Customs-Related Transaction Costs, Firm Size and International Trade Intensity

Customs are generally perceived as a time-consuming impediment to international trade. However, few studies have empirically examined the determinants and the impact of this type of government-imposed transaction costs. This paper analyses the role of firm size as a determinant of customs-related transaction costs, as well as the effect of firm size on the relationship between these costs and the international trade intensity of firms. The results of this study indicate that customs-related transaction costs repress international trade activities of firms, even at low levels of these costs. The paper identifies transaction-related economies of scale, simplified customs procedures and advanced information and communication technology as main determinants of customs-related transaction costs. It is shown that when these factors are taken into account, firm size has no effect on customs-related transaction costs. Policy implications are considered for firm strategy and public policy.

Effect of a pharmacist-led multicomponent intervention focussing on the medication monitoring phase to prevent potential adverse drug events in nursing homes

OBJECTIVES: To determine the extent to which the use of a clinical informatics tool that implements prospective monitoring plans reduces the incidence of potential delirium, falls, hospitalizations potentially due to adverse drug events, and mortality.

DESIGN: Randomized cluster trial.

SETTING: Twenty-five nursing homes serviced by two long-term care pharmacies.

PARTICIPANTS: Residents living in nursing homes during 2003 (1,711 in 12 intervention; 1,491 in 13 usual care) and 2004 (1,769 in 12 intervention; 1,552 in 13 usual care).

INTERVENTION: The pharmacy automatically generated Geriatric Risk Assessment MedGuide (GRAM) reports and automated monitoring plans for falls and delirium within 24 hours of admission or as part of the normal time frame of federally mandated drug regimen review.

MEASUREMENTS: Incidence of potential delirium, falls, hospitalizations potentially due to adverse drug events, and mortality.

RESULTS: GRAM triggered monitoring plans for 491 residents. Newly admitted residents in the intervention homes experienced a lower rate of potential delirium onset than those in usual care homes (adjusted hazard ratio (HR)=0.42, 95% confidence interval (CI)=0.35–0.52), overall hospitalization (adjusted HR=0.89, 95% CI=0.72–1.09), and mortality (adjusted HR=0.88, 95% CI=0.66–1.16). In longer stay residents, the effects of the intervention were attenuated, and all estimates included unity.

CONCLUSION: Using health information technology in long-term care pharmacies to identify residents who might benefit from the implementation of prospective medication monitoring care plans when complex medication regimens carry potential risks for falls and delirium may reduce adverse effects associated with appropriate medication use.

Children’s views on unlicensed/off-label paediatric prescribing and paediatric clinical trials.

Objectives: To explore the views and perspectives of children on the unlicensed/off-label use of medicines in children and on the participation of children in clinical trials. Methods: Focus-group discussions, involving school children, were carried out in a range of primary and secondary schools in Northern Ireland. A purposeful sample was chosen to facilitate representation of various socioeconomic groupings. Results: A total of 123 pupils, aged from 10 to 16 years, from six schools, participated in 16 focus groups. In general, pupils viewed the unlicensed/off-label use of medicines in children as unsafe and unethical and felt it is necessary to test medicines in children to improve the availability of licensed products. The majority felt that older children should be told, and that parents should be told, about the unlicensed/off-label use of medicines in children, yet they recognised some implications of this, such as potential medication non-adherence. Conclusions: This is the first study to explore the views of healthy children on unlicensed medicine use in children. Children were able to recognise potential risks associated with the unlicensed use of medicines and felt it is necessary to test and license more medicines in children. Practice implications Health care professionals should consider the views of children in decisions that affect their health.

