Systematic review and analysis of evidences on clinical efficacy and cost-effectiveness of biological drugs for the treatment of Ankylosing Spondylitis

Technology: Infliximab and comparator biological such as adalimumab, etanercept, golimumab. Conditions: Ankylosing spondylitis (AS) Issue: Infliximab is registered to be used in patients with AS. The aim of the Report is to evaluate the clinical efficacy and safety of infliximab and comparator biologicals for the treatment of adult AS. Methods: Systematic literature review and analysis as well as meta-analysis (direct and indirect comparison) of published randomised controlled clinical trials (RCT) were performed, all relevant health economics literature were identified ad analysed. Results: Clinical efficacy of biological therapies is based on good clinical evidences regarding to all clinical efficacy endpoints (ASAS20, ASAS40, ASAS 5/6, and BASDAI 50% response). Altogether, 22 trials are included in our meta-analysis, 12 infliximab, 3 adalimumab studies, 6 etanercept and 1 golimumab. Efficacy of biological treatments for the treatment of AS has been established by clinical scientific evidences, significant improvement at all outcomes considered was confirmed. According to the results of indirect comparison, there were no significant difference between biological treatments and placebo in terms of safety and tolerability endpoints. We found no significant difference between the clinical efficacy and safety of infliximab, adalimumab, etanercept and golimumab therapies. Cost-utility analysis of adalimumab and/or infliximab, etanercept and golimumab treatment for AS were performed in the UK, Canada, The Netherlands, Germany, Spain and France. There are no cost-utility studies from Eastern Central Europe. Implications for decision making: Efficacy of infliximab and comparator biologicals for the treatment of Ankylosing Spondylitis (AS) was proved by clinical evidence, significant improvement at all outcomes considered was confirmed. We found no significant differences in efficacy and safety of different biological treatments. Health economics results suggest that biological therapies are cost-effective alternatives for the treatment of AS in group of developed high income countries. There is a lack of health economics results in Central-Eastern European countries however these data are more and more required by governments and funders as part of the company economic dossiers.

The Attributes of Social Media as a Strategic Marketing Communication Tool

New digital trends are transforming the media industry landscape, modifying elemental characteristics and attitudes of companies as well as of consumers. Firms often claim that their presence in social media (SM) is a key element to success. SM helps companies rethink the traditional one-way flow of their marketing messages and to incorporate a new interactive pattern into their communications. Nevertheless, these tendencies involve problems of strategic myopia for firms that do not structurally integrate these tools. One main problem is that institutions can rarely differentiate between the various types of SM and the attributes thereof, while the literature equally reveals a number of contradictions in the subject. The present conceptual paper lays the foundations of a strategic approach to SM and discusses its theoretical implications. Following an overview on the concept of SM, through a content analysis of the specialized management literature (n = 14), we present various best practices and reflect on the apparent lack of strategic thinking in using SM as a marketing application. Then, we compare these practical examples with general marketing strategy theory. By merging theory and practice, we aim to provide an insight towards a well-founded application of SM as a genuinely strategic marketing tool.

The Butler wears Prada. A Hungarian case-study based on the analysis of the uniform and hotel industry from the point of sustainability

What is the connection between the hotel and fashion industry? The authors aim to answer this question approaching from different aspects. It can be stated that both of these industries are harmful for the environment from the point of sustainability. On the other hand there is a common solution from the viewpoint of sustainability: the uniforms and the primary materials, which are used during the production, such as the man-made and natural fibres. In our research the authors introduce the main problems which are related to the fashion industry, especially focusing on producing fibres from the viewpoint of sustainability. We introduce the solution for the fashion industry based on the literature and also present the emerging problems and solutions of the hotel industry based on the best practices. As a part of it, we are introducing the best practices from the hotel industry, where environmentally friendly uniforms are used. Finally, as a primary research part of our paper, we interpret the results of a Hungarian case-study.

