Academic literature on the topic 'Flextime – Europe – Case studies'
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Journal articles on the topic "Flextime – Europe – Case studies"
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Varga, Esztella. "Refugee Problem in Europe – Case Studies." Eurasian Journal of Social Sciences 3, no. 4 (2015): 37–45. http://dx.doi.org/10.15604/ejss.2015.03.04.004.
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Kulick, Don. "Queer in Europe: Contemporary Case Studies." Contemporary Sociology: A Journal of Reviews 43, no. 1 (December 30, 2013): 79–80. http://dx.doi.org/10.1177/0094306113514539j.
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Desprez, Bertrand, and Catherine Mahony. "Cosmetics Europe systemic toxicity case studies." Toxicology Letters 280 (October 2017): S319. http://dx.doi.org/10.1016/j.toxlet.2017.08.062.
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Davie, Grace. "Is Europe an Exceptional Case?" International Review of Mission 95, no. 378-379 (July 10, 2006): 247–58. http://dx.doi.org/10.1111/j.1758-6631.2006.tb00562.x.
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Klos, Zbigniew, and Jedrzej Kasprzak. "16th SETAC Europe LCA case studies symposium." International Journal of Life Cycle Assessment 15, no. 5 (April 22, 2010): 425–27. http://dx.doi.org/10.1007/s11367-010-0178-1.
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Jantz, Richard L. "Review of:Forensic Anthropology: Case Studies from Europe." Journal of Forensic Sciences 53, no. 4 (July 2008): 1009. http://dx.doi.org/10.1111/j.1556-4029.2008.00779.x.
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Fokas, Effie. "Islam In Europe The Unexceptional Case." Nordic Journal of Religion and Society 24, no. 01 (February 10, 2017): 1–17. http://dx.doi.org/10.18261/issn1890-7008-2011-01-01.
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Komar, Debra A. "Book review: Forensic Anthropology: Case Studies from Europe." American Journal of Physical Anthropology 135, no. 3 (2008): 367–68. http://dx.doi.org/10.1002/ajpa.20730.
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Brada, Josef C., Alexandra Hess, and Inderjit Singh. "Corporate Governance in Eastern Europe: Findings from Case Studies." Post-Soviet Geography and Economics 37, no. 10 (December 1996): 589–614. http://dx.doi.org/10.1080/10889388.1996.10641032.
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Trnkova, Petra. "Photography in 1848: Five Case Studies from Central Europe." History of Photography 43, no. 3 (July 3, 2019): 233–50. http://dx.doi.org/10.1080/03087298.2019.1643546.
Full textDissertations / Theses on the topic "Flextime – Europe – Case studies"
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CHATZIDIMITRIOU, EVANGELIA. "Alien Invasive Species in Europe: Three Case Studies." Doctoral thesis, Università degli studi di Padova, 2016. http://hdl.handle.net/11577/3427137.
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The incidental introduction of alien phytophagous insects and mites has become quite a common event in the world owing to intensive commercial exchanges of plants and goods and ever-increasing tourist traffic. There is evidence that this phenomenon is increasing, in spite of the control measures of the EU phytosanitary system in order to minimize unintentional introductions.
The introduction of an alien species in a new ecosystem and the interaction between an alien species and the autochthonous species usually has many disadvantages. The alien species can dominate the invaded ecosystems and eventually become an invasive species due also to the absence or paucity of natural enemies. These invasions can affect the native species that become less common or threatened with extinction. Apart from the environmental impacts alien species are known for their economic and health impacts.
In this study were investigated mostly 3 recently introduced alien species in Italy, namely Tuberocephalus (Trichosiphoniella) tianmushanensis Zang (Hemiptera Aphididae), Cydalima perspectalis (=Glyphodes) (Walker, 1859) (Lepidoptera Crambideae), the box caterpillar and Phenacoccus defectus Ferris (Rhynchota Pseudococcidae).
The first chapter is a background of invasive ecology and presents with graphs the high number of alien species introduced in Europe the last years..
The second chapter is dealing with Tuberocephalus (Trichosiphoniella) tianmushanensis Zang, an Asiatic heteroecious species so far not recorded in Italy. This species was collected in the University Botanical Garden of Padova in spring 2012. On May 30, 2012 reddish-pink galls, with aphids inside, were observed on the leaves of two Prunus subhirtella cv. pendula trees (Rosaceae) (Weeping Higan Cherry), about 40 years old. Once mounted on slides the aphids were identified as Tuberocephalus (Trichosiphoniella) tianmushanensis Zang. The purposes of this study were to collect data on species distribution over the territory, by monitoring ornamental cherry trees in the Veneto region, to observe the phenology and biology of the Asiatic aphid, to study the life-cycle in screen houses and outdoors, to verify if its secondary host plant was an Artemisia sp., as reported in bibliography. Another aspect of the work was to provide an overview of the species belonging to the genus Tuberocephalus so far described, by consulting the available literature. It was made an effort to gather all the currently available information for each species, its distribution and information on their biology mainly regarding the first and secondary host plants. Results showed that Tuberocephalus (T.) tianmushanensis, is now considered acclimatized in our environment. The aphid is closely related to the presence of its primary host Prunus subhirtella v. pendula with pink flowers. The aphid can carry on two generations on Prunus and can induce two types of leaf galls. The gall A is induced by the fundatrix, while the gall B is induced by the fundatrigeniae. The trial of colonization on Artemisia vulgaris, failed for the second successive year so possibly Artemisia vulgaris is not the secondary host plant of the aphid, as reported in literature.
The third chapter concers Cydalima perspectalis (Lepidoptera, Crambiidae) (Walker, 1859), an asiatic pest of Buxus. It was reported for the first time in Europe in Germany in 2007. In Italy it was detected in 2011, in Lombardy, Como province. In a very short time it invaded the other northern regions and was recorded in Veneto in 2012. The larvae feed on leaves and shoots of the box trees and the infestations lead to defoliation of the plants. The objective of this study was to investigate the phenology of C. perspectalis. More precisely we examined the biological cycle of life, the number of molts and the overwintering stage. In addition host plants were monitored by regular samplings, from late winter to late fall to collect data on species distribution over the territory. The life-cycle was studied in screen houses and in the field, to investigate the role of potential predators and parasitoids. Additionally experiments were conducted with pheromones traps with the purpose of checking, monitoring and collecting data on species distribution over the territory, finding any possible differences based on climate, checking the potential differences between types of traps. According to the results of 2014 and 2015 in the Veneto Region C. perspectalis develops three generations / year. In 2014 the overwintering larvae started their activity early in February until mid-April while in 2015 one month later until end of April probably due to different climate conditions between these years. C. perspectalis overwinters in a silk cocoon in-between the leaves as a larva of 2nd instar and the number of larval instar is 5.
