Colorectal cancer survival in the USA and Europe: a CONCORD high-resolution study.

OBJECTIVES: To assess the extent to which stage at diagnosis and adherence to treatment guidelines may explain the persistent differences in colorectal cancer survival between the USA and Europe. DESIGN: A high-resolution study using detailed clinical data on Dukes' stage, diagnostic procedures, treatment and follow-up, collected directly from medical records by trained abstractors under a single protocol, with standardised quality control and central statistical analysis. SETTING AND PARTICIPANTS: 21 population-based registries in seven US states and nine European countries provided data for random samples comprising 12 523 adults (15-99 years) diagnosed with colorectal cancer during 1996-1998. OUTCOME MEASURES: Logistic regression models were used to compare adherence to 'standard care' in the USA and Europe. Net survival and excess risk of death were estimated with flexible parametric models. RESULTS: The proportion of Dukes' A and B tumours was similar in the USA and Europe, while that of Dukes' C was more frequent in the USA (38% vs 21%) and of Dukes' D more frequent in Europe (22% vs 10%). Resection with curative intent was more frequent in the USA (85% vs 75%). Elderly patients (75-99 years) were 70-90% less likely to receive radiotherapy and chemotherapy. Age-standardised 5-year net survival was similar in the USA (58%) and Northern and Western Europe (54-56%) and lowest in Eastern Europe (42%). The mean excess hazard up to 5 years after diagnosis was highest in Eastern Europe, especially among elderly patients and those with Dukes' D tumours. CONCLUSIONS: The wide differences in colorectal cancer survival between Europe and the USA in the late 1990s are probably attributable to earlier stage and more extensive use of surgery and adjuvant treatment in the USA. Elderly patients with colorectal cancer received surgery, chemotherapy or radiotherapy less often than younger patients, despite evidence that they could also have benefited.

Collective Marketing Arrangements for Geographically Differentiated Agricultural Products: Welfare Impacts and Policy Implications, May 2006

This paper examines the incentive of atomistic agricultural producers within a specific geographical region to differentiate and collectively market products. We develop a model that allows us to analyze the market and welfare effects of the main types of real-world producer organizations, using it to derive economic insights regarding the circumstances under which these organizations will evolve, and describing implications of the results obtained in the context of an ongoing debate between the European Union and United States. As the anticipated fixed costs of development and marketing increase and the anticipated size of the market falls, it becomes essential to increase the ability of the producer organization to control supply in order to ensure the coverage of fixed costs. Whenever a collective organization allows a market (with a new product) to exist that otherwise would not have existed there is an increase in societal welfare. Counterintuitively, stronger property right protection for producer organizations may be welfare enhancing even after a differentiated product has been developed. The reason for this somewhat paradoxical result is that legislation aimed at curtailing the market power of producer organizations may induce large technological distortions.

Fiscal decentralization policies and sub-national government debt in evolving federations

As part of a process of democratization, many countries spanning Europe, Latin Amertica, Africa, and Asia are reorganizing their governments bydevolving fiscal responsibility and authority to newly empowered regionaland local governments. Although decentralization in each country proceedsdifferently, a common element tends to be an initially heavy relianceon central government grants to fund regional spending. We develop atheoretical model of regional borrowing decisions in which the incentivesfor regional borrowing depend crucially on how the regions expect thefederal system of finance to evolve. We examine the implications of themodel using data on Spanish regions for the period 1984-1995 and findevidence that regions may be borrowing inefficiently in response toincentives imbedded in the Spanish system of fiscal decentralization.

The transmission of US shocks to Latin America

I study whether and how US shocks are transmitted to eight Latin American countries. US shocks are identified using sign restrictions and treated as exogenous with respect to Latin American economies. Posterior estimates for individual and average effects are constructed. US monetary shocks produce significant fluctuations in Latin America, but real demand and supply shocks do not. Floaters and currency boarders display similar output but different inflation and interest rate responses. The financial channel plays a crucial role in the transmission. US disturbances explain important portions of the variability of LatinAmerican macrovariables, producing continental cyclical fluctuations and, in two episodes, destabilizing nominal exchange rate effects. Policy implications are discussed.

Comparison and evaluation of states of health

Starting from a finite or countable set of states of health, and assumingthe existence of an objective transitive preference relation on that set,we propose a way of performing interpersonal comparisons of states ofhealth. In so doing, we first consider the population divided into types,and consider that two individuals of a different type have a comparablestate of health whenever they sit at the same centile of their respectivetype. A way of comparing and evaluating states of health for differentgroups is then proposed and rationalized. This can be viewed as both analternative and an extension of the traditional QALY approach.