An analysis of the labor market situation of vocational students based on national and international data

The article focuses on the labour market situation and opportunities of the Hungarian vocational students. After briefly placing the topic in an international context, the study introduces the findings of the Hungarian empirical researches. Due to the differences between the various national education systems, it is not easy to make international comparisons; therefore I chose former socialist countries with characteristics similar to those of Hungary. When comparing the relevant data, it became clear that obtaining a diploma provides more advantages in Hungary. Hungarian researches suggest that vocational schools mostly attract students with poor competence test scores at the end of primary school. Also a significant proportion of these students are disadvantaged. Vocational students are the most likely to drop out of the system and their return to the school later is sporadic at best. Although a completed VET improves their employment conditions and prospects, many of the graduates will leave their profession or do unskilled labour. Their labour income varies greatly depending on their type of trade and experience gained.

Utilization of needs assessments by decision makers: A comparative analysis of assessment methods

The major purpose of this study was to ascertain how needs assessment findings and methodologies are accepted by public decision makers in the U.S. Virgin Islands. To accomplish this, the following five different needs assessments were executed: (1) population survey; (2) key informants survey; (3) community forum; (4) rates-under-treatment (RUT); and (5) social indicators analysis. The assessments measured unmet needs of older persons regarding transportation, in-home care, and socio-recreation services, and determined which of the five methodologies is most costly, time consuming, and valid.^ The results of a five-way comparative analysis was presented to public sector decision makers who were surveyed to determine whether they are influenced more by needs assessment findings, or by the methodology used, and to ascertain the factors that lead to their acceptance of needs assessment findings and methodologies.^ The survey results revealed that acceptance of findings and methodology is influenced by the congruency of the findings with decision makers' goals and objectives, feasibility of the findings, and credibility of the researcher.^ The study also found that decision makers are influenced equally by needs assessment findings and methodology; that they prefer population surveys, although they are the most expensive and time consuming of the methodologies; that different types of needs assessments produce different results; and, that needs assessment is an essential program planning tool. Executive decision makers are found to be influenced more by management factors than by legal and political factors, while legislative decision makers are influenced more by legal factors. Decision makers overwhelmingly view their leadership style as democratic.^ A typology of the five needs assessments, highlighting their strengths and weaknesses, is offered as a planning guide for public decision makers. ^

Towards the formation of a sustainable South Florida: An analysis of conflict resolution and consensus building in the South Florida Everglades Ecosystem Restoration Initiative

This dissertation examines the sociological process of conflict resolution and consensus building in South Florida Everglades Ecosystem Restoration through what I define as a Network Management Coordinative Interstitial Group (NetMIG). The process of conflict resolution can be summarized as the participation of interested and affected parties (stakeholders) in a forum of negotiation. I study the case of the Governor's Commission for a Sustainable South Florida (GCSSF) that was established to reduce social conflict. Such conflict originated from environmental disputes about the Everglades and was manifested in the form of gridlock among regulatory (government) agencies, Indian tribes, as well as agricultural, environmental conservationist and urban development interests. The purpose of the participatory forum is to reduce conflicts of interest and to achieve consensus, with the ultimate goal of restoration of the original Everglades ecosystem, while cultivating the economic and cultural bases of the communities in the area. Further, the forum aim to formulate consensus through envisioning a common sustainable community by providing means to achieve a balance between human and natural systems. ^ Data were gathered using participant observation and document analysis techniques to conduct a theoretically based analysis of the role of the Network Management Coordinative Interstitial Group (NetMIG). I use conflict resolution theory, environmental conflict theory, stakeholder analysis, systems theory, differentiation and social change theory, and strategic management and planning theory. ^ The purpose of this study is to substantiate the role of the Governor's Commission for a Sustainable South Florida (GCSSF) as a consortium of organizations in an effort to resolve conflict rather than an ethnographic study of this organization. Environmental restoration of the Everglades is a vehicle for recognizing the significance of a Network Management Coordinative Interstitial Group (NetMIG), namely the Governor's Commission for a Sustainable South Florida (GCSSF), as a structural mechanism for stakeholder participation in the process of social conflict resolution through the creation of new cultural paradigms for a sustainable community. ^

Comparative analysis of a moderating and mediating model of stress, appraisal, and coping in Hispanic and non-Hispanic Alzheimer's disease caregivers

