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Negative pressure wound therapy (NPWT) has revolutionized wound care. Negative pressure therapy (NPT) is now being applied to closed incisions. Closed-incision NPT (ciNPT) management systems apply negative pressure to the incision and structurally stabilize the surrounding tissues. They are thought to be helpful in high-risk surgical closure. Patients with large sarcomas that have been previously radiated are considered to be among the highest risk for postoperative wound complications. We share our experience with ciNPT in two patients after resection of large, previously irradiated invasive sarcomas. In both cases, healing was uncomplicated. ciNPT shows promise of effective and favorable wound healing in early case reports. Additional prospective randomized clinical trials or registry studies will be necessary to provide higher levels of evidence for this technique.

A practical guide to managing fiscal risk in privately financed infrastructure projects. This resource helps governments make informed decisions about offering guarantees, which can be essential for attracting private investment but pose significant fiscal risks. Drawing on finance, history, economics, and psychology, it reviews the history of government guarantees and identifies cognitive and political obstacles to good decisions. It develops a framework for judging when governments should bear risk, explains how to value guarantees, and discusses public-sector management modifications to improve decision quality. Benefits include: * Improved risk allocation in public-private partnerships * Better management of fiscal risks * Enhanced decision-making regarding guarantees This is for governments, policymakers, infrastructure investors, and public finance professionals seeking to optimize infrastructure financing and manage fiscal exposure.

Accounting devices that artificially reduce the measured fiscal deficit can be analyzed as transactions involving unrecognized assets and liabilities. Different accounting systems recognize different sets of assets and liabilities and are thus vulnerable to different sets of devices. Some devices can be revealed by moving progressively from cash accounting to modified accrual accounting to full accrual accounting. Revealing all would require the publication of extended fiscal accounts in which all future cash flows give rise to assets or liabilities.

Government decisions are rarely driven solely by the dictates of cost–benefit analyses. Generating good decision making about fiscal support also requires processes for decision making that facilitate good analysis and temper the influence of self-interest. This report sets out a framework intended to help governments make better decisions about giving fiscal support for private infrastructure services and provides some tools to facilitate analysis.Several policies to enhance the collocation of information, incentives, and decisions are proposed:· Giving responsibility to people working on the objective (rather than the instrument or the infrastructure service);· Separating decision making from delivery;· Involving those responsible for costs;· Utilizing decision making forums that emphasize tradeoffs;· Routinely generating information on costs and benefits;· Requiring routine disclosure of information;· Charging for certain types of support; and· Ensuring accountability for decisions.

When growth-promoting spending is cut so much that the present value of future government revenues falls by more than the immediate improvement in the cash deficit, fiscal adjustment becomes like walking up the down escalator. Although short-term cash flows matter, too tight a focus on them encourages governments to invest too little. Cash-flow targets also encourage governments to shift investment spending off budget by seeking private investment in public projects, irrespective of its real fiscal or economic benefits. To deal with this problem, some observers have suggested excluding certain investments (such as those undertaken by public enterprises deemed commercial or financed by multilaterals) from cash-flow targets. These stopgap remedies may help protect some investments, but they do not provide a satisfactory solution to the underlying problem. Governments can more effectively reduce the biases created by the focus on short-term cash flows by developing indicators of the long-term fiscal effects of their decisions, including accounting and economic measures of net worth, and, where appropriate, including such measures in fiscal targets or even fiscal rules.

When growth-promoting spending is cut so much that the present value of future government revenues falls by more than the immediate improvement in the cash deficit, fiscal adjustment becomes like walking up the down escalator. Although short-term cash flows matter, too tight a focus on them encourages governments to invest too little. Cash-flow targets also encourage governments to shift investment spending off budget by seeking private investment in public projects, irrespective of its real fiscal or economic benefits. To deal with this problem, some observers have suggested excluding certain investments (such as those undertaken by public enterprises deemed commercial or financed by multilaterals) from cash-flow targets. These stopgap remedies may help protect some investments, but they do not provide a satisfactory solution to the underlying problem. Governments can more effectively reduce the biases created by the focus on short-term cash flows by developing indicators of the long-term fiscal effects of their decisions, including accounting and economic measures of net worth, and, where appropriate, including such measures in fiscal targets or even fiscal rules.

Public-private partnerships (PPPs) are popular around the world, in part because they allow governments to secure much-needed investment in public services without immediately having to raise taxes or borrow. Yet, PPPs pose a fiscal danger because a government’s desire to avoid reporting immediate liabilities may blind it to future fiscal costs and risks. Although PPPs may not blemish governments’ reported fiscal statements in the short term, they do create fiscal obligations. This increases fiscal vulnerability and can result in poorly-designed PPPs. The extent of the danger depends on the fiscal institutions that shape and constrain government decisions toward PPPs. Such fiscal institutions affect decisionmaking incentives. Better fiscal institutions therefore can increase the chance that PPPs will be well designed and appropriately used.

Accounting devices that artificially reduce the measured fiscal deficit can be analyzed as transactions involving unrecognized assets and liabilities. Different accounting systems recognize different sets of assets and liabilities and are thus vulnerable to different sets of devices. Some devices can be revealed by moving progressively from cash accounting to modified accrual accounting to full accrual accounting. Revealing all would require the publication of extended fiscal accounts in which all future cash flows give rise to assets or liabilities