Comparing potentially avoidable hospitalization rates related to ambulatory care sensitive conditions in Switzerland: the need to refine the definition of health conditions and to adjust for population health status.

BACKGROUND: Regional rates of hospitalization for ambulatory care sensitive conditions (ACSC) are used to compare the availability and quality of ambulatory care but the risk adjustment for population health status is often minimal. The objectives of the study was to examine the impact of more extensive risk adjustment on regional comparisons and to investigate the relationship between various area-level factors and the properly adjusted rates. METHODS: Our study is an observational study based on routine data of 2 million anonymous insured in 26 Swiss cantons followed over one or two years. A binomial negative regression was modeled with increasingly detailed information on health status (age and gender only, inpatient diagnoses, outpatient conditions inferred from dispensed drugs and frequency of physician visits). Hospitalizations for ACSC were identified from principal diagnoses detecting 19 conditions, with an updated list of ICD-10 diagnostic codes. Co-morbidities and surgical procedures were used as exclusion criteria to improve the specificity of the detection of potentially avoidable hospitalizations. The impact of the adjustment approaches was measured by changes in the standardized ratios calculated with and without other data besides age and gender. RESULTS: 25% of cases identified by inpatient main diagnoses were removed by applying exclusion criteria. Cantonal ACSC hospitalizations rates varied from to 1.4 to 8.9 per 1,000 insured, per year. Morbidity inferred from diagnoses and drugs dramatically increased the predictive performance, the greatest effect found for conditions linked to an ACSC. More visits were associated with fewer PAH although very high users were at greater risk and subjects who had not consulted at negligible risk. By maximizing health status adjustment, two thirds of the cantons changed their adjusted ratio by more than 10 percent. Cantonal variations remained substantial but unexplained by supply or demand. CONCLUSION: Additional adjustment for health status is required when using ACSC to monitor ambulatory care. Drug-inferred morbidities are a promising approach.

The use of future-oriented knowledge in regional innovation processes: Research on knowledge generation, transfer and conversion

The importance of the regional level in research has risen in the last few decades and a vast literature in the fields of, for instance, evolutionary and institutional economics, network theories, innovations and learning systems, as well as sociology, has focused on regional level questions. Recently the policy makers and regional actors have also began to pay increasing attention to the knowledge economy and its needs, in general, and the connectivity and support structures of regional clusters in particular. Nowadays knowledge is generally considered as the most important source of competitive advantage, but even the most specialised forms of knowledge are becoming a short-lived resource for example due to the accelerating pace of technological change. This emphasizes the need of foresight activities in national, regional and organizational levels and the integration of foresight and innovation activities. In regional setting this development sets great challenges especially in those regions having no university and thus usually very limited resources for research activities. Also the research problem of this dissertation is related to the need to better incorporate the information produced by foresight process to facilitate and to be used in regional practice-based innovation processes. This dissertation is a constructive case study the case being Lahti region and a network facilitating innovation policy adopted in that region. Dissertation consists of a summary and five articles and during the research process a construct or a conceptual model for solving this real life problem has been developed. It is also being implemented as part of the network facilitating innovation policy in the Lahti region.

Las Maras como nueva amenaza regional a partir del período 2000-2007. Caso de estudio : El Salvador y Honduras

El presente trabajo de investigación surge de la necesidad de estudiar el reciente fenómeno de las maras que se presenta en la región, analizando los elementos que las componen y los escenarios que las rodean, siendo los puntos claves para lograr entender su peligrosidad y porque se les considera un desafío a la seguridad de las naciones.

Incidencia del renacimiento Africano en la cooperación para el desarrollo socioeconómico regional. Estudio de caso Sudáfrica-Burundi periodo 2007-2011

En el sistema internacional África es un continente que todavía se encuentra jalonando en su proceso de desarrollo socioeconómico. Esquemas de cooperación norte-sur no han logrado los resultados esperados en el continente y por esta razón es necesario mirar hacía otras alternativas. Este trabajo de grado presenta un modelo de cooperación regional y de cooperación sur-sur que surge del Renacimiento Africano para responder a este dilema de la cooperación tradicional. Presenta los aspectos principales del Renacimiento Africano como la solución de problemas africanos, la recuperación del continente, el Ubuntu y el desarrollo socioeconómico en el contexto específico de la cooperación entre Sudáfrica y Burundi con el fin de comprender la totalidad de este modelo novedoso de la región.

El arsenal de Israel como amenaza para la seguridad regional, pero no para la seguridad mundial

Con el fin de la Guerra Fría, la disolución de la Unión Soviética y el comienzo del proceso de Globalización, nuevos factores de amenaza no había recibido la trascendencia necesaria, pero muy silenciosamente iban cobrando vitalidad dentro del amplio concepto de seguridad. Este es el caso de la proliferación nuclear, que ha dejado de ser exclusivo de las grandes potencias, como herramienta fundamental de contención entre ambos bloques durante la Guerra Fría, para estar al alcance de países de menor importancia o grupo de personas, que quieran satisfacer su ambición de convertirse en una potencia nuclear, dejando incluso de lado o simplemente olvidando una serie de necesidades básicas de su población.