This dissertation utilizes a cross-sectional study to examine the phenomenon of caregiving within a theoretically grounded stress, appraisal, and coping model. Hispanic and non-Hispanic caregivers were studied to examine the factors associated with variance in caregiver appraisal, coping, and outcomes of caregiving strain (depression and somatic complaints) and caregiving gain (life satisfaction, mastery, and personal gain). A purposive sampling strategy was used to recruit 204 Alzheimer's disease caregivers in South Florida. A self-report questionnaire was used to collect demographic data, and to measure stress, appraisal, coping, and psychological well-being of caregivers. Regression equations were developed to compare moderating and mediating models of appraisal and coping. Emotion-focused coping skills were found to significantly moderate the effects of stress (F [1,195] = 4.62, p < .05), explaining approximately 21% of the variance in satisfaction was found to moderate the effects of stress (F [1,195] = 7.09; p < .05), explaining approximately 27% of the variance in personal gain and approximately 8% of the variance in life satisfaction (F [1,195] = 4.14; p < .05). Appraisal of Burden was found to significantly mediate the effects of stress, explaining approximately 30% of the variance in somatic complaints (F [1,196] = 31.60; p < .001) and 32% of the variance in depression (F [1,196] = 38.18; p < .001). The results of the analyses indicate that appraisal and coping skills are important variables in the stress process. The results of this study underscore the importance of accounting for positive and negative outcomes in providing a fuller understanding of the stress, appraisal and coping process of Alzheimer's Disease caregivers. ^

A comparison of the effects of social constructivist and traditional approaches to teaching on students' attitude and achievement in high school chemistry

Current views of the nature of knowledge and of learning suggest that instructional approaches in science education pay closer attention to how students learn rather than on teaching. This study examined the use of approaches to teaching science based on two contrasting perspectives in learning, social constructivist and traditional, and the effects they have on students' attitudes and achievement. Four categories of attitudes were measured using the Upper Secondary Attitude Questionnaire: Attitude towards school, towards the importance of science, towards science as a career, and towards science as a subject in school. Achievement was measured by average class grades and also with a researcher/teacher constructed 30-item test that involved three sub-scales of items based on knowledge, and applications involving near-transfer and far-transfer of concepts. The sample consisted of 202 students in nine intact classrooms in chemistry at a large high school in Miami, Florida, and involved two teachers. Results were analyzed using a two-way analysis of covariance (ANCOVA) with a pretest in attitude as the covariate for attitudes and prior achievement as the covariate for achievement. A comparison of the adjusted mean scores was made between the two groups and between females and males. ^ With constructivist-based teaching, students showed more favorable attitude towards science as a subject, obtained significantly higher scores in class achievement, total achievement and achievement on the knowledge sub-scale of the knowledge and application test. Students in the traditional group showed more favorable attitude towards school. Females showed significantly more positive attitude towards the importance of science and obtained significantly higher scores in class achievement. No significant interaction effects were obtained for method of instruction by gender. ^ This study lends some support to the view that constructivist-based approaches to teaching science is a viable alternative to traditional modes of teaching. It is suggested that in science education, more consideration be given to those aspects of classroom teaching that foster closer coordination between social influences and individual learning. ^

Political corruption in the Caribbean Basin: A comparative analysis of Jamaica and Costa Rica

Political corruption in the Caribbean Basin retards state economic growth and development, undermines government legitimacy, and threatens state security. In spite of recent anti-corruption efforts of intergovernmental and nongovernmental organizations (IGO/NGOs), Caribbean political corruption problems appear to be worsening in the post-Cold War period. This dissertation discovers why IGO/NGO efforts to arrest corruption are failing by investigating the domestic and international causes of political corruption in the Caribbean. The dissertation's theoretical framework centers on an interdisciplinary model of the causes of political corruption built within the rule-oriented constructivist approach to social science. The model first employs a rational choice analysis that broadly explains the varying levels of political corruption found across the region. The constructivist theory of social rules is then used to develop the structural mechanisms that further explain the region's levels of political corruption. The dissertation advances its theory of the causes of political corruption through qualitative disciplined-configurative case studies of political corruption in Jamaica and Costa Rica. The dissertation finds that IGO/NGO sponsored anti-corruption programs are failing because they employ only technical measures (issuing anti-corruption laws and regulations, providing transparency in accounting procedures, improving freedom of the press, establishing electoral reforms, etc.). While these IGO/NGO technical measures are necessary, they are not sufficient to arrest the Caribbean's political corruption problems. This dissertation concludes that to be successful, IGO/NGO anti-corruption programs must also include social measures, e.g., building civil societies and modernizing political cultures, for there to be any hope of lowering political corruption levels and improving Caribbean social conditions. The dissertation also highlights the key role of Caribbean governing elite in constructing the political and economic structures that cause their states' political corruption problems. ^

