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Shpak, Nestor, Oleh Kuzmin, Olga Melnyk, Mariana Ruda y Włodzimierz Sroka. "Implementation of a Circular Economy in Ukraine: The Context of European Integration". Resources 9, n.º 8 (15 de agosto de 2020): 96. http://dx.doi.org/10.3390/resources9080096.
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The current model of resource management mainly contributes to mass short-term consumption, which creates an unstable and extremely critical situation on the planet. Going beyond the traditional industrial model of Take-Make-Waste, the circular economy aims to reduce waste (and therefore minimize costs) and to redefine sustainable development. This entails a gradual separation of economic activity from the consumption of scarce resources and the removal of waste from the system. In order to foreground the principles of a circular economy in Ukraine, this study analyzes its benefits based on the relevant experience of the EU. The paper also presents the results of research and content analysis on the situation of waste management in Ukraine and compares the trends using key indicators. The core of the paper is developing a conceptual model of making and coordinating management decisions on the implementation of business projects in the context of a circular economy in Ukraine. A multifactor model (the Farrar–Glauber method was further developed) has been built by identification of the main factors, i.e., the volume of generated waste from economic activity per unit of GDP at constant prices, emissions of pollutants, and capital investments for the protection of the environment. Factor coefficients indicate how many units will change the resultant trait Y, measured in thousand tonnes, if one of them changes by 1 (each in units of measure). It means that if the volume of waste generated from economic activity per unit of GDP at constant 2011 purchasing power parity (PPP) prices decreases by 1 kg/$1000, waste management of I–IV classes will be reduced by 952,737 thousand tonnes. The approbated model can be used to analyze the situation with recycling in the EU countries, considering the amount of capital investment in environmental protection.
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Hegedić, Miro, Nedeljko Štefanić y Mladen Nikšić. "Life cycle assessment: Assessing the environmental impact in the railway maintenance". MATEC Web of Conferences 180 (2018): 01004. http://dx.doi.org/10.1051/matecconf/201818001004.
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The railway sector plays an important role in the European transport sector and its environmental sustainability is a highly important issue today recognized by all the main stakeholders, including the European Commission. EU-28 railway transport network consisted of 220,000 km of railway lines in 2013. Such a big railway transport network requires maintenance. Maintenance of a railway infrastructure is a resource- and cost-demanding activity that has as well a considerable impact on the environment. This paper presents the results of the environmental assessment of an innovative new product which aims to decrease the environmental impact of the railway maintenance processes. Life cycle assessment methodology was used and results show that the biggest environmental impact, in all impact categories, is achieved in the use and maintenance phase. In the end, the normalized data of the environmental impact were presented using the standard functional unit for the freight trains: tonne for kilometre (tkm). Additionally, authors have compared two different functional units that could be used in Life cycle assessment of the self-propelled freight railway vehicles, proposing the use of the new functional unit: tonne for working hour (twh). Use of such customized functional unit is more appropriate because of the specific nature of work that selfpropelled bulk carriages have.
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Costa, Daniele, Erick Galante, Izabela Andrade y Jéssica Cunha. "Environmental life-cycle assessment of a military explosive production unit: a preliminary approach". U.Porto Journal of Engineering 1, n.º 1 (5 de septiembre de 2017): 2–10. http://dx.doi.org/10.24840/2183-6493_001.001_0002.
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It is generally known that plants of the chemical industry have great potential to generate environmental impacts and health hazards. However, systematic measurements of these impacts are not common. Life Cycle Assessment (LCA) is a tool that allows quantitative environmental impacts evaluation and it was applied in a preliminary approach to analyze selected subsystems in a RDX (1,3,5-trinitroperhydro-1,3,5-triazine) military production unit. LCA was applied through analysis of the plant data in the free software OpenLCA, using ELCD (European Reference Lyfe Cycle Database) and the TRACI (Tool for the Reduction and Assessment of Chemical and other environmental Impacts) method. As a result, the following impact categories were assessed: acidification, ecotoxicity, eutrophication, global warming, human health, ozone depletion, photochemical oxidation and resource depletion.
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Papanicolaou, S., A. Davies, M. Espuña-Pons, C. Hampel, S. Hunskaar, B. Monz, G. Samsioe, A. Wagg y D. Sykes. "PUK22 DERIVING UNIT COSTS FOR RESOURCE UTILISATION IN PROSPECTIVE URINARY INCONTINENCE RESEARCH (PURE)—AN OBSERVATIONAL STUDY IN 14 EUROPEAN COUNTRIES". Value in Health 7, n.º 6 (noviembre de 2004): 804–5. http://dx.doi.org/10.1016/s1098-3015(10)66161-x.
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Taylor, T. L. "International differences in the value for money provided by institutions in european countries at different stages of deinstitutionalisation and with different economies". European Psychiatry 26, S2 (marzo de 2011): 2146. http://dx.doi.org/10.1016/s0924-9338(11)73849-4.
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BackgroundIndividuals with a diagnosis of schizophrenia or schizoaffective disorder may require longer term care. Due to the complexities of caring for this population and the high resource cost of care, it is important to ensure that mental health services are efficient and effective.AimsThis investigation aims to examine international differences in quality of care and service user experience when compared to national health expenditure and the degree of deinstitutionalisation in 10 countries.MethodsThe quality of care provided in 213 units was measured using the Quality Indicator for Rehabilitative Care (QuIRC). Service users living in these units (N = 1750) were asked to assess the care they received. Multilevel models were used to examine the relationships between quality (QuIRC domain ratings), level of deinstitutionalisation and national health care expenditure. As no formalised assessment of deinstitutionalisation has been published, a quantitative tool was developed and validated. Percentage of gross domestic product spent on health care and per capita total health care spend was taken from World Health Organisation data to assess national health care expenditure.ResultsMultilevel models examining the relationships between deinstitutionalisation levels, health care expenditure, quality and service user experience will be presented. Results were adjusted for unit (type and size) and service user (age, gender and level of functioning) characteristics.ConclusionsRecommendations on the best use of resources within a facility providing longer term care and how best to increase the quality of care provided without additional financial expenditure will be discussed in relation to the results.
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Bauer, Michael W. "Impact of administrative reform of the European Commission: results from a survey of heads of unit in policy-making directorates". International Review of Administrative Sciences 75, n.º 3 (septiembre de 2009): 459–72. http://dx.doi.org/10.1177/0020852309337690.
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The Kinnock reform has changed the European Commission. This article discusses the link between reform effects and policy output. A survey of more than 100 heads of unit (HoU) of policy-making Directorates-General serves as the empirical basis. It is concluded that the recent reform of the Commission does indeed comprehensively redefine the role of the HoU. Their resource base to focus on policy drafting has been hugely reduced. Negative consequences for the organization’s potential to deliver policy draft of high quality are therefore very likely. Points for practitioners This article deals with the following areas: • Middle management as organizational backbone • The perils of decentralizing management functions • The impact of administrative reform on policy output.
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Akacem, Mohammed. "OPEC: What Next?" Energy Exploration & Exploitation 5, n.º 1 (febrero de 1987): 5–15. http://dx.doi.org/10.1177/014459878700500102.
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OPEC policy implications of resource economics are different for the ‘cash-starved’ members, the countries with large populations and a low resource base such as Nigeria, Algeria and Indonesia in contrast to the ‘rich’ members with small populations and considerable resources such as Saudi Arabia, Kuwait, UAE and Qatar. Conflicts in priorities of the two groups have been an important factor in the oil glut. The ‘poor’ members of OPEC will probably leave the organization upon depletion of their resources. Until this happens the interests of the oil producers can best be met with aid to the ‘poor’ members to prevent the dumping on the spot market. OPEC should establish a balance-of-payment ‘support’ programme to ‘tie’ those countries that develop balance-of -payment difficulties. OPEC will eventually be replaced by GOPEC, the Gulf Organization of Petroleum Exporting Countries. The smaller GOPEC would exert some control over the world's oil markets in the 1990s: they own more than 40% of the world's reserves. If Iran and Iraq were included the percentage would rise to more than 60% but their presence in this organization would inject the instability which now affects OPEC. GOPEC could be expected to have a long-term pricing policy with a stable growth rate, greater involvement with distribution and active in the world market of petrochemicals. It will be faced with the problem of consumers finding alternative energy sources and with the protectionism already apparent in Europe and the US. The emergence of a stable GOPEC will once more raise the issue of the currency used to price oil and oil products. It would find advantage in detaching itself from the dollar as a primary unit. Instead, a ‘basket’ of currencies should be used such as the European Currency Unit (ECU), the yen and the US dollar. Such means will lead to greater stability for producers and consumers. Eventually, GOPEC should have pricing in terms of the Gulf Dinar or the Gulf Currency Unit (GCU) which would be traded in its own right.
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Jensen, Erik Steen, Laurent Bedoussac, Georg Carlsson, Etienne-Pascal Journet, Eric Justes y Henrik Hauggaard-Nielsen. "Enhancing Yields in Organic Crop Production by Eco-Functional Intensification". Sustainable Agriculture Research 4, n.º 3 (18 de junio de 2015): 42. http://dx.doi.org/10.5539/sar.v4n3p42.
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<p>Organic agriculture faces challenges to enhance food production per unit area and simultaneously reduce the environmental and climate impacts, e.g. nitrate leaching per unit area and greenhouse gas (GHG) emissions per unit mass produced. Eco-functional intensification is suggested as a means to reach these objectives. Eco-functional intensification involves activating more knowledge and refocusing the importance of ecosystem services in agriculture. Organic farmers manage agrobiodiversity by crop rotation (diversification in time). However, sole cropping (SC) of genetically identical plants in organic agriculture may limit resource use efficiency and yield per unit area. Intercropping (IC) of annual grain species, cultivar mixes, perennial grains, or forage species and forestry and annual crops (agroforestry) are examples of spatial crop diversification. Intercropping is based on eco-functional intensification and may enhance production by complementarity in resource use in time and space. Intercropping is based on the ecological principles of competition, facilitation and complementarity, which often increases the efficiency in acquisition and use of resources such as light, water and nutrients compared to sole crops, especially in low-input systems. Here we show that IC of cereals and grain legumes in European arable organic farming systems is an efficient tool for enhancing total grain yields compared to their respective sole crops. Simultaneously, we display how intercropping of cereals and legumes can be used as an efficient tool for weed management and to enhance product quality (i.e. cereal grain protein concentration). We discuss how intercropping contributes to efficient use of soil N sources and minimizes losses of N by nitrate leaching via <em>Ecological Precision Farming</em>. It is concluded that intercropping has a strong potential to increase yield and hereby reduce global climate impacts such as GHG kg<sup>-1</sup> grain. Finally, we discuss likely barriers and lock-in effects for increased use of intercropping in organic farming and suggest a roadmap for innovation and implementation of IC strategies in organic agriculture.</p>
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Ericksno, Christopher L. y Sarosh Kuruvilla. "Labor Costs and the Social Dumping Debate in the European Union". ILR Review 48, n.º 1 (octubre de 1994): 28–47. http://dx.doi.org/10.1177/001979399404800103.
