Reforming the Swedish employment-related social security system:activation, administrative modernization and strengthening local autonomy

The Swedish system of social security has often been regarded as comprehensive and comprehensive and inclusive. During major reforms in the 1990s and 2000s, it has maintained its essential character as a popular and well-endowed provider of social security and stability. Employment-related benefits are generous in financial terms, but come with the need for recipients to remain actively engaged in the economic or educational field. However, Sweden’s geographical and demographic diversity made it necessary to increase the role of local authorities in implementing active labour market policies. This article tracks these developments since the mid-1990s, both with regard to changing the benefits system and with regard to changing local government involvement. It argues that backed by broad political support, the Swedish system has achieved the necessary modernisation and adaptation to remain a viable alternative to more neo-liberal welfare retrenchment projects conducted in other European countries.

Economic evaluations of clinical pharmacy services in Ireland, 2007-2015

Introduction The concept of this thesis was driven by stagnation within the Irish healthcare system. Multiple reports from pharmacy organisations had outlined possible future directions for the profession but progress was minimal, especially in comparison with other countries. The author’s directive was to evaluate the economic impact of a series of clinical pharmacy services (CPS) in hospital and community settings. Methods A systematic review of economic evaluations of clinical pharmacy services in hospital patients was undertaken to gain insight into recent research in the field. Eligible studies were evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS), to establish the quality, consistency and transparency of relevant research. A retrospective analysis of an internal hospital pharmacy interventions database was conducted. A method first described by Nesbit et al. was implemented to estimate the level of cost avoidance achieved. A cost-effectiveness analysis based on data from a randomised controlled trial of a pharmacist-supervised patient self-testing (PST) of warfarin therapy is presented. Outcome measure was the incremental cost associated with six months of intervention management. A similar cost-effectiveness analysis based on previously published RCT data was used to evaluate a novel structured pharmacist review of medication in older hospitalised patients. Cost-effectiveness analysis was presented in the form of an incremental cost-effectiveness ratio (ICER). An ICER is an additional cost per unit effect, in the case of this study, the cost of preventing an additional non-trivial ADR in hospital. A method described by Preaud et al. was adapted to estimate the clinical and economic benefit gained from vaccination of patients by a community pharmacist in Ireland in 2013/14. Sample demographic data was obtained from a national chain of community pharmacies and applied to overall national vaccination data. Results Systematic review identified twenty studies which were eligible for inclusion. Overall, pharmacist interventions had a positive impact on hospital budgets. Only three studies (15%) were deemed to be “good-quality” studies. No ‘novel’ clinical pharmacist intervention was identified during the course of this review. Analysis of internal hospital database identified 4,257 interventions documented on 2,147 individual patients over a 12 month period. Substantial cost avoidance of €710,000 was generated over a 1 year period from the perspective of the health care provider. Mean cost avoidance of €166 per intervention was generated. The cost of providing these interventions was €82,000. Substantial net cost-benefits of €626,279 and a cost-benefit ratio of 8.64 : 1 were generated based on this evaluation of pharmacist interventions. Results from an evaluation of a novel pharmacist-led form of warfarin management indicated indicated that on a per patient basis, PST was slightly more expensive than established anticoagulant management. On a per patient basis over a six month period, PST resulted in an incremental cost of €59.08 in comparison with routine care. Overall cost of managing a patient through pharmacist-supervised PST for a six month period is €226.45. However, for this increase in cost a clinically significant improvement in care was provided. Patients achieved a significantly higher time in therapeutic range during the PST arm in comparison with routine care, (72 ± 19.7% vs 59 ± 13.5%). Difference in overall cost was minimal and PST was the dominant strategy in some scenarios examined during sensitivity analysis. Structured pharmacist review of medication was determined to be dominant in comparison to usual pharmaceutical care. Even if the healthcare payer was unwilling to pay any money for the prevention of an ADR, the intervention strategy is still likely to be cost-effective (probability of being determined cost-effective = 0.707). Implementation of pharmacist-led influenza vaccination has resulted in substantial clinical and economic benefits to the healthcare system. The majority of patients (64.9%) who availed of this service had identifiable influenza-related risk factors. Of patients with influenza-related risk factors, age ≥65 year was the most commonly cited risk factor. Pharmacist vaccination services averted a total of 848 influenza cases across all age groups during the 2013/2014 influenza season. Due to receipt of vaccination in a pharmacy setting, 444 influenza-related GP visits were prevented. In terms of more serious influenza-associated events, 11 hospitalisations and five influenza-related deaths were averted. Costs averted were approximately €305,000. These were principally wider societal-related costs associated with lost productivity. Conclusion Overall, clinical pharmacy services are adding value to the Irish healthcare system in both hospital and community settings, but provision of additional funding for new services would enable them to offer a great deal more.

