ESTRO-HERO survey: Radiotherapy equipment and departments in the European countries: Final results from the ESTRO-HERO survey

Background: Documenting the distribution of radiotherapy departments and the availability of radiotherapy equipment in the European countries is an important part of HERO the ESTRO Health Economics in Radiation Oncology project. HERO has the overall aim to develop a knowledge base of the provision of radiotherapy in Europe and build a model for health economic evaluation of radiation treatments at the European level. The aim of the current report is to describe the distribution of radiotherapy equipment in European countries. Methods: An 84-item questionnaire was sent out to European countries, principally through their national societies. The current report includes a detailed analysis of radiotherapy departments and equipment (questionnaire items 2629), analyzed in relation to the annual number of treatment courses and the socio-economic status of the countries. The analysis is based on validated responses from 28 of the 40 European countries defined by the European Cancer Observatory (ECO). Results: A large variation between countries was found for most parameters studied. There were 2192 linear accelerators, 96 dedicated stereotactic machines, and 77 cobalt machines reported in the 27 countries where this information was available. A total of 12 countries had at least one cobalt machine in use. There was a median of 0.5 simulator per MV unit (range 0.31.5) and 1.4 (range 0.44.4) simulators per department. Of the 874 simulators, a total of 654 (75%) were capable of 3D imaging (CT-scanner or CBCToption). The number of MV machines (cobalt, linear accelerators, and dedicated stereotactic machines) per million inhabitants ranged from 1.4 to 9.5 (median 5.3) and the average number of MV machines per department from 0.9 to 8.2 (median 2.6). The average number of treatment courses per year per MV machine varied from 262 to 1061 (median 419). While 69% of MV units were capable of IMRT only 49% were equipped for image guidance (IGRT). There was a clear relation between socio-economic status, as measured by GNI per capita, and availability of radiotherapy equipment in the countries. In many low income countries in Southern and Central-Eastern Europe there was very limited access to radiotherapy and especially to equipment for IMRT or IGRT. Conclusions: The European average number of MV machines per million inhabitants and per department is now better in line with QUARTS recommendations from 2005, but the survey also showed a significant heterogeneity in the access to modern radiotherapy equipment in Europe. High income countries especially in Northern-Western Europe are well-served with radiotherapy resources, other countries are facing important shortages of both equipment in general and especially machines capable of delivering high precision conformal treatments (IMRT, IGRT)

Authoritarian Responses to Foreign Pressure: Spending, Repression, and Sanctions

This paper explores how international sanctions affect authoritarian rulers’ decisions concerning repression and public spending composition, and how different authoritarian rulers respond to foreign pressure. If sanctions are assumed to increase the price of loyalty to the regime, then rulers whose budgets are not severely constrained by sanctions will tend to increase spending in those categories that most benefit their core support groups. In contrast, when constraints are severe due to reduced aid and trade, dictators are expected to greatly increase their levels of repression. Using data on regime types, public expenditures and spending composition (1970–2000) as well as on repression levels (1976–2001), we show that the empirical patterns conform well to our theoretical expectations. Single-party regimes, when targeted by sanctions, increase spending on subsidies and transfers which largely benefit more substantial sectors of the population and especially the urban classes. Likewise, military regimes increase their expenditures on goods and services, which include military equipment and soldiers’ and officers’ wages. Conversely, personalist regimes reduce spending in all categories, especially capital expenditures, while increasing repression much more than other regime types when targeted by sanctions.

Banning Obsolete Weapons or Reshaping Perceptions of Military Utility: Discursive Dynamics in Weapons Prohibitions

The paper focuses on the argumentative process through which new international norms prohibiting the use of weapons causing severe civilian harm emerge. It examines the debate surrounding the use and usefulness of landmines and cluster munitions and traces the process through which NGOs change conceptions of military utility and effectiveness of certain weapons by highlighting their humanitarian problems and questioning their military value. By challenging military thinking on these issues, NGOs redefine the terms of the debate – from a commonplace practice, the use of such weapons becomes controversial and military decisions need to be justified. The argument-counterargument dynamic shifts the burden of proof of the necessity and safety of the weapons to the users. The process witnesses the ability of NGOs to influence debates on military issues despite their disadvantaged position in hard security issue areas. It also challenges realist assumptions that only weapons that are obsolete or low-cost force equalizers for weak actors can be banned. To the contrary, the paper shows that in the case of landmines and cluster munitions, defining the military (in)effectiveness of the weapons is part and parcel of the struggle for their prohibition.

