A model to assess the cost effectiveness of statins in achieving the UK National Service Framework target cholesterol levels

Background: Coronary heart disease (CHD) is a public health priority in the UK. The National Service Framework (NSF) has set standards for the prevention, diagnosis and treatment of CHD, which include the use of cholesterol-lowering agents aimed at achieving targets of blood total cholesterol (TC) < 5.0 mmol/L and low density lipoprotein-cholesterol (LDL-C) < 3.0 mmol/L. In order to achieve these targets cost effectively, prescribers need to make an informed choice from the range of statins available. Aim: To estimate the average and relative cost effectiveness of atorvastatin, fluvastatin, pravastatin and simvastatin in achieving the NSF LDL-C and TC targets. Design: Model-based economic evaluation. Methods: An economic model was constructed to estimate the number of patients achieving the NSF targets for LDL-C and TC at each dose of statin, and to calculate the average drug cost and incremental drug cost per patient achieving the target levels. The population baseline LDL-C and TC, and drug efficacy and drug costs were taken from previously published data. Estimates of the distribution of patients receiving each dose of statin were derived from the UK national DIN-LINK database. Results: The estimated annual drug cost per 1000 patients treated with atorvastatin was £289 000, with simvastatin £315 000, with pravastatin £333 000 and with fluvastatin £167 000. The percentages of patients achieving target are 74.4%, 46.4%, 28.4% and 13.2% for atorvastatin, simvastatin, pravastatin and fluvastatin, respectively. Incremental drug cost per extra patient treated to LDL-C and TC targets compared with fluvastafin were £198 and £226 for atorvastatin, £443 and £567 for simvastatin and £1089 and £2298 for pravastatin, using 2002 drug costs. Conclusions: As a result of its superior efficacy, atorvastatin generates a favourable cost-effectiveness profile as measured by drug cost per patient treated to LDL-C and TC targets. For a given drug budget, more patients would achieve NSF LDL-C and TC targets with atorvastatin than with any of the other statins examined.

Resource-efficient supply chains:a research framework, literature review and research agenda

Purpose: To define a research agenda for creating Resource-Efficient Supply Chains (RESC) by identifying and analysing their key characteristics as well as future research opportunities. Design/methodology/approach: We follow a systematic review method to analyse the literature and to understand RESC taking a substantive theory approach. Our approach is grounded in a specific domain, the agri-food sector, because it is an intensive user of an extensive range of resources. Findings: The review shows that literature has looked at the use of resources primarily from the environmental impact perspective. It shows a lack of understanding of the specific RESC characteristics, and concludes more research is needed on multi-disciplinary methods for resource use and impact analyses as well as assessment methods for resource sensitivity and responsiveness. There is a need to explore whether or not, and how, logistics/supply chain decisions will affect the overall configuration of future food supply chains in an era of resource scarcity and depletion and what the trade-offs will be. Research limitations/implications: The paper proposes an agenda for future research in the area of resource–efficient supply chain. The framework proposed along with the key characteristics identified for RESC can be applied to other sectors. Practical implications: Our research should facilitate further understanding of the implications and trade-offs of supply chain decisions taken on the use of resources by supply chain managers. Originality/value: The paper explores the interaction between supply chains and natural resources and also defines the key characteristics of RESC.

Automated Software Reengineering Model and Framework

Тодор П. Чолаков, Димитър Й. Биров - Тази статия представя цялостен модел за автоматизиран реинженеринг на наследени системи. Тя описва в детайли процесите на превод на софтуера и на рефакторинг и степента, до която могат да се автоматизират тези процеси. По отношение на превода на код се представя модел за автоматизирано превеждане на код, съдържащ указатели и работа с адресна аритметика. Също така се дефинира рамка за процеса на реинженеринг и се набелязват възможности за по-нататъшно развитие на концепции, инструменти и алгоритми.

