895 resultados para Regional analysis


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INTRODUCTION: Acute respiratory distress syndrome (ARDS) is a common clinical syndrome with high mortality and long-term morbidity. To date there is no effective pharmacological therapy. Aspirin therapy has recently been shown to reduce the risk of developing ARDS, but the effect of aspirin on established ARDS is unknown.

METHODS: In a single large regional medical and surgical ICU between December 2010 and July 2012, all patients with ARDS were prospectively identified and demographic, clinical, and laboratory variables were recorded retrospectively. Aspirin usage, both pre-hospital and during intensive care unit (ICU) stay, was included. The primary outcome was ICU mortality. We used univariate and multivariate logistic regression analyses to assess the impact of these variables on ICU mortality.

RESULTS: In total, 202 patients with ARDS were included; 56 (28%) of these received aspirin either pre-hospital, in the ICU, or both. Using multivariate logistic regression analysis, aspirin therapy, given either before or during hospital stay, was associated with a reduction in ICU mortality (odds ratio (OR) 0.38 (0.15 to 0.96) P = 0.04). Additional factors that predicted ICU mortality for patients with ARDS were vasopressor use (OR 2.09 (1.05 to 4.18) P = 0.04) and APACHE II score (OR 1.07 (1.02 to 1.13) P = 0.01). There was no effect upon ICU length of stay or hospital mortality.

CONCLUSION: Aspirin therapy was associated with a reduced risk of ICU mortality. These data are the first to demonstrate a potential protective role for aspirin in patients with ARDS. Clinical trials to evaluate the role of aspirin as a pharmacological intervention for ARDS are needed.

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The Knowledge Exchange, Spatial Analysis and Healthy Urban Environments (KESUE) project has extended work previously undertaken by a QUB team of inter-disciplinary researchers engaged with the Physical Activity in the Regeneration of Connswater (PARC) project (Tully et al, 2013). The PARC project focussed on parts of East Belfast to assess the health impact of the Connswater Community Greenway. The KESUE project has aimed to extend some of the tools used initially in East Belfast so that they have data coverage of all of Belfast and Derry-Londonderry. The purpose of this has been to enable the development of evidence and policy tools that link features of the built environment with physical activity in these two cities. The project has used this data to help shape policy decisions in areas such as physical activity, park management, public transport and planning.

Working with a range of local partners who part-funded the project (City Councils in Belfast and Derry-Londonderry, Public Health Agency, Belfast Healthy Cities and Department of Regional Development), this project has mapped all the footpaths in the two cities (covering 37% of the NI population) and employed this to develop evidence used in strategies related to healthy urban planning. Using Geographic Information Systems (GIS), the footpath network has been used as a basis for a wide range of policy-relevant analyses including pedestrian accessibility to public facilities, site options for new infrastructure and assessing how vulnerable groups can access services such as pharmacies. Key outputs have been Accessibility Atlases and maps showing how walkability of the built environment varies across the two cities.

In addition to generating this useful data, the project included intense engagement with potential users of the research, which has led to its continued uptake in a number of policies and strategies, creating a virtuous circle of research, implementation and feedback. The project has proved so valuable to Belfast City Council that they have now taken on one of the researchers to continue the work in-house.

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Past research has frequently attributed the incidence of bank failures to macroeconomic cycles and/or downturns in the regional economy. More recent analyses have suggested that the incidence and severity of bank failures can be linked to governance failures, which may be preventable through more stringent disclosure and auditing requirements. Using data on bank failures during the years 1991 to 1997, for the US, Canada, the UK and Germany, this study examines the relationship between institutional characteristics of national legal and auditing systems and the incidence of bank failures. In the second part of our analysis we then examined the relationship between the same institutional variables and the severity of bank failures.
The first part of our study notes a significant correlation between the law and order tradition (‘rule of law’) of a national legal system and the incidence of bank failures. Nations which were assigned high 'rule of law’ scores by country risk guides appear to have been less likely to experience bank failures. Another variable which appears to impact on bank failure rates is the ‘risk of contract repudiation’. Countries with a greater ‘risk of contract repudiation’ appear to be more likely to experience bank failures. We suggest that this may be due to a greater ex ante protection of stakeholders in countries where contract enforcement is more stringent.
The results of the second part of our study are less clear cut. However, there appears to be a significant correlation between the amount paid out by national deposit insurers (our proxy for the severity of bank failures) and the macroeconomic variable 'GDP change'. Here our findings follow the conventional wisdom; with greater amounts of deposit insurance funds being paid during economic downturns (i.e. low or negative GDP 'growth' correlates with high amounts of deposit insurance being paid out). A less pronounced relationship with the severity of bank failures can also be established for the institutional variables ' accounting standards' as well as 'risk of contract repudiation'. Countries with more stringent ‘accounting standards’ and a low ‘risk of contract repudiation’ appear to have been less prone to severe bank failures.