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This study examines the labor cost incentive for capital movement in manufacturing within the European Union, a key aspect of the “social dumping” debate in Western Europe. The authors find that the percentage differences in unit labor costs between the more developed and less developed countries in the Union not only were large in 1980 but actually grew between 1980 and 1986, and separate estimates of compensation and productivity growth rates do not indicate that significant convergence occurred over the remainder of the 1980s. Although these findings apparently confirm that a labor cost incentive for capital mobility does exist, analysis of foreign direct investment data indicates that during the period 1980–88 capital flows to the lower labor cost countries actually were not much larger than capital flows to the higher labor cost countries.
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Heider, Dirk, Sebastian Bernert, Hans-Helmut König, Herbert Matschinger, Theresa Hogh, Traolach S. Brugha, Paul E. Bebbington, Michel Azorin, Matthias C. Angermeyer y Mondher Toumi. "Direct medical mental health care costs of schizophrenia in France, Germany and the United Kingdom – Findings from the European Schizophrenia Cohort (EuroSC)". European Psychiatry 24, n.º 4 (mayo de 2009): 216–24. http://dx.doi.org/10.1016/j.eurpsy.2008.12.013.
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AbstractObjectivesTo quantify and compare the resource consumption and direct costs of medical mental health care of patients suffering from schizophrenia in France, Germany and the United Kingdom.MethodsIn the European Cohort Study of Schizophrenia, a naturalistic two-year follow-up study, patients were recruited in France (N = 288), Germany (N = 618), and the United Kingdom (N = 302). Data about the use of services and medication were collected. Unit cost data were obtained and transformed into United States Dollar Purchasing Power Parities (USD-PPP). Mean service use and costs were estimated using between-effects regression models.ResultsIn the French/German/UK sample estimated means for a six-month period were respectively 5.7, 7.5 and 6.4 inpatient days, and 11.0, 1.3, and 0.7 day-clinic days. After controlling for age, sex, number of former hospitalizations and psychopathology (CGI score), mean costs were 3700/2815/3352 USD-PPP.ConclusionsService use and estimated costs varied considerably between countries. The greatest differences were related to day-clinic use. The use of services was not consistently higher in one country than in the others. Estimated costs did not necessarily reflect the quantity of service use, since unit costs for individual types of service varied considerably between countries.
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McCabe, Ruth, Mara D. Kont, Nora Schmit, Charles Whittaker, Alessandra Løchen, Marc Baguelin, Edward Knock et al. "Modelling intensive care unit capacity under different epidemiological scenarios of the COVID-19 pandemic in three Western European countries". International Journal of Epidemiology 50, n.º 3 (9 de abril de 2021): 753–67. http://dx.doi.org/10.1093/ije/dyab034.
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Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has placed enormous strain on intensive care units (ICUs) in Europe. Ensuring access to care, irrespective of COVID-19 status, in winter 2020–2021 is essential. Methods An integrated model of hospital capacity planning and epidemiological projections of COVID-19 patients is used to estimate the demand for and resultant spare capacity of ICU beds, staff and ventilators under different epidemic scenarios in France, Germany and Italy across the 2020–2021 winter period. The effect of implementing lockdowns triggered by different numbers of COVID-19 patients in ICUs under varying levels of effectiveness is examined, using a ‘dual-demand’ (COVID-19 and non-COVID-19) patient model. Results Without sufficient mitigation, we estimate that COVID-19 ICU patient numbers will exceed those seen in the first peak, resulting in substantial capacity deficits, with beds being consistently found to be the most constrained resource. Reactive lockdowns could lead to large improvements in ICU capacity during the winter season, with pressure being most effectively alleviated when lockdown is triggered early and sustained under a higher level of suppression. The success of such interventions also depends on baseline bed numbers and average non-COVID-19 patient occupancy. Conclusion Reductions in capacity deficits under different scenarios must be weighed against the feasibility and drawbacks of further lockdowns. Careful, continuous decision-making by national policymakers will be required across the winter period 2020–2021.
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Leão, Teresa, Julian Perelman, Luke Clancy, Laura Hoffmann, Jaana M. Kinnunen, Nora Mélard, Paulien A. W. Nuyts et al. "Cost of youth tobacco-control policies in seven European countries". European Journal of Public Health 30, n.º 2 (18 de septiembre de 2019): 374–79. http://dx.doi.org/10.1093/eurpub/ckz150.
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Abstract Background Tobacco-control policies have been suggested to reduce smoking among adolescents. However, there is limited evidence on the real-world costs of implementation in different settings. In this study, we aimed at estimating the costs of school smoking bans, school prevention programmes and non-school bans (smoking bans in non-educational public settings, bans on sales to minors and bans on point-of-sale advertising), implemented in Finland, Ireland, the Netherlands, Belgium, Germany, Italy and Portugal, for 2016. Methods We retrospectively collected costs related to the inspection, monitoring and sanctioning activities related to bans and educational activities related to smoking prevention programmes. We used an ‘ingredients-based’ approach, identifying each resource used, quantity and unit value for one full year, under the state perspective. Costs were measured at national, regional, local and school-level and were informed by data on how these activities were performed in reality. Results Purchasing power parities adjusted-costs varied between €0.02 and €0.74 (average €0.24) per person (pp) for bans implemented outside schools. Mean costs of school smoking bans ranged from €3.31 to €34.76 (average €20.60), and mean costs of school educational programmes from €0.75 to €4.65 (average €2.92). Conclusions It is feasible to estimate costs of health policies as implemented in different settings. Costs of the tobacco control policies evaluated here depend mainly on the number of person-hours allocated to their implementation, and on the scale of intervention. Non-school bans presented the lowest costs, and the implementation of all policies cost up to €36 pp for 1 year.
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Sudarevic, Tomislav, Predrag Radojevic, Darko Marjanovic y Radovan Dragas. "Marketing and financial barriers in agri-food exporting". British Food Journal 119, n.º 3 (6 de marzo de 2017): 613–24. http://dx.doi.org/10.1108/bfj-05-2016-0183.
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Purpose The purpose of this paper is to empirically research marketing and financial export barriers by perceptions of agri-food firms from small developing country with preferential trade position in Europe. Using resource-based and contingency theories as framework, differences in barriers perceptions between exporters classified by five organizational factors were tested. Design/methodology/approach Secondary data collection for literature review, conceptualization and hypotheses setting, and primary data collection for hypotheses testing were employed. Survey’s variables and their measurement were derived from previous studies, so exploratory factor analysis was utilized to test dimensionality. A total of 224 agri-food exporters were surveyed and 86 usable responses were collected. The single export venture was used as unit of analysis. ANOVA and t test were utilized for hypotheses testing. Findings Results indicate that the biggest barriers are price competitiveness and insufficient government support. Larger firms and foreign-owned ones perceive researched export barriers as lower than smaller firms and domestic-owned ones. Research limitations/implications The primary limitation of the paper is its one country scope, limiting generalizability. Despite this, research derives several implications especially for management and policy-makers. Originality/value This research confirmed propositions of resource-based and contingency theory in export barriers researching in a case of agri-food sector of small, developing economy with preferential position in European trade, but challenges treating export experience, intensity, and product type as firm’s valuable resources and internal contingencies.
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Vaptzarova, Gabriela y Darina Ilieva. "The Participation of the Academic Archive in the Scientific Policy of BAS in the Last Years". Cultural and Historical Heritage: Preservation, Representation, Digitalization 5, n.º 2 (2019): 7–13. http://dx.doi.org/10.26615/issn.2367-8038.2019_2_001.
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SA-BAS is a specialized unit and has its place and importance in the structure of the Academy: provides the Bulgarian scientific community with a complete resource base reflecting all aspects of society's development in different historical periods – one of the main tasks of any archive. The cultural heritage, preserved in SA-BAS, fits well in the international priorities of European science and culture. Documentary sources provoke the development of research tasks in various fields: political and cultural history, art history, geography and cartography, geology, archeology, ethnology, etc. The obtained results are of great interest not only among the Bulgarian scientific community. This is the contribution of the Academic Archive to the cultural diversity of Europe and the world in historical and contemporary terms. Keywords: archive, BAS, history, cultural and historical heritage
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Hübel, Kai, Nabih Azar, David Dunning, John Reitan, Meghan E. Gallagher y Mohamad Mohty. "Multi-Center Quantification Study of Time, Effort and Resource Utilization Associated with Autologous Peripheral Blood Stem Cell Mobilization: A European Perspective". Blood 126, n.º 23 (3 de diciembre de 2015): 2087. http://dx.doi.org/10.1182/blood.v126.23.2087.2087.
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Abstract Autologous peripheral blood stem cell mobilization has demonstrated clinical benefit for improving stem cell collection prior to autologous or allogenic transplantation. With intense competition for hospital resources required to evaluate and manage patients preparing for stem cell mobilization and transplantation, resource requirements associated with varying therapeutic interventions is warranted. Plerixafor is indicated in combination with G-CSF to enhance mobilization of hematopoietic stem cells to peripheral blood (PBSC) for collection and subsequent autologous transplantation inpatients with lymphoma (Non-Hodgkin's Lymphoma (NHL)) and multiple myeloma (MM) whose cells mobilize poorly. A non-interventional two-part study using aggregated, de-identified data was initiated across three European countries to assess resource utilization associated with PBSC mobilization and apheresis in NHL patients in the era prior to and following approval of plerixafor (to the "Pre-P" era through June 1, 2009, and "P" era from July 1, 2010 onwards; "P", respectively). Adult patients aged ≥18 years, with a primary diagnosis of NHL, who underwent PBSC mobilization at 9 European centers in France, Germany and Italy were included in the study. Part I is a retrospective medical record review of 200 NHL patients. Outcomes measured in Part I included # of visits for administration of mobilizing agents and # days administered; assessment of adverse events (AEs) associated with administered mobilizing agents; # of apheresis sessions; hours of apheresis sessions; attainment of CD34+ target; and days until CD 34+ target level met. For Pre-P era patients, the peripheral CD-34+ count recorded immediately prior to the first apheresis; for P era patients, it was that recorded immediately prior to plerixafor administration. Part II is a prospective time and motion evaluation of apheresis performed at each center (5 events recorded per center; patient consent was obtained). Apheresis events were measured in consecutive patients scheduled to be candidates for PBSC mobilization. Time-motion assessments, obtained retrospectively (Part I) and prospectively (Part II), included total time to prepare the patient, perform apheresis and manage AEs. A micro-costing exercise was carried out by obtaining costs per unit of resource utilization from interviews with hospital administration staff. The study end points are the difference in mean time/effort to perform apheresis (including apheresis related AEs, if any) and total costs associated with mobilization to the hospital between patients in the Pre-P versus P eras. Evaluation of patient demographics revealed no significant differences between pre-P and P era cohorts. Analysis of the number of apheresis sessions demonstrated a statistically significant reduction (P<0.001) for the P era group, including # of sessions, total blood volume collected and total apheresis time required to reach the targeted PBSC compared with Pre-P era group. Total cost differences between cohorts was estimated based on observed clinical and resource utilization differences. In addition, more than twice as many patients who had a CD 34+ <10 were mobilized in the P era compared with patients in the Pre-P era. This study demonstrates that use of plexiafor is associated with statistically significant reductions in the # of apheresis sessions, driving both resource utilization efficiencies and cost savings for NHL patients undergoing autologous PBSC mobilization vs patients in the pre-P era. Further research to quantify the time and motion and cost-consequences of treatment approaches for stem cell mobilization in routine clinical care is warranted to optimize treatment for NHL patients. Disclosures Azar: Sanofi: Honoraria, Research Funding. Reitan:Amgen: Research Funding; Sanofi: Research Funding; Spectrum: Research Funding. Gallagher:Sanofi: Employment, Equity Ownership.
