Bringing the Outside In: Somaliland, Statebuilding and Dual Hybridity

BackgroundThe quality of the evidence used in health technology assessment (HTA) agency reports has been considered essential for decision-making processes and their legitimacy. In Brazil, CONITEC is the agency responsible for defining data mandatory for the submission of proposals for the incorporation of new technologies. The objective of this study was to analyse CONITEC recommendation reports, the type of scientific evidence used in them and their compliance with operational procedures.MethodsThis is a descriptive study based on CONITEC official reports from July 2012 through December 2016. Data were collected with a specific extraction form and analysed using descriptive statistics.ResultsWe evaluated 199 CONITEC recommendation reports. The annual number of reports increased during the study period. The absolute annual number of new technologies incorporated in 2013 (n = 24) was similar to that observed for 2014 (n = 24) and 2015 (n = 22), decreasing in 2016 (n = 13). The type of technology most frequently evaluated was ‘drugs’ (68.3%), followed by ‘procedures’ (20.1%). Overall, 117 (58.8%) reports were internal demands, 75 (37.7%) were external demands and 7 (3.5%) were mixed demands. There were differences between internal and external demands in terms of the evidence used in the reports and the decision regarding the recommendation to incorporate the technologies. Among the internal demands, the recommendation to incorporate the new technology was made for 70.9% of the reports, only 9.6% of which included full HTAs. Among the external demands, the incorporation of the new technology was recommended for 17.3% of the reports, 76.9% of which included full HTAs. Of the 101 reports in which incorporation of the new technology was recommended, 88 (87.1%) did not include a full health economic evaluation and ICER calculation. There are compliance difficulties with the recommendations in the CONITEC internal regulations regarding the type and quality of evidence considered in the analysis of recommendation reports.ConclusionsThe characteristics of the evidence used in recommendation reports and those considered to be mandatory were very different, indicating problems in decision-making processes. There is a need to study, with a broader perspective, the factors that influence the type of evidence used in decision-making processes in order to contribute to the development of better practices and policies.

Behavior needs neural variability

Fatigue is a significant health care problem of interest to professionals in many disciplines. Yet, it is poorly understood. Fatigue, as an indicator of adaptation, is examined in relationship to internal and external environmental demands in women's lives. From a secondary analysis of data collected from a large group of women in a Northwest urban community in the U.S., it was found that internal demands such as depression or anxiety are more significantly related to fatigue and vitality than external demands such as negative life events or employment status.

Effects of mental demands during dispensing on perceived medication safety and employee well-being: A study of workload in pediatric hospital pharmacies

Being a teacher educator (TE) of today is often described as a complex task. TEs have to deal with internal demands from students, colleagues and leaders and with external demands from state authorities when shaping the education programme in which they teach. The present article focuses on TEs in Swedish preschool teacher education and aims to explore how commitment to and demands, inside and outside the higher education system, are handled and reflected upon, specifically the demands on considering student-centred learning. Results from interviews with 10 TEs show a perceived lack of support from the faculty board and its office and how colleagues contribute to tensions but also are perceived as supportive colleagues to learn from. Results also show the TEs’ efforts to overcome less desirable traditions. The combined results show how TEs are part of webs of commitments regarded as related fields and threads dependent on each other rather than separate parts, making the web/teacher education programme fragile. If any part breaks, the whole programme will be damaged. The discussion relates to how to overcome traditions and making actors in the programme shape a future-directed good education together.

(1) Background: The use of advanced technology to study the energy demands of sport participants during actual sport competition is an important current research direction. The purpose of this study was to identify the physiological, internal, and external demands placed on basketball referees using ultra-wideband (UWB) technology, in relation to the period of the game. (2) Methods: The sample was comprised of nine international referees, and the data collection took place during the Women’s EuroBasket Sub-16 championship. Internal and external load were assessed through the inertial device WIMU PROTM, using UWB technology in order to quantify the effort exerted by each referee. The internal load was examined in relation to each individual’s heart rate (HR). The external load included the kinematic variables accelerations (Acc), decelerations (Dec), Acc/min, Dec/min, distance covered, steps, maximum speed (Vmax), average speed (Vavg), and speed zones, as well as the neuromuscular variables impacts (Imp), PlayerLoadTM (PLTM), PLTM/min, Metabolic Power (PMet), and PMet/min. (3) Results: The results exposed that referees work around 62% HRmax and spend more than 80% of the match at intensities between 0–12 km/h. The first period was the period in which the greatest work demand was experienced in relation to these neuromuscular outcomes (11.92 PL; 3.61 Met; 277 Impacts). The results revealed a diminishment of internal and external demands on the referees over the course of the game. (4) Conclusions: The results highlight the importance of monitoring and quantifying the workload of basketball officials, because doing so would allow for the establishment of individualized performance profiles that could be designed with the purpose of benefiting referee performance during games. The use of inertial devices allows for the objective quantification of referee workload under competitive circumstances.

