaries of TEs are, in most cases, well-to-do individuals and large enterprises. This blog post is published jointly with the Council on Economic Policies.

*The GTED is a joint effort of think tanks and research institutions from Europe, Asia, Africa and Latin America led by the Council on Economic Policies (CEP) and the German Development Institute (DIE).

[i-cast-teatus-deletus]

So, this list is overall pretty good, if a lot less specific than the last one from Strategist.

Not everything is relevant, and some of the items are Not Great in general—Cortibalm, in particular, is fine if you use it for a few weeks while you recover and throw it away afterwards, but you can't use it long term. (If you click through to Amazon, you can read a bunch of reviews about people who went through Topical Steroid Withdrawal from it, and that is a bad time.) And if you follow me normally, I think you have a good guess how I feel about essential oils (bad).

Adhesive remover was the real lightbulb for me on this list, as hardly anyone else has mentioned it in all of my research (I don't have an actual opinion on Unisolv vs. the other options as of right this moment, but it IS the cheapest and most ubiquitous option I have come across).

[i-cast-teatus-deletus]

Not everyone wants or needs a wedge pillow for recovery, but Strategist did an article in early August profiling a few recommendations at a couple of different price points.

I'm hoping they'll do an updated post on backrests/husband pillows sometime soon, since the last one they did was in 2020 and I think one of their selections out of the whole list is still available for purchase.

[i-cast-teatus-deletus]

Post-surgical nutrition is not one of my real areas of interest for this blog, for a lot of reasons. For example, as surgeries go, top surgery isn't a particularly invasive surgery and the recovery time isn't particularly long. Nutrition is also a somewhat complicated topic because there's no one-size-fits-all solution and trying to be specific enough to be useful but general enough to cover even part of the spectrum of possible diets is pretty difficult.

This is a moderately long article with a lot to think about, but I think that they managed to give a lot of very specific advice that will suit a wide variety of people. Some things that it includes that are difficult to find in a lot of articles on post-surgical nutrition are:

Written (at least partially) by an Registered Dietician who has a MHSc (Master of Health Science) as well.

Doesn't recommend any additional supplements outside of regular vitamins, a particular pet peeve of mine because of the ridiculously lax regulations on supplements in the states. I mean, maybe bromelain or arnica or whatever helps, but most likely it has zero benefit and at the risk of getting a supplement that's incorrectly labeled or intentionally tainted/cut with other products.

Wide variety of food recommendations, including some recs that would work for someone who's vegetarian or has specific food allergies. Some of the products they mention specifically are pretty cost-effective, as well.

Pretty reasonable recommendations on how to increase calorie intake after surgery without confounding the point with a bunch of diet talk.

I likely won't add anything else about post-surgical nutrition unless it's a similarly high quality source (though I am making a tag for it), but even if I don't, this is a pretty robust resource that probably doesn't need supplemented.

[i-cast-teatus-deletus]

A direct link to the current PDF is here, but the main website has some printable pages that could be useful.

They're in the process of reformulating this workbook, and one can hardly blame them as it was released in March 2020 and the page on COVID protocols shows it.

There's definitely a few pages (but fewer than you would think) that are specific to Canadian Health Care**, but a lot of the information is still relevant. The Pre- and Post-surgical sections are both quite good, including sections on dividing up your chores between volunteers, self-care before and after surgery, and some ways to move your body even if you can't get out of bed.

I like that this workbook emphasizes that you can't expect one person to provide wraparound care AND do all of your chores, and reminds that there are a probably a lot of people in your life that you didn't even consider that might not be able to be with you after surgery but might be able to do one of your other chores.

** In my estimation, the only Canadian-specific pages are 5-6 and 23, Everything else might have one or two pieces of info that needs a name substituted out or disregarded.

[i-cast-teatus-deletus]

I'm not precisely sure when online shops in the United States universally, seemingly overnight, all went to "you can't buy syringes without giving us a prescription." I assume the government was involved (and possibly also a stock control thing?) but it was deeply jarring to someone who remembers The Old Internet.

If you're injecting HRT and live in the States, you have probably already heard of Allegro, one of the few legit sites that will sell needles/syringes without a script. It's actually how my household came across them, in fact. There was an issue in getting the right size needle from the pharmacy, and they asked their friend network for advice.

Allegro is more than just syringes, though (and not even just syringes for injection!). They have a lot of home health products, including ostomy and wound care supplies. I'm not 100% sure how their prices stack up against most retail places (I don't spend a lot of time looking at customer-facing retail prices of home care supplies) but I suspect they are fairly competitive, even against big box stores. Even if they're higher, Allegro is nearly always running sales or shipping discounts.