The Island of Drive. Representations, somatic states and the origin of drive

Freud defined the drive as "a concept on the frontier between the mental and the somatic". Today this view that was based on clinical observations interpreted within the psychoanalytical framework, can be revisited in light of the current neuroscientific notions of neuronal plasticity and somatic states. Indeed, through the mechanisms of plasticity experience leaves a trace that forms the neural basis of a representation of the experience. Such a representation R is associated with a somatic state S in the sense taken from the "somatic marker" model of Damasio. Thus, the internal reality of the subject, particularly the unconscious one, is constituted by such connected R's and S's. In the model that we discuss, the posterior insula represents the primary interoceptive cortex where information about somatic states S converges, while in the anterior insula the connection between R and S can take place and establish a neurobiological correlate for the notion of drive. We posit that the re-representations of S associated with R in the anterior insula may correspond to the Vorstellungsrepräsentanz postulated by Freud. We further propose that the tension between R and S established in the anterior insula is discharged according to the notion of drive through the motor arm of the limbic system, namely the anterior cingulate cortex which is heavily connected with the anterior insula.

Optimization of Snow Drifting Mitigation and Control Methods for Iowa Conditions Part II, TR-626, 2015

Blowing and drifting of snow is a major concern for transportation efficiency and road safety in regions where their development is common. One common way to mitigate snow drift on roadways is to install plastic snow fences. Correct design of snow fences is critical for road safety and maintaining the roads open during winter in the US Midwest and other states affected by large snow events during the winter season and to maintain costs related to accumulation of snow on the roads and repair of roads to minimum levels. Of critical importance for road safety is the protection against snow drifting in regions with narrow rights of way, where standard fences cannot be deployed at the recommended distance from the road. Designing snow fences requires sound engineering judgment and a thorough evaluation of the potential for snow blowing and drifting at the construction site. The evaluation includes site-specific design parameters typically obtained with semi-empirical relations characterizing the local transport conditions. Among the critical parameters involved in fence design and assessment of their post-construction efficiency is the quantification of the snow accumulation at fence sites. The present study proposes a joint experimental and numerical approach to monitor snow deposits around snow fences, quantitatively estimate snow deposits in the field, asses the efficiency and improve the design of snow fences. Snow deposit profiles were mapped using GPS based real-time kinematic surveys (RTK) conducted at the monitored field site during and after snow storms. The monitored site allowed testing different snow fence designs under close to identical conditions over four winter seasons. The study also discusses the detailed monitoring system and analysis of weather forecast and meteorological conditions at the monitored sites. A main goal of the present study was to assess the performance of lightweight plastic snow fences with a lower porosity than the typical 50% porosity used in standard designs of such fences. The field data collected during the first winter was used to identify the best design for snow fences with a porosity of 50%. Flow fields obtained from numerical simulations showed that the fence design that worked the best during the first winter induced the formation of an elongated area of small velocity magnitude close to the ground. This information was used to identify other candidates for optimum design of fences with a lower porosity. Two of the designs with a fence porosity of 30% that were found to perform well based on results of numerical simulations were tested in the field during the second winter along with the best performing design for fences with a porosity of 50%. Field data showed that the length of the snow deposit away from the fence was reduced by about 30% for the two proposed lower-porosity (30%) fence designs compared to the best design identified for fences with a porosity of 50%. Moreover, one of the lower-porosity designs tested in the field showed no significant snow deposition within the bottom gap region beneath the fence. Thus, a major outcome of this study is to recommend using plastic snow fences with a porosity of 30%. It is expected that this lower-porosity design will continue to work well for even more severe snow events or for successive snow events occurring during the same winter. The approach advocated in the present study allowed making general recommendations for optimizing the design of lower-porosity plastic snow fences. This approach can be extended to improve the design of other types of snow fences. Some preliminary work for living snow fences is also discussed. Another major contribution of this study is to propose, develop protocols and test a novel technique based on close range photogrammetry (CRP) to quantify the snow deposits trapped snow fences. As image data can be acquired continuously, the time evolution of the volume of snow retained by a snow fence during a storm or during a whole winter season can, in principle, be obtained. Moreover, CRP is a non-intrusive method that eliminates the need to perform man-made measurements during the storms, which are difficult and sometimes dangerous to perform. Presently, there is lots of empiricism in the design of snow fences due to lack of data on fence storage capacity on how snow deposits change with the fence design and snow storm characteristics and in the estimation of the main parameters used by the state DOTs to design snow fences at a given site. The availability of such information from CRP measurements should provide critical data for the evaluation of the performance of a certain snow fence design that is tested by the IDOT. As part of the present study, the novel CRP method is tested at several sites. The present study also discusses some attempts and preliminary work to determine the snow relocation coefficient which is one of the main variables that has to be estimated by IDOT engineers when using the standard snow fence design software (Snow Drift Profiler, Tabler, 2006). Our analysis showed that standard empirical formulas did not produce reasonable values when applied at the Iowa test sites monitored as part of the present study and that simple methods to estimate this variable are not reliable. The present study makes recommendations for the development of a new methodology based on Large Scale Particle Image Velocimetry that can directly measure the snow drift fluxes and the amount of snow relocated by the fence.