The number of captures from the sex pheromones traps was low. No differences were observed between the two types of pheromones. C. perspectalis has spread quickly in our environment proving that it has acclimatized. So far, it seems there has been no adaptation by indigenous natural enemies (parasitoids) to C. persectalis.
The next chapter is focued on the difficulty to separate the Phenacoccus solani Ferris and P. defectus Ferris (Hemiptera: Pseudococcidae). They are morphologically similar and the microscopic morphological characters of the adult female alone are not enough. In order to resolve their identity, a canonical variates morphological analysis of 199 specimens from different geographical origins and host plants and a molecular analysis of the CO1 and 28S genes were performed. The morphological analysis supported synonymy of the two species, as although the type specimens of the "species" are widely separated from each other in the canonical variates plot, they are all part of a continuous range of variation. The molecular analysis showed that P. solani and P. defectus are grouped in the same clade. On the basis of the morphological and molecular analyses, P. defectus is synonymized under the senior name P. solani, syn. n.
Finally a zoogeographic analysis of the Greek scale insects fauna (Hemiptera, Coccoidea) was carried out with the aim to highlight how many alien scale insects species are so far present in the Greek territory. According to the last data, the scale insect fauna of whole Greek territory comprehends 207 species; a total of 187 species are recorded in mainland Greece and minor islands, whereas only 87 scale species are known so far in the island of Crete. The most numerous families are the Diaspididae, with 86 species in total, followed by Coccidae, with 35 species and by Pseudococcidae, with 34 species. The results of a first zoogeographical analysis of scale insect fauna of mainland Greece and the island of Crete is also presented. Five scale species, respectively four in mainland Greece and one in Crete, are considered as endemic. This analysis demonstrated that alien scale insects, introduced and acclimatized a long time ago or recent invaders, make up 30% of the Greek scale insects fauna.Tra le specie di Phenacoccus neartiche, P. defectus Ferris, P. solani Ferris è P. solenopsis Tinsley condividono l’insolito carattere morfologico dell’assenza di pori pentaoculari è sono morfologicamente simili da rendere difficile l’ identificazione. Il problema della loro identificazione è stato evidenziato da diversi autori (McKenzie, 1967; Williams & Granara de Willink, 1992; Culik & Gullan, 2005; Pellizzari & Porcelli, 2013), benché sia generalmente riconosciuto che P. solenopsis possieda un maggior numero di pori multiloculari e un circulus di maggiori dimensioni rispetto alle altre due specie; inoltre quest’ultima è una specie bisessuale mentre le altre due si riproducono per partenogenesi. Le tre specie di cocciniglie condividono diverse piante ospite. In accordo con Hodgson et al. (2008) ci sono elementi che supportano l’ipotesi che si tratti di varianti di una singola specie. Per definire meglio il loro status tassonomico, abbiamo amplificato mediante PCR e sequenziato il frammento di DNA ‘barcode’ di P. solani, P. solenopsis, e P. defectus.
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Farahmand, Hossein. "Integrated Power System Balancing in Northern Europe - Models and Case Studies." Doctoral thesis, Norges teknisk-naturvitenskapelige universitet, Institutt for elkraftteknikk, 2012. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-16864.
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Maintaining a continuous balance between generation and load is crucial for the safeguarding of the power systems. In order to effectively deal with the various uncertainties that contribute to the real-time imbalance in liberalised power systems, Transmission System Operators (TSOs) procure and employ the so-called balancing services through balancing markets. In Europe, though such mechanisms are well in place at the national level, the potential of multinational balancing markets has not been fully exploited (with the exception of the Nordic system and various pilot projects). This thesis analyses the potential for integrating the balancing power markets in northern Europe, including the Nordic system, Germany and the Netherlands. It addresses the twin issues of the procurement and employment of cross-border balancing services by using mathematical models. Beginning with an outline of the role of balancing markets in Europe, an overview of existing balancing markets in the northern European system is presented. A discussion on the cross-border balancing arrangements is then carried out, paving the way for quantitative analysis. A quantitative analyses of the multinational balancing markets are carried out, both in terms of attainable socio-economic cost savings, and their effect on the exchange of regional balancing services and generation dispatch. In this respect, two cases of balancing market integration are analysed: the current state with separate balancing markets, and the anticipated state of full integration of these markets. In the proposed modelling approach a two-step model is used, representing the day-ahead and balancing markets, respectively. First, the day-ahead market is modelled as a common market for the whole European continent. Simultaneously, reserve procurement for northern Europe is modelled. Available transmission capacity is allocated implicitly to the balancing services exchange, based on the trade-off between day-ahead energy and balancing capacity exchange. Next, the balancing energy market is modelled as a real-time power dispatch on the basis of the day-ahead market clearing results and simulated imbalances. Detailed results illustrate the consequences of market integration between two synchronous areas on procured and activated reserves, dispatch of generators, and power flows. The profitability of balancing market integration is quantified by the observed cost savings obtained due to the use of cheaper balancing resources and less activation of reserves caused by imbalance netting. The implementation of cross-border balancing entails both qualitative and quantitative analyses of different balancing exchange scenarios. This thesis focuses on the qualitative studies of cross-border balancing arrangements together with the quantitative analysis of cross-border balancing. The methodology developed in the thesis enables the study of the benefits of integrating the northern European balancing markets, and the resulting exchange of balancing services among the Nordic countries, Germany and the Netherlands. The multinational balancing market can be adapted to capture the effect of different market integration scenarios. The presented modelling approach includes a flow-based market model, which takes into account physical power flows and loop flows, especially suitable for the European systems with highly meshed transmission grids. A four tiered sequential approach is used to organize the primary contributions of the research work, as highlighted by the four distinct publications arising out of it. Tier 1: An optimal methodology for reserve activation in the Nordic system is established. Tier 2: Using the first tier as the basis, a cross-border reserves procurement algorithm is proposed for an integrated European system. Superimposing Tier 2 on Tier 1 results in a bottom-up approach of capturing the full spectrum of reserve procurement and activation for integrated balancing markets. Tier 3: The profitability of balancing market integration is brought forward through both weekly and yearly analysis on the basis of mathematical models developed in Tier 1 and 2. Tier 4: It is shown that the flexibility concerns warranted by penetration of renewable energy resources can be well addressed by using the developed framework of cross-border balancing market integration. A case study of a future power system (in 2030) with wind energy penetration has been employed in this regard. The results include the optimal distribution of balancing reserve capacity allocations for procurement among the constituent countries, and the optimal exchange of balancing energy that ensues upon activating these capacity reserves. An annual analysis of the post-integration scenario results demonstrates the significant cost savings that are achievable under the framework of multinational balancing markets. The results also demonstrate the potential for increased production flexibility, in light of increased wind energy penetration in the future operation of power systems through the mechanism of multinational balancing markets.