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Bowman, Zelia, Aaron Cumpston, Michael Craig, Sijin Wen, Peter L. Perrotta, Janice Ahn, Naomi Fei, Nilay A. Shah y Abraham Sebastian Kanate. "Single Unit Red Blood Cell Transfusion Is a Safe and Effective Alternative to Double Unit Transfusion in Hematologic Malignancies". Blood 128, n.º 22 (2 de diciembre de 2016): 3855. http://dx.doi.org/10.1182/blood.v128.22.3855.3855.
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Abstract Introduction Blood products are a valuable resource associated with infectious and immunological adverse effects, hence the ongoing efforts for blood conservation. Evidence supports the use of restrictive Hemoglobin (Hb) triggers as safe and effective. Nevertheless, transfusion practice remains based largely on physician preference. The use of single-unit (SU) rather than double-unit (DU) transfusions per transfusion episode may be another strategy. Scant retrospective data from the 1960's discarded this idea as being ineffective in treating anemia.A recent European study demonstrated that using a SU transfusion protocol led to a 25% reduction in red blood cell usage amongst patients with hematologic malignancies(Berger et al; Haematologica, 2012). There have been no comparative studies done in the US population outside the orthopedic population which yielded similar benefit (Ma et al; Transfusion Medicine, 2005). Clinical Decision Support Systems (CDSS) are protocols shown to be effective in standardizing practice. At our academic institution, a CDSS was initiated for admissions to the Malignant Hematology and Transplantation Service. From September 2014, a protocol amendment prompted providers to order SU red blood cells (RBCs) for transfusion for Hb <8. Herein, we report the adherence to CDSS, and the differences in RBC utilization and patient outcomes one year before (DU-gp) and one year after (SU-gp) implementation of this protocol. Methods Retrospective chart review was performed on all adult patients admitted to the Malignant Hematology and Transplantation Service who received routine RBC transfusions from 9/1/2013- 8/31/2014 (DU-gp) and 9/1/2014 to 8/31/2015 (SU-gp). Patients with active bleeding were excluded. The primary endpoint for this study was median RBC units transfused per admission. Analysis was limited to RBC products only. Chi-square test and t-test were used in the data analysis for categorical variables and continuous variables, respectively. A mixed model was used for repeated measurements. Results 147 patients in 201 admissions in DU-gp and 126 patients in 170 admissions in SU-gp were analyzed. Baseline characteristics are presented in Table 1 with no significant differences noted between groups. Excellent adherence to the CDSS protocol was noted in both the DU (97%) and SU (92%) groups. Baseline admission Hb was similar, but Hb at discharge was significantly higher in DU-gp 9.4 g/dL vs 8.8 g/dL in SU-gp (P=0.005). The median number of transfusion episodes (each time RBC orders were placed) per admission in the DU-gp and SU-gp was 2 (range, 1-16) and 3 (range, 1-27), respectively (P<0.001). The corresponding median number of RBC units given per admission was 4 (range, 1-29) and 3 (range, 1-44), respectively (P=0.02). Overall, a 29% reduction in RBC utilization was noted in SU-gp (731 units) compared to DU-gp (1031 units). No difference was noted in 30-day mortality and readmissions, outpatient transfusion requirements or transfusion reactions between the 2 groups (Table 2). Conclusions Our data show that implementing a CDSS, transfusing single-unit RBCs instead of double-units for Hb < 8g/dL had an excellent adherence, highlighting the feasibility of such a strategy. It is noteworthy that although patients required more transfusion encounters, the overall RBC utilization fell by 29%. Single-unit RBC transfusion was safe, efficacious and significantly reduced the RBC utilization per admission. Prospective data is required to confirm our results as well as assess the potential cost-benefit advantage with single-unit RBC transfusions. Disclosures No relevant conflicts of interest to declare.
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Kobelt, Gisela, Jennifer Eriksson, Glenn Phillips y Jenny Berg. "The burden of multiple sclerosis 2015: Methods of data collection, assessment and analysis of costs, quality of life and symptoms". Multiple Sclerosis Journal 23, n.º 2_suppl (23 de junio de 2017): 4–16. http://dx.doi.org/10.1177/1352458517708097.
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Introduction: This article describes the methods used to perform this large European-wide burden-of-illness study on multiple sclerosis (MS) using individual patient data. Methods: The study collected all MS-related resource consumption, workforce participation, prevalent disease symptoms and health-related quality of life (HRQoL). Patients were recruited by national patient associations and, after informed consent, completed a specific questionnaire either on-line or on paper. Analyses were performed by country as well as for the study overall. Costs were estimated from the societal perspective, using publicly available unit costs and reported in national currencies and in EUR 2015 adjusted for purchasing power parity. The results are reported by disease severity groups according to self-assessed Expanded Disability Status Scale (EDSS) (mild, moderate, severe) and by EDSS point to highlight the development of costs as disability progresses. Results: A total of 16,808 patients in 16 countries participated in the study: Austria, Belgium, Denmark, Czech Republic, France, Germany, Hungary, Italy, the Netherlands, Poland, Portugal, Russia, Spain, Sweden, Switzerland and the United Kingdom. Conclusion: This study, endorsed by the European Platform of MS Societies, provides up-to-date information on costs and expands the previously available information on HRQoL and symptoms.
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Field, Geoffrey. "Perspectives on the Working-Class Family in Wartime Britain, 1939–1945". International Labor and Working-Class History 38 (1990): 3–28. http://dx.doi.org/10.1017/s0147547900010176.
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In the late 1940s the British people seemed preoccupied with family and children to an unprecedented degree. A similar revival of family life occurred in other European countries, testimony to the common legacy of the war years, during which private life had been broken apart by death, forced separations, constant anxiety, and unaccustomed privation. But the specific form of postwar familial ideology in Britain reflects the complex circumstances, cultural traditions, and mood of the nation. Everywhere the faces of smiling, responsible parents and healthy, carefree children gazed out from advertising billboards and National Health posters, symbolic of the nation's “social capital” and a better future. Widespread concern about low birthrates helped to strengthen domestic and mothering images of women; magazines and radio espoused the ideas of a growing phalanx of child-care professionals; and government social policy redefined the reciprocal obligations of parents and the state, reflecting a new “social democratic” conception of family as the basic unit of society and the chief incubator of citizenship and community values.
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Nicolle, Amandine, Roderic Moitié, Julien Ogor, Franck Dumas, Aurélie Foveau, Eric Foucher y Eric Thiébaut. "Modelling larval dispersal of Pecten maximus in the English Channel: a tool for the spatial management of the stocks". ICES Journal of Marine Science 74, n.º 6 (26 de diciembre de 2016): 1812–25. http://dx.doi.org/10.1093/icesjms/fsw207.
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AbstractThe great scallop Pecten maximus supports one of the most important and valuable commercial fisheries around the British Isles and in the northwest of France, but the resource is mainly managed at the scale of each local fishing ground through a combination of European, national and local measures. To analyse the larval dispersal pathways and connectivity patterns among fishing grounds of the great scallop in the Celtic Sea and the English Channel, a particle tracking model was developed. The model combined a 3D physical circulation model that simulated currents and temperature fields and a scallop larval submodel that took into account a temperature-dependent planktonic larval duration and an active vertical swimming behaviour. Due to the lack of stock assessment at the regional scale, the location of the main fishing grounds was established by combining different sources (e.g. grey literature, unpublished scientific surveys, vessel monitoring data, fishermen) while the spawning biomass of each stock was estimated from landings data. Results indicated that each local stock could not be considered as a single independent management unit and that all stocks except that of the Bay of Brest were connected to neighbouring stocks, suggesting that the management should be defined in a metapopulation context. Three major groups of strongly interconnected stocks including two or three stocks exhibiting high retention and self-recruitment rates and some peripheral stocks with a low self-recruitment rate were defined: the North Brittany and Channel Islands, the eastern English Channel, and the SW of England. Our results were discussed in terms of the definition of management units in comparison with genetic and phenotypic data, and in terms of resource management in a transnational context.
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Szierbowski-Seibel, Klaas y Ruediger Kabst. "The impact of HR outsourcing and strategic HR integration on the HR-to-employee ratio". International Journal of Manpower 39, n.º 2 (8 de mayo de 2018): 283–300. http://dx.doi.org/10.1108/ijm-06-2016-0129.
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Purpose Two simultaneous trends have arisen in the field of HRM: the development of the human resource (HR) function toward a more strategic, value adding unit and the trend of HR outsourcing (HRO). Opinions are divided in the field of HRM research regarding the interdependences between these two trends and whether the HR function has a positive or negative effect. Therefore, the purpose of this paper is to examine the triangular relationship among strategic HR integration, the HR-to-employee ratio and HRO. Design/methodology/approach This study analyses data from three large evaluations conducted in 14 European countries and compares the results obtained from the 2000, 2005 and 2010 Cranet survey waves. For the hypotheses, a multilevel regression design was used. Findings The results allow concluding that HRO supports the professionalization of the HR function in an effort to make it a strategic asset. Research limitations/implications This study extends prior understandings of the theoretical perspective on HRO and its organizational impact. The sample is nested within 14 European countries and influenced by cultural aspects and institutional factors. These influences could be an exciting avenue for further research. Practical implications This paper includes important implications for HR practitioners. The results support a rather optimistic view of the HR function regarding its relationship with HRO and the latter’s impact on the HR-to-employee ratio and strategic HR integration. Originality/value The study answers the question: has HRO downsized internal HR staff over the past decade, and how is it related to the strategic integration of the HR function? In this context, this study analyses Cranet data to contribute to the discussion on the development of strategic HR integration and the impact of HRO on such efforts. Moreover, the study examines the influence of HRO on internal HR staff based on the theoretical framework of the resource-based view.
