An end to Nordic exceptionalism? Europeanisation and Nordic development policies

The Nordic countries have traditionally been praised for their generous and advanced development policies. Recently, however, it has been claimed that the Nordic model has faded: that the Nordic donors have become more similar to other European donors. One possible reason for such trends is influences from EU policies, that is, Europeanisation. This article critically evaluates such claims by presenting arguments for and against Europeanisation effects. We argue that changes have indeed taken place. The Nordic exceptionalism has been eroded. At the same time, a convergence of European aid policies has occurred. The question is if this is the consequence of Europeanisation – or is it rather a result of Nordicisation (the Nordic countries influencing the EU), or perhaps like-mindisation (a broader set of progressive member states having impact upon EU policies)? We suggest that Europeanisation has been extremely weak while there is strong evidence of Nordicisation but also, and increasingly, of like-mindisation. Today, a core group of mainly northern member states, including the Nordics, are the main driving forces behind European aid convergence

Intervention thresholds for osteoporosis in men and women: A study based on data from Sweden

The aim of this study was to determine the threshold of fracture probability at which interventions became cost-effective in men and women, based on data from Sweden. We modeled the effects of a treatment costing $500 per year given for 5 years that decreased the risk of all osteoporotic fractures by 35$200-500/year). Data on costs and risks were from Sweden. Costs included direct costs, but excluded indirect costs due to morbidity. A threshold for cost-effectiveness of approximately $45,000/QALY gained was used. Cost of added years was included in a sensitivity analysis. With the base case ($500 per year; 35% efficacy) treatment in women was cost-effective with a 10-year hip fracture probability that ranged from 1.2% at the age of 50 years to 7.4% at the age of 80 years. Similar results were observed in men except that the threshold for cost-effectiveness was higher at younger ages than in women (2.0 vs 1.2%, respectively, at the age of 50 years). Intervention thresholds were sensitive to the assumed effectiveness and intervention cost. The exclusion of osteoporotic fractures other than hip fracture significantly increased the cost-effectiveness ratio because of the substantial morbidity from such other fractures, particularly at younger ages. We conclude that the inclusion of all osteoporotic fractures has a marked effect on intervention thresholds, that these vary with age, and that available treatments can be targeted cost-effectively to individuals at moderately increased fracture risk

The risk and burden of vertebral fractures in Sweden

The aim of this study was to determine the risk and burden of vertebral fractures judged as those coming to clinical attention and as morphometric fractures. Incidence and utility loss were computed from data from Malmo, Sweden. Clinical fractures accounted for 23% of all vertebral deformities in women and for 42% in men. The average 10-year fracture probability for morphometric fractures increased with age in men from 2.9% at the age of 50 years (7.2% in women) to 8.4 at the age of 85 years (26.7% in women). As expected, probabilities increased with decreasing T-score for hip BMD. Cumulative utility loss from a clinical vertebral fracture was substantial and was 50-62% of that due to a hip fracture depending on age. When incidence of fractures in the population was weighted by disutility, all spine fractures accounted for more morbidity than hip fracture up to the age of 75 years. We conclude that vertebral fractures have a major personal and societal impact that needs to be recognised in algorithms for assessment of risk and in health economic strategies for osteoporosis

Numerical study of transient evolution of lifted jet flames: partially premixed flame propagation and influence of physical dimensions

Three-dimensional (3D) unsteady Reynolds-averaged Navier–Stokes simulations of a spark-ignited turbulent methane/air jet flame evolving from ignition to stabilisation are conducted for different jet velocities. A partially premixed combustion model is used involving a correlated joint probability density function and both premixed and non-premixed combustion mode contributions. The 3D simulation results for the temporal evolution of the flame's leading edge are compared with previous two-dimensional (2D) results and experimental data. The comparison shows that the final stabilised flame lift-off height is well predicted by both 2D and 3D computations. However, the transient evolution of the flame's leading edge computed from 3D simulation agrees reasonably well with experiment, whereas evident discrepancies were found in the previous 2D study. This difference suggests that the third physical dimension plays an important role during the flame transient evolution process. The flame brush's leading edge displacement speed resulting from reaction, normal and tangential diffusion processes are studied at different typical stages after ignition in order to understand the effect of the third physical dimension further. Substantial differences are found for the reaction and normal diffusion components between 2D and 3D simulations especially in the initial propagation stage. The evolution of reaction progress variable scalar gradients and its interaction with the flow and mixing field in the 3D physical space have an important effect on the flame's leading edge propagation.Z. C. acknowledges the financial supports of Cambridge Overseas Trust and China Scholarship Council.This is the author accepted manuscript. The final version is available from Taylor & Francis via https://doi.org/10.1080/13647830.2016.116123

Reducing uncertainty in health-care resource allocation

A key task for health policymakers is to optimise the outcome of health care interventions. The pricing of a new generation of cancer drugs, in combination with limited health care resources, has highlighted the need for improved methodology to estimate outcomes of different treatment options. Here we introduce new general methodology, which for the first time employs continuous hazard functions for analysis of survival data. Access to continuous hazard functions allows more precise estimations of survival outcomes for different treatment options. We illustrate the methodology by calculating outcomes for adjuvant treatment of gastrointestinal stromal tumours with imatinib mesylate, which selectively inhibits the activity of a cancer-causing enzyme and is a hallmark representative for the new generation of cancer drugs. The calculations reveal that optimal drug pricing can generate all win situations that improve drug availability to patients, make the most of public expenditure on drugs and increase pharmaceutical company gross profits. The use of continuous hazard functions for analysis of survival data may reduce uncertainty in health care resource allocation, and the methodology can be used for drug price negotiations and to investigate health care intervention thresholds. Health policy makers, pharmaceutical industry, reimbursement authorities and insurance companies, as well as clinicians and patient organisations, should find the methodology useful

Body fat mass and the proportion of very large adipocytes in pregnant women are associated with gestational insulin resistance.

Pregnancy is accompanied by fat gain and insulin resistance. Changes in adipose tissue morphology and function during pregnancy and factors contributing to gestational insulin resistance are incompletely known. We sought to characterize adipose tissue in trimesters 1 and 3 (T1/T3) in normal weight (NW) and obese pregnant women, and identify adipose tissue-related factors associated with gestational insulin resistance