Measuring Intermediary Determinants of Early Childhood Health: A Composite Index Comparing Colombian Departments

In recent years there has been growing interest in composite indicators as an efficient tool of analysis and a method of prioritizing policies. This paper presents a composite index of intermediary determinants of child health using a multivariate statistical approach. The index shows how specific determinants of child health vary across Colombian departments (administrative subdivisions). We used data collected from the 2010 Colombian Demographic and Health Survey (DHS) for 32 departments and the capital city, Bogotá. Adapting the conceptual framework of Commission on Social Determinants of Health (CSDH), five dimensions related to child health are represented in the index: material circumstances, behavioural factors, psychosocial factors, biological factors and the health system. In order to generate the weight of the variables, and taking into account the discrete nature of the data, principal component analysis (PCA) using polychoric correlations was employed in constructing the index. From this method five principal components were selected. The index was estimated using a weighted average of the retained components. A hierarchical cluster analysis was also carried out. The results show that the biggest differences in intermediary determinants of child health are associated with health care before and during delivery.

Measuring early childhood health : a composite index comparing Colombian departments

This paper presents a composite index of early childhood health using a multivariate statistical approach. The index shows how child health varies across Colombian departments, -administrative subdivisions-. In recent years there has been growing interest in composite indicators as an efficient analysis tool and a way of prioritizing policies. These indicators not only enable multi-dimensional phenomena to be simplified but also make it easier to measure, visualize, monitor and compare a country’s performance in particular issues. We used data collected from the Colombian Demographic and Health Survey, DHS, for 32 departments and the capital city, Bogotá, in 2005 and 2010. The variables included in the index provide a measure of three dimensions related to child health: health status, health determinants and the health system. In order to generate the weight of the variables and take into account the discrete nature of the data, we employed a principal component analysis, PCA, using polychoric correlation. From this method, five principal components were selected. The index was estimated using a weighted average of the components retained. A hierarchical cluster analysis was also carried out. We observed that the departments ranking in the lowest positions are located on the Colombian periphery. They are departments with low per capita incomes and they present critical social indicators. The results suggest that the regional disparities in child health may be associated with differences in parental characteristics, household conditions and economic development levels, which makes clear the importance of context in the study of child health in Colombia.

A Game to Promote Understanding about UCD Methods and Process

The User-centered design (UCD) game is a tool forhuman-computer interaction practitioners to demonstrate the key user-centered design methodsand how they interrelate in the design process in an interactive and participatory manner. The target audiences are departments and institutions unfamiliar with UCD but whose work is related to the definition, creation, and update of a product or service.

Nuclear Weapons as Symbols. The Role of Norms in Nuclear Policy Making

Throughout history, nuclear weapons have been considered to be the ultimate weapons. This understanding largely detached them from the portfolio of conventional military means and assigned them a symbolic meaning that influenced the identity and norms creation of nations. In most countries today, the development of nuclear weapons is considered morally prohibitive, incompatible with a country’s identity and international outlook. In some states, however, these negative norms are overridden by a positive set of norms, causing nuclear weapons to become either symbols of invulnerability to perceived threats or the regalia of major power status. Main purpose of this paper is to explore on the conditions that cause most states to develop a moral aversion to nuclear weapons, yet effectively lead to their glorification in others. Many studies on the normative understanding of nuclear weapons consider the existence of a negative normative predisposition, often referred to as ‘nuclear taboo’, as a major factor in preventing their acquisition and use. Other studies acknowledge the existence of a nuclear taboo inhibiting the use of nuclear weapons, but point to the existence of the opposing effect of norms, frequently referred to as the ‘nuclear myth’, when it comes to the acquisition of nuclear weapons. This myth emerges when certain symbolic meanings are attached to nuclear weapons, such as a state’s identity, self-image, and its desired position in the international system. With 180 odd countries in the world abstaining from the acquisition of nuclear weapons and 8 countries in possession of them (with two further countries assumed to have pursued their acquisition), one might consider the dominance of the nuclear taboo over the nuclear myth to be the rule. The core question is thus why and how this relationship reversed in the case of defectors.

La mujer y la geografia universitaria española

This article lies within the sphere of studies initiated recently in various social sciences and which aim to introduce women's problems as an element of analysis, or in other words, the gender perspective. In the field of geography, the earliest contributions of this nature were made in English-speaking countries. It is only in the 1980s that similar contributions begin to appear in Spanish geography, albeit sporadically . In the first part of this article, an analysis is made of the presence of women geographers in Spanish universities, based on a questionnaire submitted to twenty-six departments of geography. The questionnaires provide information on the age, sex and marital status of women staff, and other relevant facts. It becomes evident that women lecturers are in the minority in Spanish university Geography Departments, especially in the top posts, although the percentage compares favourably with English-speaking countries. The second part of the article consists of a study of the written contributions of women geographers through the analysis of the various geographical magazines published by geography departments and other related bodies. The author reaches the conclusion that the percentage of articles written by women geographers is even lower than the corresponding percentage of staff members. Especially noteworthy is the very limited number of articles in the fields of physical geography and geographical theory, in contrast to a certain tendency to publish studies on, for example, population or urban topics with a highly restricted territorial scope

Pitfalls to Avoid when Measuring Institutions: Is 'Doing Business' Damaging Business?