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Alexander, Timothy J., Pascal Vonlanthen y Ole Seehausen. "Does eutrophication-driven evolution change aquatic ecosystems?" Philosophical Transactions of the Royal Society B: Biological Sciences 372, n.º 1712 (19 de enero de 2017): 20160041. http://dx.doi.org/10.1098/rstb.2016.0041.
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Eutrophication increases primary production and changes the relative abundance, taxonomic composition and spatial distribution of primary producers within an aquatic ecosystem. The changes in composition and location of resources alter the distribution and flow of energy and biomass throughout the food web. Changes in productivity also alter the physico-chemical environment, which has further effects on the biota. Such ecological changes influence the direction and strength of natural and sexual selection experienced by populations. Besides altering selection, they can also erode the habitat gradients and/or behavioural mechanisms that maintain ecological separation and reproductive isolation among species. Consequently, eutrophication of lakes commonly results in reduced ecological specialization as well as genetic and phenotypic homogenization among lakes and among niches within lakes. We argue that the associated loss in functional diversity and niche differentiation may lead to decreased carrying capacity and lower resource-use efficiency by consumers. We show that in central European whitefish species radiations, the functional diversity affected by eutrophication-induced speciation reversal correlates with community-wide trophic transfer efficiency (fisheries yield per unit phosphorus). We take this as an example of how evolutionary dynamics driven by anthropogenic environmental change can have lasting effects on biodiversity and ecosystem functioning. This article is part of the themed issue ‘Human influences on evolution, and the ecological and societal consequences'.
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Vahedian-Azimi, Amir, Mohammadreza Hajiesmaeili, Mari Kangasniemi, Joana Fornés-Vives, Rita L. Hunsucker, Farshid Rahimibashar, Mohammad A. Pourhoseingholi, Leily Farrokhvar y Andrew C. Miller. "Effects of Stress on Critical Care Nurses: A National Cross-Sectional Study". Journal of Intensive Care Medicine 34, n.º 4 (10 de marzo de 2017): 311–22. http://dx.doi.org/10.1177/0885066617696853.
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Background: Health care is a demanding field, with a high level of responsibility and exposure to emotional and physical danger. High levels of stress may result in depression, anxiety, burnout syndrome, and in extreme cases, post-traumatic stress disorder. The aim of this study was to determine which personal, professional, and organizational variables are associated with greater perceived stress among critical care nurses for purposes of developing integrative solutions to decrease stress in the future. Methods: We conducted a correlation research survey using a cross-sectional design and an in-person survey method. The questionnaire consisted of 2 parts: (1) socioeconomic, professional, and institutional variables and (2) work stressors. Surveys were conducted between January 1, 2011, and December 1, 2015. Multistage cluster random sampling was utilized for data collection. Inclusion criteria were (1) age ≥18 years, (2) registered nurse, (3) works in the intensive care unit (ICU), and (4) willing and able to complete the survey. Results: We surveyed 21 767 ICU nurses in Iran and found that male sex, lower levels of peer collaboration, working with a supervisor in the unit, nurse–patient ratios, and working in a surgical ICU were positively associated with greater stress levels. Increasing age and married status were negatively associated with stress. Intensive care unit type (semi-closed vs open), ICU bed number, shift time, working on holidays, education level, and demographic factors including body mass index, and number of children were not significantly associated with stress levels. Conclusion: As the largest study of its kind, these findings support those found in various European, North, and South American studies. Efforts to decrease workplace stress of ICU nurses by focusing on facilitating peer collaboration, improving resource availability, and staffing ratios are likely to show the greatest impact on stress levels.
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Huxley, Peter John. "The development and results of the European Mental Health Integration Index (2014)". Journal of Public Mental Health 14, n.º 4 (21 de diciembre de 2015): 205–10. http://dx.doi.org/10.1108/jpmh-07-2015-0030.
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Purpose – The purpose of this paper is to report on the development and results of the Mental Health Inclusion Index. Design/methodology/approach – Data gathering and interviews with key policy makers in 30 countries in Europe (the EU28 plus Switzerland and Norway). Data gathered enabled the production of an 18 indicator benchmarking index ranking the 30 countries based on their commitment to integrating people with mental illness. Findings – The main findings were: mental illness exacts a substantial human and economic toll on Europe, and there is a substantial treatment gap, especially for people with common mental health problems. Germany’s generous social provision and strong healthcare system put it number one in the Mental Health Integration Index. The UK and Scandinavian states come next. The lowest-scoring countries in the index are from Europe’s south-east, where there is a long history of neglect of mental illness and poorly developed community services. One needs to understand that the leading countries are not the only ones providing examples of best practice in integrating those with mental illness. Employment is the field of greatest concern for people with mental illness, but employment is also the area with the most inconsistent policies across Europe. A distinction can be made between countries whose policies are aspirational and those where implantation is support by substantial and most importantly sustained, resource investment. Europe as a whole is only in the early stages of the journey from institution- to community-based care. Lack of data makes greater understanding of this field difficult, and improvement can only be demonstrated by repeated surveys of this kind, based on more substantial, comprehensive and coherent information. Research limitations/implications – Usual caveats about the use of surveys. Missing data due to non-response and poverty of mental health inclusion data in many European countries. Practical implications – The author reflects on the findings and considers areas for future action. The main implications are: better services result from substantial, but most importantly, sustained investment; and that employment is most important to people with mental health problems, but is one of the most inconsistent policy areas across Europe. Social implications – Supports the need for consistent investment in community mental health services and more consistent employment policies in Europe. Originality/value – This survey is the first of its kind in Europe, and was conducted by the Economist Intelligence Unit in London, and sponsored by Janssen.
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Blahova Dusankova, J., T. Kalincik, T. Dolezal, G. Kobelt y E. Havrdova. "Cost of multiple sclerosis in the Czech Republic: The COMS study". Multiple Sclerosis Journal 18, n.º 5 (30 de septiembre de 2011): 662–68. http://dx.doi.org/10.1177/1352458511424422.
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Background: Information about cost of multiple sclerosis (MS) is available from a number of European countries, but no data from the Czech Republic have been published so far. Objective: The objective of this study was to establish the cost of MS in the Czech Republic, overall and by level of disease severity. Methods: Data on demographics, disease history, resource consumption and production losses were collected from 909 patients recruited in 7 MS centres in the Czech Republic. Annual costs were estimated in the societal perspective, using 2007 unit costs. To evaluate the relationship between disability and costs, patients were stratified into those with mild (67%), moderate (27%) and severe (10%) disability using the Expanded Disability Status Scale. Results: Mean total annual costs per patient were €12,272, of which 51% were direct medical costs, 4% direct non-medical costs and 45% indirect costs. The average annual costs in patients with mild, moderate and severe disability amounted to €9905, €14,064 and €22,880, respectively. Conclusion: The total costs of MS in the Czech Republic are estimated at €208.6 million per year. Consistent with other studies, the costs increase significantly with the severity of MS.
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Lindgren, Peter, Martin Buxton, Thomas Kahan, Neil R. Poulter, Björn Dahlöf, Peter S. Sever, Hans Wedel y Beng Jönsson. "Cost-Effectiveness of Atorvastatin for the Prevention of Coronary and Stroke Events: An Economic Analysis of the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid-Lowering Arm (ASCOT-LLA)". European Journal of Cardiovascular Prevention & Rehabilitation 12, n.º 1 (febrero de 2005): 29–36. http://dx.doi.org/10.1177/204748730501200105.
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Background The aim of this study is to assess the cost-effectiveness of the lipid-lowering arm of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT-LLA) where patients from seven countries with hypertension and no history of coronary heart disease (CHD) were randomized to receive 10 mg atorvastatin or placebo. Design Economic analysis of a randomized controlled trial. Methods Data on resource use were aggregated for all patients during the entire trial period (median 3.3 years) and multiplied with unit costs for Sweden and the UK. The total number of cardiovascular events and procedures avoided was used as the measure of effectiveness. Results Patients treated with atorvastatin had an additional net costs of 449 ϵ (4114 SEK) in Sweden and 414 ϵ (£260) in the UK, but fewer events per patient (0.097 compared to 0.132). The incremental cost-effectiveness ratios were 12673 ϵ (116119 SEK) and 11693 ϵ (£7349) per event avoided. Conclusion Based on comparisons with the WOSCOPS and 4S studies, atorvastatin at 10 mg to treat patients as in the ASCOT study, appears to be a cost-effective strategy. Eur J Cardiovasc Prev Rehabil 12:29-36 © 2005 The European Society of Cardiology
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Cusenza, Maria Anna, Teresa Maria Gulotta, Marina Mistretta y Maurizio Cellura. "Life Cycle Energy and Environmental Assessment of the Thermal Insulation Improvement in Residential Buildings". Energies 14, n.º 12 (10 de junio de 2021): 3452. http://dx.doi.org/10.3390/en14123452.
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The refurbishment of the building stock is a key strategy towards the achievement of the climate and energy goals of the European Union. This study aims at evaluating the energy and environmental impacts associated with retrofitting a residential apartment to improve its vertical envelope thermal insulation. Two insulation materials, stone wool and cellulose fibers, are compared. The life cycle assessment methodology is applied assuming 1 m2 of retrofitted vertical envelope as functional unit. Moreover, to estimate the net energy and environmental benefits achievable in the retrofitted scenario compared with the non-retrofitted one, a second analysis is performed in which the system boundaries are expanded to include the building operational phase, and 1 m2 of walkable floor per year is assumed as reference. The results show that the use of cellulose fibers involve lower impacts in most of the assessed categories compared to stone wool, except for abiotic resource depletion. In detail, the use of cellulose fibers allows to reduce the impact on climate change up to 20% and the consumption of primary energy up to 10%. The evaluation of the net energy and environmental benefits shows the effectiveness of the retrofit energy policies.
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Wiepjes, M., H. Q. Huynh, J. Wu, M. Chen, L. Shirton, M. Zarrabi y J. Turner. "A113 COST SAVINGS OF SEROLOGIC VERSUS BIOPSY PROVEN DIAGNOSIS OF PEDIATRIC CELIAC DISEASE". Journal of the Canadian Association of Gastroenterology 3, Supplement_1 (febrero de 2020): 131–32. http://dx.doi.org/10.1093/jcag/gwz047.112.