Techno-economic analysis of three HVAC retrofitting options

Accounting for around 40% of the total final energy consumption, the building stock is an important area of focus on the way to reaching the energy goals set for the European Union. The relatively small share of new buildings makes renovation of existing buildings possibly the most feasible way of improving the overall energy performance of the building stock. This of course involves improvements on the climate shell, for example by additional insulation or change of window glazing, but also installation of new heating systems, to increase the energy efficiency and to fit the new heat load after renovation. In the choice of systems for heating, ventilation and air conditioning (HVAC), it is important to consider their performance for space heating as well as for domestic hot water (DHW), especially for a renovated house where the DHW share of the total heating consumption is larger. The present study treats the retrofitting of a generic single family house, which was defined as a reference building in a European energy renovation project. Three HVAC retrofitting options were compared from a techno-economic point of view: A) Air-to-water heat pump (AWHP) and mechanical ventilation with heat recovery (MVHR), B) Exhaust air heat pump (EAHP) with low-temperature ventilation radiators, and C) Gas boiler and ventilation with MVHR. The systems were simulated for houses with two levels of heating demand and four different locations: Stockholm, Gdansk, Stuttgart and London. They were then evaluated by means of life cycle cost (LCC) and primary energy consumption. Dynamic simulations were done in TRNSYS 17. In most cases, system C with gas boiler and MVHR was found to be the cheapest retrofitting option from a life cycle perspective. The advantage over the heat pump systems was particularly clear for a house in Germany, due to the large discrepancy between national prices of natural gas and electricity. In Sweden, where the price difference is much smaller, the heat pump systems had almost as low or even lower life cycle costs than the gas boiler system. Considering the limited availability of natural gas in Sweden, systems A and B would be the better options. From a primary energy point of view system A was the best option throughout, while system B often had the highest primary energy consumption. The limited capacity of the EAHP forced it to use more auxiliary heating than the other systems did, which lowered its COP. The AWHP managed the DHW load better due to a higher capacity, but had a lower COP than the EAHP in space heating mode. Systems A and C were notably favoured by the air heat recovery, which significantly reduced the heating demand. It was also seen that the DHW share of the total heating consumption was, as expected, larger for the house with the lower space heating demand. This confirms the supposition that it is important to include DHW in the study of HVAC systems for retrofitting.

Development of a responsive fisheries management system for the Portuguese crustacean bottom trawl fishery: Lessons learnt

A prototype for a Responsive Fisheries Management System (RFMS) was developed in the context of the European FP7 project EcoFishMan and tested on the Portuguese crustacean trawl fishery. Building on Results Based Management principles, RFMS involves the definition of specific and measurable objectives for a fishery by the relevant authorities but allows resource users the freedom to find ways to achieve the objectives and to provide adequate documentation. Taking into account the main goals of the new Common Fisheries Policy, such as sustainable utilization of the resources, end of discards and unwanted catches, a management plan for the Portuguese crustacean trawl fishery was developed in cooperation with the fishing industry, following the process and design laid out in the RFMS concept. The plan considers biological, social and economic goals and assigns a responsibility for increased data collection to the resource users. The performance of the plan with regard to selected indicators was evaluated through simulations. In this paper the process towards a RFMS is described and the lessons learnt from the interaction with stakeholders in the development of an alternative management plan are discussed. (C) 2014 Elsevier Ltd. All rights reserved.