Combined quality function deployment and logical framework analysis to improve quality of emergency care in Malta

Purpose – The purpose of this paper is to develop an integrated patient-focused analytical framework to improve quality of care in accident and emergency (A&E) unit of a Maltese hospital. Design/methodology/approach – The study adopts a case study approach. First, a thorough literature review has been undertaken to study the various methods of healthcare quality management. Second, a healthcare quality management framework is developed using combined quality function deployment (QFD) and logical framework approach (LFA). Third, the proposed framework is applied to a Maltese hospital to demonstrate its effectiveness. The proposed framework has six steps, commencing with identifying patients’ requirements and concluding with implementing improvement projects. All the steps have been undertaken with the involvement of the concerned stakeholders in the A&E unit of the hospital. Findings – The major and related problems being faced by the hospital under study were overcrowding at A&E and shortage of beds, respectively. The combined framework ensures better A&E services and patient flow. QFD identifies and analyses the issues and challenges of A&E and LFA helps develop project plans for healthcare quality improvement. The important outcomes of implementing the proposed quality improvement programme are fewer hospital admissions, faster patient flow, expert triage and shorter waiting times at the A&E unit. Increased emergency consultant cover and faster first significant medical encounter were required to start addressing the problems effectively. Overall, the combined QFD and LFA method is effective to address quality of care in A&E unit. Practical/implications – The proposed framework can be easily integrated within any healthcare unit, as well as within entire healthcare systems, due to its flexible and user-friendly approach. It could be part of Six Sigma and other quality initiatives. Originality/value – Although QFD has been extensively deployed in healthcare setup to improve quality of care, very little has been researched on combining QFD and LFA in order to identify issues, prioritise them, derive improvement measures and implement improvement projects. Additionally, there is no research on QFD application in A&E. This paper bridges these gaps. Moreover, very little has been written on the Maltese health care system. Therefore, this study contributes demonstration of quality of emergency care in Malta.

A közösségi versenyképesség elméleti keretei = Analytical framework to study competitiveness of communities