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Abstract Background Celiac disease (CD) affects approximately one percent of the population in Canada and the United States. At present, endoscopic diagnosis (ED) of CD remains the gold standard in North America, despite mounting evidence and validated European guidelines for serologic diagnosis (SD). Within publicly funded healthcare systems there is pressure to ensure optimal resource utilization and cost efficiency, including for endoscopic services. At Stollery Children’s Hospital, Edmonton, Canada, we have adopted serologic diagnosis as routine practice since 2016. Aims The aim of this study is to estimate cost savings, i.e. hard dollar savings and capacity improvements, to the health care system as well as impacts on families in regard to reduced work days lost and missing child school days for SD versus ED. Initial cost saving data is presented. Methods Micro-costing methods were used to determine health care resource use in patients undergoing ED or SD from 2017–2018. SD testing included anti-tissue glutaminase antibody (aTTG) ≥200IU/mL (on two occasions), human leukocyte antigen (HLA) DQA5/DQ2, blood sampling, transport and laboratory costs. ED diagnosis included gastroenterologist, anesthetist, OR equipment, staff, overhead and histopathology. Cost of each unit of resource was obtained from the schedule of medical benefits (Alberta) and reported average ambulatory cost for day hospital endoscopy for Stollery Children’s Hospital determined in 2016; reported in CAN$. Results Between March 2017-December 2018, 473 patients were referred for diagnosis of CD; 233 had ED and 127 SD. Estimated cost for ED was $1240 per patient; for SD was $85 per patient (6.8% of ED cost). Based on 127 patients not requiring endoscopy and a cost saving of $1155 per patient there was a total cost savings of $146,685 over 22 months. Conclusions A SD approach presents a significant cost savings to the public health care system. It also frees up valuable endoscopic resources, and limits exposure of children to the immediate and long-term risks associated with anesthesia and biopsy. SD also decreases time to diagnosis and the cost of the process to families (lost days of school/work, travel costs etc.). Our costing data can be used in combination with mounting evidence on the test performance of SD versus ED to determine cost-effectiveness of serological diagnosis for pediatric CD. Given the potential for cost saving and more efficient operating room utilization, SD for pediatric CD warrants further investigation in North America. Funding Agencies None
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Mandrik, Olena, Saskia Knies, Zoltan Kalo y Johan L. Severens. "REVIEWING TRANSFERABILITY IN ECONOMIC EVALUATIONS ORIGINATING FROM EASTERN EUROPE". International Journal of Technology Assessment in Health Care 31, n.º 6 (2015): 434–41. http://dx.doi.org/10.1017/s0266462315000677.
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Objectives: The aim of this study is to analyze the quality and transferability issues reported in published peer-reviewed English-language economic evaluations based in healthcare settings of the Central and Eastern European (CEE) and former Soviet countries.Methods: A systematic search of economic evaluations of healthcare interventions was performed for Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Turkmenistan, Kazakhstan, Lithuania, the former Yugoslav Republic of Macedonia, Republic of Moldova, Romania, the Russian Federation, Serbia, Slovenia, and Ukraine. The included studies were assessed according to their characteristics, quality (using Drummond's checklist), use of local data, and the transferability of inputs and results, if addressed.Results: Most of the thirty-four economic evaluations identified were conducted from a healthcare or payer perspective (74 percent), with 47 percent of studies focusing on infectious diseases. The least frequently and transparently addressed parameters were the items’ stated perspectives, relevant costs included, accurately measured costs in appropriate units, outcomes and costs credibly valued, and uncertainties addressed. Local data were often used to assess unit costs, baseline risk, and resource usage, while jurisdiction-specific utilities were included in only one study. Only 32 percent of relevant studies discussed the limitations of using foreign data, and 36 percent of studies discussed the transferability of their own study results to other jurisdictions.Conclusions: Transferability of the results is not sufficiently discussed in published economic evaluations. To simplify the transferability of studies to other jurisdictions, the following should be comprehensively addressed: uncertainty, impact of influential parameters, and data transferability. The transparency of reporting should be improved.
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Corbu, Luminița-Claudia. "Erasmus+ programs-the need to create a competitive space of the Romanian education system". Proceedings of the International Conference on Business Excellence 14, n.º 1 (1 de julio de 2020): 1071–82. http://dx.doi.org/10.2478/picbe-2020-0101.
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AbstractThe need to create a competitive framework of the Romanian education system and the current needs of the labor market have aroused the interest of the human resource in the pre-university education, which manifests its interest towards the European funds that can be attracted in the field of education and which are necessary for the creation of a context that raises the education system to the standards of the European Union, a fact also demonstrated by the legislation in force. By the Government Decision no. 76 / 27.01.2005 and the Government Decision no. 67/2007 has been designated the National Agency for Community Programs in the Field of Education and Vocational Training (“Agency”, AN), as an agency for implementing the community programs “Lifelong Learning” (LLP), “Youth in action” (YiA) and Erasmus Mundus from 2007-2013. This document included the Europass National Center, the Eurydice National Unit and the Eurodesk National Office in the AN. In 2013, through the Government Memorandum no. 10988/ 09.12.2013, AN was designated as the Implementing Agency for the Erasmus + program, from 2014-2020, having as a mission the administration of the European Union program that supports the national project for the better change of communities, attitudes and mentalities of individuals. Erasmus + is the EU program in the fields of education, training, youth and sport for the period 2014-2020. Education, training, youth and sport make a significant contribution to combating socio-economic change, to Europe’s greatest challenges by the end of the decade, and to the implementation of the European policies for growth, jobs, equity and social inclusion. Combating the rising unemployment rate - especially among young people, has become one of the most urgent tasks of European governments. Too many young people leave school prematurely, thus risking becoming unemployed and socially marginalized. The same risk threatens many low-skilled adults. The technologies change the way the company operates, so their full use is necessary. European companies need to become more competitive through talent and innovation. Europe needs more cohesive and inclusive societies that enable citizens to play an active role in democratic life. Education and youth activities are essential elements for preventing radicalization through violence and by promoting common European values, social inclusion, enhancing interculturality and a sense of belonging to a community. Erasmus + is an important tool for promoting the integration of people from disadvantaged backgrounds, of newly arrived migrants, responding to critical events affecting European countries. The Erasmus + program aims to help the countries participating in the program to effectively use Europe’s talent and social capital, in a lifelong learning perspective, by linking the support provided to formal, non-formal and informal learning in the fields of education, training and youth.
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Melnyk, Alla. "Management of territory resources in the context of European and national policy for regional growth". Herald of Ternopil National Economic University, n.º 3(89) (10 de octubre de 2018): 7–22. http://dx.doi.org/10.35774/visnyk2018.03.007.
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The research paper examines the issue of territory resource availability in light of reviewing European and national policies to support regional growth, decentralization and creation of territory communities in Ukraine. A particular emphasis is placed on strengthening the resourse base of new administrative and territory units, and the importance of results- based management of its effective utilization. The conceptual framework of ‘territory resourses’ is described; the range of functional applications of the concept in theoretical studies and management practices is outlined. A number of factors that affect the choice of policies for management of territory resources are determined, and the significance of applying the inclusive principle for leveraging resources in the resource base of territory communities is acknowledged. The article presents some shortcomings of the analytic database for assessing territory resources. It also provides a range of indicators by types of resources, which can be used for analysis and forcast by state and local authorities, and for decision-making related to supply and utilization of resources. Methods of calculating the integral indicator of supply of resources and areas of their utilization are proposed and evaluated. Based on empirical research, challenges of supply and utilization of resources in the process of economic and social growth of territory communities are identified. The article emphasizes that local authorities ought to make sound policies related to supply and efficient utilization of resources. This step is followed by the formulation of key principles, management goals, targets, priorities and a line of activities. In order to address the challenges of creating and developing territory resources a number of resource management techniques are proposed, some of which have become widespread abroad. These techniques include strategic resource management, resource analysis, marketing research, monitoring of public-private partnership, project management, financial management, risk management, local cluster formation. The challenges of implementing them into practice at the level of territory communities are revealed. Suggestions are made for each area of functional activity. A special emphasis is placed on the consistency between techniques applied in territory resources management.
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Rančić, Jovana, Nemanja Rančić, Nemanja Majstorović, Vladimir Biočanin, Marko Milosavljević y Mihajlo Jakovljević. "Cost differentials of dental outpatient care across clinical dentistry branches". Farmeconomia. Health economics and therapeutic pathways 16, n.º 1 (30 de marzo de 2015): 25–32. http://dx.doi.org/10.7175/fe.v16i1.661.
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Background: Dental care presents affordability issues in Central & Eastern European transitional economies due to lack of insurance coverage in most countries of the region and almost complete out-of-pocket payments by citizens.Objective: Real world estimates on cost differentials across clinical dentistry branches, ICD-10 diagnostic groups and groups of dental services.Methods: Prospective case-series cost analysis was conducted from the patient perspective. A six months time horizon was adopted. Sample size was 752 complete episodes of treatment in 250 patients, selected in 2012/2013 throughout several specialist state- and private-owned dental clinics in Serbia. All direct costs of dental care were taken into account and expressed in Euros (€).Results: Mean total costs of dental care were € 46 ± 156 per single dentist visit while total costs incurred by this population sample were € 34,424. Highest unit utilization of services belongs to conservative dentistry (31.9%), oral surgery (19.5%) and radiology (17.4%), while the resource with the highest monetary value belongs to implantology € 828 ± 392, orthodontics € 706 ± 667 and prosthetics € 555 ± 244. The most frequently treated diagnosis was tooth decay (33.8% unit services provided), pulpitis (11.2%) and impacted teeth (8.5%), while most expensive to treat were anomalies of tooth position (€ 648 ± 667), abnormalities of size and form of teeth (€ 508 ± 705) and loss of teeth due to accident, extraction or local periodontal disease (€ 336 ± 339).Conclusion: Although the range of dental costs currently falls behind EU average, Serbia’s emerging economy is likely to expand in the long run while market demand for dental services will grow. Due to threatened financial sustainability of current health insurance patterns in Western Balkans, getting acquainted with true size and structure of dental care costs could essentially support informed decision making in future.
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Flaherty, Thomas M. y Ronald Rogowski. "Rising Inequality As a Threat to the Liberal International Order". International Organization 75, n.º 2 (2021): 495–523. http://dx.doi.org/10.1017/s0020818321000163.