Chernobyl: Living with Risk and Uncertainty

The nuclear accident in Chernobyl in 1986 is a dramatic example of the type of incidents that are characteristic of a risk society. The consequences of the incident are indeterminate, the causes complex and future developments unpredictable. Nothing can compensate for its effects and it affects a broad population indiscriminately. This paper examines the lived experience of those who experienced biographical disruption as residents of the region on the basis of qualitative case studies carried out in 2003 in the Chernobyl regions of Russia, Ukraine and Belarus. Our analysis indicates that informants tend to view their future as highly uncertain and unpredictable; they experience uncertainty about whether they are already contaminated, and they have to take hazardous decisions about where to go and what to eat. Fear, rumours and experts compete in supplying information to residents about the actual and potential consequences of the disaster, but there is little trust in, and only limited awareness of, the information that is provided. Most informants continue with their lives and do what they must or even what they like, even where the risks are known. They often describe their behaviour as being due to economic circumstances; where there is extreme poverty, even hazardous food sources are better than none. Unlike previous studies, we identify a pronounced tendency among informants not to separate the problems associated with the disaster from the hardships that have resulted from the break-up of the USSR, with both events creating a deep-seated sense of resignation and fatalism. Although most informants hold their governments to blame for lack of information, support and preventive measures, there is little or no collective action to have these put in place. This contrasts with previous research which has suggested that populations affected by disasters attribute crucial significance to that incident and, as a consequence, become increasingly politicized with regard to related policy agendas.

Movement and Orientation

The ways in which fish use space in nature are described, distinguishing between movements within a home range, dispersal and directed migration, as are the mechanisms that determine how fish use space. The external stimuli to which fish respond, how they use these cues to find their way around and the role of hormones in migration are also covered. An account is then given of how movement and orientation change with age, the evidence for inherited differences in these aspects of behaviour and environmental effects on development of space use patterns. The benefits that accrue to fish from moving in particular ways are described, as are adverse consequences of such movements, in the form of energetic costs and exposure to predators and pathogens. The ways in which benefits and costs are balanced against each other are discussed, with special reference to diurnal vertical migration. Although cultured fish usually inhabit confined spaces, their natural patterns of orientation and movement can cause a number of problems in aquaculture and some of these are described. Such problems are amenable to biological solutions and these are considered in the final section of this chapter, which also looks at the potential for using what is known about how fish move about to improve the effectiveness of general husbandry practices.

Prefab (and preserve): An investigation of retrofitting for Belfast's Victorian terraced social housing

This paper investigates the potential for the reuse of Belfast's existing Victorian terraced housing. The aim is to study methods behind retrofitting these unique pieces of architectural heritage, bringing them up to modern day standards with reduced energy costs and CO2 emissions in line with the Climate Change Act of 2008 (‘the Act’). It also highlights the characteristics of sustainable retrofitting examples and original prefabricated element, which enable the 19th-century properties to be re-adapted to suit modern day needs. The analysis builds on a report by Mark Hines Architects, in association with SAVE Britain's Heritage,1 in which the company explains the detrimental effect that the ‘Pathfinder’ scheme has had on English cities. Similarly, in Belfast, redevelopment schemes such as that in the ‘Village’ district have intended to replace undervalued terraced housing stock, and search for more sustainable options to retain these homes along with with the embodied energy and traditions attached to them.

Ecological dynamics of extinct species in empty habitat networks. 1. The role of habitat pattern and quantity, stochasticity and dispersal

We examined a remnant host plant (Primula veris L.) habitat network that was last inhabited by the rare butterfly Hamearis lucina L. in north Wales in 1943, to assess the relative contribution of several spatial parameters to its regional extinction. We first examined relationships between P. veris characteristics and H. lucina eggs in surviving H. lucina populations, and used these to predict the suitability and potential carrying capacity of the habitat network in north Wales. This resulted in an estimate of roughly 4500 eggs (ca 227 adults). We developed a discrete space, discrete time metapopulation model to evaluate the relative contribution of dispersal distance, habitat and environmental stochasticity as possible causes of extinction. We simulated the potential persistence of the butterfly in the current network as well as in three artificial (historical and present) habitat networks that differed in the quantity (current and X3) and fragmentation of the habitat (current and aggregated). We identified that reduced habitat quantity and increased isolation would have increased the probability of regional extinction, in conjunction with environmental stochasticity and H. lucina's dispersal distance. This general trend did not change in a qualitative manner when we modified the ability of dispersing females to stay in, and find suitable habitats (by changing the size of the grid cells used in the model). Contrary to most metapopulation model predictions, system persistence declined with increasing migration rate, suggesting that the mortality of migrating individuals in fragmented landscapes may pose significant risks to system-wide persistence. Based on model predictions for the present landscape we argue that a major programme of habitat restoration would be required for a re-established metapopulation to persist for > 100 years.