Road Safety Audit for US 151 from Amana to US 30 in Cedar Rapids in Benton, Iowa and Linn Counties, Iowa, 2010

US 151 was originally constructed as IA 149 in 1931-1934 and has been rehabilitated several times. The most recent major improvements, which were completed in 2005-2006, consisted of hot mix asphalt resurfacing and partial shoulder paving. Major widening and resurfacing improvements were also completed in 2007 between Fairfax and US 30 in Cedar Rapids. According to a preliminary 2009 estimate, traffic volumes range from about 5,900 vehicles per day (vpd) north of Amana to about 14,400 vpd at the US 30 interchange in Cedar Rapids. In response to high crash densities and medium to medium-high crash rates along the route, the Iowa Department of Transportation (Iowa DOT) requested a road safety audit to examine the roadway and suggest possible mitigation. Representatives from the Iowa DOT, Federal Highway Administration, Institute for Transportation, local law enforcement, and state government met to review crash data and discuss potential safety improvements to this segment of US 151. This report outlines the findings and recommendations of the road safety audit team for addressing the safety concerns on this roadway.

Comparisons of intensity-duration patterns of physical activity in the US, Jamaica and 3 African countries.

BACKGROUND: This difference in how populations living in low-, middle or upper-income countries accumulate daily PA, i.e. patterns and intensity, is an important part in addressing the global PA movement. We sought to characterize objective PA in 2,500 participants spanning the epidemiologic transition. The Modeling the Epidemiologic Transition Study (METS) is a longitudinal study, in 5 countries. METS seeks to define the association between physical activity (PA), obesity and CVD risk in populations of African origin: Ghana (GH), South Africa (SA), Seychelles (SEY), Jamaica (JA) and the US (suburban Chicago). METHODS: Baseline measurements of objective PA, SES, anthropometrics and body composition, were completed on 2,500 men and women, aged 25-45 years. Moderate and vigorous PA (MVPA, min/d) on week and weekend days was explored ecologically, by adiposity status and manual labor. RESULTS: Among the men, obesity prevalence reflected the level of economic transition and was lowest in GH (1.7%) and SA (4.8%) and highest in the US (41%). SA (55%) and US (65%) women had the highest levels of obesity, compared to only 16% in GH. More men and women in developing countries engaged in manual labor and this was reflected by an almost doubling of measured MPVA among the men in GH (45 min/d) and SA (47 min/d) compared to only 28 min/d in the US. Women in GH (25 min/d), SA (21 min/d), JA (20 min/d) and SEY (20 min/d) accumulated significantly more MPVA than women in the US (14 min/d), yet this difference was not reflected by differences in BMI between SA, JA, SEY and US. Moderate PA constituted the bulk of the PA, with no study populations except SA men accumulating > 5 min/d of vigorous PA. Among the women, no sites accumulated >2 min/d of vigorous PA. Overweight/obese men were 22% less likely to engage in manual occupations. CONCLUSION: While there is some association for PA with obesity, this relationship is inconsistent across the epidemiologic transition and suggests that PA policy recommendations should be tailored for each environment.

Federal Dynamics in Times of Economic and Financial Crisis

The global economic and financial crisis is a challenge for all governments, but particularly for federal states because divided and/or shared territorial powers make federations susceptible to coordination problems in fiscal policy making. This article explores the effects of the ongoing crisis on federal relations. Three kinds of problems that may become the cause of federal tensions and conflicts are evoked: opportunism of subgovernments, centralisation and erosion of solidarity among members of the federation. Our analysis of fiscal policies and federal conflicts of 11 federations between 2007 and the present reveals three kinds of coordination problems: shirking in the use of federal government grants, rent-seeking in equalisation payments, and over-borrowing and over-spending. Our results show that shirking remained limited to few cases and occurred only in the first part of the crisis. However, rent-seeking and over-borrowing and over-spending led to a reduction of solidarity among subgovernments and to increased regulation of the fiscal discretion of the members of the federation. Subsequently, tensions in federal relations increased - although only in one case did this challenged the federal order.