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AbstractThe rise of top-heavy inequality—earnings concentration in a very thin layer of elites—calls into question our understanding of the distributional effects of the Liberal International Order. Far more people lose from globalization, and fewer gain, than traditional economic models suggest. We review three modern trade theories (neo-Heckscher-Ohlin-Stolper-Samuelson or H-O-S-S, new new trade theory, and economic geography) that each arrive at the conclusion of top-heavy inequality by introducing some form of unit heterogeneity—an assumption that the actors we once treated as identical actually differ from one another in important ways. Heterogeneity allows the gains from globalization to concentrate in a narrow segment of workers with superlative talents, extraordinarily productive firms, or heavily agglomerated cities. An analysis of European voting data shows that shocks from trade and migration elicit populist opposition only where the top 1 percent have gained the most. With few politically feasible alternatives to protectionism, most notably the failure of democracies to redistribute income, our analysis predicts a persistence of public support for antiglobalization parties, especially those on the Right.
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Poór, József, Allen D. Engle, Ildikó Éva Kovács, Michael J. Morley, Kinga Kerekes, Agnes Slavic, Nemanja Berber et al. "Multinationals and the evolving contours of their human management practices in Central and Eastern Europe and the former Soviet Union". Employee Relations: The International Journal 42, n.º 3 (8 de marzo de 2020): 582–608. http://dx.doi.org/10.1108/er-01-2019-0082.
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PurposeWe explore the effects of three organizational variables (country of origin of the multinational company (MNC), the timing of entry into the European Union and the mode of establishment of the MNC subsidiary unit) on the human resource management (HRM) practices being pursued by subsidiaries of large MNCs operating in selected countries in Central and Eastern Europe (CEE) and the Former Soviet Union. Furthermore, we examine whether the degree of autonomy afforded to the subsidiary over its preferred HR recipes is related to overall local unit performance.Design/methodology/approachWe profile the HRM practices of 379 foreign owned subsidiaries located in Bulgaria, Croatia, The Czech Republic, Kazakhstan, Poland, Hungary, Russia, Romania, Serbia and Slovakia. Using descriptive statistics, we present the general characteristics of the sample and we then use bivariate statistical analysis to test our hypotheses relating to the impact of different organizational factors on the HR practice mix implemented in the MNC subsidiaries covered in our survey.FindingsWe find a significant correlation between the annual training budget, the importance of knowledge flow from headquarters (HQs) to the subsidiary and the perceived criticality of training and development and whether the subsidiary is a greenfield site or an acquisition. A correlation was also found between the national timing of EU membership (older members, newer and then candidate countries and non-EU members) and three HR practice variables: the use of expatriates, external service providers and employee relations practices.Research limitations/implicationsOur research calls attention to the issue of balancing the efficiencies of standardization with the local preferences and traditions of customization which results in more successful MNC control and ultimately higher levels of performance. It also calls attention to the challenges in pursuing research of this nature over time in the CEE region, especially given the dynamic nature of the MNC mix in each of the countries.Practical implicationsOur findings serve to reduce the information gap on foreign-owned companies in CEE and the Former Soviet Union.Originality/valueDespite some 30 years of transition, there remains a paucity of empirical research on the HR practices of MNCs across a number of countries in the CEE region. For a decade and a half, the CEEIRT group[1] has been systematically gathering empirical evidence. The combination of the breadth (10 countries) and depth (numerous items related to MNC subsidiary relationships with corporate HQs and patterns of HR practices and roles) characterizing the ongoing research effort of the CEEIRT collaboration serves as a mechanism for augmenting the empirical base on HRM in the region.
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Fusi, Francesca, Valentina Lorenzi, Giorgio Franceschini, Riccardo Compiani, Valeria Harper, Jessica Ginestreti, Giandomenico Ferrara, Carlo Angelo Sgoifo Rossi y Luigi Bertocchi. "Animal welfare and biosecurity assessment: a comparison between Italian and Irish beef cattle rearing systems". Animal Production Science 61, n.º 1 (2021): 55. http://dx.doi.org/10.1071/an19611.
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Context European beef production is facing fresh challenges on various fronts: increasing public concern on animal welfare; declining EU meat consumption; and, conversely, expected growth in global demand for meat. The Italian National Reference Centre for Animal Welfare (CReNBA) has developed an assessment protocol for collecting information about beef cattle welfare and biosecurity conditions, with the intention of better understanding animal needs and disseminating best practices. Aims The protocol was applied on Italian and Irish farms, and the results were used as a starting point for a specific statistical analysis for comparing animal welfare and biosecurity levels in the two countries. Methods The protocol consists of animal-based measures and non-animal-based measures (management-based and resource-based indicators) and has been designed to determine the major hazards and benefits that can influence cattle health and welfare, including the presence of biosecurity issues. The outcomes of welfare and biosecurity assessments conducted during November 2016–July 2017 of 40 Irish beef herds reared indoors were compared with those of 85 Italian beef units assessed over the same period. Differences obtained within each beef-unit distribution were calculated by the VARNC index (diversity index), and a distance estimate of the beef-unit distribution from a hypothetical ideal condition was calculated by using the distance from ideal (dfi) index. Key results The dfi index revealed that Irish farms were closer to the ideal condition for the measures ‘experience and training of stockpersons’, ‘water provision’, ‘handling facilities’, ‘restraint facilities’, and ‘temperature, humidity and ventilations conditions’. Italian farms were closer to the ideal condition for ‘diet calculation and feed quality’, ‘feeding management’, ‘feeding place dimension’, ‘cleanliness of water points’, ‘cleanliness of floors’, ‘type of floors’, ‘cleanliness of animals’, and ‘integument alterations’. In contrast to the Italian farms, there was particular awareness of the importance of biosecurity on Irish farms. Conclusions The results revealed intrinsic management and housing differences between the two rearing systems, although only few dissimilarities were found in the animal outcomes: in fact, the assessment of the animal-based measures gave very similar results for the two countries, except for ‘cleanliness of the animals’ and ‘integument alterations’. Implications In the face of global challenges affecting the pursuit of farming sustainability, farmers should be encouraged to improve safeguards for animal welfare and reduce the spread of animal diseases. This can be achieved by facilitating knowledge exchange internationally.
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Rafele, Carlo, Giulio Mangano, Anna Corinna Cagliano y Antonio Carlin. "Assessing batteries supply chain networks for low impact vehicles". International Journal of Energy Sector Management 14, n.º 1 (6 de enero de 2020): 148–71. http://dx.doi.org/10.1108/ijesm-11-2018-0004.
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Purpose This paper aims to evaluate different logistics configuration to deliver batteries from the supplier to the production lines of a European carmaker who is implementing new propulsions for its models. Design/methodology/approach Several scenarios about the supply chain for traction batteries have been identified based on the company’s requirements and constraints. Then, the variables used for the assessment of each scenario have been selected to calculate the unit battery supply chain cost. Findings The results underline that a direct transport without intermediate nodes is the cheapest one. On the contrary, an additional warehouse makes the organization of the network more complex. However, with this configuration, it is possible to cover the risk of supply since that a certain level of inventory is always guaranteed. Research limitations/implications This study is limited to the analysis of only one model car, and just manual operations have been taken into account for computing the human resource time and cost. The present study is one of the first works exploring the organization of the supply chain for the batteries integrated in electric and hybrid vehicles together with the choice of the location of the related warehouses. Originality/value This paper is one of the first work on the assessment of batteries’ supply chain that are going to be integrated in low impact vehicles, focusing on location of the associated warehouse. The evaluation is carried out by taking into account all the sources of cost.
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MANRESA, ALBA, ANDREA BIKFALVI y ALEXANDRA SIMON. "THE USE AND DETERMINANTS OF TRAINING AND DEVELOPMENT FOR CREATIVITY AND INNOVATION". International Journal of Innovation Management 22, n.º 07 (octubre de 2018): 1850062. http://dx.doi.org/10.1142/s1363919618500627.
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Human Resource Management (HRM) practices are considered as a possible contributor to firm success. Further research is needed in this field to address how HRM practices contribute to a firm’s ability to be creative and innovative. The first objective of this paper is to map the implementation of training and development practices for creativity and innovation (TD4CI) in manufacturing and the second is to analyse the factors that most influence this implementation. The study, based on the Spanish sub-sample of the European Manufacturing Survey, demonstrates the unexhausted potential of TD4CI as a step prior to innovation. The results show that one third of the companies currently use TD4CI and that this figure is rising. Most of the firms, however, have not put these practices into place and they have no intention of doing so. Regarding the determinants that influence the studied practices, the results show that there are some significant factors, for example new products or services being introduced within the company in the previous three years, that positively affect all the practices. Other determinants are individually significant, for instance the complexity of the product. Some factors, on the other hand, such as size or single unit production, do not appear to influence any of the practices studied so far. The value of this research lies in the up-to-date, relevant figures it provides regarding the implementation and dissemination of TD4CI.
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Gomo, Fortune Faith, Christopher Macleod, John Rowan, Jagadeesh Yeluripati y Kairsty Topp. "Supporting better decisions across the nexus of water, energy and food through earth observation data: case of the Zambezi basin". Proceedings of the International Association of Hydrological Sciences 376 (1 de febrero de 2018): 15–23. http://dx.doi.org/10.5194/piahs-376-15-2018.
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Abstract. The water–energy–food (WEF) nexus has been promoted in recent years as an intersectional concept designed to improve planning and regulatory decision-making across the three sectors. The production and consumption of water, energy and food resources are inextricably linked across multiple spatial scales (from the global to the local), but a common feature is competition for land which through different land management practices mediates provisioning ecosystem services. The nexus perspective seeks to understand the interlinkages and use systems-based thinking to frame management options for the present and the future. It aims to highlight advantage and minimise damaging and unsustainable outcomes through informed decisions regarding trade-offs inclusive of economic, ecological and equity considerations. Operationalizing the WEF approach is difficult because of the lack of complete data, knowledge and observability – and the nature of the challenge also depends on the scale of the investigation. Transboundary river basins are particularly challenging because whilst the basin unit defines the hydrological system this is not necessarily coincident with flows of food and energy. There are multiple national jurisdictions and geopolitical relations to consider. Land use changes have a profound influence on hydrological, agricultural, energy provisioning and regulating ecosystem services. Future policy decisions in the water, energy and food sectors could have profound effects, with different demands for land and water resources, intensifying competition for these resources in the future. In this study, we used Google Earth Engine (GEE) to analyse the land cover changes in the Zambezi river basin (1.4 million km2) from 1992 to 2015 using the European Space Agency annual global land cover dataset. Early results indicate transformative processes are underway with significant shifts from tree cover to cropland, with a 4.6 % loss in tree cover and a 16 % gain in cropland during the study period. The changes were found to be occurring mainly in the eastern (Malawi and Mozambique) and southern (Zimbabwe and southern Zambia) parts of the basin. The area under urban land uses was found to have more than doubled during the study period gearing urban centres increasingly as the foci for resource consumption. These preliminary findings are the first step in understanding the spatial and temporal interlinkages of water, energy and food by providing reliable and consistent evidence spanning the local, regional, national and whole transboundary basin scale.