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Long-term precipitation series are critical for understanding emerging changes to the hydrological cycle. To this end we construct a homogenized Island of Ireland Precipitation (IIP) network comprising 25 stations and a composite series covering the period 1850–2010, providing the second-longest regional precipitation archive in the British-Irish Isles. We expand the existing catalogue of long-term precipitation records for the island by recovering archived data for an additional eight stations. Following bridging and updating of stations HOMogenisation softwarE in R (HOMER) homogenization software is used to detect breaks using pairwise and joint detection. A total of 25 breakpoints are detected across 14 stations, and the majority (20) are corroborated by metadata. Assessment of variability and change in homogenized and extended precipitation records reveal positive (winter) and negative (summer) trends. Trends in records covering the typical period of digitization (1941 onwards) are not always representative of longer records. Furthermore, trends in post-homogenization series change magnitude and even direction at some stations. While cautionary flags are raised for some series, confidence in the derived network is high given attention paid to metadata, coherence of behaviour across the network and consistency of findings with other long-term climatic series such as England and Wales precipitation. As far as we are aware, this work represents the first application of HOMER to a long-term precipitation network and bodes well for use in other regions. It is expected that the homogenized IIP network will find wider utility in benchmarking and supporting climate services across the Island of Ireland, a sentinel location in the North Atlantic.

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BACKGROUND: Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control.

METHODS: Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75,000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights.

FINDINGS: 5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease.

INTERPRETATION: International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems.


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Background: Underweight and severe and morbid obesity are associated with highly elevated risks of adverse health outcomes. We estimated trends in mean body-mass index (BMI), which characterises its population distribution, and in the prevalences of a complete set of BMI categories for adults in all countries.

Methods: We analysed, with use of a consistent protocol, population-based studies that had measured height and weight in adults aged 18 years and older. We applied a Bayesian hierarchical model to these data to estimate trends from 1975 to 2014 in mean BMI and in the prevalences of BMI categories (<18·5 kg/m2 [underweight], 18·5 kg/m2 to <20 kg/m2, 20 kg/m2 to <25 kg/m2, 25 kg/m2 to <30 kg/m2, 30 kg/m2 to <35 kg/m2, 35 kg/m2 to <40 kg/m2, ≥40 kg/m2 [morbid obesity]), by sex in 200 countries and territories, organised in 21 regions. We calculated the posterior probability of meeting the target of halting by 2025 the rise in obesity at its 2010 levels, if post-2000 trends continue.
Findings: We used 1698 population-based data sources, with more than 19·2 million adult participants (9·9 million men and 9·3 million women) in 186 of 200 countries for which estimates were made. Global age-standardised mean BMI increased from 21·7 kg/m2 (95% credible interval 21·3–22·1) in 1975 to 24·2 kg/m2 (24·0–24·4) in 2014 in men, and from 22·1 kg/m2 (21·7–22·5) in 1975 to 24·4 kg/m2 (24·2–24·6) in 2014 in women. Regional mean BMIs in 2014 for men ranged from 21·4 kg/m2 in central Africa and south Asia to 29·2 kg/m2 (28·6–29·8) in Polynesia and Micronesia; for women the range was from 21·8 kg/m2 (21·4–22·3) in south Asia to 32·2 kg/m2 (31·5–32·8) in Polynesia and Micronesia. Over these four decades, age-standardised global prevalence of underweight decreased from 13·8% (10·5–17·4) to 8·8% (7·4–10·3) in men and from 14·6% (11·6–17·9) to 9·7% (8·3–11·1) in women. South Asia had the highest prevalence of underweight in 2014, 23·4% (17·8–29·2) in men and 24·0% (18·9–29·3) in women. Age-standardised prevalence of obesity increased from 3·2% (2·4–4·1) in 1975 to 10·8% (9·7–12·0) in 2014 in men, and from 6·4% (5·1–7·8) to 14·9% (13·6–16·1) in women. 2·3% (2·0–2·7) of the world's men and 5·0% (4·4–5·6) of women were severely obese (ie, have BMI ≥35 kg/m2). Globally, prevalence of morbid obesity was 0·64% (0·46–0·86) in men and 1·6% (1·3–1·9) in women.

