Community involvement in the implementation of the WFD in Greece

The paper provides critical reflections beyond the mere rehearsal of existing arguments and theories of participation within the Water Framework Directive. Following a critical overview of the pilot river basin projects, originally aimed at testing in practice the provisions of the WFD, the paper addresses empirically questions related to participatory issues involved in the implementation of the directive in rigid top-down and strongly hierarchical settings. The paper argues that the participatory requirements of the directive may reach the actual stakeholders in a rather distorted way turning participation into an “ornamental” issue instead of a substantive element of the directive. Reflecting on the selected case, part of Pinios river basin project in Greece, the paper argues that only a distorted version of public participation is assessed on the official documents, questioning the very purpose of the pilot projects. The paper concentrates on how local stakeholders can learn to participate, overcome existing barriers of the water governance structure in Greece and following, by upscaling their “experience to participate” at regional level, contribute to the participation requirements of the WFD.El presente artículo ofrece una reflexión crítica más allá del simple ensayo de los argumentos de las teorías existentes y de la participación dentro de la Directiva Marco del Agua (DMA). Tras una revisión crítica de los proyectos piloto de la cuenca del río, originalmente destinados a comprobar en la práctica las disposiciones de la DMA, se abordan empíricamente cuestiones relacionadas con temas de participación concernientes a la implementación de la directiva con configuraciones rígidas de arriba hacia abajo y fuertemente jerárquicas. El documento sostiene que los requisitos de participación de la Directiva pueden llegar a los actores de una manera más bien distorsionada, convirtiendo la participación en una cuestión “ornamental” más que en un elemento sustantivo de la Directiva. Reflexionando sobre el caso seleccionado, que forma parte del proyecto cuenca del río Pinios en Grecia, el documento sostiene que en los documentos oficiales sólo se evalúa una versión distorsionada de la participación pública, lo que cuestiona la propia finalidad de los proyectos piloto. El documento se centra en cómo los actores locales pueden aprender a participar, a superar las barreras existentes en la estructura de gobernabilidad del agua en Grecia y, después, por la ampliación de su "experiencia de participación" a nivel regional, contribuir a los requisitos de participación de la DMA.Humboldt University Berlin, Department of Agricultural Economics, Division of Resource Economic

Firm dynamics in job growth - employment growth determinants

Understanding the determinants of employment growth is important in light of the concentration of population and employment in urban centres. As economic activity concentrates, smaller urban centres, and rural areas and towns find themselves at a growing disadvantage. Yet not all small urban or rural towns share the same experience. Moreover, not all urban centres grow significantly. It is thus of academic interest to discover more precisely what the employment growth determinants are.Another aspect of employment growth is the particular source of employment change. Employment growth is not single-dimensional, but it has four components (growth from firm births and business expansions; and decreases from firm deaths and business declines), each of which may have unique determinants. Thus, in investigating the determinants of employment change, it is important to recognize the businesses’ life cycle and test whether the key influences vary over that life cycle. This study empirically estimates the determinants of employment growth and assesses their role and relative importance in a community’s job growth. The major determinants include industrial composition, human capital, spatial variables and policy variables. The study is carried out at two levels: sub-provincial and provincial and covers the years 1983-1999. Two econometric methods of estimation are applied, random effects and fixed effects. An important finding is that there are significant differences among the four components of employment change. This implies that when we simply examine overall employment growth we are masking very different effects that the determinants of employment change have among the four components of job growth. At the community level industrial diversification assists the growth of expanding firms and boosts employment due to the establishment of new businesses. On the other side, communities that have high industrial concentration experience lower employment losses from declining and exiting firms. Regions with a higher share of population that has received some post secondary education have, ceteris paribus, higher job growth rates. Another finding is that the farther away a community is situated from a large Census Metropolitan Area, the less employment growth it has. These results offer significant refinements to undifferentiated employment change findings

Diagnosing the role of the state for local collective action: Types of action situations and policy instruments