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Rousseau, Jacques. "La forêt mixte du Québec dans la perspective historique". Cahiers de géographie du Québec 7, n.º 13 (12 de abril de 2005): 111–20. http://dx.doi.org/10.7202/020422ar.
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The mixed forest of the St. Lawrence valley, which presents jour successive landscapes during its seasonal rhythm, bas been the dorsal spine of Eastern Canada s economy since the establishment of the French colony. The various people who have successively inhabited this forest have either used it as members of the bio-sociological unit or tried to modify its ecology, depending on their traditional culture. It was occupied soon after the glacier recession by the Red-ochre Man, who was followed by the Algonkian forest hunters. Later, the same territory was inhabited by Iroquoian tribes, who brought with them their agriculture which had evolved in the South, but was reoccupied by the Algonkian tribes just before the foundation of Québec. At this time it became a country of European settlers, who carried with them their Old World agriculture and tried to reconstruct in a new continent their Normandie or Poitou landscape. For a newly established agriculturist, the land hardly produced enough for a living. The exploitation of Canadian forests was unpopular amongst the LaRochelle merchants who preferred to trade in the Baltic regions. The first important economic resource was the fur trade. Later, when Napoleon Bonaparte set up a blockade in the Baltic sea, England had to look elsewhere to save and develop her navy and found in the forests of Eastern Canada the pine-trees she needed. Finally, the increase in the number of news-papers, which was largely a consequence of the French revolution, developed another type of forest industry, the production of spruce pulp.
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Marsenić, Miloš y Saša Stanojević. "Digital resources in history teaching with reference to the European project Europeana". Зборник радова Филозофског факултета у Приштини 50, n.º 4 (2020): 185–96. http://dx.doi.org/10.5937/zrffp50-28944.
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The development of new technologies and the information society has accelerated changes in everyday life and modern teaching. Information and communication technologies (ICT) better motivate students to learn. In order to better preserve historical sources, they are digitized and thus protected, hence researchers can access the source faster and at a less cost. The possibilities of using the Internet in teaching are vast. It is necessary for schools to have computers, as well as for teachers and students to be motivated to use new electronic sources. Many websites have original historical material, from written and printed sources to audio-visual ones. We can call all this material digital resources (materials, sources, electronic historical sources). Teachers need to create engaging and imaginative teaching materials. However, a critical approach and caution in working with materials from the internet is essential. It is the teacher's responsibility to recommend verified sites and documents. Much of the material on the Internet has been posted with the conscious intention of spreading inaccurate data. The possibilities of ICT are great in history studies, as well. It is possible to modernize teaching at all levels of studies, but the financial capabilities of schools do not allow the possibility of keeping up with those innovations. One of the web portals that can be used for teaching purposes with its digitized content is Europeana. It is a database of the cultural and historical heritage of Europe, through which it is possible to search the digitized material of institutions. The Europeana portal is a broad project that provides free access to tens of millions of digital units. One of the most important collections within this portal is dedicated to the First World War and is called Europeana 1914-1918.
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LAU, Wing-Yu Siobhan, Paul Anthony HEATON y Siba Prosad PAUL. "IMPROVED ADHERENCE TO THE ESPGHAN GUIDELINES IS NECESSARY FOR DIAGNOSING CELIAC DISEASE IN CHILDREN: A SINGLE-CENTER EXPERIENCE". Arquivos de Gastroenterologia 58, n.º 2 (junio de 2021): 164–67. http://dx.doi.org/10.1590/s0004-2803.202100000-28.
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ABSTRACT BACKGROUND: Celiac disease (CD) is an immune-mediated systemic disorder elicited by the ingestion of gluten. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines published in 2012 suggested a no-biopsy pathway (NBP) for symptomatic children with IgA tissue transglutaminase (TGA-IgA) ≥10x upper limit of normal (ULN). Biopsy confirmation remained mandatory for other cases. OBJECTIVE: This retrospective case note study was aimed at evaluating the adherence to the ESPGHAN 2012 guidelines for diagnosing CD in our unit. METHODS: Forty-three cases with positive TGA-IgA were identified by a laboratory database search from January 2013 to December 2019. 6 of 43 patients were not referred for a confirmation of CD diagnosis. Data was collected on the diagnostic pathways followed, and appropriateness of adherence was compared with the existing ESPGHAN guidelines. RESULTS: A total of 37 cases were included with 35 children diagnosed with CD. 29/35 (83%) were diagnosed via the NBP;15/29 (52%) children did not meet all the criteria required for NBP, but were diagnosed and managed as having CD. 20/35 (57%) children were diagnosed with CD in adherence to the 2012 guidelines. CONCLUSION: The recommended diagnostic guidelines were frequently not implemented; adherence to the guidelines may improve following regular educational sessions. The revised 2020 ESPGHAN guidelines which exclude HLA-DQ2/DQ8 testing would address the issue of diagnosis for the 10/15 NBP cases (with TGA-IgA >10xULN) in our study who did not have HLA testing and were therefore non-adherent to the 2012 diagnostic guidelines. NBP, with the reduced need for endoscopy may be beneficial in resource limited settings.
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Győriné Szabó, Gabriella. "Using of European Union’s Cohesion Resources – In the Context of Ruling and Efficiency". E-conom 3, n.º 2 (2015): 31–37. http://dx.doi.org/10.17836/ec.2014.2.031.
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Horpynych, Olha y Zarema Ibrahimova. "Intercultural model of the development of modern cities: a conceptual analysis". Grani 23, n.º 4 (5 de julio de 2020): 13–19. http://dx.doi.org/10.15421/172036.
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The article presents a conceptual analysis of the intercultural model of development of modern cities, with an emphasis on the selection strategy and activity of axiological approach to developing models of modernization of a modern city, marked specific features of urban culture - multicultural, multipolarity interests, values, needs and opportunities for groups. Revealed that about the virtualization of the social space and the introduction of information and communication technologies, which express a qualitative difference between the interaction of the urban population as a unit of sociocultural stratification of the culture of a particular regional community, are determined by particularly significant factors influencing the formation of the modern sociocultural space of a multi-ethnic city. The tendencies of participation in the formation of the sociocultural space of Ukrainian cities by wide circles of the public with the active and consistent participation of citizens in exercising control over cultural policy are characterized and organizational conditions for sustained feedback from the public and authorities. The theoretical and methodological foundations of the practice of sociological support of the development processes of multi-ethnic Ukrainian urban communities in the context of the implementation of the European intercultural strategy are considered. The emphasis is on solving the problems of a sociological study of the needs of the urban community in the information environment and the complication of sociocultural relationships between the subjects of the processes of modernization of the cultural urban environment. The need for a systematic combination of sociological approaches based on the integration of the concepts of the city’s public space, the resource concept of the city, the concept of socialization, the socio-cultural capital of the city, the concepts of sociocultural identification and urban identity is stated. The author 's case was the conclusion that the processes of maintenance practices for the development of multi-ethnic Ukrainian urban communities in the context of the European strategy for intercultural indicate significant prospects of sociological studies of social and cultural development of the Ukrainian regional multicultural cities. The article emphasizes that the following areas are relevant: the development of research criteria for potentially productive sectors of the development of the sociocultural urban environment and the factors of activation of interested social groups in the context of the implementation of strategies and objectives of the concept of interculturalism.
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GASSMANN, OLIVER y BARBARA BECKER. "TOWARDS A RESOURCE-BASED VIEW OF CORPORATE INCUBATORS". International Journal of Innovation Management 10, n.º 01 (marzo de 2006): 19–45. http://dx.doi.org/10.1142/s1363919606001387.
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Corporate incubators for technology development are a recent phenomenon whose functioning and implications are not yet well understood. The resource-based view can offer an explanatory model on how corporate incubators function as specialised corporate units that hatch new businesses. While tangible resources, such as the financial, physical and even explicit knowledge flow, are all visible, and therefore easy to measure, intangible resources such as tacit knowledge and branding flow are harder to detect and localise. Managing the resource flow requires the initial allocation of resources to the corporate incubator during its set-up as well as a continuous resource flow to the technology venture and, during the harvest phase, also from it. Two levels of analysis need to be distinguished: (1) the resource flow between the corporate incubator and the technology venture and (2) the resource flow interface between the corporate incubator and the technology venture. Our empirical findings are based on two phases: First, in-depth case studies of 22 companies through 47 semi-structured interviews that were conducted with managers of large technology-intensive corporations' corporate incubators in Europe and the U.S., and second, an analysis of the European Commission's benchmarking survey of 77 incubators.
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Michalski, Bartosz. "The Competitiveness of Polish Resource-and Labour-Intensive Exports in the Context of Membership of the European Union". Studia Oeconomica Posnaniensia 6, n.º 1 (2018): 76–90. http://dx.doi.org/10.18559/soep.2018.1.5.
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Zaharie, Monica, József Poór, Patricia Ratiu y Codruta Osoian. "International assignments, human capital resources and MNC subsidiary performance in CEE countries". Multinational Business Review 28, n.º 1 (21 de diciembre de 2019): 65–85. http://dx.doi.org/10.1108/mbr-08-2019-0094.
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Purpose Multinational companies (MNCs) expect the highest return from their locally dispersed units, and thus the factors that impact the success of the subsidiaries have been of great interest to the literature. Building on the resource-based view, this paper aims to explore the effects of a set of contextual resources, in particular, the international staffing (expatriate and inpatriate assignments) and human capital resources on the performance of foreign-owned subsidiaries in Central and Eastern European (CEE) countries. Design/methodology/approach By means of a survey applied on 295 MNC subsidiaries from five CEE countries (Hungary, Romania, Poland, Serbia and the Czech Republic), the paper reveals the main relationships between contextual subsidiary level resources (the in-coming and out-going international assignments, human capital resources at both employee and management level and the human resource knowledge transfer) and the subsidiary performance. Findings This paper brings empirical support for the positive relationship between the MNCs’ contextual resources, in particular, the inpatriate assignments, the human capital resources and the performance of the locally dispersed subsidiaries. The findings show an interaction effect between the inpatriate and the expatriate assignments on the performance of the subsidiaries. The empirical results bring an insight into the understanding of the added value that the out-going inpatriate assignments and the human capital resources have for the global businesses. Research limitations/implications This paper is empirical in nature and calls for further exploration of the topic on larger random MNC samples. The findings of this paper have the potential to improve how the management of the global businesses leverages the inpatriate assignments and human capital resources, thus leading to more value-added to stakeholders. Originality/value The originality of the paper stems from the implementation of the empirical survey in the dynamic but under-researched context of the CEE region. Thus, the findings reveal valuable input about the contribution of the human capital resources at the subsidiary level for the performance of the locally dispersed MNC units in five European developing countries.