Tanulmányunk célja a versenyképesség közösségi beágyazottságának elemzéséhez alkalmas elemzési keretek bemutatása és a versenyképesség fogalmának elemzése a fogalom intézményi, normatív tartalma szempontjából. Célunk a közösségi versenyképesség fogalmának és az ezt elemezni képes megközelítés kidolgozása. A feladat kettős: 1. A versenyképesség értelmezése a döntések közösségi keretei szempontjából 2. A közösségi keretek versenyképességre gyakorolt hatásának elemzése Ennek érdekében a tanulmány első fejezetében az egyéni döntést meghatározó tényezőket és az egyéni döntések jövőbeli interakciók környezetére gyakorolt hatását elemző keretet vázoljuk fel. Megközelítésünk szerint az egyéni döntést négy tényező határozza meg. a közösségi környezet, a természeti környezet, s személyes jellemzők és az interakciós partnerek. Az ez alapján születő döntések formálják a jövőbeli döntési környezetet. A döntések hatásának elemzéséhez a környezetre gyakorolt hatások értékelését orientáló fogalomra van szükség. Elemzésünk esetében ez a fogalom az értékteremtés, amit a következőképp határozunk meg: az értékteremtő tevékenységek során valaki arra törekszik, hogy saját személyes céljait a másokkal való kölcsönösen előnyös együttműködések lehetőségeinek bővítésével, hozamainak növelésével szolgálja. A második fejezetben az egyéni döntések közösségi kereteit és az egyéni döntések közösségre gyakorolt hatását elemezzük részletesen. A formális és informális intézmények világát, a közösségi magatartásokat szabályozó normák és konvenciók rendszerét a következő öt – a valóságban gyakran keveredő - alapelemre bontjuk értékrend, konvenció, közösségi szabály, hivatalos előírás, egyének közötti megállapodás. Ezek közül a magánszereplők együttműködésének az érintett szereplők által módosítható intézményi elemeinek (konvenció, megállapodás) alkalmazkodása a leggyorsabb, a közösség egészét irányító formális intézmények a status quo iránti elfogultságuk miatt lomhábbak, míg a közösség életét informálisan befolyásoló normák a legstabilabb intézményi elemek. A közösségek változása általában lassú, legtöbbször nem szándékolt hatások következménye. Mindezek mellett a közösségi intézmények tudatos alakításában komoly szerepe van (1) a konvenciókat megújító intézményi innovátoroknak, (2) a szerződéses formulákon módosító vállalkozóknak és (3) a hivatalos előírások formálásába bekapcsolódó politikai szereplőknek politikai vállalkozóként, tisztviselőként, vagy közéleti résztvevőként. A harmadik fejezetben a versenyképesség fogalmát elemezzük, és ez alapján határozzuk meg a közösségi versenyképesség fogalmát. Megvizsgáljuk, milyen feltevésekkel él a fogalom a közösségi környezettel kapcsolatban, illetve milyen normatív elemei vannak a definíciónak. A vizsgálathoz a versenyképesség fogalmának egy lecsupaszított változatát használtuk. E szerint a versenyképesség valaki képessége értékteremtő módon bekapcsolódni a gazdasági munkamegosztásba úgy, hogy tevékenysége relatív hozama nem csökken. Az elemzés alapján a versenyképesség a közösségi környezet következő hét elemére épül: 1. A közösség tagjainak és a tagság tartalmának meghatározottsága; 2. a potenciális együttműködő felek közös múltja, jövője, konvenció- és normarendszere; 3. A gazdasági együttműködés intézményeinek (csere, vállalkozás, tulajdon, szerződés) működőképessége; 4. Az értékteremtés normatív koncepciója és az arra épülő részleteiben meghatározott, és részleteiben is közösségi legitimációval bíró szabályrendszer; 5. Az innovációt támogató és a kellően rugalmas értékrend és közösségi szabályok. 6. A gazdasági munkamegosztás igényeihez részleteiben és változásával is igazodó konvenciók, hivatalos előírások és szerződések; 7. A közösségi környezet tudatos alakításával foglalkozó szereplők (közösségi innovátorok, vállalkozók és politikai szereplők) motivációja és lehetősége a hozamok relatív szintjének tartását támogató intézményi környezet karbantartásában. A versenyképesség fogalmának intézményi elemzése rámutat, hogy a fogalom gazdag értéktartalommal és határozott közösségi intézményrendszer-képpel rendelkezik. A közösségi versenyképesség ez alapján a versenyképesség fogalmába kódolt közösségi környezetként határozható meg. A kutatás következő lépése a közösségi versenyképesség meghatározása, az azt befolyásoló mechanizmusok feltárása és javítását támogató elemzési eszközök, gyakorlati segédletek kidolgozása. Ezen feladatok előkészítése érdekében a tanulmány mellékletében két történelmi esettanulmányt mutatunk be, röviden áttekintjük a téma szempontjából releváns irodalom főbb eredményeit és bemutatunk egy praktikus alkalmazásra szánt normatív elemzési eszközt, mellyel az elemezhető, hogy az állami lépések mennyire bátorítják az értékteremtő vállalkozást. _________ This paper (1) introduces an analytical framework to study the impact of the community on competitiveness and (2) analyses the institutional and normative content in the concept of competitiveness. The goal is to elaborate an approach that supports the definition and analysis of the ‘competiveness of community’. This task has two main parts: 1. interpretation of competiveness from social choice perspective 2. assessing the impact of social settings on the competiveness of a community The first chapter of the study draws up an analytical framework to study the social factors of individual decisions and their impact on the environment of future interactions. We focus on four main factors that shape setting of future interactions: social environment, natural environment, personal characteristics and partners in interactions. We use the concept of value creation to assess the impact of individual decisions on these factors. The second chapter discusses the social factors of individual decisions and the impact of individual decisions on the community. Institutions are conceptualized as value systems, conventions, community rules, official rules and contracts in the study. The conventions and contracts can accommodate to the changes of environment more smoothly, formal institutions are less flexible due to their bias toward status quo. Informal rules and value systems resists change more frequently. The formation of social environment is usually slow and based on unintended effects. Altogether (1) innovators who revise social conventions, (2) entrepreneurs who reshape contracts and (4) political entrepreneurs who formulate formal rules have influential roles on the institutional setting. The third chapter discusses the social assumptions included into the definition of competitiveness and we give a definition for the competiveness of communities. A simplified definition of competitiveness is used for this analysis: competiveness is someone’s ability and motivation to participate in the economic division of labor in a way that is based on value creation and maintains the relative return of activities. Our analysis reveals that competitiveness assumes the following features of the community: 1. Defined membership of community: who are the members and what does membership mean. 2. Common past, future, convention and norm system of the potential participants of interactions 3. Functionality of institutions that facilitate division of labor (exchange, entrepreneurship, property, contract) 4. Existing normative concept on value creation and social accepted rules that govern interactions 5. Value system and rules that promote innovation 6. Conventions, official norms and contracts that fits to economic division of labor in a detailed and dynamic way 7. Motivation and potential of actors who shape social environment consciously to maintain institutions in order to sustain the relative return of economic activities This analysis shows that the concept of competitiveness assumes well established values and detailed expectations on institutional settings. Followingly, competiveness of community can be defined with these criteria of social environment. Two historical case studies and the draft of a policy oriented toolkit demonstrate the applicability of the introduced approach in the appendix. The core findings of the literature are also reviewed there.