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Carstens, T. H. M. "Aspekte van nasionale en kulturele identiteit van 'n verenigende Europa sedert 1958 : enkele gevallestudies." Thesis, Stellenbosch : Stellenbosch University, 2003. http://hdl.handle.net/10019.1/53294.
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Thesis (MA)--University of Stellenbosch, 2003.ENGLISH ABSTRACT: In a globalizing world it follows that the identity of individuals will come under scrutiny as borders between states fade. It is exactly for this reason that so many people feel uncomfortable within themselves and become involved in a desperate search for new terms of reference and value systems. By virtue of this, history is utilized to explore the problem by tracing circumstances on a continent where the issue is currently very topical. Certain facets of Europe, which was the axis of the catastrophic Second World War but simultaneously the cradle of an Eurocentrism which has evolved gradually over centuries, is carefully scrutinized in order to determine what tendencies are becoming noticeable. This investigation cannot ignore the demise of the Soviet Empire and the burgeoning nation states of Eastern Europe since it represents an important divide in the European history of the twentieth century. A unifying Europe is embodied in various institutions which have sprung up since the Second World War, partially due to efforts of Europeans to organise themselves or alternatively, as a consequence of the Atlantic allies' attempts to present a united front to Soviet Russia. With the demise of the Soviet Republic in 1989, the concept underwent a further change when the Eastern European countries joined the institutional structures of a unifying nature such as the Council of Europe. It is exactly because of this that the identity issue came to the fore. The only realistic and pragmatic yardstick to measure national and cultural identity within the defined period is by employing the sovereignty of the nation state. Concurrently with this yardstick is the realisation that the protection or loss of sovereignty occurs within the upper constitutional or political levels where the public is seldom involved, but ultimately as a consequence affected. This reflects a democratic deficit. Seen from the angle of the early protagonists of Eurocentrism as well as the USA, there were conflicting views on the protection or loss of sovereignty, but an admission that greater unity could lead to the loss of some sovereignty. Britain, without publicly acknowledging it, had indeed surrendered some of its sovereignty during the 1970's when it became a member of the European Economic Community, by subjecting itself to the ruling that European Union legislation would be superior to that of Britain in the event of a conflict. Britain had thus, with regard to national and cultural identity, already proceeded to a new relationship. This new relationship was reinforced by Britain's under-writing of the principle of subsidiarity which ultimately promotes a dual identity of being British and European. The same tendency was noticeable in the institutional arrangements and programmes of the Council of Europe and the European Union. On investigating the viewpoints and role which Belgium, as one of the founder members of the European Economic Community, and simultaneously a small nation, this tendency also becomes very apparent, but possibly with greater emphasis of the regional role as a result of strong identity forming influences. In conclusion, it is thus apparent that being a European, and British or Flemish simultaneously, is currently becoming the vogue. However, being European is currently of a consumer-goods nature. It does not embrace a vibrant European identity particularly as a consequence of the language difference which limit the Europeanisation of national and cultural identities. Attempts to resolve the problem through adages such as "unity in diversity" has not produced the expected results.
AFRIKAANSE OPSOMMING: In 'n globaliserende wêreld volg dit dat die identiteit van individue onder druk sal kom omdat die grense tussen state neig om te vervaag. Dit is juis as gevolg hiervan dat soveel mense ongemaklik voel met hulself en betrokke raak by 'n desperate soeke na nuwe punte van verwysing en nuwe waardestelsels. Gedagtig hieraan word die geskiedenis ingespan om die problematiek te verken deur ondersoek in te stel na die verloop van omstandighede op 'n kontinent waar die kwessie inderdaad tans uiters aktueel is. Sekere aspekte van Europa, wat die spilpunt van die katastrofale Tweede Wêreld Oorlog was, maar terselfdertyd ook die bakermat van 'n Eurosentrisme wat geleidelik oor eeue ontluik het, word onder die vergrootglas geplaas ten einde te bepaal watter neigings te bespeur is. Hierdie ondersoek kon ook nie die val van die Sowjet-ryk en die opkomende nasiestate in Oos-Europa ignoreer nie, omdat dit 'n belangrike breuklyn in die Europese geskiedenis van die twintigste eeu verteenwoord ig. 'n Verenigende Europa word vergestalt in verskeie organisasies wat sedert die Tweede Wêreld Oorlog ontstaan het enersyds vanweë pogings van Europeërs om hulself te orden, of andersyds, vanweë pogings van die Atlantiese bondgenote om 'n verenigende front jeens Sowjet-Rusland te vorm. Met die val van die Sowjet-Republiek in 1989, het die begrip 'n verdere verandering ondergaan toe Oos-Europese lande aangesluit het by institusionele strukture van 'n verenigende aard soos die Raad van Europa. Juis as gevolg hiervan het die identiteitskwessie sterker na vore getree. Die enigste realistiese en pragmatiese norm om dit te meet binne die gegewe tydsgewrig was aan die hand van die soewereiniteit van die nasiestate. Die meting gaan egter gepaard met die wete dat soewereiniteitsbeskerming of -verlies plaasvind op hoë politieke of konstitusionele vlakke waarby die algemene publiek selde betrek, maar inderdaad as uitvloeisel, geaffekteer word. Dit lei dus tot 'n gebrekkige demokratiseringsproses. Gesien vanuit die oogpunt van die vroeër denkers van Europeanisering asook die VSA, was daar botsende menings oor die verlies of beskerming van soewereiniteit, maar 'n erkenning dat groter eenheid tog tot "n mate van soewereiniteitsverlies kon lei. Brittanje het inderdaad, sonder om dit openlik te erken, reeds met sy aansluiting in die 1970's afstand gedoen van "n gedeelte van haar soewereiniteit deur die aanvaarding van die toetredingsvoorwaarde dat, waar Britse en Europese Ekonomiese Gemeenskap wetgewing bots, laasgenoemde sou oorheers. Gedagtig hieraan, is dit dus duidelik dat wat nasionale en kulturele identiteit betref, Brittanje reeds haarself begeef het in "n nuwe verhouding. Die nuwe verhouding versterk deur Brittanje se onderskrywing van die beginsel van subsidiariteit, kom eintlik daarop neer dat "n persoon terselfdertyd Brits en Europeër kan wees. Dieselfde tendens is te bespeur in die institusionele reëlings en programme van die Raad van Europa asook die Europese Unie. Wanneer die standpunte en rol van België as een van die stigterlande van die Europese Ekonomiese Gemeenskap, maar terselfdertyd "n kleinstaat, ondersoek word, kom die verskynselook sterk na vore, moontlik egter met nog meer beklemtoning van die streeksrolle van gebiede as gevolg van sterk identiteitsvormende invloede. Ten laaste word dit dus duidelik dat "n gelyktydige Europees-wees asook Brits-wees, of Vlaams-wees, nou aan die orde van die dag begin kom. Die Europees-wees is egter nog van "n verbruikersgoedere aard. Dit omvat nog nie "n lewenskragtige Europese identiteit nie veral as gevolg van die taalverskille wat belemmerend inwerk op die Europeanisering van nasionale en kulturele identiteite. Pogings om die probleem op te los deur slagspreuke soos "eenheid in diversiteit" werp nog nie die nodige vrugte af nie.