This paper presents a diagnostic approach to the role and capacity of governments to facilitate local collective action and alleviate environmental problems. The paper adds to a nascent scholarship aiming to conciliate theories on “governance by government” and “governance by self-organization”. We adopt two premises for that purpose: (1) policy instruments shall be tailored to the strategic nature of local resource management decisions; and (2) such nature is not static and can be modified via governmental policies. We first build on the Institutional Analysis and Development (IAD) framework to characterize the decision-making situations that local resource users face and the local rules that shape said situations. Then, based on common pool resource (CPR) and policy instrument choice theory, we identify four mechanisms through which different policy instruments can facilitate local collective action (change in payoffs and their perception, reduction of transaction costs, reduction of un- certainty, and normative consonance). This analytical approach is then applied to four illustrative cases of water management in Germany, France, Greece and Spain. As shown, local resource users are embedded in not one but many overlapping decision-making situations. In this context, the promotion of collective action is rarely ac- complished via a single policy instrument or mechanism but via bundles of them. Also, the paper illustrates the importance of understanding how governmental policies modify the structure of rules and incentives that affect local resource users, potentially facilitating local collective action and the solution of environmental problems

Diagnosing the role of the state for local collective action : types of action situations and policy instruments

Unidad de excelencia María de Maeztu MdM-2015-0552This paper presents a diagnostic approach to the role and capacity of governments to facilitate local collective action and alleviate environmental problems. The paper adds to a nascent scholarship aiming to conciliate theories on "governance by government" and "governance by self-organization". We adopt two premises for that purpose: (1) policy instruments shall be tailored to the strategic nature of local resource management decisions; and (2) such nature is not static and can be modified via governmental policies. We first build on the Institutional Analysis and Development (IAD) framework to characterize the decision-making situations that local resource users face and the local rules that shape said situations. Then, based on common pool resource (CPR) and policy instrument choice theory, we identify four mechanisms through which different policy instruments can facilitate local collective action (change in payoffs and their perception, reduction of transaction costs, reduction of uncertainty, and normative consonance). This analytical approach is then applied to four illustrative cases of water management in Germany, France, Greece and Spain. As shown, local resource users are embedded in not one but many overlapping decision-making situations. In this context, the promotion of collective action is rarely accomplished via a single policy instrument or mechanism but via bundles of them. Also, the paper illustrates the importance of understanding how governmental policies modify the structure of rules and incentives that affect local resource users, potentially facilitating local collective action and the solution of environmental problems

Energy-based decision engine for household human activity recognition

We propose a framework for energy-based human activity recognition in a household environment. We apply machine learning techniques to infer the state of household appliances from their energy consumption data and use rulebased scenarios that exploit these states to detect human activity. Our decision engine achieved a 99.1% accuracy for real-world data collected in the kitchens of two smart homes

Cross-cultural evaluation of the relevance of the HCAHPS survey in five European countries

Objective To describe the systematic language translation and cross-cultural evaluation process that assessed the relevance of the Hospital Consumer Assessment of Healthcare Providers and Systems survey in five European countries prior to national data collection efforts. Design An approach involving a systematic translation process, expert review by experienced researchers and a review by ‘patient' experts involving the use of content validity indexing techniques with chance correction. Setting Five European countries where Dutch, Finnish, French, German, Greek, Italian and Polish are spoken. Participants ‘Patient' experts who had recently experienced a hospitalization in the participating country. Main OutcomeMeasure(s) Content validity indexing with chance correction adjustment providing a quantifiable measure that evaluates the conceptual, contextual, content, semantic and technical equivalence of the instrument in relationship to the patient care experience. Results All translations except two received ‘excellent' ratings and no significant differences existed between scores for languages spoken in more than one country. Patient raters across all countries expressed different concerns about some of the demographic questions and their relevance for evaluating patient satisfaction. Removing demographic questions from the evaluation produced a significant improvement in the scale-level scores (P= .018). The cross-cultural evaluation process suggested that translations and content of the patient satisfaction survey were relevant across countries and languages. Conclusions The Hospital Consumer Assessment of Healthcare Providers and Systems survey is relevant to some European hospital systems and has the potential to produce internationally comparable patient satisfaction score

Prenatal Buprenorphine/Naloxone or Methadone Use on Neonatal Outcomes in Michigan