Social movements theory: A Burkean approach to the rhetoric of abolition

Inspired by Kenneth Burke's dramatism, this thesis examined the viability of social movements rhetorical theory in its application to literature by focusing on the 19th century abolitionist movement in the United States and moving from the analysis of public speeches to fictional works. ^ Chapter one applied the rhetorical analysis of social movements to noteworthy speeches by William Lloyd Garrison and Francis Maria W. Stewart. Chapter two examined social movements rhetoric in The Narrative of the Life of Frederick Douglass. Chapter three considered Uncle Tom's Cabin and determined whether social movements rhetorical theory could illuminate this persuasive work of fiction. ^ Dramatistically speaking, each of these works attempted to persuade the reader or auditor to join the abolitionist cause through symbolic action in their rhetoric. This thesis concluded that the social movements approach derived from Burkean dramatism is indeed powerful in its application to literature as it unpacks the rhetoric of abolition. ^

Against small arms: An analysis of an international network

Small Arms and Light Weapons (SALW) proliferation was undertaken by the Non-Governmental Organizations (NGOs) as the next important issue in international relations after the success of the International Campaign to Ban Landmines (ICBL). This dissertation focuses on the reasons why the issue of SALW resulted in an Action Program rather than an international convention. Thus, this result was considered as unsuccessful by the advocates of regulating the illicit trade in SALW. The study provides a social movement theoretical approach, using framing, political opportunity and network analysis to explain why the advocates of regulating the illicit trade in SALW did no succeed in their goals. The UN is taken as the arena in which NGOs, States and International Governmental Organizations (IGOs) discussed the illicit trade in SALW. ^ The findings of the study indicate that the political opportunity for the issue of SALW was not ideal. The network of NGOs, States and IGOs was not strong. The NGOs advocating regulation of SALW were divided over the approach of the issue and were part of different coalitions with differing objectives. Despite initial widespread interest among States, only a couple of States were fully committed to the issue till the end. The regional IGOs approached the issue based on their regional priorities and were less interested in an international covenant. The advocates of regulating illicit trade in SALW attempted to frame SALW as a humanitarian issue rather than as a security issue. Thus they were not able to use frame alignment to convince states to treat SALW as a humanitarian issue. In conclusion it can be said that all three items, framing, political opportunity and the network, play a role in the lack of success of advocates for regulating the illicit trade in SALW. ^

Sales tax enforcement: An empirical analysis of compliance enforcement methodologies and pathologies

Most research on tax evasion has focused on the income tax. Sales tax evasion has been largely ignored and dismissed as immaterial. This paper explored the differences between income tax and sales tax evasion and demonstrated that sales tax enforcement is deserving of and requires the use of different tools to achieve compliance. Specifically, the major enforcement problem with sales tax is not evasion: it is theft perpetrated by companies that act as collection agents for the state. Companies engage in a principal-agent relationship with the state and many retain funds collected as an agent of the state for private use. As such, the act of sales tax theft bears more resemblance to embezzlement than to income tax evasion. It has long been assumed that the sales tax is nearly evasion free, and state revenue departments report voluntary compliance in a manner that perpetuates this myth. Current sales tax compliance enforcement methodologies are similar in form to income tax compliance enforcement methodologies and are based largely on trust. The primary focus is on delinquent filers with a very small percentage of businesses subject to audit. As a result, there is a very large group of noncompliant businesses who file on time and fly below the radar while stealing millions of taxpayer dollars. ^ The author utilized a variety of statistical methods with actual field data derived from operations of the Southern Region Criminal Investigations Unit of the Florida Department of Revenue to evaluate current and proposed sales tax compliance enforcement methodologies in a quasi-experimental, time series research design and to set forth a typology of sales tax evaders. This study showed that current estimates of voluntary compliance in sales tax systems are seriously and significantly overstated and that current enforcement methodologies are inadequate to identify the majority of violators and enforce compliance. Sales tax evasion is modeled using the theory of planned behavior and Cressey’s fraud triangle and it is demonstrated that proactive enforcement activities, characterized by substantial contact with non-delinquent taxpayers, results in superior ability to identify noncompliance and provides a structure through which noncompliant businesses can be rehabilitated.^