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Weaver, Alexandra R. "Case Studies on the Implementation and Impact of Gender Quotas in European Legislative Bodies." Scholarship @ Claremont, 2013. http://scholarship.claremont.edu/scripps_theses/227.
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This research is an examination of the impact of gender quotas in EU legislative bodies, analyzing data regarding the increase of women in national governments since quota implementation. This paper analyzes and compares the results of four case studies: France, Spain, Romania and Slovenia. The data is analyzed relative to their respective histories, cultures and political systems. The sources used for obtaining numerical data are government/EU documents, other academic work, and newspaper articles that have been published on the subject. Due to the limited scope of the research, the purpose is not to draw any definite, far-reaching conclusions about gender quotas in European Union legislatures. Rather, it is a demonstration of the knowledge acquired in conducting the research and how it may be pertinent to further research.
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Weiss, Jana. "Human exposure to persistent organic pollutants : Illustrated by four case studies in Europe." Doctoral thesis, Stockholm : Department of Environmental Chemistry, Stockholm University, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-1057.
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MATOS, Inês Ferreira Pita de Campos. "The relationship between context and health inequalities: Europe and Portugal as case studies." Doctoral thesis, Instituto de Higiene e medicina Tropical, 2018. http://hdl.handle.net/10362/50901.
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As desigualdades socioeconómicas na saúde têm sido observadas há séculos por todo o mundo. Décadas de investigação identificaram múltiplos fatores que determinam estas desigualdades, como educação ou emprego. Recentemente, o foco da investigação sobre desigualdades em saúde mudou de determinantes individuais para determinantes contextuais, como as características físicas e sociais do ambiente. No entanto, a investigação sobre os determinantes contextuais depara-se com a ausência de uma base teórica sobre como estes determinantes influenciam a saúde. Portugal, sendo um dos
países Europeus mais desiguais, tanto em rendimento como em saúde, é um caso de estudo interessante para o estudo das desigualdades em saúde. Esta tese procura contribuir para a compreensão do impacto dos determinantes contextuais na saúde e na sua distribuição, utilizando Portugal e a Europa como casos de estudo.
Para cumprir este objetivo, foram selecionados três determinantes contextuais – capital social, regimes de bem-estar e alterações macroeconómicas – e os seus efeitos sobre a saúde e sobre as desigualdades em saúde foram explorados. Fora utilizados dados
transversais do European Social Survey para analisar a associação entre capital social e saúde auto-declarada em países Europeus entre 2002 e 2012. A mesma base de dados foi utilizada para analisar a associação entre a mobilidade social e saúde auto-declarada em seis tipos de regimes de bem-estar Europeus. Estas análises utilizaram regressões logísticas multinível. Para analisar evidência sobre desigualdades socioeconómicas na saúde em Portugal depois de 2000 foi efetuada uma revisão sistemática da literatura.
Dados transversais do European Union Survey on Income and Living Conditions foram utilizados para analisar alterações da desigualdade nas limitações em saúde em Portugal entre 2004 e 2014, tendo em conta as alterações macroeconómicas no País. Nesta análise, foram utilizados o índice de concentração e regressões logísticas múltiplas.
O capital social contextual estava associado com pior saúde auto-declarada em indivíduos com pouca confiança interpessoal, influenciando assim a distribuição da saúde. Regimes de bem-estar Europeus estavam associados com a magnitude do impacto da mobilidade social na saúde. A revisão sistemática mostrou que o estudo dos determinantes contextuais em Portugal ainda é incomum. Alterações macroeconómicas em Portugal influenciaram a saúde e a sua distribuição na última década.
Com base nestes resultados, foi delineado um quadro conceptual sobre a influência do contexto na saúde da população e na sua distribuição. O quadro conceptual distingue claramente entre um mecanismo que influencia a saúde da população e outro que influencia a sua distribuição. Este quadro pode ser utilizado como base de análises
futuras para clarificar os mecanismos pelos quais o contexto influencia a saúde e as desigualdades em saúde. Pode também apoiar decisões sobre políticas que procurem influenciar a saúde da população e reduzir as desigualdades em saúde.