Having bought from them in the past, I've been pleasantly surprised each time how fast things show up, even if the order is small. A lot of places anymore, it feels like if you're not willing to spend at least $150 on an order, you get whatever shipping timetable you get. Allegro's orders have shown up extremely fast (typically 2-3 days for us and we're not in a big city), even when the entire order was a box of 25g needles.

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Re cars: This is something I've only passingly thought about so far and I am SO grateful you brought it up.

We have sort of the opposite issue of you and Large Bastard: I am the tallest at 173cm/5'8", and our guys getting teats deleted are 168cm/5'6" and 152 cm/5'0".

We have multiple cars available, loosely falling into "low-ish 4-door sedan," which I can drive but are not super comfortable for me, and "small-ish 4-seat SUV". The SUV is a slam dunk for taking the taller one to and from, but I am unsure what to do about the smaller one if I drive. I suspect the lower car would be easier for him, but if I drive it will for SURE not be easier for me. This will require some thought, luckily we have time.

Re hotel room: I had been debating getting a hotel room, probably the closest suite-style place to wherever the surgery is being done, for maybe the day night before (to make getting there on time easier since I don't need to be psychic to know our wake-up time is going to completely incompatible with my second shift work schedule and 4am work night bedtime and literally anything to make that morning less awful will be to all our benefits) and maybe a day or two after anyway. The logic here prior to reading how hard that drive can be on anesthesia is that one of them is in the bedroom furthest from the bathroom—like, opposite end of the house furthest—and while walking is good, I was worried that might be too difficult for a day or two after. The other option is dislodge EVERYONE to give the person recovering the closest bedroom, which sounds like a bad time.

It'd increase sleeping space, too. One of them sleeps alone in a queen-size bed, so no problem there, but the other shares a (split) king with me. If we get a hotel room, they could have 1-3 days with a full or queen bed to themselves (and so could I, though hotel beds are usually WAY too soft and I end up with my back and neck messed up.)

The other logic is the cats, the SMALLER of which is about 8 kg/17ish lbs and the other is still getting bigger every single day and is threatening to be like 14kg fully grown. They are significantly more motile than a dog, and I am concerned they will be a problem the first day or two. Not that they would deliberately hurt anyone, but they are used to being able to jump up on anyone they please at any time.

If we have a close-after followup (like 3-4 days) I may just cave and do that and go home after the followup appointment, but we'll see. I will admit that I am not extremely excited about that idea, but I'm unsure if it makes sense to drive back out twice if it's close together.

It's hard because I've had major surgery as an adult, but it's 15+ years in the past, and I don't remember the drive home being all that bad, but I lived like 20ish minutes from the hospital on rural back roads, not 90+ minutes of highway driving.

ALSO, thank for the advice on open heart surgery. It'll be nice to look at something besides mastectomy resources because genuinely, reading blog posts from cis women who had mastectomies for cancer is like THE worst part of this whole thing.

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Thread is "If there was one item you could recommend for top surgery recovery, what would it be?"

I was going to post my resources in a different order, but given the situation at Reddit, I don't think waiting around is a good decision. I archived it using a service that's recommended on reddit since it's all text, just in case, and will link other archives on other services if I become aware of them.

This sort of question comes up a LOT on r/ftm, and the difference between this specific thread and the dozens and dozens of clones is:

It's current (from 2023)

It was active (most of these threads only get 10-20 responses, this one has 180+)

This was one of my top resources while compiling my original list of things we needed (the Strategist post about breast surgery was the other one I leaned on heavily).

While a lot of these answers show up on most lists, I did appreciate some of the oddball answers (@ms-demeanor one of them even suggested your beloved server aprons for recovery), as well as doing test runs with your arms at your sides to see what in your house needs moved/modified.

I also liked the link to a specific brand of disposable bath washcloths, which always struck me as more useful than baby wipes (no offense to baby wipe devotees). Haven't decided if we're doing wipes marketed to campers or wipes marketed to home health but I assume camping just because the quantities are usually more reasonable. I may just do washcloth baths, but there's no decisions as of right now.

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This lady is a professional organizer (I know, I know), so naturally there is some steering towards buying her organization printables. But the info is sound for surgery of all kinds and includes some steps I haven't seen other places (including cleaning out the car).

I've been using Back To School time as a way to pick up binders, folder, etc to make a binder for stuff we may need at appointments and a way to keep paperwork handy (as well stuff for coloring books, etc), since there's so many more options and they are cheaper than if I picked stuff up randomly all across the year.

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Strategist recently (August 22, 2024) updated this list of body lotions for dry skin, most of which are free of fragrances/essential oils and actives like AHAs (there is one on this list with AHAs and a heavy fragrance, but it's listed as an exfoliating lotion so it's not a surprise or anything).