This paper focuses on joint production/inventory optimization in single and multiple horizons, respectively, within a complicated supply network (CSN) consisting of firm nodes with coupled demands and firm nodes with coupled demands. We first formulate the single-epoch joint optimal output model by allowing the production of extra quantity for stock underage, considering the fixed costs incurred by having inventory over demand and shortfalls. Then, the multi-temporal dynamic joint production model is further investigated to deal with stochastic demand fluctuations among CSN nodes by constructing a dynamic input–output model. The K-convexity defined in Rn space is proved to obtain the optimal control strategy. According to physical flow links, all demands associated to the nodes of CSN are categorized into the inter-node demand inside CSN (intermediate demand) and external demand outside CSN (final demand). We exploit the meliorated input–output matrix to describe demand relations, building dynamic input–output models where demand fluctuates randomly in single-cycle CSN and finite multi-cycle CSN. The novel monocyclic and multicyclic dynamic models have been developed to minimize system-wide operational costs. Unlike existent literature, we consider fixed costs incurred by overdemand and underdemand inventory into system operational cost functions and then demonstrate the convexity of objective functions. The cost function with two fixed penalty costs due to excess and shortage of inventory is developed in a multicycle model, and the K-convexity defined in Rn is proved to find out the optimal strategy for joint dynamic production of CSNs in the case of multi-products and multicycles.

Since China's reform and opening-up in 1978, its international trade has experienced rapid growth, with a long-term trade surplus becoming a prominent feature against the backdrop of sustained economic expansion. In particular, its bilateral trade with the United States has consistently been in a trade surplus. This paper examines the relationship between the trade surplus and China's economic growth through a literature review, aiming to systematically analyse the dual effects of the trade surplus. The research findings indicate a positive correlation between the trade surplus and China's economic growth. The trade surplus drives economic growth by boosting external and internal demand, accumulating foreign exchange reserves (enhancing the ability to stabilise exchange rates and ensure import security), and strengthening government investment in infrastructure, human capital, and strategic industries. However, trade surpluses also pose risks, including resource misallocation leading to industrial imbalances, increased vulnerability to global shocks due to overreliance on external demand, and pressure on the renminbi to appreciate, which weakens export competitiveness.

The aim of this study was to analyze the effects of space and number of players manipulation on the external and internal load demands of youth futsal athletes. Forty-two male U17 players (age = 15.62 ± 0.58 years) from three futsal teams participated in the study. In this cross-sectional study that lasted 8-week, the player's sample practiced six futsal tasks (T1-T6) and a futsal game played under the official rules (T7). From T1-T6, two task constraints were manipulated: (i) the number of players and, (ii) the space of play. The WIMU PRO™ Ultra-Wideband (UWB) tracking system was used to measure the external and internal load during the futsal tasks. External load was quantified using kinematic and mechanical variables extracted from positional data and, the internal load was quantified using Heart rate (HR) and rating of perceived exertion (RPE). Repeated measures ANOVA was used for comparison purposes. In general, the results showed high external (total distance, distance 18.1-21, above 21 Km/h, and high intensity acceleration and deceleration, p < 0.001) and internal load (heart rate average and rating of perceived exertion, p < 0.001) in the tasks with low number of players and high area. In relation to the match, the tasks with small relative area per player (GK + 2 vs. 2 + GK and GK + 3 vs. 3 + GK in 20 × 20 m) promoted low external load. It was concluded that increasing the relative area by reducing the number of players involved in the tasks in the form of small-sided games (GK + 2 vs. 2 + GK and GK + 3 vs. 3 + GK), in relation to the futsal game (GK + 4 vs. 4 + GK), can be considered a pedagogical strategy to increase the external and internal load demands of young futsal players.