Apesar das suas limitações, este trabalho produz evidência sobre os determinantes socioeconómicos da saúde em Portugal e sobre o impacto que o contexto pode ter nestes determinantes e nas desigualdades em saúde. O quadro conceptual proposto poderá
avançar o debate sobre a influência do contexto na saúde e na sua distribuição.Socioeconomic inequalities in health have been observed for centuries throughout the world. Decades of research have identified multiple factors that determine these inequalities, such as education or employment. More recently, the focus of research in health inequalities shifted from individual to contextual determinants, such as physical and social characteristics of the environment. However, research on contextual determinants has been undermined by the absence of a theoretical basis to explain how these determinants influence health outcomes. Portugal is an interesting case study as it is one of the most unequal European countries both in income and health inequality, with limited academic and political attention to the topic. This dissertation aims to contribute to the understanding of how contextual characteristics can impact population health and health distribution, using Portugal and Europe as case studies. To achieve its aim, this research selected three contextual determinants – social capital, welfare regimes, and macroeconomic changes – and explored their effect on health and health inequalities. Cross-sectional data from the European Social Survey was used to analyse how social capital was associated with self-assessed health in European countries between 2002 and 2012. The same database was used to analyse the association between social mobility and self-assessed health in six welfare regime types in Europe. These analyses used multilevel logistic regressions. A systematic review of the literature was done to collect and analyse evidence about socioeconomic health inequalities in Portugal after 2000. Cross-sectional data from the European Union Survey on Income and Living Conditions was used to analyse how inequalities in health limitations changed in Portugal between 2004 and 2014, in light of important macroeconomic changes in the country. For this analysis, the concentration index was calculated and a multiple logistic regression model was run for each year. Contextual social capital was found to have an effect on individuals with low interpersonal trust, thus influencing health distribution. Welfare regime types were associated with the magnitude of the impact of social mobility on health. The systematic review showed that the study of contextual determinants of health inequalities is still uncommon in Portugal. Finally, important contextual changes in Portugal over the last decade seem to have influenced health and its distribution in the country. Drawing on the findings from these analyses, a conceptual framework was outlined, summarising how context influences population health and health distribution. The framework draws a clear distinction between a mechanism that leads to changes in population health, and another mechanism that leads to changes in health distribution. This framework can be used as a basis for future empirical research, helping clarify the mechanisms by which context influences health and health inequalities. It can also support policies seeking to influence population health and health inequalities. Despite its limitations, this work provides evidence on the social determinants of health in Portugal and on the impact that contextual characteristics can have on these determinants and on health inequalities. The proposed conceptual framework will hopefully further the debate on how context can influence population health and health distribution.
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Wang, Li, and Xin Xiong. "How to obtain Marketing Advantage for Corporation? : A case study of SuperMap Europe." Thesis, University of Gävle, Department of Business Administration and Economics, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-4523.
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This master’s thesis was carried out at SuperMap.SuparMap is a Chinese company supplying the Geographic Information System (GIS)software and service. It is leading the way in GIS research. The product of SuperMapis called SuperMap GIS applied by lots of government agencies, schools, andorganizations. SuperMap actively gets involved in the market of Japan, Korea,Singapore, Vietnam, India, Kazakhstan, and South Africa. However, in 2008, it hasentered the Sweden market and tries to involve in the whole European market.In European market, the GIS technology is relatively mature and the most marketshares have been taken by ESRI the top GIS software company. SuperMap has toimprove the strategy to make the customers turn to it from the ESRI. According to the4Ps, 4Cs and Brand management theory, SuperMap adopt a series of measures onmarketing.In this article we will analyze those measures referring to the 4Ps, 4Cs and brandmanagement theory. At the end of our thesis, we summarized our suggestions basedon our thesis analyzing.
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El-Sayed, Laila Hashem. "Discourses on emotions : communities, styles, and selves in early modern Mediterranean travel books : three case studies." Thesis, University of Kent, 2016. https://kar.kent.ac.uk/56635/.
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The present study focuses on emotion discourses in early modern travel books. It attempts a close textual, intertextual, and contextual analysis of several embedded narratives on emotions in three late sixteenth- and seventeenth-century travel books: Kitāb Nāṣir al-Dīn 'ala 'l-Qawm al-Kāfirīn: Mukhtaṣar Riḥlat al-Shihāb 'ila Liqā´ al-Aḥbāb by Andalusian traveller Ahmed bin Qāsim al-Ḥajarī (1570- c.1641), The Diary of Master Thomas Dallam by an English craftsman, Thomas Dallam (1575-1630), and Seyahâtnâme (The Book of Travels) by Ottoman traveller Evliya Çelebi (1611-1685). In these travel books, al-Ḥajarī, Dallam, and Evliya narrate their journeys as emotionally protean experiences. They associate emotions with the contexts of their journeys, their volition to travel, and their authorial motives to write about their journeys. They display their emotions in their dreams, humour, and other subjective experiences. Their narratives yield uncommon notions of emotions, namely the emotions of encounter. A love story between a Muslim traveller and a Catholic girl, an English craftsman's anxiety at the court of an Ottoman Sultan, a disgusting meal in a foreign land, are just a few examples of emotionally freighted situations which are unlikely to be found in any genre but a travel book. The close textual analysis aims to identify the role of the writers' cultures in shaping and regulating their discourses on emotions. The intertextual and contextual analysis of these narratives reveals that the meaning and function of these displayed emotions revolve around the traveller's community affiliation, religion, ideology, and other culture-specific discourses and practices such as Sufism, folk medicine, myths, folk traditions, natural and geographical phenomena, cultural scripts, social norms, and power relations. In a nutshell, reading the travellers' discourses on emotions means reading many cultural and historical aspects of the early modern world. To approach discourses on emotions in texts of the past, the present study draws on the theory of culture-construction of emotions. It uses three analytical notions from the fields of language, anthropology and history of emotions: 'emotional communities', 'emotional styles' and 'emotional self-fashioning'. The present study uses a theoretical framework defined by a recent wave of studies on self-narratives as sources for the history and cultural diversity of emotions in the medieval and early modern periods. Within this approach, travel writing is seen as a self-narrative, a communicative act, and a social practice. This approach to emotion discourses in Riḥla, travel journals and Seyahat genres allows us to project the transcultural and entangled history of the early modern Mediterranean, which as much it was a contested frontier between Islam and Christianity, was also a space of religious conversion and hybrid identities, the articulation of diplomacy and cultural exchange, mysticism and religious pluralism. This approach also pinpoints the diverse forms of cosmopolitanism, or rather cosmopolitanisms, in the plural.
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Chae, Sun Hee. "The transfer of Korean passenger car production to East Central Europe : the case of direct investment by Daewoo Motor." Thesis, University College London (University of London), 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.298290.
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Bright, Ryan M. "Environmental Systems Analysis of Road Transportation Based on Boreal Forest Biofuel : Case Studies and Scenarios for Nordic Europe." Doctoral thesis, Norges teknisk-naturvitenskapelige universitet, Institutt for energi- og prosessteknikk, 2011. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-15617.
Full textBooks on the topic "Flextime – Europe – Case studies"
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A, France L., ed. Case studies from Europe. Newcastle upon Tyne: Newcastle upon Tyne Polytechnic, School of Geography andEnvironmental Studies, 1985.