Conservation Agriculture and its contribution to the achievement of agri-environmental and economic challenges in Europe

Conservation Agriculture is an ecosystem approach to farming capable of providing solutions for numerous of the agri-environmental concerns in Europe. Certainly, most of the challenges addressed in the Common Agriculture Policy (CAP) could be tackled through Conservation Agriculture (CA). Not only the agri-environmental ones, but also those concerning farmer and rural communities’ prosperity. The optimisation of inputs and similar yields than conventional tillage, make Conservation Agriculture a profitable system compared to the tillage based agriculture. Whereas this sustainable agricultural system was conceived for protecting agrarian soils from its degradation, the numerous collateral benefits that emanate from soil conservation, i.e., climate change mitigation and adaptation, have raised Conservation Agriculture as one of the global emerging agrosciences, being adopted by an increasing number of farmers worldwide, including Europe.

Vanadium Redox Flow Battery Storage System Linked to the Electric Grid

This paper focuses on technology state of the art for the charge/discharge of electric energy storage supported by vanadium redox flow battery linked to the electric grid. Properties of vanadium, the main configuration and the reaction of charge/discharge of a vanadium redox flow battery are addressed. The vanadium redox flow battery has the highest cell voltage among the other redox flow battery, implying higher power and energy density which favours application at power plants. This electric energy storage is viewed as a promising contribution to be integrated in power system due to a reasonably bulky size and to successful applications currently allowing storage of energy at power plants or at electrical grids. For instances, allowing storage of energy as an economic improvement providing spin reserve to avoid penalty for imbalances between the energy delivered and energy contracted at closing of electricity market or as an economic improvement to diminish the cost of electricity usage of a consumer. The vanadium redox flow battery has the advantages of scalability customized to meet requirements for power and energy capacity and of excellent combination of energy efficiency, capital cost and life cycle costs compared with other technology.

Emergy analysis of a silvo-pastoral system, a case study in southern Portugal

The Mediterranean silvo-pastoral system known as Montado, in Portugal, is a complex land use system composed of an open tree stratum in various densities and an herbaceous layer, used for livestock grazing. Livestock also profit from the acorns, and the grazing contributes to avoid shrub encroachment. In the last 20 years, subsidies from the European Union have greatly promoted cattle rearing in this system and the introduction of heavy breeds, at the expense of sheep, goats or the native cattle breeds. The balance of the traditional system is thus threatened, and a precise assessment of the balance between the different components of the system, therefore is highly needed. The goal of this study was to gain a better under- standing of a Montado farm system with cattle rearing as the major economic activity by applying the emergy evaluation method to calculate indices of yield, investment, environmental loading and sustainability. By integrating different ecosystem components, the emergy evaluation method allows a comprehensive evaluation of this complex and multifunctional system at the scale of an individual farm. This method provides a set of indices that can help us understand the system and design management strategies that maximize emergy flow in the farm. In this paper, we apply the emergy evaluation method to a Montado farm with cattle rearing, as a way to gain a better understanding of this system at the farm scale. The value for the transformity of veal (2.66E?06 sej J-1) is slightly higher, when compared to other systems producing protein. That means that the investment of nature and man in this product was higher and it requires a premium price on the market. The renewa- bility for Holm Oaks Farm (49 %), lower than for other similar systems, supports the assumption that this is a farm in which, comparing with others, the number of purchased inputs in relation to renewable inputs provided by nature, is higher. The Emergy Investment Ratio is 0.91 for cattle rearing compared to a value of 0.49 for cork and 0.43 for firewood harvesting, making it clear that cattle rearing is a more labor demanding activity comparing with extractive activities as cork and firewood harvesting.