Estimating external loads and internal demands by positioning systems and innovative data processing approaches during intermittent running activities in team and racquet sports

Stress in health care is affected by moral factors. When people are prevented from doing 'good' they may feel that they have not done what they ought to or that they have erred, thus giving rise to a troubled conscience. Empirical studies show that health care personnel sometimes refer to conscience when talking about being in ethically difficult everyday care situations. This study aimed to construct and validate the Stress of Conscience Questionnaire (SCQ), a nine-item instrument for assessing stressful situations and the degree to which they trouble the conscience. The items were based on situations previously documented as causing negative stress for health care workers. Content and face validity were established by expert panels and pilot studies that selected relevant items and modified or excluded ambiguous ones. A convenience sample of 444 health care personnel indicated that the SCQ had acceptable validity and internal consistency (Cronbach's alpha exceeded 0.83 for the overall scale). Explorative factor analysis identified and labelled two factors: 'internal demands' and 'external demands and restrictions'. The findings suggest that the SCQ is a concise and practical instrument for use in various health care contexts.

Turbulences' check-up Département des diagnostics Western economies began their recovery one year ago, but it is still difficult to foresee jobs and capacities creations on the near term. National situations exhibit quite varied imprints of indebtedness and disindebtedness waves brought about by the deregulations and monetary policies. Continental Europe, Germany excepted, has achieved the curbing of corporate failures, but persistingly high real interest rates stand in the way of investment. Money and budget managements have been very upset by the swerves of the private demand. They will become clearer as turbulences move off. In Europe, reducing interest rates will be the only way to alleviate the fiscal austerity. In the United states the buoyant activity will reignite inflation, although an increased response to interest rates, and budget cuts, will check the demand during 1995. Japan is still striving towards slowing his production capacities growth ; public support is essential during 1994 to resume a moderate growth. In the United Kigdom, the activity is now heavily dependent on the internal demand, but the covering of the general government needs will limit the financial ressources of the private sector that will find itself short of equipments. Germany has definitely entered the disinflationary process, which allows the lowering of short term interest rates, but corporate accounts are not enough restored to boost investment. Recent tensions on bond yields betray the European subordination to capital markets. Savings are presently more drawn on in the United States, but also by the emerging markets the advance of which is dramatic. Asian dynamism has supported the world trade in 1993, a conflicting period for market shares. Trade developments will be faster (+ 6 % to + 7 % a year) and more balanced during 1994 et 1995. In France the recovery is mostly obvious in business surveys ; quantitative data are still scarce to confirm it. As long as the final demand dees not strengthen significantly, inventories bear the bulk of the ongoing adjustment. The economic policy attempts to reconcile several targets : the franc / mark parity, the lowering of interest rates, the support of activity, the checking of public deficits, the curbing of tax and contribution rates. When these targets prove to be inconsistent, the government is induced to get rather pragmatic. In 1994, GDP will grow by 1,1 %. The internal demand, excluding inventories, would rise somewhat from its depressed level of 1993. A weak increase of private consumption, a recovery of the real estate business and a sustained advance of public investment would go toward starting growth ; but the equipment spending by firms would be hardly stabilized, following their strong 1993 fall. In 1995 it would speed up, when inventories are considered satisfactory. GDP growth could then exceed 2,5 %, as both intenal and external demands would intensify. During both years, exports would increase more than imports. The French growth would thus benefit by the international environment, the domestic components of demand remaining subdued by some disindebtedness. A widening external surplus is forecasted, as well as a shrinking inflation. But the unemployment would keep spreading, this year, and would level off next year.

Headline EU: Internal and external demand will remain very weak

Engaging in innovation requires companies to go through a lengthy and detailed process in order to develop and introduce their innovation. In such a process, they face a number of demands. Internally, they need to do take into account the demands of top management, different departments, and people who are influenced by the innovative initiatives. Their demands can also be conflicting (e.g., while the marketing department might emphasize innovation needed by customers, the manufacturing department might emphasize innovation that is easy to manufacture, and yet the finance department might be interested in innovation that is less expensive). Externally, companies also need to deal with customers, suppliers, investors, and competitors. Similar to the internal demands, external demands can also be conflicting (e.g., while customers might want useful innovation, the investors might want higher and quicker returns on their investments). As a result, companies need to balance all these conflicting demands in order to be successful. In this research, we present an empirical evidence showing how these conflicting demands influence the innovation process. Keywords: Innovation, Demands, Manufacturing.