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Schwizer, Paola, Alessandro Carretta, and Vittorio Boscia, eds. Cooperative Banking in Europe: Case Studies. Basingstoke: Palgrave Macmillan, 2009. http://dx.doi.org/10.1057/9780230248601.
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Aymo, Brunetti, Michal Sven, and Switzerland Staatssekretariat für Wirtschaft, eds. Services liberalization in Europe: Case studies. Berne: SECO, 2007.
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Cooperative banking in Europe: Case studies. Basingstoke [England]: Palgrave Macmillan, 2010.
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Barbara, Obrębska-Starklowa, ed. Climate variability in Europe: Case studies. Cracow: Institute of Geography and Spatial Management, Jagiellonian University, 2002.
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Queer in Europe: Contemporary case studies. Burlington, VT: Ashgate Pub. Company, 2011.
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Aymo, Brunetti, Michal Sven, and Switzerland Staatssekretariat für Wirtschaft, eds. Services liberalization in Europe: Case studies. Berne: SECO, 2007.
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Edwards, John. Europe. Cheltenham: Stanley Thornes, 1998.
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Markandya, Anil, and Marcella Pavan, eds. Green Accounting in Europe — Four case studies. Dordrecht: Springer Netherlands, 1999. http://dx.doi.org/10.1007/978-94-011-4597-8.
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Helmut Kohl Institute for European Studies, Amitai Reuven, and Nachmani Amikam, eds. Islam in Europe: Case studies, comparisons & overviews. Jerusalem: Hebrew University of Jerusalem, European Forum at the Hebrew University, 2007.
Find full textBook chapters on the topic "Flextime – Europe – Case studies"
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van der Pligt, J., W. Otten, William Leiss, Christine Massey, Peter M. Wiedemann, Carsten Henschel, Philip C. R. Gray, et al. "Case studies." In Communicating about Risks to Environment and Health in Europe, 43–284. Boston, MA: Springer US, 1998. http://dx.doi.org/10.1007/978-1-4757-2894-1_3.
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Rossi, Emanuele, and Rok Stepic. "Case Studies in CEE." In Infrastructure Project Finance and Project Bonds in Europe, 80–102. London: Palgrave Macmillan UK, 2015. http://dx.doi.org/10.1057/9781137524041_6.
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do Amaral, Marcelo Parreira. "Comparative Case Studies: Methodological Discussion." In Landscapes of Lifelong Learning Policies across Europe, 41–60. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-030-96454-2_3.
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AbstractCase Study Research has a long tradition and it has been used in different areas of social sciences to approach research questions that command context sensitiveness and attention to complexity while tapping on multiple sources. Comparative Case Studies have been suggested as providing effective tools to understanding policy and practice along three different axes of social scientific research, namely horizontal (spaces), vertical (scales), and transversal (time). The chapter, first, sketches the methodological basis of case-based research in comparative studies as a point of departure, also highlighting the requirements for comparative research. Second, the chapter focuses on presenting and discussing recent developments in scholarship to provide insights on how comparative researchers, especially those investigating educational policy and practice in the context of globalization and internationalization, have suggested some critical rethinking of case study research to account more effectively for recent conceptual shifts in the social sciences related to culture, context, space and comparison. In a third section, it presents the approach to comparative case studies adopted in the European research project YOUNG_ADULLLT that has set out to research lifelong learning policies in their embeddedness in regional economies, labour markets and individual life projects of young adults. The chapter is rounded out with some summarizing and concluding remarks.
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Brown, Linden, and Malcolm H. B. McDonald. "Uses of Case Studies to Enhance Learning." In Competitive Marketing Strategy for Europe, 340–48. London: Macmillan Education UK, 1994. http://dx.doi.org/10.1007/978-1-349-23392-2_7.
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De Boer-Ashworth, Elizabeth. "Central Europe: Introduction to the Case-Studies." In The Global Political Economy and Post-1989 Change, 55–63. London: Palgrave Macmillan UK, 2000. http://dx.doi.org/10.1057/9780333985038_3.
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Oosterhuis, Frans, Frieder Rubik, and Gerd Scholl. "Product Policy in Practice: Four Case Studies." In Product Policy in Europe: New Environmental Perspectives, 91–149. Dordrecht: Springer Netherlands, 1996. http://dx.doi.org/10.1007/978-94-009-0277-0_5.
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Kirchhofer, A. "Fish conservation in Switzerland - three case-studies." In Conservation of Endangered Freshwater Fish in Europe, 135–45. Basel: Birkhäuser Basel, 1996. http://dx.doi.org/10.1007/978-3-0348-9014-4_14.
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Richardson, Dominic. "Regional Case Studies—Child Well Being in Europe." In From Child Welfare to Child Well-Being, 403–26. Dordrecht: Springer Netherlands, 2010. http://dx.doi.org/10.1007/978-90-481-3377-2_22.
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Meyer, B. C., and G. Mezosi. "Landscapes and climate change – case studies from Europe." In The Routledge Handbook of Landscape Ecology, 446–60. London: Routledge, 2021. http://dx.doi.org/10.4324/9780429399480-27.
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Jeston, John. "Case Studies from the USA, Asia, and Europe." In Business Process Management, 525–54. 5th ed. London: Routledge, 2022. http://dx.doi.org/10.4324/9781003170075-31.
Full textConference papers on the topic "Flextime – Europe – Case studies"
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Schropfer, Gerold, Mark McNie, Mark da Silva, Rhodri Davies, Alexandra Rickard, and Francois-Xavier Musalem. "Designing manufacturable MEMS in CMOS-compatible processes: methodology and case studies." In Photonics Europe, edited by Hakan Urey and Ayman El-Fatatry. SPIE, 2004. http://dx.doi.org/10.1117/12.544971.
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Yin, Yongkai, Dong He, Zeyi Liu, Xiaoli Liu, and Xiang Peng. "Phase aided 3D imaging and modeling: dedicated systems and case studies." In SPIE Photonics Europe, edited by Christophe Gorecki, Anand K. Asundi, and Wolfgang Osten. SPIE, 2014. http://dx.doi.org/10.1117/12.2051850.