Double Dyke System - Natural engineering solutions

According to various studies, the effects of climate change will be a danger to ecosystems and the population, especially in coastal areas, increasing the risk of floods. Authorities are taking action to prevent future disasters using traditional engineering solutions. These solutions can have high environmental and economic costs, fixing the coastline, increasing the salinization of aquifers, and can be subject to failure mechanisms. For this reason, studies were made to use natural engineering solutions for coastal protection, instead of traditional solutions, to achieve the UN SDGs. Coastal ecosystems have the natural ability to repair and restore themselves, increasing soil elevation, and attenuating waves. One of these solutions is the Double Dyke System, consisting of creating a salt marsh between the first dyke and a second inland. The goal is to protect the coasts and to restore ecosystems. The purpose of this study is to compare the costs of natural engineering solutions with traditional ones. It is assumed that these solutions may be more effective and less expensive in the long run. For this evaluation, a suitability analysis of the polders in the Dutch Zeeland region to assess the costs and benefits under different SLR scenarios was made. A saline intrusion model was also created to analyze the effects of a salt marsh on the aquifers. From the analyzes conducted, the implementation of the DDS turns out to be the cheapest coastal defense system in all SLR scenarios. The presence of a salt marsh could also have a positive impact on the prevention of saline intrusion in the various scenarios considered. The DDS could have a positive economic and environmental impact in the long term, reducing the investment costs for coastal defense and bringing important benefits for the protection of man and nature. Despite the results, more studies are needed on the efficiency of this defense system and on the economic evaluation of non-marketable ecosystem services.

Distributed non-cooperative robust economic predictive control for dynamically coupled linear systems.

In this thesis, a tube-based Distributed Economic Predictive Control (DEPC) scheme is presented for a group of dynamically coupled linear subsystems. These subsystems are components of a large scale system and control inputs are computed based on optimizing a local economic objective. Each subsystem is interacting with its neighbors by sending its future reference trajectory, at each sampling time. It solves a local optimization problem in parallel, based on the received future reference trajectories of the other subsystems. To ensure recursive feasibility and a performance bound, each subsystem is constrained to not deviate too much from its communicated reference trajectory. This difference between the plan trajectory and the communicated one is interpreted as a disturbance on the local level. Then, to ensure the satisfaction of both state and input constraints, they are tightened by considering explicitly the effect of these local disturbances. The proposed approach averages over all possible disturbances, handles tightened state and input constraints, while satisfies the compatibility constraints to guarantee that the actual trajectory lies within a certain bound in the neighborhood of the reference one. Each subsystem is optimizing a local arbitrary economic objective function in parallel while considering a local terminal constraint to guarantee recursive feasibility. In this framework, economic performance guarantees for a tube-based distributed predictive control (DPC) scheme are developed rigorously. It is presented that the closed-loop nominal subsystem has a robust average performance bound locally which is no worse than that of a local robust steady state. Since a robust algorithm is applying on the states of the real (with disturbances) subsystems, this bound can be interpreted as an average performance result for the real closed-loop system. To this end, we present our outcomes on local and global performance, illustrated by a numerical example.

Subsidence history, thermal maturity, and structural inversion of the Greater Caucasus-Kura-Adjara-Trialeti basin system of central-eastern Georgia

This study aims at defining the tectonic evolution of a portion of the Caucasian region, in Georgia, which experienced a complex pattern of deformation events throughout Mesozoic and Cenozoic times. An integrated approach was applied to unravel the thermo-tectonic history of three inverted sedimentary basins from burial to exhumation. Additionally, this dissertation provides examples of structural inversion of sedimentary basins in response to far-field transmission of compressional stresses away from collision zones, contributing to elucidate the dynamics of stress partitioning during continental collisions. The Adjara-Trialeti fold-and-thrust belt in south-western Georgia results from the structural inversion of a Middle Eocene continental back-arc rift basin opened as a consequence of the Northern Neotethys slab rollback. This study quantitatively defines the subsidence and exhumation history of the Adjara-Trialeti basin, constraining its Middle Miocene inception of structural inversion. The western Kura Basin is a flexural foreland basin trapped between the Lesser Caucasus to the south and the Greater Caucasus to the north. This study constrains successive and competing episodes of flexural subsidence during Oligocene-Miocene times, followed by partial inversion through thick- and thin-skinned tectonics in response to continued convergence between the adjacent, oppositely verging orogenic belts. The Greater Caucasus results from the structural inversion of a Jurassic continental back-arc basin, but the timing of its growth is still debated. An across-strike transect in its southern central domain was studied, indicating that this sector of the Greater Caucasus experienced two phases of structural inversion during Late Cretaceous-Paleocene and Late Miocene times. Overall, the dataset presented in this dissertation points to a complex and episodic history of incremental deformation, characterised by successive phases of extensional and compressional tectonics which developed in response to sequential terrane accretion at the southwestern margin of Eurasia since Late Cretaceous times, eventually determining the current configuration of the Arabia-Eurasia collision zone.