Confiscated Growth Département des diagnostics de l'OFCE In 1986 both the price of oil and the exchange rate of the dollar have come back to levels more in line with market equilibrium. But these have not had the expected stimulating effects. The improvements in the terms of trade — particularly large in Europe and Japan -- have slowed down the growth of general government and corporate net debt at a time when many developing countries have been forced to adopt severe financial measures. The flow of capital to the OECD countries has been balanced by a sharp reduction of the demand from the rest of the world, while important losses of market shares were conceded to the newly-industrialising countries. The recovery of private consumption has been significant, but not enough to stimulate investment. An important portion of corporate resources has continued to flow to the financial markets, contributing to keeping real interest rates high. In 1987 and early 1988 the slackening of demand in the United States and then its contraction, will dominate the international environment. In such a context the persistence of the American external deficit will aggravate monetary, trade and financial tensions. Faced with increased external competition and weak world demand, Japan and above all Europe will suffer seriously from any additional drop of the dollar. In France the likelihood of significant growth appears limited. Household consumption growth will slow down because of low wage increases, not fully compensated by a strong growth in non-wage income. The recovery of private investment will accelerate but its pace will remain slower than the improvement in profits. The growth of final domestic demand will tend to benefit foreign more than French suppliers, who are facing hightened competition in domestic and world markets from the South-East Asian countries. The trade balance could turn negative. A 1.7 per cent GDP growth in 1987 will not be enough to stop unemployment from rising. A more expansionist economic policy could curb this upward trend, but there is a continuing risk of any surge in demand being captured largely by foreign competitors. expected slowdown of household consumption, the near-stagnation of investment, and the weakness of exports. Destocking following involuntary stockbuilding in the second quarter of 1986 is expected to depress activity in the first part of this year, notwithstanding some strengthening of final demand. A modest pick-up is therefore not likely until the second quarter, led by investment and exports. Household consumption is likely to recover only moderately, given the weak growth of real incomes. The slowdown in the growth of world demand, projected for around the end of this year, will again limit growth in 1988. Overall, GNP seems likely to grow by 1.7 per cent in 1987 and 1.3 per cent in 1988. As a result only part of the considerable increase in profits in 1985-86 seems likely to be used for productive investment. The risk of an upturn in inflation in France in the coming quarters seems small. The policy of strict control of public sector salaries, combined with rising unemployment, seems likely to lead to moderation in the overall growth of incomes : hourly wage rates are likely to increase by a modest 2.8 per cent in 1987 and 2.4 per cent in 1988. Output prices seem likely to stop growing faster than unit costs, except in the tertiary sector, which has not yet restored its margins to the levels of the 1970s. On the assumption that the price of oil will stabilize around $ 16 per barrel at the end of the second quarter, the growth of the consumer price index will be around 2.7 per cent in 1987 and 2.4 per cent in 1988. Under the assumption of a progressive increase in the oil price to $20 by the end of 1988, inflation could be around 3 per cent both this year and next. In either case disinflation, as measured by the GNP deflator, will continue, with inflation falling from 5 per cent in 1986 to 3 per cent in 1987 and 2.5 per cent in 1988. Despite the modest growth of domestic demand and inflation, the external surplus of goods and services recorded in 1986 (around FF 21 billion) seems likely to be smaller this year because of a reduction in the manufactures balance of FF 15 billion. The decline in international competitiveness, due to the fall of the dollar since 1985, could be expected to result in some loss of market share. Nevertheless this is likely to be limited to 1.5 points in 1987 and 1 point in 1988, compared with 3 points over the course of the last two years. The slow growth of employment in the market sector seen in 1986 risks being interrupted because of modest growth of production and the perverse effect of the youth employment scheme "Emploi des Jeunes". It seems that a number of people were taken into employment in 1986 in anticipation of an exemption from social charges. Despite the recent new measures in respect of long-term unemployed, unemployment will continue to grow significantly. The number of unemployed could reach 2.8 million in the spring of 1988. The pick-up of investment in industry in 1984-1985 seems likely to continue in the next two years (6.5 per cent in 1987 and 5.4 per cent in 1988 in 1970 prices for the total of non-financial enterprises). Is this likely to be sufficient ? It would seem to be so if compared with the likely growth of internal and external demand, but not if considered in relation to the now considerable capacity to finance productive investment out of retained earnings. The study reported in the last part of this article suggests that the reduction of corporation tax would probably not be effective in sparking off a significant increase in investment. For given budgetary cost a direct subsidy to productive investment in the form of a tax credit would be ten times as effective. But the benefits would be realised only over the medium term.