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Zieliński, Mariusz. "Changes in competitiveness of labour resources of the Visegrad Group countries after joining the European Union". Studia i Prace WNEiZ 51 (2018): 335–45. http://dx.doi.org/10.18276/sip.2018.51/3-27.
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Vieira, Rui Castro. "An overview of the developments of the European Common Fisheries Policy regarding sustainable development and its regionalisation in Portugal and the Autonomous Regions". UNIO – EU Law Journal 5, n.º 1 (13 de junio de 2019): 92–108. http://dx.doi.org/10.21814/unio.5.1.254.
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The European integration is not only a continental, but also a maritime integration, with the development of a maritime market including its maritime resources like fisheries. The development of the Common Fisheries Policy, in the European Union, has been marked by a few peculiar principles and tension among Member States. These developments have also been challenged by the developments of International Law, especially the Law of the Seas Convention, as well as the increasing attention given to a sustainable development and the need for maritime environmental development. The latest years have also been marked by a need for decentralization and regionalisation of the Common Fisheries Policy. The Iberian nations, especially Portugal, are a distinctive case with the rather difficult Common Fisheries Policy Integration. In spite of that, its singularity regarding its maritime presence and autonomic decentralized model give new potential for a new management and development of a decentralized Common Fisheries Policy, as well as a new possibility for sustainable development. In this paper, we analyse the development of the European Common Fisheries Policy as well as its role and interaction with International Law and the new concerns regarding sustainability of fishing stocks and its new management approach and needs for regionalisation. We also analyse its repercussions on Portugal and the potential offered by its own maritime and territorial peculiarities with its archipelagos and their own qualities and aptitude for a sustainable integration of the Common Fisheries Policy.
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Brilhante, Dialina, Ana Macedo y Ana Harfouche. "Blood, Esa’s and Costs". Blood 112, n.º 11 (16 de noviembre de 2008): 1303. http://dx.doi.org/10.1182/blood.v112.11.1303.1303.
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Abstract Background: The demand for allogeneic blood (packed red blood cells) has been progressively increasing. The introduction of safety measures substantially increased its cost and limited the available supply. Because both supply and demand for blood has not yet reached a plateau, namely in Portugal, the introduction and adoption of treatments that reduce transfusion, such as Erythropoiesis Stimulating Agents (ESA’S) for patients with chemotherapy induced anemia (CIA) is a welcome strategy to manage the hospital blood supply. Recently an advisory panel to the US Food and Drug Administration has recommended that the agency further limit the use of ESA’S, and in Europe, the European Medicines Agency (EMEA) emitted a statement that “cancer patients with a reasonably long life expectancy” should receive blood transfusions rather than take drugs for anemia. With these warnings we are probably going to see an increase in demand for blood. Estimating blood costs is a complex undertaking, surpassing simple versus demand economics, and is not simple or straightforward; the underlying issue is whether hospitals are billing appropriately for blood products and how extensively its value is calculated. The National Health Care System is making a huge effort to control the rising costs associated with the delivery of health services, namely developing a new allocation method for hospitals. Activity-based costing (ABC) is an approach to the management of resources that allows the ‘real’ resource costs and time of a service activity to be estimated. Traditional costing systems often group many costs together as overheads. The Accounting System for Activities in the Hospitals (SCAH) is outlined to evaluate detailed cost elements, understanding cost behaviour, which can facilitate future policy decisions, because policy makers have the opportunity to more fully understand the implications of incremental changes. We applied the SCAH to the Blood Bank of IPOFG Lisbon, in order to evaluate a far more accurate appraisal of the actual cost of the blood. The cost of correcting CIA is an open issue as both ESAS’S and Transfusion may offer symptomatic benefit. In Portugal the price of ESA’S, Erythropoietin alfa decreased almost 50% from 2000–2008, not including the final price, negotiated in each hospital. On the other hand, the price of one unit of packed RBCs continues to rise, and with different values, depending on the methodology used. Purpose: Evaluation of the costs of both alternatives to increase 1g of haemoglobin, in a hemato-oncological hospital, belonging to National Health Service and not for profit. Methods: We analysed the official prices of ESA’S between 2000–2008 published by the Ministry of Health. We used an activity – based approach to more fully account for the cost of blood, than present estimates, derived from the concept of activity-based costing (ABC). We applied this method to the process Chart flows of activities associated with blood collection facility and the others associated to the transfusion service. Results: Prices of Epoeitin - a (1000 UI/5μg) and Darbepoeitin according to National Catalogue Prices 2000 2001 2002 2003 2004 2005 2006 2007 2008 Epoietin-a €11,17 €7,20 €6,73 €6,52 €6,52 €6,12 €6,12 €6,12 €6,12 Darbepoeitin - - - €7,80 €7,00 €6,52 €6,52 €6,12 €6,12 Price of Packed RBC (2007), calculated using ABC methodology % Price (€) Personnel 25,32 90,26 Material to blood collection 6,47 23,07 Equipment 1,03 3,67 Common Costs 5,03 17,92 Reagents 3,69 13,15 Outsourcing 1,83 6,52 Structures 1,01 3,60 Laboratory analysis 15,85 56,50 Transfusion Session 39,77 141,75 Total 100% 356,44 Increment of 1g haemoglobin 1 unit of Packed RBC and transfusion session 30.000 UI EPO-a (fixed dose every week) 150 mg Darbepoeitin (fixed dose every week) €356.44 + €30* €183,6 × 2 = €367,2 * Haemovigilance network €183,6 × 4 = €734,4 The cost of 1 unit of packed RBC is equivalent a two fixed doses of EPO- a and Darbepoitin, respectively (30000 UI and 150 mg). Each hospital can negotiate catalogue adjusted prices for ESA’s, so if we presume that these values can be reduced by half, the price of 1 unit of packed RBC is equivalent to 4 fixed doses of treatment with ESA’s. Conclusions: Once the ability of ESA’s to reduce transfusions requirements has been documented in the literature, the costs of ESA’S and Transfusion might be another factor in determining which approach should be used.
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Gómez Codina, J., M. Provencio, A. Rueda, F. Capote, F. Carbonell, E. Conde, J. Fernandez Rañada, P. Giraldo, E. Rios y C. Varela. "Cost-effectiveness of rituximab maintenance therapy for patients with follicular lymphoma: The Spanish perspective". Journal of Clinical Oncology 25, n.º 18_suppl (20 de junio de 2007): 8092. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.8092.
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8092 Background: In patients with relapsed or refractory follicular lymphoma (FL) who attain a response with either cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) alone or Rituximab + CHOP, maintenance treatment with Rituximab has shown to significantly improve overall survival (OS) (85% at 3 years vs. 77%, p=0.011) and progression free survival (PFS) (51,5 vs. 14.9 months, p<0.001) as compared to observation alone (OA). We analyzed the cost-effectiveness, from a Spanish perspective, of Rituximab maintenance therapy (375mg/m2 every 3 months until progression or for 2 years) versus OA according to the population and data described for the European Organization for Research Treatment of Cancer (EORTC) 20981 study (van Oers MHJ Blood 2006). Methods: Incremental cost-effectiveness was assessed through a deterministic, three health states model (disease-free, progression and death) transition model. Base case model: PFS and OS were extrapolated from EORTC 20981 data using a Weibull distribution, Rituximab maintenance benefit was assumed to last 5 years, 10 years time horizon, 3.5% discount rate on costs and benefits, and Spanish National Health Service perspective (direct costs only). Resource use was estimated from a Spanish expert panel and EORTC 20981 study. Unit costs were obtained from local databases (May 2006 €). Health states utility values were derived from an ad hoc study. Sensitivity analyses were performed for all mentioned variables. Results: For the base case, more quality-adjusted life years (QALY), life-years (LY) and progression-free survival years per patient on maintenance therapy were obtained versus OA (incremental values of 0.85, 0.94 and 1.46, respectively). Total cost per patient was higher with Rituximab than with OA (+8,026€). Incremental cost per QALY gained was 9,358€, with a cost per LY gained of 8.493€ and a cost per PFS year gained of 5,485€. In the sensitivity analysis, values ranged between 7.263€ and 22.160€ per QALY gained. Conclusions: This study confirms that in patients with relapsed /refractory FL who attain a response with further therapy, maintenance treatment with Rituximab compared to observation alone is cost-effective. No significant financial relationships to disclose.
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Szucs, Thomas D., Patricia R. Blank y Matthias Schwenkglenks. "Cost-Effectiveness of Ferric Carboxymaltose Supplementation in Chemotherapy-Induced Anemia Patients Treated with Erythropoiesis-Stimulating Agents." Blood 114, n.º 22 (20 de noviembre de 2009): 1372. http://dx.doi.org/10.1182/blood.v114.22.1372.1372.
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Abstract Abstract 1372 Poster Board I-394 Background: Erythropoiesis-stimulating agents (ESA) are widely used in the treatment of chemotherapy-induced anemia (CIA). ESA prescription has come under pressure in this indication due to safety concerns and because of their high acquisition price. Recent studies suggest that the efficiency of ESA can be maximized by optimising iron stores and iron bioavailability. However, little is known about the economic implications of adding intravenous ferric carboxymaltose (iv FCM; an innovative iv iron formulation allowing the administration of high iron dosages in a short time) to ESA treatment. Aims: This study aimed at estimating the incremental cost-effectiveness of adding iv FCM to ESA treatment in patients with CIA, in the Swiss health care setting. Methods: Using a Swiss third party perspective, incremental cost effectiveness of iv FCM use was expressed as cost per additional CIA patient responding to anemia treatment. Response rates and medical resource use parameters were retrieved as weighted averages from 4 randomised controlled clinical trials of solid tumour patients, which used other iv iron preparations. An assumption of equal clinical effectiveness was made. Mean treatment duration was 11.9 weeks. Unit costs were based on average ex-factory prices for ESAs. The European target ex-factory price for 100 mg iv FCM was €25. Results: Per-patient costs were determined to be €4'943 for ESA treatment alone and €5'227 for ESA plus iv FCM. The addition of iv iron to ESA increased the response rate from 55% to 74%. Hence, the incremental cost-effectiveness (cost per additional patient responding to treatment) for iv FCM was estimated at €1′455. Summary/conclusions: The addition of iv FCM to ESA treatment appears to be economically viable in patients with CIA, on the basis of a marked increase in response rate due to iv iron use. Additional economic analyses are certainly warranted, as soon as appropriate clinical data become available. Cost savings associated with reduced administration time are not covered by this analysis. Disclosures: Schwenkglenks: Amgen: Honoraria, Research Funding.