The Impact of Electrical Capacity Market Mechanisms on Capacity Mobility and End Use Customer Pricing

Potential impacts of electrical capacity market design on capacity mobility and end use customer pricing are analyzed. Market rules and historical evolution are summarized to provide a background for the analysis. The summarized rules are then examined for impacts on capacity mobility. A summary of the aspects of successful capacity markets is provided. Two United States market regions are chosen for analysis based upon their market history and proximity to each other. The MISO region is chosen due to recent developments in capacity market mechanisms. The PJM region neighbors the MISO region and is similar in size and makeup. The PJM region has had a capacity market mechanism for over a decade and allows for a controlled comparison of the MISO region’s developments. Capacity rules are found to have an impact on the mobility of capacity between regions. Regulatory restrictions and financial penalties for the movement of capacity between regions are found which effectively hinder such mobility. Capacity market evolution timelines are formed from the historical evolution previously summarized and compared to historical pricing to inspect for a correlation. No direct and immediate impact on end use customer pricing was found due to capacity market design. The components of end use customer pricing are briefly examined.

Incidencia de la política de autonomía fiscal de los Estados miembros de la UE en el comercio intrazona. Estudio de caso: El Impuesto Excepcional de Crisis húngaro en su relación comercial con Austria y Alemania. Período 2010-2011

En el año 2010 el gobierno húngaro implementó el Impuesto Excepcional de Crisis, que grava a las empresas del sector de telecomunicaciones, energía y agroalimentario con el fin de hacer frente a los graves problemas fiscales que aquejaban a Hungría. Dicho impuesto se enmarca dentro de la política de autonomía fiscal de los Estados miembros de la UE, ya que cada gobierno tiene potestad para determinar la cuantía de los impuestos sobre las empresas con el fin de que se puedan cumplir los intereses económicos nacionales; aun así, dicha autonomía se basa en el respeto al tratado de Maastricht y al pacto de estabilidad y crecimiento, que establecen que las políticas fiscales de los Estados miembros deben estar en armonía con la libre circulación de mercancías, servicios y capitales, así como un trato equitativo a todas las empresas, ya sean nacionales o extranjeras. Este gravamen recae principalmente en empresas ligadas al sector de las exportaciones en Hungría, con nacionalidad de Austria y Alemania, los principales socios comerciales de Hungría, afectando de esta forma las relaciones comerciales de los actores en mención. Así, el trabajo analiza las implicaciones que tiene dicho impuesto para la consecución del interés económico de Hungría, a partir de su incidencia en las metas fiscales y el comercio que este Estado tiene con Austria y Alemania.

Factores que determinan el aumento o la disminución de cooperación internacional en Colombia por parte de Estados Unidos a través de la Agencia de Estados Unidos para el Desarrollo - USAID

El interés de este estudio de caso es responder a la pregunta ¿Cuáles son los factores que determinan la ayuda de cooperación internacional en Colombia por parte de Estados Unidos a través de su agencia USAID? El propósito más puntual es explicar que estos factores están relacionados con aspectos externos ajenos a la manipulación de estos recursos por parte del gobierno colombiano. Estos factores son, crisis económicas internacionales, política exterior de ambos actores, intereses de las instituciones que asignan los recursos y priorización de Estados Unidos en materia de cooperación internacional. Para esto, se realizará un estudio más dinámico de las posibles variables que se presentan al momento de identificar los determinantes del aumento o la disminución de la cooperación internacional en Colombia. Siguiendo la perspectiva liberal, se avanza hacia el resultado de la investigación que permite identificar y corroborar de forma clara estos factores que determinan el aumento o la disminución de la cooperación internacional.

La diplomacia cultural como herramienta para el mejoramiento de la relación económica de Colombia con Corea del Sur y Australia

Esta investigación se preocupa por dilucidar la función de la diplomacia cultural como herramienta para mejorar la relación económica de Colombia con Corea del Sur y Australia. Así, se analiza a la diplomacia cultural y lo que hace Colombia en esta materia en ambos países; así como el estado de la relación económica de Colombia en un periodo de ocho años con dichos países, y cómo las acciones culturales colombianas podrían llegar a mejorar dicha relación económica. De esta manera además del desarrollo conceptual de diplomacia cultural y los indicadores económicos, a saber; exportaciones; Inversión Extranjera Directa y turismo; se corrió un modelo de regresión lineal para saber si efectivamente hay relación entre ambas variables y una contribución final que consiste en una propuesta de generación de indicadores de gestión a utilizarse al momento de implementar la diplomacia cultural como herramienta en política exterior.