Evaluation of corporate environmental management approaches: A framework and application

This article proposes a framework to evaluate corporate environmental strategies. In the proposed framework, a company's environmental risks are analyzed on two dimensions, One dimension, the endogenous environmental risks, arises from the internal operations of the company. The other dimension, the exogenous environmental risks, are determined by the company's external world: its location, its ecological setting, and the demographic characteristics of the physical environment in which it operates. Four environmental management approaches are defined as a function of endogenous and exogenous environmental risks: reactive, proactive, strategic, and crisis preventive. The framework was applied in a survey of 141 company representatives in Hungary. A relationship was sought between the a priori defined environmental management approaches based on technology and location and the companies' environmental management characteristics defined by senior managers. Variables that differentiated among the four environmental management approaches were identified and ranked. The study concludes that there is a relatively well-defined relationship between the environmental risks of companies and the nature of their environmental management approaches, Implementing a strategic environmental management approach may not be the best option for all companies - although there is a growing pressure to do so.

The construct of work commitment: Testing an integrative framework

This dissertation meta-analytically examined the expansive material associated with work commitment. Work commitment, a multidimensional construct, encompasses the level of involvement an employee has with his or her work, organization, job, career, and union (Morrow & Goetz, 1998). Each of the dimensions of work commitment has been further divided into a number of subdimensions. The primary purpose of this study was to (1) cumulate the correlations found among each of the dimensions of work commitment to see which, if any, were intercorrelated, and to (2) determine the impact of work commitment dimensions and subdimensions on specific outcome variables (job satisfaction, job performance, and turnover). ^ A number of interesting results stemmed from the 213 separate meta-analyses that were conducted. First, the evidence did not indicate that all of the subdimensions for each respective dimension were positively correlated. Specifically, there was not enough evidence to indicate that continuance organizational commitment was positively correlated with its other organizational commitment subdimensions. Future research might consider revamping the work commitment taxonomy so that all subdimensions that fall within a particular dimension are interrelated. It might be appropriate, therefore, to drop continuance organizational commitment from the work commitment taxonomy. Second, while most of the respective dimensions were interrelated, this was not the case across the board. For instance, there was no evidence of a significant positive relationship between organizational commitment and union commitment. In fact, the only significant relationship was negative between organizational commitment and belief in unionism. Further, there was no evidence of a positive relationship between union commitment and either work ethic endorsement or job involvement, respectively. These findings supported Morrow's (1993) rationale for excluding union commitment from the work commitment taxonomy. ^

A multimedia indexing and retrieval framework for multimedia database systems

The main challenges of multimedia data retrieval lie in the effective mapping between low-level features and high-level concepts, and in the individual users' subjective perceptions of multimedia content. ^ The objectives of this dissertation are to develop an integrated multimedia indexing and retrieval framework with the aim to bridge the gap between semantic concepts and low-level features. To achieve this goal, a set of core techniques have been developed, including image segmentation, content-based image retrieval, object tracking, video indexing, and video event detection. These core techniques are integrated in a systematic way to enable the semantic search for images/videos, and can be tailored to solve the problems in other multimedia related domains. In image retrieval, two new methods of bridging the semantic gap are proposed: (1) for general content-based image retrieval, a stochastic mechanism is utilized to enable the long-term learning of high-level concepts from a set of training data, such as user access frequencies and access patterns of images. (2) In addition to whole-image retrieval, a novel multiple instance learning framework is proposed for object-based image retrieval, by which a user is allowed to more effectively search for images that contain multiple objects of interest. An enhanced image segmentation algorithm is developed to extract the object information from images. This segmentation algorithm is further used in video indexing and retrieval, by which a robust video shot/scene segmentation method is developed based on low-level visual feature comparison, object tracking, and audio analysis. Based on shot boundaries, a novel data mining framework is further proposed to detect events in soccer videos, while fully utilizing the multi-modality features and object information obtained through video shot/scene detection. ^ Another contribution of this dissertation is the potential of the above techniques to be tailored and applied to other multimedia applications. This is demonstrated by their utilization in traffic video surveillance applications. The enhanced image segmentation algorithm, coupled with an adaptive background learning algorithm, improves the performance of vehicle identification. A sophisticated object tracking algorithm is proposed to track individual vehicles, while the spatial and temporal relationships of vehicle objects are modeled by an abstract semantic model. ^