The Financial Services Regime in International Economic Law: on the Difficult Relationship between Trade Liberalization and Prudential Measures

The PhD thesis analyses the financial services regime in international economic law from the perspective of the difficult relationship between trade liberalisation and prudential measures. Financial stability plays a fundamental role for the well-being and well-functioning of the global economy, but, it is at the same time a complex sector to regulate and supervise and, especially after the 2007-08 economic crisis, States have tightened up their regulation of financial services, introducing more severe and protectionist prudential measures. However, in an increasingly interconnected global economy, the harmonization of prudential regulation at the international level is an essential step to guarantee integrity, fairness and stability of financial markets and trade. The research analyses the tools at disposition to achieve this aim, the related problematic issues and the perspectives and possible solutions for the future, starting from the World Trade Organization (WTO) legal framework and its General Agreement on Trade in Services (GATS), devoted to discipline trade in services among the WTO Members. Then, the research moves to a second legal instrument, the Free Trade Agreements (FTAs), which has witnessed a remarkable spread in the last decades. Finally, the research addresses the international standards, developed by supranational entities and implemented by an increasing number of States, as they offer rules and guidelines adequate to update the international financial scenario. Nevertheless, the international standards alone cannot be the solution because, first, they are not mandatory, as governments decide voluntarily to apply them and, second, their decision-making process do not respect the requirements of transparency and representative membership. In light of this analysis, the thesis aims at providing an answer to its research question: how to give more certainty to States and economic operators in the planning of the domestic disciplines and business activities in order to provide a sound and stable international financial system.

Advanced studies on two animal models, murine and fish. RadKI21A626T mouse model: new insights into molecular mechanisms of enteric neuro-epithelial pathology. European sea bass: study of the effects of essential oils in different diets on the gastric system.

My PhD research period was focused on the anatomical, physiological and functional study of the gastrointestinal system on two different animal models. In two different contexts, the purpose of these two lines of research was contribute to understand how a specific genetic mutation or the adoption of a particular dietary supplement can affect gastrointestinal function. Functional gastrointestinal disorders are chronic conditions characterized by symptoms for which no organic cause can be found. Although symptoms are generally mild, a small subset of cases shows severe manifestations. This subset of patients may also have recurrent intestinal sub-occlusive episodes, but in absence of mechanical causes. This condition is referred to as chronic intestinal pseudo-obstruction, a rare, intractable chronic disease. Some mutations have been associated with CIPO. A novel causative RAD21 missense mutation was identified in a large consanguineous family, segregating a recessive form of CIPO. The present thesis was aimed to elucidate the mechanisms leading to neuropathy underlying CIPO via a recently developed conditional KI mouse carrying the RAD21 mutation. The experimental studies are based on the characterization and functional analysis of the conditional KI Rad21A626T mouse model. On the other hand aquaculture is increasing the global supply of foods. The species selected and feeds used affects the nutrients available from aquaculture, with a need to improve feed efficiency, both for economic and environmental reasons, but this will require novel innovative approaches. Nutritional strategies focused on the use of botanicals have attracted interest in animal production. Previous research indicates the positive results of using essential oils (EOs) as natural feed additives for several farmed animals. Therefore, the present study was designed to compare the effects of feed EO supplementation in two different forms (natural and composed of active ingredients obtained by synthesis) on the gastric mucosa in European sea bass.