Interpretation: If post-2000 trends continue, the probability of meeting the global obesity target is virtually zero. Rather, if these trends continue, by 2025, global obesity prevalence will reach 18% in men and surpass 21% in women; severe obesity will surpass 6% in men and 9% in women. Nonetheless, underweight remains prevalent in the world's poorest regions, especially in south Asia.

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From a macro perspective, it is widely acknowledged that University incubation models within a region are important stimulants of economic development through innovation and job creation. With the emergence of quadruple helix innovation ecosystems, universities have had re-evaluate their University incubation activity and models to engage more fully with industry and end users. However, within a given region, the type of University may influence their ability to engage with quadruple helix stakeholders and consequently impact their incubation activity. To date there is a scarcity of research which explores this 'meso' environment and its subsequent impact on University incubation models. Therefore, the aim of this paper is to use a stakeholder lens to explore University Incubation models within unique regional and organisational characteristics and constraints. The research methodology employed was based on a comparative case analysis of incubation of two different Universities within a UK peripheral region. It was found that variances existed in relation to the two universities incubation models which were found to result from both regional (macro environment) and organisational (meso environment) influences (i.e. university type). This research contributes to both regional and national agendas by empirically illustrating the need for appropriate design and tailoring of university incubation models (via acknowledgement of quadruple helix stakeholder influence) to incorporate contextual influences rather than adopting a best practise approach.

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Do ponto de vista da política económica, existe a possibilidade de utilizar a receita dos impostos ambientais para baixar os impostos sobre o trabalho, promovendo assim o emprego. Esta oportunidade surge na literatura como forma dos países industrializados responderem a um duplo desafio: um crescente nível de poluição e um decrescente nível de emprego. Alguns países tomaram já decisões no sentido de alcançar o “duplo dividendo”: melhorias ambientais e diminuição do desemprego. Os resultados teóricos, na sua maioria cépticos em relação à verificação do segundo dividendo, são substancialmente contrariados por uma série de estudos que utilizam modelos de equilíbrio geral. Pretendese com este trabalho fazer uma simulação para a economia portuguesa de uma reforma fiscal ambiental com as características referidas e a verificação da existência do “duplo dividendo”, através de um modelo computacional de equilíbrio geral. Para além disso, é feita uma análise dos impactos do Mercado Europeu de Licenças de Emissão, ao nível sectorial e regional, em Portugal, utilizando dados microeconómicos, com o objectivo de estudar as consequências ao nível das trasacções entre sectores e efeitos distributivos entre regiões.

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Coronary CT angiography is widely used in clinical practice for the assessment of coronary artery disease. Several studies have shown that the same exam can also be used to assess left ventricle (LV) function. LV function is usually evaluated using just the data from end-systolic and end-diastolic phases even though coronary CT angiography (CTA) provides data concerning multiple cardiac phases, along the cardiac cycle. This unused wealth of data, mostly due to its complexity and the lack of proper tools, has still to be explored in order to assess if further insight is possible regarding regional LV functional analysis. Furthermore, different parameters can be computed to characterize LV function and while some are well known by clinicians others still need to be evaluated concerning their value in clinical scenarios. The work presented in this thesis covers two steps towards extended use of CTA data: LV segmentation and functional analysis. A new semi-automatic segmentation method is presented to obtain LV data for all cardiac phases available in a CTA exam and a 3D editing tool was designed to allow users to fine tune the segmentations. Regarding segmentation evaluation, a methodology is proposed in order to help choose the similarity metrics to be used to compare segmentations. This methodology allows the detection of redundant measures that can be discarded. The evaluation was performed with the help of three experienced radiographers yielding low intraand inter-observer variability. In order to allow exploring the segmented data, several parameters characterizing global and regional LV function are computed for the available cardiac phases. The data thus obtained is shown using a set of visualizations allowing synchronized visual exploration. The main purpose is to provide means for clinicians to explore the data and gather insight over their meaning, as well as their correlation with each other and with diagnosis outcomes. Finally, an interactive method is proposed to help clinicians assess myocardial perfusion by providing automatic assignment of lesions, detected by clinicians, to a myocardial segment. This new approach has obtained positive feedback from clinicians and is not only an improvement over their current assessment method but also an important first step towards systematic validation of automatic myocardial perfusion assessment measures.