A nested Petri net framework for modeling and analyzing multi-agent systems

In the past two decades, multi-agent systems (MAS) have emerged as a new paradigm for conceptualizing large and complex distributed software systems. A multi-agent system view provides a natural abstraction for both the structure and the behavior of modern-day software systems. Although there were many conceptual frameworks for using multi-agent systems, there was no well established and widely accepted method for modeling multi-agent systems. This dissertation research addressed the representation and analysis of multi-agent systems based on model-oriented formal methods. The objective was to provide a systematic approach for studying MAS at an early stage of system development to ensure the quality of design. ^ Given that there was no well-defined formal model directly supporting agent-oriented modeling, this study was centered on three main topics: (1) adapting a well-known formal model, predicate transition nets (PrT nets), to support MAS modeling; (2) formulating a modeling methodology to ease the construction of formal MAS models; and (3) developing a technique to support machine analysis of formal MAS models using model checking technology. PrT nets were extended to include the notions of dynamic structure, agent communication and coordination to support agent-oriented modeling. An aspect-oriented technique was developed to address the modularity of agent models and compositionality of incremental analysis. A set of translation rules were defined to systematically translate formal MAS models to concrete models that can be verified through the model checker SPIN (Simple Promela Interpreter). ^ This dissertation presents the framework developed for modeling and analyzing MAS, including a well-defined process model based on nested PrT nets, and a comprehensive methodology to guide the construction and analysis of formal MAS models.^

Investing in Hospitality Operations in the People's Republic of China: The Legal Framework

In the late 1970s, the People's Republic of China announced its "Open Door Policy. "After being closed to the outside world for decades, the Western world was not certain what to make of this turnaround. The author looks at a number of questions: Was China sincere in its statements that it wanted foreign investment on its soil? Was it willing to provide the economic and legal framework within which foreign investors could feel secure about placing their investment dollars? What concerns or issues still remain with regard to such investment decisions today?

Self -management factors, influences, and conditions for type 2 diabetes among Black ethnic groups in Miami, Florida and Abidjan, Cote d'Ivoire

The Dahlgren and Whitehead ecological theory provides the framework for a cross-sectional design to compare socio-demographic characteristics, living and working conditions, and lifestyle daily habits as well as cultural and ecological factors among six diabetic multiethnic Black groups in Miami and Abidjan. Approximately 180 Black Americans (African-, Caribbean-, and Haitian-) and 180 Black Africans (Akan, Malinke, and Krou) aged 20 years and older were surveyed. During the preliminary of this study participants' attitudes and behaviors were qualitatively assessed (N=60) and a tool was developed to describe, in the main study (N=360), differences in participants' strength of commitment to diabetes lifestyle self-management. Despite similarities found in terms of age and gender, statistically significant differences were also found within and among groups in terms of living and working conditions, education level, and religion. African American groups were more likely to participate in more diabetes classes than Haitian Americans and Caribbean Americans. However, African Americans were less likely to adhere to daily dietary and weight control regimens. Although, Black African groups reported limited access to equipment, facilities, and financial support they were more likely to follow dietary and weight control recommendations than Black American groups. Overall, African American participants showed the poorest attitudes towards recommended foods, Caribbean American respondents reported the best attitudes and behaviors towards weight control regimens, and the Malinke group had significantly more strength of commitment to successful weight control. Furthermore, Black African groups had significantly more strength of commitment to successful dietary adherence and significantly less support for weight control than Black American groups. ^ Significant differences found within Black groups suggest that understanding each patient's conditions may help healthcare professionals in initiating individualized appropriate counseling before goal setting, and in developing culturally relevant type 2 diabetes management programs. Moreover, significant differences exist in strength of commitment to lifestyle adherence among Black groups in Miami and Abidjan. Cultural, socio-demographic factors and self-management habits may explain differences in participants' outcomes. At the policy level, Black groups should not be approached as a homogenous group and assessment of the vulnerability of each ethnic group may be necessary in the decision-making process.^