Failure of a numerical quality assessment scale to identify potential risk of bias in a systematic review: a comparison study

BACKGROUND: Assessing methodological quality of primary studies is an essential component of systematic reviews. Following a systematic review which used a domain based system [United States Preventative Services Task Force (USPSTF)] to assess methodological quality, a commonly used numerical rating scale (Downs and Black) was also used to evaluate the included studies and comparisons were made between quality ratings assigned using the two different methods. Both tools were used to assess the 20 randomized and quasi-randomized controlled trials examining an exercise intervention for chronic musculoskeletal pain which were included in the review. Inter-rater reliability and levels of agreement were determined using intraclass correlation coefficients (ICC). Influence of quality on pooled effect size was examined by calculating the between group standardized mean difference (SMD).

RESULTS: Inter-rater reliability indicated at least substantial levels of agreement for the USPSTF system (ICC 0.85; 95% CI 0.66, 0.94) and Downs and Black scale (ICC 0.94; 95% CI 0.84, 0.97). Overall level of agreement between tools (ICC 0.80; 95% CI 0.57, 0.92) was also good. However, the USPSTF system identified a number of studies (n = 3/20) as "poor" due to potential risks of bias. Analysis revealed substantially greater pooled effect sizes in these studies (SMD -2.51; 95% CI -4.21, -0.82) compared to those rated as "fair" (SMD -0.45; 95% CI -0.65, -0.25) or "good" (SMD -0.38; 95% CI -0.69, -0.08).

CONCLUSIONS: In this example, use of a numerical rating scale failed to identify studies at increased risk of bias, and could have potentially led to imprecise estimates of treatment effect. Although based on a small number of included studies within an existing systematic review, we found the domain based system provided a more structured framework by which qualitative decisions concerning overall quality could be made, and was useful for detecting potential sources of bias in the available evidence.

Understanding Risk: Contributions from the Journal of Risk and Governance

During recent years, news headlines have been rife with criticisms of the risk management practices of public and private sector entities. These criticisms have often been accompanied by calls for greater transparency in the way government entities manage risks and communicate dangers to the public. Similarly, in the private sector, the internationalisation of economic activity has heightened concerns over the potential adverse implications of mismanagement and financial scandals, and has led to calls for greater regulation and supervision. While the responses of public sector agencies and private sector actors to these challenges have differed, they share a common acknowledgement that effective governance relies on the pro-active identification, assessment, and management of risks as well as appropriate regulatory frameworks.

This edited book covers a number of divergent topics illustrating the emergence of several novel themes in the area of economic and social risks. As a communality, these novel themes relate to the complexity in which human activity in this late stage of capitalist development is embedded. This risk-generating complexity, in turn, can be observed at several levels, including workplace hazards, governance problems within the private sector or the intersection between public and private, and in relation to the economic risks faced by larger entities such as national governments.

Cathepsin S: therapeutic, diagnostic, and prognostic potential

Cathepsin S is a member of the cysteine cathepsin protease family. It is a lysosomal protease which can promote degradation of damaged or unwanted proteins in the endo-lysosomal pathway. Additionally, it has more specific roles such as MHC class II antigen presentation, where it is important in the degradation of the invariant chain. Unsurprisingly, mis-regulation has implicated cathepsin S in a variety of pathological processes including arthritis, cancer, and cardiovascular disease, where it becomes secreted and can act on extracellular substrates. In comparison to many other cysteine cathepsin family members, cathepsin S has uniquely restricted tissue expression and is more stable at a neutral pH, which supports its involvement and importance in localised disease microenvironments. In this review, we examine the known involvement of cathepsin S in disease, particularly with respect to recent work indicating its role in mediating pain, diabetes, and cystic fibrosis. We provide an overview of current literature with regards cathepsin S as a therapeutic target, as well as its role and potential as a predictive diagnostic and/or prognostic marker in these diseases.

Overweight and obesity on the island of Ireland: an estimation of costs

Objectives The increasing prevalence of overweight and obesity worldwide continues to compromise population health and creates a wider societal cost in terms of productivity loss and premature mortality. Despite extensive international literature on the cost of overweight and obesity, findings are inconsistent between Europe and the USA, and particularly within Europe. Studies vary on issues of focus, specific costs and methods. This study aims to estimate the healthcare and productivity costs of overweight and obesity for the island of Ireland in 2009, using both top-down and bottom-up approaches.