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Esta tese tem como principal objetivo analisar as características, a importância e o papel da inovação territorial em turismo e o seu impacto no desenvolvimento dos destinos. Consiste num estudo multidisciplinar suportado numa exaustiva revisão da literatura sobre temas como desenvolvimento, inovação e modelos de inovação territorial. Com base nas principais conclusões de natureza conceptual, considerou-se o modelo dos sistemas regionais de inovação como o mais adequado para aplicação ao sistema turístico, e a constituição de redes como estruturas fundamentais para a sua operacionalização. A partir desta abordagem teórica, foi desenvolvido um quadro conceptual para a análise da inovação sistémica no sector do turismo. Esta abordagem permitiu a definição de um conjunto de hipóteses, as quais foram testadas através dos resultados da parte empírica da tese. Foram desenvolvidos dois estudos empíricos distintos, mas complementares nas regiões do Douro e de Aveiro. O primeiro teve como objetivo inquirir empresas turísticas, enquanto o segundo foi dirigido a instituições regionais com intervenção no sector do turismo ou na inovação. Os resultados obtidos conduziram a importantes conclusões sobre o desempenho das empresas e regiões em termos de inovação, os padrões de networking desenvolvidos no âmbito de processos de inovação, a importância do conhecimento existente nas regiões e os fatores específicos das mesmas para a inovação em turismo, a perceção das empresas turísticas sobre o ambiente de inovação e o seu contributo para a evolução e para o sucesso dos destinos turísticos. A tese recorre a uma abordagem quantitativa que inclui estatística descritiva e indutiva e ao método da análise de redes (sociometria). A combinação de métodos levou a importantes conclusões sobre a inovação em turismo, com uma focalização especial no que a relaciona com os sistemas regionais de inovação. As conclusões permitem avançar com um conjunto de implicações e sugestões para futuros projetos de investigação sobre o tema, bem como para a gestão dos destinos turísticos, uma vez que contribui para um maior e mais aprofundado conhecimento do fenómeno da inovação em turismo desenvolvida a nível regional. Os resultados demonstram que diferentes regiões apresentam sistemas regionais de inovação distintos. Assim, não existe um modelo único que possa ser aplicado indistintamente em todas as regiões. Contudo, as conclusões apontam para a existência de padrões e práticas que aperfeiçoam o seu funcionamento, aumentando o desempenho ao nível da inovação, bem como a competitividade global do destino.

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The better understanding of the interactions between climate change and air quality is an emerging priority for research and policy. Climate change will bring changes in the climate system, which will affect the concentration and dispersion of air pollutants. The main objective of the current study is to assess the impacts of climate change on air quality in 2050 over Portugal and Porto urban area. First, an evaluation and characterization of the air quality over mainland Portugal was performed for the period between 2002 and 2012. The results show that NO2, PM10 and O3 are the critical pollutants in Portugal. Also, the influence of meteorology on O3, NO2 and PM10 levels was investigate in the national main urban areas (Porto and Lisboa) and was verified that O3 has a statistically significant relationship with temperature in most of the components. The results also indicate that emission control strategies are primary regulators for NO2 and PM10 levels. After, understanding the national air quality problems and the influence that meteorology had in the historical air quality levels, the air quality modelling system WRF-CAMx was tested and the required inputs for the simulations were prepared to fulfil the main goal of this work. For the required air quality modelling inputs, an Emission Projections under RCP scenarios (EmiPro-RCP) model was developed to assist the estimation of future emission inventories for GHG and common air pollutants. Also, the current emissions were estimated for Portugal with a higher detailed disaggregation to improve the performance of the air quality simulations. The air quality modelling system WRF/CAMx was tested and evaluated over Portugal and Porto urban area and the results point out that is an adequate tool for the analysis of air quality under climate change. For this purpose, regional simulations of air quality during historical period and future (2045-2050) were conducted with CAMx version 6.0 to evaluate the impacts of simulated future climate and anthropogenic emission projections on air quality over the study area. The climate and the emission projections were produced under the RCP8.5 scenario. The results from the simulations point out, that if the anthropogenic emissions keep the same in 2050, the concentrations of NO2, PM10 and O3 will increase in Portugal. When, besides the climate change effects, is consider the projected anthropogenic emissions the annual mean concentrations of NO2 decrease significantly in Portugal and Porto urban area, and on the contrary the annual mean PM10 concentrations increases in Portugal and decrease in Porto urban area. The O3 results are mainly caused by the reduction of ozone precursors, getting the higher reductions in urban areas and increases in the surrounding areas. All the analysis performed for both simulations for Porto urban area support that, for PM10 and O3, there will be an increase in the occurrence of extreme values, surpassing the annual legislated parameters and having more daily exceedances. This study constitutes an innovative scientific tool to help in future air quality management in order to mitigate future climate change impacts on air quality.