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Giacalone, Francesco, Alessandro Tamburini, Michael Papapetrou, Andrea Cipollina, and Giorgio Micale. "Reverse Electrodialysis: Applications to Different Case Studies." In 2018 IEEE International Conference on Environment and Electrical Engineering and 2018 IEEE Industrial and Commercial Power Systems Europe (EEEIC / I&CPS Europe). IEEE, 2018. http://dx.doi.org/10.1109/eeeic.2018.8493961.
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Gizopoulos, Dimitris, Kaushik Roy, Subhasish Mitra, and Pia Sanda. "Soft Errors: System Effects, Protection Techniques and Case Studies." In 2008 Design, Automation and Test in Europe. IEEE, 2008. http://dx.doi.org/10.1109/date.2008.4484646.
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Pearce, Greg, and Richard Frewer. "Interdisciplinary Design Case Studies in Europe and Southeast Asia." In Architectural Engineering Conference (AEI) 2003. Reston, VA: American Society of Civil Engineers, 2003. http://dx.doi.org/10.1061/40699(2003)29.
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Ocampo, C. L., B. Webb, D. Hill, and S. Bracken. "Slanted-Streamer Acquisition - Broadband Case Studies in Europe / Africa." In 75th EAGE Conference and Exhibition incorporating SPE EUROPEC 2013. Netherlands: EAGE Publications BV, 2013. http://dx.doi.org/10.3997/2214-4609.20130489.
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Goto, Tada-nori, Takafumi Kasaya, Ryo Takagi, Noriaki Sakurai, Makoto Harada, Keizo Sayanagi, and Masataka Kinoshita. "Methane hydrate detection with marine electromagnetic surveys: Case studies off Japan coast." In OCEANS 2009-EUROPE (OCEANS). IEEE, 2009. http://dx.doi.org/10.1109/oceanse.2009.5278243.
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Glenister, Simon, Ali Arefi, Moayed Moghbel, Md Asaduzzaman Shoeb, Martina Calais, David Edwards, David Stephens, Luke Jones, and Pierce Trinkl. "Low Voltage Network Clustering for High Renewable Penetration Studies–An Isolated Network Case Study." In 2020 IEEE PES Innovative Smart Grid Technologies Europe (ISGT-Europe). IEEE, 2020. http://dx.doi.org/10.1109/isgt-europe47291.2020.9248972.
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Faranda, Roberto, Hossein Hafezi, and Sonia Leva. "Case Studies on Possible Failures in PV Power Plants." In 2018 IEEE International Conference on Environment and Electrical Engineering and 2018 IEEE Industrial and Commercial Power Systems Europe (EEEIC / I&CPS Europe). IEEE, 2018. http://dx.doi.org/10.1109/eeeic.2018.8494569.
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SCHOEMAN, PETER K., SANDER E. HOOGEWONING, CARLOTA MONTORI I. BLANCH, PAUL G. J. SISTERMANS, and ODELINDE E. NIEUWENHUIS. "MANAGING COASTAL EROSION IN EUROPE ILLUSTRATED BY 60 CASE STUDIES." In Proceedings of the 29th International Conference. World Scientific Publishing Company, 2005. http://dx.doi.org/10.1142/9789812701916_0257.
Full textReports on the topic "Flextime – Europe – Case studies"
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Uhrig, Bettina, and Barbara Spanó. Working on impact and contributing to R&I policies – looking back and ahead. Fteval - Austrian Platform for Research and Technology Policy Evaluation, April 2022. http://dx.doi.org/10.22163/fteval.2022.557.
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This article presents impact case studies at research project and organisational levels by exploiting the Horizon Europe concept of pathways to impact and the proposed indicators. In Horizon Europe, which is the European Commission’s funding programme for research and innovation, time-sensitive Key Impact Pathways and related indicators are used as a tool for assessing the different types of impact: scientific, societal, and economic. Based on many years of experience with stakeholder engagement and impact, the authors focus on the indicators for assessing societal impact. In this way, the authors would like to contribute to the discussion on creating societal impact through research projects and institutional strategies. Leading questions are 1) Can Research & Innovation (R&I) policies be improved by using Horizon Europe Key Impact Pathways and related indicators? And 2) Can an institutional impact project and even a research project benefit from using Horizon Europe indicators and at the same time feed into R&I policies?
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Triakina, Olga O., Olena O. Pavlenko, Nataliia P. Volkova, and Darja Kassim. Usage of E-learning Tools in Self-education of Government Officers Involved in Global Trade Activities. [б. в.], November 2018. http://dx.doi.org/10.31812/123456789/2670.
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The article concerns the issue of e-learning tools implementation, including the Customs Learning and Knowledge Community electronic platform designed by the World Customs Organization and the Trade Facilitation Implementation Guide case studies collected by the United Nations Economic Commission for Europe, into the self-education process of current government employees (within in-service training) and future public officers (within master’s programs) connected with international trade transactions. The authors give a description of the content and characteristical features of existing e-learning instruments related to training of professionals in Customs and trade fields as well as of certain tasks developed by the authors. The efficiency of the abovementioned e-learning tools has been experimentally proved in the paper, which has shown that these tools promote the growth of the professional competence of government officers and give a great opportunity for them to be involved in life-long learning to acquire various professional knowledge and skills.
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Perera, Duminda, Vladimir Smakhtin, Spencer Williams, Taylor North, and Allen Curry. Ageing Water Storage Infrastructure: An Emerging Global Risk. United Nations University Institute for Water, Environment and Health, January 2021. http://dx.doi.org/10.53328/qsyl1281.