La política exterior turca en el marco del Complejo de Seguridad Regional de Medio Oriente. Del soft power al smart power. (2002 - 2013)

Dada la confluencia de Turquía en Asia, Medio Oriente, los Balcanes y Europa, el gobierno está en la necesidad de responder a los desafíos de ser un Estado pivote. Es en este punto donde su política exterior se convierte en la mayor herramienta para sobresalir y sobrevivir en un ambiente heterogéneo. El objetivo de esta monografía de grado es analizar la política exterior turca en el marco del Complejo de Seguridad Regional de Medio Oriente a partir de los aportes de la Escuela de Copenhague y su Teoría de los Complejos de Seguridad Regional, para comprender sus estrategias de soft y hard power en su política exterior a fin de analizar si se consolidó un smart power que permita posicionar a Turquía en una potencia regional.

Ongoing Pristina – Belgrade Talks: from Decentralization to Regional Cooperation and Future Perspectives. EDAP 04/2012, 2012

On 17 February 2008, Kosovo declared independence, ending its nine years unresolved status. The principal goal was, and remains, the need to involve different communities in the state structures. The new state, which aims to fulfil all the obligations set by the Ahtisaari plan, is trying to complete the decentralization process the implementation of which continuous to face obstacles in the two main communities: the Serbs and the Albanians. This article discusses matters related to community acceptance of the decentralization process, the functioning of the parallel structures, the situation in North Kosovo and the on - going talks between Pristina and Belgrade. The article provides evidences that while the implementation of the decentralization process is the best possibility for Kosovo, it must not follow only an ethnic line.

The potential to narrow uncertainty in regional climate predictions

Faced by the realities of a changing climate, decision makers in a wide variety of organisations are increasingly seeking quantitative predictions of regional and local climate. An important issue for these decision makers, and for organisations that fund climate research, is what is the potential for climate science to deliver improvements - especially reductions in uncertainty - in such predictions? Uncertainty in climate predictions arises from three distinct sources: internal variability, model uncertainty and scenario uncertainty. Using data from a suite of climate models we separate and quantify these sources. For predictions of changes in surface air temperature on decadal timescales and regional spatial scales, we show that uncertainty for the next few decades is dominated by sources (model uncertainty and internal variability) that are potentially reducible through progress in climate science. Furthermore, we find that model uncertainty is of greater importance than internal variability. Our findings have implications for managing adaptation to a changing climate. Because the costs of adaptation are very large, and greater uncertainty about future climate is likely to be associated with more expensive adaptation, reducing uncertainty in climate predictions is potentially of enormous economic value. We highlight the need for much more work to compare: a) the cost of various degrees of adaptation, given current levels of uncertainty; and b) the cost of new investments in climate science to reduce current levels of uncertainty. Our study also highlights the importance of targeting climate science investments on the most promising opportunities to reduce prediction uncertainty.

The potential to narrow uncertainty in projections of regional precipitation change

We separate and quantify the sources of uncertainty in projections of regional (*2,500 km) precipitation changes for the twenty-first century using the CMIP3 multi-model ensemble, allowing a direct comparison with a similar analysis for regional temperature changes. For decadal means of seasonal mean precipitation, internal variability is the dominant uncertainty for predictions of the first decade everywhere, and for many regions until the third decade ahead. Model uncertainty is generally the dominant source of uncertainty for longer lead times. Scenario uncertainty is found to be small or negligible for all regions and lead times, apart from close to the poles at the end of the century. For the global mean, model uncertainty dominates at all lead times. The signal-to-noise ratio (S/N) of the precipitation projections is highest at the poles but less than 1 almost everywhere else, and is far lower than for temperature projections. In particular, the tropics have the highest S/N for temperature, but the lowest for precipitation. We also estimate a ‘potential S/N’ by assuming that model uncertainty could be reduced to zero, and show that, for regional precipitation, the gains in S/N are fairly modest, especially for predictions of the next few decades. This finding suggests that adaptation decisions will need to be made in the context of high uncertainty concerning regional changes in precipitation. The potential to narrow uncertainty in regional temperature projections is far greater. These conclusions on S/N are for the current generation of models; the real signal may be larger or smaller than the CMIP3 multi-model mean. Also note that the S/N for extreme precipitation, which is more relevant for many climate impacts, may be larger than for the seasonal mean precipitation considered here.