Even if "heavy body moisturizer with no fragrance" isn't normally what you purchase for yourself, it's not uncommon to have drier-than-normal skin for weeks after undergoing general anesthesia and you may be more sensitive to fragrance agents than normal (with a bonus that you should probably not you anything with a fragrance you actually like immediately after surgery or a serious illness because your brain may end up associating that scent with the stressful postsurgical period instead of all of the other times you've used it).

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I know that a lot of the links that I share, especially shopping links, are very North America-centric. I (unfortunately) live in the States, and have never sent anything to Europe or anywhere else, so there's no doubt that colors the resources I use and the places that I recommend.

I said all of that to make a post about iHerb, one of the places that I shop that cannot be accused of being exclusive to North America. iHerb says that it ships to over 180 countries, often with multiple shipping options. I've never had an issue with an order from iHerb and it always shows up pretty fast and for prices that are roughly comparable to Amazon (outside of the States, your experience may vary on how comparable they are).

If you know me, you know that I have a pretty negative view of most herbal products and dietary supplements, especially since the U.S. market for dietary supplements is incredibly bad and lacks transparency and accountability, even if the herbs and supplements did what they claimed to do (hardly any have rigorous testing for efficacy and safety). So, if I'm not buying herbs and supplements from iHerb, what sorts of things am I buying?

snacks, especially if you're on a special diet. I need soy-free ready-to-eat snacks for one of the guys and there's a pretty interesting set of options. We're especially partial to these California Gold Nutrition protein bars, which are an iHerb house brand and nearly always on sale. They also have a really wide selection of speciality candies and gummies, especially if you can't have cane sugar.

protein powder for smoothies - besides the normal whey and pea, they also have more unusual options like brown rice and pumpkin seed, both of which we really like.

multivitamins - one of the guys really likes the California Gold Nutrition Ultramins, which I'm not linking because most formulations are indefinitely backordered right now.

I also buy some letter vitamins from them, including Vitamins C and D supplements. It's not true of every product they carry, but many of them have independent lab certification (especially their house brands), which is one of my top concerns when buying these kinds of products. They're also one of the few reliable places to get soy-free fat-soluble vitamins (like Vitamin D) and my perception is their vegan/halal/kosher/etc vitamin offerings are quite good as well.

probiotics, especially their California Gold brand.

skincare products - I originally got into iHerb after the pandemic cut off my access to some of the other places I'd been buying skincare, and iHerb decided at the time to start carrying some Korean and Japanese skincare products. Their shipping is dramatically faster than a lot of my other options, and their prices and shipping times on some products, like Kikumasamune lotion, are basically unbeatable.

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This is available attached to another post (and I linked to it on the masterpost but not the version of that post that's being reblogged, naturally), but since I have a lot of new eyes on this blog suddenly I thought it would be helpful to draw even more attention to this document.

tumblr user wrenseyeview attached this document to a reblog of one of my early posts, and it's genuinely one of the most thorough documents I've come across in all of my research so far. It starts all the way from starting therapy and HRT and goes all the way to wrenseyeview's revision surgery in excruciating detail, including final costs, all items purchased, insurance documentation, and a list of medications to stop 2 weeks prior to surgery.

I'm so grateful to wrenseyeview for sharing this with me, and I wanted to make sure that it wasn't lost in the shuffle as I reorganized my posts.

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Masterpost

Top Surgery Categories

Part 0: Introduction

About This Organizational System

Part 1: Resources

By Type:

Nutrition Resources

Prepping References

Recovery References

Scar Care References

Shopping References

Surgery References

By Source:

Blog posts

Reddit threads

Strategist

wrenseyeview's google doc

Part 2: Clothing

Flannel shirts

Hoodies

Pajamas

Robes

Part 3: Entertainment

Apps

Books

Part 4: Quality of Life (No posts so far)

Part 5: Personal Care

Skincare

Part 6: Snacks (No posts so far)

Part 7: Miscellaneous

Other Tags

ICTD Responds

ICTD Miscellaneous

Tumblr User Info

General Surgery Resources

Mastectomy Resources for Cis Women

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While posted by a group of orthopedic surgeons, so their restrictions can and will differ from the specifics of a surgeon who specializes in top surgery, this is one of the more comprehensive, basic write-ups I've seen for preparing for surgery in general and what restrictions to anticipate when dressing yourself for surgery, which is all information that can be very helpful if you've never had major surgery before and have no idea what to expect.

They did another helpful article with a timeline for prepping for surgery and one on ambulatory surgery centers that I also thought were pretty helpful.