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The research is centred on economic growth and it adopts a regional view focused on European regions (NUTS 2). Under analysis is the undergoing convergence process in Europe to evaluate if there is an increase in regional economic growth and a simultaneous decrease in regional disparities. The empirical evidence shows signs of transience on the regional convergence process, along with the formation of several clusters of regions. Considering this evidence it is of interest to assess the profiles of such clusters, and evaluate the homogeneousness of its regions and their spread across European space. As suggested in the literature, space is a relevant factor in the spread of clusters, according to the different variables (regions profiles, diversity measures and growth indicators). Regional disparities across Europe are, on average, large and persistent, with a high degree of stability among the relative rankings of European regions. Such results cast shadows about the impact of European structural funding in diminishing regional disparities. Such an approach is of interest due to the growing need to evaluate the effectiveness and efficiency of public policies implemented. The fact that there is an undergoing process of economic integration in Europe increases the usefulness of such an analysis, especially in a context in which European public funds are negotiated and granted.

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Dissertação de mest., Economia Regional e Desenvolvimento Local, Faculdade de Economia, Univ. do Algarve, 2011

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Tourism sector in Algarve region is the main engine of regional economy. Although frequently, tourism is considered as a low – moderate innovative sector, tourism competitiveness is still highly dependent on specific features of a Regional Innovation Platform, highlighting the crucial importance of knowledge creation and diffusion, learning, cooperative and collaborative interaction that may evolve to a Regional Innovation System (RIS). Studies of Local Knowledge Spillovers have been frequently focused on empirical evidence provided by regions highly related with manufacturing sectors. Considering a case study in Tourism Algarve Region, emphasizing a theoretical character on the analysis of these areas and using a qualitative methodology, the goal of this study was to provide preliminary evidence of the main sources and vehicles of regional knowledge spillovers used by tourism enterprises. Main information has been obtained using primary information collected from 20 interviews over main stakeholders regarding regional private and public sector. Primary information was complemented with secondary information, a deeply and extensive bibliography revision and also statistical information. Results show that, on the one hand, main sources of knowledge used by micro and small tourism enterprises are human resources and formal and informal networks. On the other hand, large tourism companies are weakly related with regional sources using mainly internal company and economic group resources to generate innovation activities. Regional innovation platform shows clear weaknesses on linkages and coordinated initiatives to promote and support innovation performance of firms hampering to increase tourism competitiveness and regional development.

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Every can of tuna purchased by the consumer has taken a long journey before reaching the supermarket shelves. For each can bought there is a lengthy process from sea to shelf. A large proportion of the tuna cans purchased in the European Union come all the way from West Africa; a developing region with a high dependency on fisheries. Amidst an ever-increasing demand for tuna products the global tuna fisheries are set to continue expanding, apparently one of the last natural resource based industries fit to do so in West Africa. Tuna is the biggest fisheries export and dominates the fisheries sector in Ghana, a country situated in West Africa. This thesis aims to understand how this globally important industrial fisheries functions in terms of procedures, practices, Governance and finance. Socioeconomic influences, in the setting of a developing country, were also examined. For these purposes a Value Chain Analysis was employed. A Value Chain Analysis is a tool commonly used to understand how different companies and organizations participate in a domestic policy environment, which directs conclusion in the global economy. This analysis has the potential to allow researchers to fully understand a commodity chain and hence identify realistic opportunities for consequential improvements. Interviews and questionnaires were employed in-field Ghana along with secondary data collection techniques. It was found that the fisheries functions at the production level under influences from large multinational companies and tends to operate with a certain degree of lawlessness. Governance over the value chain is well defined, however implementation is poor or non-existent. The processors, whom are also dominated by multinationals, exert some control over the producers and their sales, however the high value links which are highlighted occur at the retail stage. Socioeconomic dynamics acting in the chain included the lack of communication between the public and private sector, power imbalances amongst players at production, the role of local businesswomen as actors in the chain and the general characteristics of the workers in the industry. Value addition and upgrading are needed the most in Governance over the chain, especially within Monitoring, Control and Surveillance. The results of the study provide a wealth of material about the components of a cost-heavy fishing industry in a developing country; an industry on which many eyes have recently turned due to illegal fishing activities. It highlights clearly where funding and future focus are needed. This value chain can be used as a guide for those that need to comprehend the financial complexities and real life dynamics of the Ghanaian tuna fishing industry today.