Study on Input/Output Accounting Systems on EU agricultural holdings

Of 241 questionnaires sent out to 20 countries 55 completed forms were returned. No information could be obtained about systems in Portugal or the USA. The subject of nutrients was covered by 91% of systems, pesticides 38%, energy 29% and other subjects including wastes 44%. Nearly half of the systems covered more than one subject, the most common single subject system was nutrients. The arable sector was covered most often by the systems (76%), with dairy (62%) and pig (56%) the most prominent of the livestock sectors. The respondents judged that 65% of systems were at least moderately effective in improving the ratio of inputs to outputs. The highest levels of ratio reduction tended to occur with systems which included the livestock sectors or protected horticultural crops. Over half (56%) of farmers had a good opinion of the system, indifferent or bad opinions were more likely to be due to effect on income than the type of system or who managed it. High uptake was more likely in compensated systems. Farm incomes in the arable and dairy sectors were most likely to be improved by systems, negative effects were most likely in the horticultural sector. Government was the main driving force in 38% of the systems, but government was not necessarily the driving force behind the 15% compulsory systems and only one of these was compensated. Increasing concern about environmental issues was the driving force behind development of each of the systems studied. In most cases a major part of the funding to develop the system or run pilot projects came from government. Benefits in terms of increased awareness of problem areas were identified by several systems originators. Anecdotal evidence suggests that farmers are encouraged to make actual changes to their management on the basis of the systems, if they receive detailed help from an adviser associated with the system, or if the system results in a marketing advantage. It seems likely that input output accounting systems could be used to increase awareness and provide evidence of the impact of management changes, they may need to be linked to supporting systems of technical advice. More than 40 IOA systems representing very different approaches have been developed and applied on farms in European countries with the aim of improving environmental performance. Major differences regard especially two characteristics: The no topics covered (single or multiple) and the way indicators are presented. In many systems the indicators used are presented as calculations of input related to output and are derived from accounts based data. Other systems present indicators that are transformed to a standard scale and often these indicators are based on a combination of practise and account data compared with norms for Good Agricultural Practices. Moreover, the systems differ in their origin and driving force: Only a few systems have been developed for mandatory use or for labelling and formal auditioning. Most systems have been developed for the use by advisory services on a voluntary basis. A number of very different systems seem to have been successful. Effectiveness is defined here as the combination of a system with high (potential) impact on the participating farmers in combination with high uptake in terms of the no of farmers willing to use the system. Generally documentation of effects and uptake is poor and more investigations into this are needed. It seems that many systems have not passed the pilot phase, even though some of them did get a positive evaluation by the farmers. In several examples the effort of researchers to develop a scientifically valid concept was not matched by efforts to secure the uptake by advisors or other institutions afterwards. The right institutional setting and political context seems to be more important than the character of the indicators used for the question of farmer uptake. But that does not mean that the choice of indicators is not important from another point of view. In none of the reviewed systems were the use of confidence intervals or variation coefficients an established part of the procedure. Only few reports exist that analyse the variation between farms or between years on specific farms in order to decide to which degree differences are due to systematically different management practices

Cost-Effectiveness and Cost-Utility of Early Levodopa in Parkinson's Disease

Background: In the Levodopa in EArly Parkinson's disease (LEAP) study, 445 patients were randomized to levodopa/carbidopa 100/25 mg three times per day for 80 weeks (early-start) or placebo for 40 weeks followed by levodopa/carbidopa 100/25 mg three times per day for 40 weeks (delayed-start).Objective: This paper reports the results of the economic evaluation performed alongside the LEAP-study.Methods: Early-start treatment was evaluated versus delayed-start treatment, in which the cost-effectiveness analysis (CEA) and the cost-utility analysis (CUA) were performed from the societal perspective, including health care costs among providers, non-reimbursable out-of-pocket expenses of patients, employer costs of sick leave, and lowered productivity while at work. The outcome measure for the CEA was the extra cost per unit decrease on the Unified Parkinson's Disease Rating Scale 80 weeks after baseline. The outcome measure for the CUA was the extra costs per additional quality adjusted life year (QALY) during follow-up.Results: 212 patients in the early-start and 219 patients in the delayed-start group reported use of health care resources. With savings of D 59 per patient (BCa 95% CI: -829, 788) in the early-start compared to the delayed-start group, societal costs were balanced. The early-start group showed a mean of 1.30 QALYs (BCa 95% CI: 1.26, 1.33) versus 1.30 QALYs (BCa 95% CI: 1.27, 1.33) for the delayed-start group. Because of this negligible difference, incremental cost-effectiveness and cost-utility ratios were not calculated.Conclusion: From an economic point of view, this study suggests that early treatment with levodopa is not more expensive than delayed treatment with levodopa.Neurological Motor Disorder

Voting for Environmental Policy Under Income and Preference Heterogeneity

We examine the design of policies for promoting the consumption of green products under preference and income heterogeneity using organic food as an example. Two instruments are considered: a price subsidy for organic food products and a tax on conventional products. When the income differences and social benefits of organic farming are large, these factors dominate in shaping the policy preferences of the majority. In this case, the environmental policies preferred by the majority tend to be stricter than socially optimal policies. However, when income differences are small, policy preferences are more directly determined by tastes for organic products and the majority may prefer no intervention. Copyright 2008, Oxford University Press.

Levodopa Response in Patients with Early Parkinson Disease: Further Observations of the LEAP Study

Background and Objectives: The Levodopa in EArly Parkinson's Disease (LEAP) study enabled us to conduct post hoc analyses concerning the effects of levodopa in patients with early Parkinson disease. Methods: The LEAP study was a double-blind, placebo-controlled, randomized, delayed-start trial in which patients with early Parkinson disease were randomized to receive levodopa/carbidopa 300/75 mg daily for 80 weeks (early-start group) or to placebo for 40 weeks followed by levodopa/carbidopa 300/75 mg daily for 40 weeks (delayed-start group). We analyzed the effect of levodopa with the Unified Parkinson's Disease Rating Scale on bradykinesia, rigidity, and tremor. At week 80, participants answered 3 questions regarding motor response fluctuations. Results: A total of 222 patients were randomized to the early-start group (mean ± SD age at baseline 64.8 ± 8.7 years; 71% male) and 223 to the delayed-start group (mean ± SD age at baseline 65.5 ± 8.8 years; 69% male). The difference between the early-and delayed-start groups in mean change from baseline to week 4, expressed as Hedges g effect size, was-0.33 for bradykinesia,-0.29 for rigidity, and-0.25 for tremor (for all symptoms indicating a small effect in favor of the early-start group); from baseline to week 22, respectively,-0.49,-0.36, and-0.44 (small to medium effect); and from baseline to week 40, respectively,-0.32,-0.19, and-0.27 (small effect). At 80 weeks, fewer patients in the early-start group (46 of 205 patients, 23%) experienced motor response fluctuations than patients in the delayed-start group (81 of 211, 38%; p < 0.01). Discussion: In patients with early Parkinson disease, levodopa improves bradykinesia, rigidity, and tremor to the same order of magnitude. For all 3 symptoms, effects were larger at 22 weeks compared with 4 weeks. At 80 weeks, there were fewer patients with motor response fluctuations in the group that had started levodopa earlier. Classification of Evidence: This study provides Class II evidence that the effect of levodopa on bradykinesia, rigidity, and tremor is larger after 22 weeks compared with 4 weeks of treatment. Trial Registration Information: ISRCTN30518857, EudraCT number 2011-000678-72