Methods Costs were estimated across four categories: healthcare utilisation, drug costs, work absenteeism and premature mortality. Healthcare costs were estimated using Population Attributable Fractions (PAFs). PAFs were applied to national cost data for hospital care and drug prescribing. PAFs were also applied to social welfare and national mortality data to estimate productivity costs due to absenteeism and premature mortality.

Results The healthcare costs of overweight and obesity in 2009 were estimated at €437 million for the Republic of Ireland (ROI) and €127.41 million for NI. Productivity loss due to overweight and obesity was up to €865 million for ROI and €362 million for NI. The main drivers of healthcare costs are cardiovascular disease, type II diabetes, colon cancer, stroke and gallbladder disease. In terms of absenteeism, low back pain is the main driver in both jurisdictions, and for productivity loss due to premature mortality the primary driver of cost is coronary heart disease.

Conclusions The costs are substantial, and urgent public health action is required in Ireland to address the problem of increasing prevalence of overweight and obesity, which if left unchecked will lead to unsustainable cost escalation within the health service and unacceptable societal costs.

Genotoxicity in humans and indicator species exposed to uranium wastes

Os riscos dos resíduos provenientes da extração do urânio estão associados ao seu conteúdo em metais e radionuclídeos, o que levanta preocupações às autoridades governamentais e à população em geral. As populações humanas e outras espécies animais que vivem em zonas de exploração de urânio poderão estar expostas à radiação através de resíduos e poeiras radioactivase também através de água e alimentos contaminados. A determinação dos riscos deste tipo de contaminantes é feita, principalmente, através da análise química de amostras ambientais, dando-se menos importância à determinação de efeitos biológicos. A determinação de efeitos biológicos causados pela exposição a poluentes, tem-se revelado muito importante para uma avaliação da qualidade ambiental, de modo a providenciar indicações acerca dos efeitos negativos nos seres vivos e também para complementar a informação dada pelas análises químicas de amostras ambientais. Este facto levou ao estabelecimento de biomarcadores, que consistem em respostas biológicas adversas que são específicas de uma exposição a toxinas ambientais, para serem usadas como ferramentas de avaliação da qualidade ambiental. Neste trabalho foram analisadas respostas a nível molecular e celular, em minhocas, ratinhos do campo e humanos, a fim de determinar o risco químico e radiológico dos resíduos provenientes da mina de urânio da Cunha Baixa. Este trabalho teve também como objectivo a clarificação das respostas subjacentes à exposição a metais e radionuclídeos, a fim de permitir o desenvolvimento de potenciais novos biomarcadores moleculares. Durante este trabalho foram efectuados ensaios com minhocas, em que estas foram expostas durante 56 dias a solo contaminado proveniente da mina de urânio da Cunha Baixa, em laboratório e in situ. Durante a exposição foram analisados vários parâmetros, como o crescimento, reprodução, bioacumulação de metais e radionuclídeos, histopatologia, danos no DNA, citotoxicidade e perfil de expressão genética. Para além disso, foram amostrados ratinhos do campo na mina de urânio da Cunha Baixa e numa área de referência para determinação de danos no DNA, níveis de expressão e mutações em genes supressores de tumores e também bioacumulação de metais. Por fim, foram recolhidas amostras de sangue em voluntários saudáveis pertencentes à população da aldeia da Cunha Baixa, para determinação de danos no DNA, imunofenotipagem e quantificação de metais no sangue. Os resultados revelaram que as minhocas assim como os ratinhos do campo foram negativamente afetados pela exposição aos resíduos mineiros em todos os níveis de organização biológica aqui analisados, o que faz destes organismos bons indicadores para a determinação do risco destas áreas contaminadas, evidenciando o potencial risco da exposição a estes contaminantes. Para além disso, o estudo feito à população da Cunha Baixa revelou danos no ADN e diminuição de populações importantes de células imunitárias (nomeadamente linfócitos T e NK), o que poderá resultar da exposição aos resíduos da mina, tornando as pessoas mais susceptíveis ao desenvolvimento de processos de carcinogénese. O presente estudo contribuiu significativamente para a caracterização dos riscos da exposição a resíduos provenientes de minas de urânio abandonadas, evidenciando os seus efeitos negativos a nível molecular e celular, que potencialmente poderão causar instabilidade genómica e aumentar o risco de desenvolvimento de doenças genéticas.