Over recent years, both governments and international aid organizations have been devoting large amounts of resources to "simplifying" the procedures for setting up and formalizing firms. Many of these actions have focused on reducing the initial costs of setting up the firm, disregarding the more important role of business registers as a source of reliable information for judges, government departments and, above all, other firms. This reliable information is essential for reducing transaction costs in future dealings with all sorts of economic agents, both public and private. The priorities of reform policies should therefore be thoroughly reviewed, stressing the value of the legal institutions rather than trivializing them as is often the case.

Pitfalls to avoid when measuring institutions: Is "Doing Business" damaging business?

Over recent years, both governments and international aid organizations have been devoting large amounts of resources to simplifying the procedures for setting up and formalizing firms. Many of these actions have focused on reducing the initial costs of setting up the firm, disregarding the more important role of business registers as a source of reliable information for judges, government departments and, above all, other firms. This reliable information is essential for reducing transaction costs in future dealings with all sorts of economic agents, both public and private. The priorities of reform policies should therefore be thoroughly reviewed, stressing the value of the legal institutions rather than trivializing them as is often the case.

FOSS issues in technology transfers from the University to the Industry

FOSS has always been particularly welcome in Universities. Its spirit corresponds generally with the academic state of mind, and royalty-free technologies are particularly appreciated where money is usually lacking.But at the opposite side of the spectrum, the universities¿ TTO¿s (Technology Transfer Officers) are supposed to ¿valorize¿ the production of research departments and to enable profit making cooperations with the industry. How should FOSS licensing be tackled in such context?

Los libros de caballerías en América: huellas culturales y cultura impresa (1492-1516)

El propósito de este artículo es, a partir del análisis de la difusión impresa de la literatura caballeresca en lengua española, iniciar una reflexión sobre las dimensiones literarias y la difusión de la cultura de los súbditos de la Corona de Castilla que fueron desembarcando en tierras americanas durante los primeros viajes transatlánticos, aproximadamente entre 1492 y 1516.

Percepció del patrimoni militar a la província de Girona i la Catalunya Nord

L’objecte d’aquest estudi rau en plantejar si els ciutadans de la província de Girona, concretament de la ciutat de Figueres, tenen una percepció d’indiferència vers el seu patrimoni militar i en si aquesta percepció ha influït en el desenvolupament turístic d’aquest patrimoni

La crisi del segle III, preludi de la fi del món antic

[cat] L'any 235, quan Alexandre Sever fou occit per Maximí el Traci, es va inaugurar una «crisi» caracteritzada per una anarquia militar i per tot un seguit de crisis derivades i interconnectades entre elles: la politicoinstitucional, la militar, l'econòmica i la religiosa. Tradicionalment, es considera que aquest període es va cloure amb la pujada al tron de Dioclecià, l'any 284. Aquest emperador va instaurar un nou sistema polític, conegut per tetrarquia, que va permetre que quatre emperadors governessin al mateix temps però en plena concòrdia, gràcies al qual es va poder aplicar amb més eficàcia el cúmul de reformes que Dioclecià va posar en marxa per a redreçar l'Imperi. Ara bé, aquestes reformes tingueren un alt cost social i polític: una concepció teocràtica del poder que sacralitzava l'emperador i assimilava la seva funció de govern com una missió divina.

FEMA’s Capability Development After Katrina

After Action Reports for Hurricane Isaac & Sandy concluded that WebEOC was correct choice for FEMA’s Crisis Management System: real time data easily shared between FEMA Headquarters, Regions and Incident Management Assistance Teams; cloud capability allowed use on any web connected device, laptop, tablet, iPad, smart phone; intuitive System - Offgoing personnel able to train incoming reliefs on new features or changes within minutes; widespread use of WebEOC through out country in 19 other Federal Departments and Agencies, 40 States, hundreds of cities/counties and industry provided a number of users that had prior experience using WebEOC and reduced learning curve experienced when new systems are introduced; focusing on a single shared web database reduced creation of new single purpose databases, spreadsheets and share point sites allowing best practices to be captured, refined, shared and continued