Economic preferences in the health setting. Three case studies concerning the needs of breast cancer patients, pain management in oncology and extreme end-of-life decisions

The thesis describes three studies concerning the role of the Economic Preference set investigated in the Global Preference Survey (GPS) in the following cases: 1) the needs of women with breast cancer; 2) pain undertreament in oncology; 3) legal status of euthanasia and assisted suicide. The analyses, based on regression techniques, were always conducted on the basis of aggregate data and revealed in all cases a possible role of the Economic Preferences studied, also resisting the concomitant effect of the other covariates that were considered from time to time. Regarding individual studies, the related conclusion are: 1) Economic Preferences appear to play a role in influencing the needs of women with breast cancer, albeit of non-trivial interpretation, statistically "resisting" the concomitant effect of the other independent variables considered. However, these results should be considered preliminary and need further confirmation, possibly with prospective studies conducted at the level of the individual; 2) the results show a good degree of internal consistency with regard to pro-social GPS scores, since they are all found to be non-statistically significant and united, albeit only weakly in trend, by a negative correlation with the % of pain undertreated patients. Sharper, at least statistically, is the role of Patience and Willingness to Take Risk, although of more complex empirical interpretation. 3) the results seem to indicate an obvious role of Economic Preferences, however difficult to interpret empirically. Less evidence, at least on the inferential level, emerged, however, regarding variables that, based on common sense, should play an even more obvious role than Economic Preferences in orienting attitudes toward euthanasia and assisted suicide, namely Healthcare System, Legal Origin, and Kinship Tightness; striking, in particular, is the inability to prove a role for the dominant religious orientation even with a simple bivariate analysis.

Obesity And Inflammation And The Effect On The Hematopoietic System.

Bone marrow is organized in specialized microenvironments known as 'marrow niches'. These are important for the maintenance of stem cells and their hematopoietic progenitors whose homeostasis also depends on other cell types present in the tissue. Extrinsic factors, such as infection and inflammatory states, may affect this system by causing cytokine dysregulation (imbalance in cytokine production) and changes in cell proliferation and self-renewal rates, and may also induce changes in the metabolism and cell cycle. Known to relate to chronic inflammation, obesity is responsible for systemic changes that are best studied in the cardiovascular system. Little is known regarding the changes in the hematopoietic system induced by the inflammatory state carried by obesity or the cell and molecular mechanisms involved. The understanding of the biological behavior of hematopoietic stem cells under obesity-induced chronic inflammation could help elucidate the pathophysiological mechanisms involved in other inflammatory processes, such as neoplastic diseases and bone marrow failure syndromes.

The Value Of The 2005 International Society Of Urological Pathology (isup) Modified Gleason Grading System As A Predictor Of Biochemical Recurrence After Radical Prostatectomy.

To compare time and risk to biochemical recurrence (BR) after radical prostatectomy of two chronologically different groups of patients using the standard and the modified Gleason system (MGS). Cohort 1 comprised biopsies of 197 patients graded according to the standard Gleason system (SGS) in the period 1997/2004, and cohort 2, 176 biopsies graded according to the modified system in the period 2005/2011. Time to BR was analyzed with the Kaplan-Meier product-limit analysis and prediction of shorter time to recurrence using univariate and multivariate Cox proportional hazards model. Patients in cohort 2 reflected time-related changes: striking increase in clinical stage T1c, systematic use of extended biopsies, and lower percentage of total length of cancer in millimeter in all cores. The MGS used in cohort 2 showed fewer biopsies with Gleason score ≤ 6 and more biopsies of the intermediate Gleason score 7. Time to BR using the Kaplan-Meier curves showed statistical significance using the MGS in cohort 2, but not the SGS in cohort 1. Only the MGS predicted shorter time to BR on univariate analysis and on multivariate analysis was an independent predictor. The results favor that the 2005 International Society of Urological Pathology modified system is a refinement of the Gleason grading and valuable for contemporary clinical practice.