Factors explaining the adoption of risk management instruments in mediterranean irrigated agriculture

Agriculture is highly impacted by different sources of risk. There is a wide variety of management instruments that farmers can use to cover these risks. The objective of this paper is to analyze the explanatory variables for the simultaneous adoption of a large set of risk management instruments. The main innovation is the methodological approach: first, we apply a hierarchical cluster analysis to identify the groups of instruments whose adoption is correlated; second, we use multivariate probit models to analyze the influence of different factors on the simultaneous adoption of the instruments included in each cluster. Explanatory variables capture farmers’ socio-demographic features, perception of risks, risk aversion and subjective perception of past risk experience; farms’ technical-economic characteristics; and perception of local-level climate change. The results show that there are significant differences in the variables influencing the adoption of the risk management instruments. The findings provide useful information to support the decision-making process for three main stakeholders: farmers (optimal choice over the joint use of instruments), providers of agricultural risk management instruments (e.g., the design of new combinations of risk management instruments better targeted to distinct profiles of farmers), and policymakers (policy strategies aiming to promote better risk management within the agricultural sector)

The predictive power of farmers’ risk attitude measures elicited by experimental methods

Aim of study: Farmers’ behavior is shaped by their individual attitudes towards risk. Consequently, an understanding of the heterogeneous risk attitudes among farmers is key to predicting their decision-making. Therefore, there is a need for reliable methods to assess individuals’ risk attitudes. The main objective of this paper was to contribute to the existing literature about the external validity of risk attitude measures obtained with diverse experimental methods.Area of study: Irrigated agriculture in a Mediterranean climate region.Material and methods: Two different experimental methods widely applied in the agricultural sector were used to elicit farmers’ risk attitudes in a sample of irrigators in southern Spain: the Eckel and Grossman lottery-choice task and a self-assessment general risk question. We evaluated the explanatory power of both measures for the farming risk borne by farmers, using an approach based on dispersion measures of farming returns.Main results: Results revealed stability across these elicitation methods, but the study yielded no evidence of statistical correlation with the farming risk actually borne by farmers, suggesting that it may not be advisable to use these methods for directly predicting farmers’ decision-making in modeling exercises.Research highlights: The most relevant innovation of this paper was the validation approach followed, based on measures assessing the overall level of farming risk borne by individual producers, and the complementary analyses controlling for key variables that could affect farmer risk-taking

Precautionary savings as an instrument to hedge the risk of hydrological drought in irrigated agriculture

This paper explores the use of precautionary savings as a new risk management instrument that can be implemented to hedge hydrological drought risk in irrigated agriculture, a risk currently not covered by any policy instrument. For this purpose, the Drought Savings Account (DSA) is proposed as a personal savings account to which farmers make regular contributions, with withdrawals allowed in the event of irrigation water supply gaps in order to guarantee a minimum income. The implementation of the DSA is empirically assessed in a Mediterranean-climate irrigation district using an innovative simulation approach. Based on the results obtained, the DSA has proved to be a theoretically suitable policy instrument that can overcome the problems hindering the implementation of agricultural insurance, managing the risk in a more cost-effective way. This cost-effectiveness is a key advantage of precautionary savings over agricultural insurance, since the former instrument minimizes moral hazard and adverse selection problems, and the transaction costs of risk-sharing. Moreover, in this context, precautionary savings may play a significant role as an efficient climate change adaptation measure since the self-insurance strategy adopted does not distort the signals underlying farmers’ own risk exposure, leading to better individual assessment and an adequate management of water supply gaps

Willingness to pay for improved irrigation water supply reliability: an approach based on probability density functions

In irrigated agricultural systems, a major source of uncertainty relates to water supply, as it significantly affects farm income. This paper investigates farmers’ utility changes associated with shifts in the probability density function of water supply leading to a higher water supply reliability (higher mean and lower variance in annual water allotments). A choice experiment relying on a mean-variance approach is applied to the case study of an irrigation district of the Guadalquivir River Basin (southern Spain). To our knowledge, this is the first study using parameters of these probability density functions of water supply as choice experiment attributes to value water supply reliability. Results show that there are different types of farmers according to their willingness to pay (WTP) for improvements in water supply reliability, with some willing to pay nothing (47.8%) while others have a relatively low (28.0%) or high (24.2%) WTP. A range of factors influencing farmers’ preferences toward water supply reliability are revealed, with those related to risk exposure to water availability being of special importance. The results can be used to assist the design of more efficient policy instruments to improve water supply reliability in Mediterranean and semi-arid climate region

The capital budgeting process: a methodological approach based on financial and intellectual value creation