Comparison of results from several AOGCMs for global and regional sea-level change 1900-2100

Sea-level rise is an important aspect of climate change because of its impact on society and ecosystems. Here we present an intercomparison of results from ten coupled atmosphere-ocean general circulation models (AOGCMs) for sea-level changes simulated for the twentieth century and projected to occur during the twenty first century in experiments following scenario IS92a for greenhouse gases and sulphate aerosols. The model results suggest that the rate of sea-level rise due to thermal expansion of sea water has increased during the twentieth century, but the small set of tide gauges with long records might not be adequate to detect this acceleration. The rate of sea-level rise due to thermal expansion continues to increase throughout the twenty first century, and the projected total is consequently larger than in the twentieth century; for 1990-2090 it amounts to 0.20-0.37 in. This wide range results from systematic uncertainty in modelling of climate change and of heat uptake by the ocean. The AOGCMs agree that sea-level rise is expected to be geographically non-uniform, with some regions experiencing as much as twice the global average, and others practically zero, but they do not agree about the geographical pattern. The lack of agreement indicates that we cannot currently have confidence in projections of local sea- level changes, and reveals a need for detailed analysis and intercomparison in order to understand and reduce the disagreements.

Country, sector and regional factors in European property returns

For those portfolio managers who follow a top-down approach to fund management when they are trying to develop a pan-European investment strategy they need to know which are the most important factors affecting property returns, so as to concentrate their management and research efforts accordingly. In order to examine this issue this paper examines the relative importance of country, sector and regional effects in determining property returns across Europe using the largest database of individual property returns currently available. Using annual data over the period 1996 to 2002 for a sample of over 25,000 properties the results show that the country-specific effects dominate sector-specific factors, which in turn dominate the regional-specific factors. This is true even for different sub-sets of countries and sectors. In other words, real estate returns are mainly determined by local (country specific) conditions and are only mildly affected by general European factors. Thus, for those institutional investors contemplating investment into Europe the first level of analysis must be an examination of the individual countries, followed by the prospects of the property sectors within the country and then an assessment of the differences in expected performance between the main city and the rest of the country.

Changes in the relative importance of sector and regional factors: 1987-2002

A stylised fact in the real estate portfolio diversification literature is that sector (property-type) effects are relatively more important than regional (geographical) factors in determining property returns. Thus, for those portfolio managers who follow a top-down approach to portfolio management, they should first choose in which sectors to invest and then select the best properties in each market. However, the question arises as to whether the dominance of the sector effects relative to regional effects is constant. If not property fund managers will need to take account of regional effects in developing their portfolio strategy. Using monthly data over the period 1987:1 to 2002:12 for a sample of over 1000 properties the results show that the sector-specific factors dominate the regional-specific factors for the vast majority of the time. Nonetheless, there are periods when the regional factors are of equal or greater importance than the sector effects. In particular, the sector effects tend to dominate during volatile periods of the real estate cycle; however, during calmer periods the sector and regional effects are of equal importance. These findings suggest that the sector effects are still the most important aspect in the development of an active portfolio strategy.

The regional focus of Asian multinational enterprises

In recent issues of this Journal a debate has raged concerning the appropriate nature of academic research in the Asia Pacific region. While we support the desire for both rigor and regional relevance in this research, we wish to demonstrate a strong commonality between the performance of large Asian firms and others from Europe and North America. This prompts us to question the need for a new theory of the MNE based on the experience of Asian firms. Like their counterparts elsewhere, the large Asian firms mostly operate on an intra-regional basis. While in the literature it has been assumed that the path to success for Asian firms is globalization, we show that the data supporting this is confined to a handful of unrepresentative case studies. We also present a bibliometric analysis which shows an overwhelming case study sample selection bias in academic studies towards this small number of unrepresentative cases

Sector and regional factors in real estate returns

This paper presents a simple method to measure the effect of sector and regional factors in real estate returns, and thus provides a quantitative framework for analysing the relative impact of these two diversification categories to real estate portfolio selection. Using data on Retail, Office and Industrial properties spread across 326 real estate locations in the UK, over the period 1981 to 1995, the results show that the performance of real estate is largely sector-driven. A result in line with previous work. Which implies that the sector composition of the real estate fund should be the first level of analysis in constructing and managing the real estate portfolio. As a consequence real estate fund managers need to pay more attention to the sector allocation of their portfolios than the regional spread.

Changes in the relative importance of sector and regional Factors: 1987-2002

A stylised fact in the real estate portfolio diversification literature is that sector (property-type) effects are relatively more important than regional (geographical) factors in determining property returns. Thus, for those portfolio managers who follow a top-down approach to portfolio management, they should first choose in which sectors to invest and then select the best properties in each market. However, the question arises as to whether the dominance of the sector effects relative to regional effects is constant. If not property fund managers will need to take account of regional effects in developing their portfolio strategy. We find the results show that the sector-specific factors dominate the regional-specific factors for the vast majority of the time. Nonetheless, there are periods when the regional factors are of equal or greater importance than the sector effects. In particular, the sector effects tend to dominate during volatile periods of the real estate cycle; however, during calmer periods the sector and regional effects are of equal importance. These findings suggest that the sector effects are still the most important aspect in the development of an active portfolio strategy.