Background: Maternal opioid exposure during pregnancy has various effects on neonatal health. Buprenorphine/naloxone and methadone are examples of medications for opioid use disorder (MOUD) used for the treatment of opioid use disorder (OUD). Research comparing the impacts of these MOUD modalities on neonatal outcomes when used to treat pregnant people with OUD remains limited. We evaluated the differences in outcomes between neonates with in-utero exposure to buprenorphine/naloxone versus methadone. Methodology: We performed a retrospective cohort chart review between October 15, 2008, and October 15, 2019, evaluating mother/neonate dyads at two medical centers in Michigan. The charts of female patients, aged 18+, with OUD and buprenorphine/naloxone or methadone treatment, were examined. The charts of the corresponding neonates were also examined. Multiple regression analysis was performed. Results: In total, 343 mother/infant dyads were included: 99 patients were treated with buprenorphine/naloxone and 232 patients were treated with methadone. The buprenorphine/naloxone group had significant differences in maternal age, hepatitis status, asthma, gestational age in weeks, neonatal intensive care unit (NICU) length of stay (LOS), neonatal opioid withdrawal syndrome (NOWS) peak score, birth head circumference, and birth weight compared to the methadone group at baseline. Adjusted multivariable regression analysis demonstrated neonates with exposure to buprenorphine/naloxone had a NOWS peak score 3.079 points less (95% confidence interval (CI): -4.525, 1.633; p = 0.001) and NICU LOS 8.955 days less (95% CI: -14.399, -3.511; p = 0.001) than neonates exposed to methadone. Conclusions: Neonates with in-utero exposure to buprenorphine/naloxone had significantly lower NOWS scores and shorter NICU LOS compared to neonates with in-utero exposure to methadone. These findings demonstrate that buprenorphine/naloxone is potentially a more favorable treatment for the reduction in metrics representing adverse neonatal outcomes in pregnant people with OUD than methadone

Does COVID-19 Vaccination Warrant the Classical Principle " ofelein i mi vlaptin"?

The current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic warrants an imperative necessity for effective and safe vaccination, to restrain Coronavirus disease 2019 (COVID-19) including transmissibility, morbidity, and mortality. In this regard, intensive medical and biological research leading to the development of an arsenal of vaccines, albeit incomplete preconditioned evaluation, due to emergency. The subsequent scientific gap raises some concerns in the medical community and the general public. More specifically, the accelerated vaccine development downgraded the value of necessary pre-clinical studies to elicit medium- and long-term beneficial or harmful consequences. Previous experience and pathophysiological background of coronaviruses' infections and vaccine technologies, combined with the global vaccines' application, underlined the obligation of a cautious and qualitative approach, to illuminate potential vaccination-related adverse events. Moreover, the high SARS-CoV-2 mutation potential and the already aggregated genetical alterations provoke a rational vagueness and uncertainty concerning vaccines' efficacy against dominant strains and the respective clinical immunity. This review critically summarizes existing evidence and queries regarding SARS-CoV-2 vaccines, to motivate scientists' and clinicians' interest for an optimal, individualized, and holistic management of this unprecedented pandemic

Nurse forecasting in Europe (RN4CAST): Rationale, design and methodology

Contains fulltext : 97171.pdf (postprint version ) (Open Access)BACKGROUND: Current human resources planning models in nursing are unreliable and ineffective as they consider volumes, but ignore effects on quality in patient care. The project RN4CAST aims innovative forecasting methods by addressing not only volumes, but quality of nursing staff as well as quality of patient care. METHODS/DESIGN: A multi-country, multilevel cross-sectional design is used to obtain important unmeasured factors in forecasting models including how features of hospital work environments impact on nurse recruitment, retention and patient outcomes. In each of the 12 participating European countries, at least 30 general acute hospitals were sampled. Data are gathered via four data sources (nurse, patient and organizational surveys and via routinely collected hospital discharge data). All staff nurses of a random selection of medical and surgical units (at least 2 per hospital) were surveyed. The nurse survey has the purpose to measure the experiences of nurses on their job (e.g. job satisfaction, burnout) as well as to allow the creation of aggregated hospital level measures of staffing and working conditions. The patient survey is organized in a sub-sample of countries and hospitals using a one-day census approach to measure the patient experiences with medical and nursing care. In addition to conducting a patient survey, hospital discharge abstract datasets will be used to calculate additional patient outcomes like in-hospital mortality and failure-to-rescue. Via the organizational survey, information about the organizational profile (e.g. bed size, types of technology available, teaching status) is collected to control the analyses for institutional differences.This information will be linked via common identifiers and the relationships between different aspects of the nursing work environment and patient and nurse outcomes will be studied by using multilevel regression type analyses. These results will be used to simulate the impact of changing different aspects of the nursing work environment on quality of care and satisfaction of the nursing workforce. DISCUSSION: RN4CAST is one of the largest nurse workforce studies ever conducted in Europe, will add to accuracy of forecasting models and generate new approaches to more effective management of nursing resources in Europe