Indoor air quality in elementary schools of Lisbon and Aveiro

Tem havido uma preocupação crescente com a qualidade do ar interior (QAI) nas escolas em muitos países. Muitos estudos epidemiológicos têm encontrado diferenças regionais entre ambientes interiores. Apesar da elevada incidência de asma e rinite na população infantil, praticamente nada se sabia sobre a QAI em escolas portuguesas. A percepção dos problemas de QAI é crucial para avaliar os riscos para a saúde e rendimento dos estudantes, e para sugerir meios de reduzir a exposição a poluentes indesejáveis. Neste estudo procurou-se obter as concentrações de poluentes de interesse em estabelecimentos de ensino do 1º ciclo de Lisboa e Aveiro, estimar o estado atual de casos de asma e rinite em escolas primárias da capital, avaliar a influência de diferentes materiais das salas de aula/construção e hábitos escolares na QAI, identificar potenciais fontes de poluentes nos interiores e exteriores das salas de aula e propor medidas mitigadoras. Catorze escolas de Lisboa foram visitadas para obter a caracterização física das construções em termos de estrutura, ventilação, materiais de acabamento, produtos de limpeza, densidade de ocupação e potenciais fontes interiores de poluição. Os estudantes foram questionados sobre os seus hábitos e sintomas respiratórios através de inquéritos do modelo ISAAC (International Study of Asthma and Allergies in Childhood). Durante a primavera, outono e inverno (2008-2010), nas salas de aula e pátios, foram monitorizados, por amostragem passiva, compostos orgânicos voláteis (COVs), carbonilos e dióxido de azoto (NO2). Foram também medidos parâmetros de conforto e níveis de microrganismos. Duas escolas localizadas, uma no centro da cidade e outra na região suburbana, em Aveiro foram estudadas em 2010. Parâmetros de conforto, microrganismos, COVs, NO2, material particulado (PM10) foram medidos no interior e no exterior de ambas escolas. Os iões solúveis, carbono orgânico e elementar (OC e EC), e compostos orgânicos presentes no material particulado foram subsequentemente analisados em laboratório. Uma medida mitigadora - fitoremediação - foi avaliada na escola do centro da cidade de Aveiro em 2011. Os resultados do estudo mostraram que a QAI é pior do que a do ar exterior. Em geral, os níveis de CO2 e dos bioaerosóis excederam os níveis máximos aceitáveis para o conforto dos ocupantes estipulado pelas regulamentações portuguesas. Quase todos os COVs e carbonilos identificados mostraram razões interior/exterior (I/E) maiores que uma unidade, o que demonstra a importante contribuição de fontes interiores em todas as escolas. As razões I/E das concentrações de NO2 nunca excederam a unidade. Os níveis interiores diários de PM10 foram sempre maiores que os exteriores, exceto nos fins de semana. Após a colocação de plantas numa das salas de aula, observou-se uma redução estatisticamente significativa nos níveis de CO2, COVs, carbonilos, PM10, OC, e dos iões nitrato, sulfato, amónia, cálcio e carbonato. A possível redução dos níveis de poluentes no interior após a colocação de plantas pode representar uma solução de baixo custo para reduzir a exposição a muitos compostos, melhorar o rendimento e aumentar o bem estar dos alunos e professores em sala de aula.

Evaluating the potential for urban consolidation centres

This paper focuses upon the potential for Urban Consolidation Centres (UCCs) to alleviate local environmental and traffic problems within urban areas. An international literature review was undertaken, interviews were held with a range of relevant parties, and an evaluation framework was developed. In previous work a narrow focus has typically been adopted and no examples of thorough scheme evaluation were found. A particular concern discussed in the paper is the identification and subsequent allocation of the costs and benefits of implementing and operating a UCC. Lessons learned from existing and attempted UCCs are then presented, and a number of themes and location types that point to successful implementation are identified. The likelihood of a UCC being successful depends considerably upon the legal and planning frameworks in the locality or country involved.

Development and characterization of novel vehicles for topical drug delivery

Tese de doutoramento, Farmácia (Tecnologia Farmacêutica), Universidade de Lisboa, Faculdade de Farmácia, 2016