Development of an instrument to measure high school students' global awareness and attitudes: Looking through the lens of social sciences

The purpose of this study was to develop an instrument to measure high school students’ perspectives on global awareness and attitudes toward social issues. The research questions that guided this study were: (a) Can acceptable validity and reliability estimates be established for an instrument developed to measure high schools students' global awareness? (b) Can acceptable validity and reliability estimates be established for an instrument developed to measure high schools students' attitudes towards global social issues? (c) What is the relationship between high school students’ GPA, race/ethnicity, gender, socio-economic status, parents’ education, getting the news, reading and listening habits, the number of classes taken in the social sciences, whether they speak a second language, and have experienced living in or visiting other countries, and their perception of global awareness and attitudes toward global social issues. ^ An ex post facto research design was used and the data were collected using a 4-part Likert-type survey. It was administered to 14 schools in the Miami-Dade County, Florida area to 704 students. A factor analysis with an orthogonal varimax rotation was vii used to select the factors that best represented the three constructs – global education, global citizenship, and global workforce. This was done to establish construct validity. Cronbach’s alpha was used to determine the reliability of the instrument. Descriptive statistics and a hierarchical multiple regression were used for the demographics to establish their relationship, if any, to the findings. ^ Key findings of the study were that reliable and valid estimates can be developed for the instrument. The multiple regression analysis for model 1 and 2 accounted for a variance of 3% and 5% for self-perceptions of global awareness (factor 1). The regression model also accounted for a 5% and 13% variance in the two models for attitudes toward global social issues (factor 2). The demographics that were statistically significant were: ethnicity, gender, SES, parents’ education, listening to music, getting the news, speaking a second language, GPA, classes taken in the social sciences, and visiting other countries. An important finding for the study was those attending public schools (as opposed to private schools) had more positive attitudes towards global social issues (factor 2) The statistics indicated that these students had taken history, economics, and social studies – a curriculum infused with global perspectives.^

Analysis of Housing Partnerships using the Balanced Scorecard framework

Housing Partnerships (HPs) are collaborative arrangements that assist communities in the delivery of affordable housing by combining the strengths of the public and private sectors. They emerged in several states, counties, and cities in the eighties as innovative solutions to the challenges in affordable housing resulting from changing dynamics of delivery and production. ^ My study examines HPs with particular emphasis upon the identification of those factors associated with the successful performance of their mission of affordable housing. I will use the Balanced Scorecard (BSC) framework in this study. The identification of performance factors facilitates a better understanding of how HPs can be successful in achieving their mission. The identification of performance factors is significant in the context of the current economic environment because HPs can be viewed as innovative institutional mechanisms in the provision of affordable housing. ^ The present study uses a mixed methods research approach, drawing on data from the IRS Form 990 tax returns, a survey of the chief executives of HPs, and other secondary sources. The data analysis is framed according to the four perspectives of BSC: the financial, customer, internal business, and learning and growth. Financially, revenue diversification affects the financial health of HPs and overall performance. Although HPs depend on private and government funding, they also depend on service fees to carry out their mission. From a customer perspective, the HPs mainly serve low and moderate income households, although some serve specific groups such as seniors, homeless, veterans, and victims of domestic violence. From an internal business perspective, HPs’ programs are oriented toward affordable housing needs, undertaking not only traditional activities such as construction, loan provision, etc., but also advocacy and educational programs. From an employee and learning growth perspective, the HPs are small in staff size, but undertake a range of activities with the help of volunteers. Every part of the HP is developed to maximize resources, knowledge, and skills in order to assist communities in the delivery of affordable housing and related needs. Overall, housing partnerships have played a key role in affordable housing despite the housing market downturn since 2006. Their expenses on affordable housing activities increased despite the decrease in their revenues.^