Objeto: El objetivo de este artículo es presentar una novedosa metodología de valoración de inversiones productivas basada en la estimación del valor total creado con cada proyecto de inversión, considerando para ello sus dos componentes: el valor financiero y el valor del capital no financiero, este último derivado del capital intelectual corporativo. Diseño/metodología: Se propone una metodología basada en la técnica multicriterio del proceso analítico jerárquico (AHP, por sus siglas en inglés). En este modelo, se definen cuatro criterios principales (capital financiero, capital humano, capital estructural, y capital relacional), varios subcriterios y las alternativas de inversión. Para determinar el valor total de cada alternativa, se requieren juicios de valor por parte de los directores generales de las empresas, información obtenida a través de un cuestionario basado en comparaciones pareadas, cuyos resultados alimentan una función de utilidad multiatributo. Un caso de estudio del sector agroalimentario ilustra la aplicabilidad práctica del modelo. Aportaciones y resultados: La aplicación empírica evidencia la necesidad de considerar el impacto de las inversiones productivas en el capital intelectual de la empresa, pues este impacto influye en la selección de la alternativa de inversión óptima. Limitaciones: Las conclusiones alcanzadas se consideran aún provisionales, dado que se trata de un estudio pionero con una aplicación empírica reducida a sólo cinco empresas. Implicaciones prácticas: Mediante el modelo teórico propuesto, los directores generales pueden valorar las inversiones productivas incorporando en el análisis, de manera formalizada, la creación de valor del capital no financiero. Este procedimiento permite tomar decisiones más adecuadas, contribuyendo de manera efectiva a seleccionar la alternativa de inversión que maximice el valor de mercado de la compañía. Valor añadido: Como principal aportación de este trabajo se destaca la incorporación del enfoque del capital intelectual en el proceso de valoración de inversiones productivas en la empresa y la propuesta de un marco metodológico formalizado y unificado.Purpose: This paper aims to develop a novel capital budgeting method to improve the quality of the appraisal process for productive investments by decomposing the total value that is created by the new assets into two components: financial value and nonfinancial capital value, the latter stemmed from the intellectual capital of the firm. Design/methodology/approach: This paper proposes a methodology based on the multi-criteria technique called the Analytic Hierarchy Process (AHP). Within the model, four main criteria (financial capital, human capital, structural capital, and relational capital), several subcriteria and the investment alternatives are defined. In order to determine the total value of each alternative, CEO preferences are required using a pairwise comparison-based questionnaire, the results of which feed a multiattribute utility function. A case study on the agrifood sector illustrates the model empirically. Findings and Originality/value: The empirical application evidences the need to consider the impact of productive investments on firms´ intangible assets, as this impact actually affects the choice of optimal investment alternative in the real world. Practical implications: Using the theoretical model proposed, CEOs can appraise productive investments by incorporating nonfinancial capital value creation into the analysis. This procedure permits more accurate and successful decision-making and contributes effectively to the selection of the investment option that maximizes firms’ market value. Originality/value: This research provides an important addition to the current literature by integrating intellectual capital into capital budgeting and by proposing a unified methodological framework.Peer Reviewe

Enumeration and Characterization of Circulating Tumor Cells in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization

Circulating tumor cells (CTCs), and particularly circulating cancer stem cells (cCSC), are prognostic biomarkers for different malignancies and may be detected using liquid biopsies. The ex vivo culture of cCSCs would provide valuable information regarding biological aggressiveness and would allow monitoring the adaptive changes acquired by the tumor in real time. In this prospective pilot study, we analyzed the presence of EpCAM+ CTCs using the IsoFlux system in the peripheral blood of 37 patients with hepatocellular carcinoma undergoing transarterial chemoembolization (TACE). The average patient age was 63.5 ± 7.9 years and 91.9% of the patients were men. All patients had detectable CTCs at baseline and 20 patients (54.1%) showed CTC aggregates or clusters in their peripheral blood. The increased total tumor diameter (OR: 2.5 (95% CI: 1.3–4.8), p = 0.006) and the absence of clusters of CTCs at baseline (OR: 0.2 (95% CI: 0.0–1.0), p = 0.049) were independent predictors of a diminished response to TACE. Culture of cCSC was successful in five out of thirty-three patients, mostly using negative enrichment of CD45− cells, ultra-low adherence, high glucose, and a short period of hypoxia followed by normoxia. In conclusion, the identification of clusters of CTCs before TACE and the implementation of standardized approaches for cCSC culture could aid to predict outcomes and to define the optimal adjuvant therapeutic strategy for a true personalized medicine in hepatocellular carcinoma