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The Report provides an overview of the current state of knowledge on the ageing of large dams –an emerging global development issue as tens of thousands of existing large dams have reached or exceeded an “alert” age threshold of 50 years, and many others will soon approach 100 years. These aged structures incur rapidly rising maintenance needs and costs while simultaneously declining their effectiveness and posing potential threats to human safety and the environment. The Report analyzes large dam construction trends across major geographical regions and primary dam functions, such as water supply, irrigation, flood control, hydropower, and recreation. Analysis of existing global datasets indicates that despite plans in some regions and countries to build more water storage dams, particularly for hydropower generation, there will not be another “dam revolution” to match the scale of the high-intensity dam construction experienced in the early to middle, 20th century. At the same time, many of the large dams constructed then are aging, and hence we are already experiencing a “mass ageing” of water storage infrastructure. The Report further explores the emerging practice of decommissioning ageing dams, which can be removal or re-operation, to address issues of ensuring public safety, escalating maintenance costs, reservoir sedimentation, and restoration of a natural river ecosystem. Decommissioning becomes the option if economic and practical limitations prevent a dam from being upgraded or if its original use has become obsolete. The cost of dam removal is estimated to be an order of magnitude less than that of repairing. The Report also gives an overview of dam decommissioning’s socio-economic impacts, including those on local livelihoods, heritage, property value, recreation, and aesthetics. Notably, the nature of these impacts varies significantly between low- and high-income countries. The Report shows that while dam decommissioning is a relatively recent phenomenon, it is gaining pace in the USA and Europe, where many dams are older. However, it is primarily small dams that have been removed to date, and the decommissioning of large dams is still in its infancy, with only a few known cases in the last decade. A few case studies of ageing and decommissioned large dams illustrate the complexity and length of the process that is often necessary to orchestrate the dam removal safely. Even removing a small dam requires years (often decades), continuous expert and public involvement, and lengthy regulatory reviews. With the mass ageing of dams well underway, it is important to develop a framework of protocols that will guide and accelerate the process of dam removal. Overall, the Report aims to attract global attention to the creeping issue of ageing water storage infrastructure and stimulate international efforts to deal with this emerging water risk. This Report’s primary target audiences are governments and their partners responsible for planning and implementing water infrastructure development and management, emphasizing adaptat
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Börjesson, Patrik, Maria Eggertsen, Lachlan Fetterplace, Ann-Britt Florin, Ronny Fredriksson, Susanna Fredriksson, Patrik Kraufvelin, et al. Long-term effects of no-take zones in Swedish waters. Edited by Ulf Bergström, Charlotte Berkström, and Mattias Sköld. Department of Aquatic Resources, Swedish University of Agricultural Sciences, 2023. http://dx.doi.org/10.54612/a.10da2mgf51.
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Marine protected areas (MPAs) are increasingly established worldwide to protect and restore degraded ecosystems. However, the level of protection varies among MPAs and has been found to affect the outcome of the closure. In no-take zones (NTZs), no fishing or extraction of marine organisms is allowed. The EU Commission recently committed to protect 30% of European waters by 2030 through the updated Biodiversity Strategy. Importantly, one third of these 30% should be of strict protection. Exactly what is meant by strict protection is not entirely clear, but fishing would likely have to be fully or largely prohibited in these areas. This new target for strictly protected areas highlights the need to evaluate the ecological effects of NTZs, particularly in regions like northern Europe where such evaluations are scarce. The Swedish NTZs made up approximately two thirds of the total areal extent of NTZs in Europe a decade ago. Given that these areas have been closed for at least 10 years and can provide insights into long-term effects of NTZs on fish and ecosystems, they are of broad interest in light of the new 10% strict protection by 2030 commitment by EU member states. In total, eight NTZs in Swedish coastal and offshore waters were evaluated in the current report, with respect to primarily the responses of focal species for the conservation measure, but in some of the areas also ecosystem responses. Five of the NTZs were established in 2009-2011, as part of a government commission, while the other three had been established earlier. The results of the evaluations are presented in a synthesis and also in separate, more detailed chapters for each of the eight NTZs. Overall, the results suggest that NTZs can increase abundances and biomasses of fish and decapod crustaceans, given that the closed areas are strategically placed and of an appropriate size in relation to the life cycle of the focal species. A meta-regression of the effects on focal species of the NTZs showed that CPUE was on average 2.6 times higher after three years of protection, and 3.8 times higher than in the fished reference areas after six years of protection. The proportion of old and large individuals increased in most NTZs, and thereby also the reproductive potential of populations. The increase in abundance of large predatory fish also likely contributed to restoring ecosystem functions, such as top-down control. These effects appeared after a 5-year period and in many cases remained and continued to increase in the longer term (>10 years). In the two areas where cod was the focal species of the NTZs, positive responses were weak, likely as an effect of long-term past, and in the Kattegat still present, recruitment overfishing. In the Baltic Sea, predation by grey seal and cormorant was in some cases so high that it likely counteracted the positive effects of removing fisheries and led to stock declines in the NTZs. In most cases, the introduction of the NTZs has likely decreased the total fishing effort rather than displacing it to adjacent areas. In the Kattegat NTZ, however, the purpose was explicitly to displace an unselective coastal mixed bottom-trawl fishery targeting Norway lobster and flatfish to areas where the bycatches of mature cod were smaller. In two areas that were reopened to fishing after 5 years, the positive effects of the NTZs on fish stocks eroded quickly to pre-closure levels despite that the areas remained closed during the spawning period, highlighting that permanent closures may be necessary to maintain positive effects. We conclude from the Swedish case studies that NTZs may well function as a complement to other fisheries management measures, such as catch, effort and gear regulations. The experiences from the current evaluation show that NTZs can be an important tool for fisheries management especially for local coastal fish populations and areas with mixed fisheries, as well as in cases where there is a need to counteract adverse ecosystem effects of fishing. NTZs are also needed as reference for marine environmental management, and for understanding the effects of fishing on fish populations and other ecosystem components in relation to other pressures. MPAs where the protection of both fish and their habitats is combined may be an important instrument for ecosystembased management, where the recovery of large predatory fish may lead to a restoration of important ecosystem functions and contribute to improving decayed habitats. With the new Biodiversity Strategy, EUs level of ambition for marine conservation increases significantly, with the goal of 30% of coastal and marine waters protected by 2030, and, importantly, one third of these areas being strictly protected. From a conservation perspective, rare, sensitive and/or charismatic species or habitats are often in focus when designating MPAs, and displacement of fisheries is then considered an unwanted side effect. However, if the establishment of strictly protected areas also aims to rebuild fish stocks, these MPAs should be placed in heavily fished areas and designed to protect depleted populations by accounting for their home ranges to generate positive outcomes. Thus, extensive displacement of fisheries is required to reach benefits for depleted populations, and need to be accounted for e.g. by specific regulations outside the strictly protected areas. These new extensive EU goals for MPA establishment pose a challenge for management, but at the same time offer an opportunity to bridge the current gap between conservation and fisheries management.
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Rankin, Nicole, Deborah McGregor, Candice Donnelly, Bethany Van Dort, Richard De Abreu Lourenco, Anne Cust, and Emily Stone. Lung cancer screening using low-dose computed tomography for high risk populations: Investigating effectiveness and screening program implementation considerations: An Evidence Check rapid review brokered by the Sax Institute (www.saxinstitute.org.au) for the Cancer Institute NSW. The Sax Institute, October 2019. http://dx.doi.org/10.57022/clzt5093.
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Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.