Biochemical investigation of multicorer sediment profile PS74/108-2

To detect and track the impact of large-scale environmental changes in a the transition zone between the northern North Atlantic and the central Arctic Ocean, and to determine experimentally the factors controlling deep-sea biodiversity, the Alfred- Wegener-Institute for Polar and Marine Research (AWI) established the deep-sea long-term observatory HAUSGARTEN, which constitutes the first, and until now only open-ocean long-term station in a polar region. Virtually undisturbed sediment samples have been taken using a video-guided multiple corer (MUC) at 13 HAUSGARTEN stations along a bathymetric (1,000 - 4,000 m water depth) and a latitudinal transect in 2,500 m water depth as well as two stations at 230 and 1,200 m water depth within the framework of the KONGHAU project. Various biogenic sediment compounds were analyzed to estimate the input of organic matter from phytodetritus sedimentation, benthic activities (e.g. bacterial exoenzymatic activity), and the total biomass of the smallest sediment-inhabiting organisms (size range: bacteria to meiofauna).

Biochemical investigation of multicorer sediment profile PS74/116-2

To detect and track the impact of large-scale environmental changes in a the transition zone between the northern North Atlantic and the central Arctic Ocean, and to determine experimentally the factors controlling deep-sea biodiversity, the Alfred- Wegener-Institute for Polar and Marine Research (AWI) established the deep-sea long-term observatory HAUSGARTEN, which constitutes the first, and until now only open-ocean long-term station in a polar region. Virtually undisturbed sediment samples have been taken using a video-guided multiple corer (MUC) at 13 HAUSGARTEN stations along a bathymetric (1,000 - 4,000 m water depth) and a latitudinal transect in 2,500 m water depth as well as two stations at 230 and 1,200 m water depth within the framework of the KONGHAU project. Various biogenic sediment compounds were analyzed to estimate the input of organic matter from phytodetritus sedimentation, benthic activities (e.g. bacterial exoenzymatic activity), and the total biomass of the smallest sediment-inhabiting organisms (size range: bacteria to meiofauna).

Biochemical investigation of multicorer sediment profile PS74/119-2

To detect and track the impact of large-scale environmental changes in a the transition zone between the northern North Atlantic and the central Arctic Ocean, and to determine experimentally the factors controlling deep-sea biodiversity, the Alfred- Wegener-Institute for Polar and Marine Research (AWI) established the deep-sea long-term observatory HAUSGARTEN, which constitutes the first, and until now only open-ocean long-term station in a polar region. Virtually undisturbed sediment samples have been taken using a video-guided multiple corer (MUC) at 13 HAUSGARTEN stations along a bathymetric (1,000 - 4,000 m water depth) and a latitudinal transect in 2,500 m water depth as well as two stations at 230 and 1,200 m water depth within the framework of the KONGHAU project. Various biogenic sediment compounds were analyzed to estimate the input of organic matter from phytodetritus sedimentation, benthic activities (e.g. bacterial exoenzymatic activity), and the total biomass of the smallest sediment-inhabiting organisms (size range: bacteria to meiofauna).

Biochemical investigation of multicorer sediment profile PS74/120-2

To detect and track the impact of large-scale environmental changes in a the transition zone between the northern North Atlantic and the central Arctic Ocean, and to determine experimentally the factors controlling deep-sea biodiversity, the Alfred- Wegener-Institute for Polar and Marine Research (AWI) established the deep-sea long-term observatory HAUSGARTEN, which constitutes the first, and until now only open-ocean long-term station in a polar region. Virtually undisturbed sediment samples have been taken using a video-guided multiple corer (MUC) at 13 HAUSGARTEN stations along a bathymetric (1,000 - 4,000 m water depth) and a latitudinal transect in 2,500 m water depth as well as two stations at 230 and 1,200 m water depth within the framework of the KONGHAU project. Various biogenic sediment compounds were analyzed to estimate the input of organic matter from phytodetritus sedimentation, benthic activities (e.g. bacterial exoenzymatic activity), and the total biomass of the smallest sediment-inhabiting organisms (size range: bacteria to meiofauna).