Design and piloting of a structured service medication dispensing process

Objetivo: Diseñar y pilotar un protocolo para el servicio de dispensación de medicamentos. Diseño: Se partió de los requisitos propuestos en el Consenso de Atención Farmacéutica del Ministerio de Sanidad, se realizó una búsqueda bibliográfica y se aplicaron técnicas cualitativas de consenso. Para el pilotaje se realizó un estudio observacional transversal de marzo a junio de 2009. Emplazamiento: 53 farmacias comunitarias de 24 provincias españolas. Participantes: Pacientes que solicitaron uno o varios medicamentos concretos con o sin receta médica para uso propio o para alguien a su cuidado. Mediciones principales: La información personalizada sobre el medicamento (IPM), los problemas relacionados con los medicamentos (PRM) y los resultados negativos asociados a la medicación (RNM) detectados por el farmacéutico en cada dispensación, así como la percepción de operatividad del farmacéutico sobre el protocolo. Resultados: Se realizaron 870 dispensaciones, se detectaron 423 (48,6%) casos de falta de información en los que se ofreció IPM. En un 10,11% de las dispensaciones realizadas se detectaron PRM y 68 sospechas de RNM (7,81%): de seguridad (n = 35; 51,5%), efectividad (n = 29; 42,6%) y necesidad (n = 4; 5,8%). El 65,21% de los farmacéuticos afirmaron que el proceso estructurado es operativo. Conclusiones: El protocolo diseñado permite detectar las carencias de información del paciente sobre sus medicamentos, así como los PRM y RNM siendo una herramienta fácil de utilizar y aplicable.Objective: The aim of this article is to design and pilot a protocol for the dispensing of medications service. Design: Using the requirements proposed in the Ministry of Health Pharmaceutical Care Consensus, a literature search was made applying qualitative consensus techniques. An observational, cross-sectional study was conducted from March to June 2009. Setting: A total of 53 community pharmacies from 24 Spanish counties. Participant: Patients who requested one or more particular medications with or without medical prescription for their own use or for someone in their care. Main measure: The personalised medication information (IPM), the problems associated with the medications (PRM), and the negative results associated with the medication (RNM), detected by the pharmacist each time medication was dispensed, as well as the perception of the pharmacist on the operability of the protocol were recorded. Results: A total of 870 medications were dispensed, with 423 (48.6%) cases of lack of personalised medication information (IPM) being detected. PRM were detected in 10.11% of the dispensed medications, as well as 68 (7.81%) suspected RNM: safety (n = 35; 51.5%), effectiveness (n = 29; 42.6%) and necessity (n = 4; 5.8%). Almost two-thirds (65.21%) of the pharmacists said that the protocol is in operation. Conclusions: The designed protocol helped to detect deficiencies in the information to the patients about their medications, as well as the PRM and RNM, and is shown to be tool that is easy to use and apply.Este estudio ha sido financiado por el Laboratorio Farmacéutico Stada S.L. y la Sociedad Española de Farmacéuticos comunitarios (SEFAC)

The Peripheral Arterial disease study (PERART/ARTPER): prevalence and risk factors in the general population

<p>Abstract</p> <p>Background</p> <p>The early diagnosis of atherosclerotic disease is essential for developing preventive strategies in populations at high risk and acting when the disease is still asymptomatic. A low ankle-arm index is a good marker of vascular events and may be diminished without presenting symptomatology (silent peripheral arterial disease). The aim of the study is to know the prevalence and associated risk factors of peripheral arterial disease in the general population.</p> <p>Methods</p> <p>We performed a cross-sectional, multicentre, population-based study in 3786 individuals >49 years, randomly selected in 28 primary care centres in Barcelona (Spain). Peripheral arterial disease was evaluated using the ankle-arm index. Values < 0.9 were considered as peripheral arterial disease.</p> <p>Results</p> <p>The prevalence (95% confidence interval) of peripheral arterial disease was 7.6% (6.7-8.4), (males 10.2% (9.2-11.2), females 5.3% (4.6-6.0); <it>p </it>< 0.001).</p> <p>Multivariate analysis showed the following risk factors: male sex [odds ratio (OR) 1.62; 95% confidence interval 1.01-2.59]; age OR 2.00 per 10 years (1.64-2.44); inability to perform physical activity [OR 1.77 (1.17-2.68) for mild limitation to OR 7.08 (2.61-19.16) for breathless performing any activity]; smoking [OR 2.19 (1.34-3.58) for former smokers and OR 3.83 (2.23-6.58) for current smokers]; hypertension OR 1.85 (1.29-2.65); diabetes OR 2.01 (1.42-2.83); previous cardiovascular disease OR 2.19 (1.52-3.15); hypercholesterolemia OR 1.55 (1.11-2.18); hypertriglyceridemia OR 1.55 (1.10-2.19). Body mass index ≥25 Kg/m²OR 0.57 (0.38-0.87) and walking >7 hours/week OR 0.67 (0.49-0.94) were found as protector factors.</p> <p>Conclusions</p> <p>The prevalence of peripheral arterial disease is low, higher in males and increases with age in both sexes. In addition to previously described risk factors we found a protector effect in physical exercise and overweight.</p

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks