Aid Decisions Research Articles

Risk Stratification Tools to Aid Decisions on Adjuvant Chemotherapy Usage in Resected Soft Tissue Sarcomas: A Ten-Year Review of an Irish Sarcoma Center Experience.

Soft tissue sarcoma (STS) is comprised of approximately 80 subtypes, with an incidence of 4 - 5 per 100,000 annually in Europe. The National Comprehensive Cancer Network (NCCN) guidelines recommend consideration of neoadjuvant/adjuvant chemotherapy in tumors at high risk of recurrence based on the American Joint Committee on Cancer (AJCC) staging. Alternatively, the Sarculator is a risk prediction tool that has identified a threshold of risk, above which chemotherapy may provide an overall survival (OS) benefit. Using this nomogram, patients with a 10-year predicted OS < 60% are classified as high risk and should be considered for chemotherapy. The aim of this study was to assess the prognostic accuracy of these two risk prediction methods in an Irish population. All newly diagnosed patients with resected STS discussed in the STS tumor board in Cork University Hospital between January 2012 and December 2021 were identified. Clinicopathological data were collected. Risk assessment using AJCC and Sarculator nomogram was performed on all patients with an extremity/trunk sarcoma. The OS was calculated including Kaplan-Meier method for time to event analysis. In total, 200 STS patients were reviewed, of whom 134 had truncal or extremity tumors. Sarculator score was calculated for 60 of these (well differentiated liposarcomas, desmoid tumors and dermatofibrosarcoma protuberans were excluded). Using the Sarculator nomogram to calculate 10-year predicted OS, 19 patients were categorized as high risk and 41 were categorized as low risk. Using AJCC staging, 25 patients were categorized as high risk and 35 as low risk. The 5-year OS rate in the Sarculator high-risk group was 60.2%, compared with 87.1% in the low-risk group (P = 0.009). The 5-year OS rate in the AJCC high-risk group was 67.6%, compared with 86.3% in the low-risk group (P = 0.083). Our cohort is representative of the broad histological subtypes expected. In our population, Sarculator score results correlate with international outcomes and higher scores were associated with increased mortality. The Sarculator was more predictive of clinical outcome than AJCC staging, and its use would lower the proportion of patients being considered for adjuvant chemotherapy thereby sparing toxicity, which is important in the setting of uncertain clinical benefit.

Placental multimodal MRI prior to spontaneous preterm birth

To utilise combined diffusion-relaxation MRI techniques to interrogate antenatal changes in the placenta prior to extreme preterm birth among both women with PPROM and membranes intact, and compare this to a control group who subsequently delivered at term. Observational study. Tertiary Obstetric Unit, London, UK. Cases: pregnant women who subsequently spontaneously delivered a singleton pregnancy prior to 32 weeks' gestation without any other obstetric complications. pregnant women who delivered an uncomplicated pregnancy at term. All women consented to an MRI examination. A combined diffusion-relaxation MRI of the placenta was undertaken and analysed using fractional anisotropy, a combined T2*-apparent diffusion coefficient model and a combined T2*-intravoxel incoherent motion model, in order to provide a detailed placental phenotype associated with preterm birth. Subgroup analyses based on whether women in the case group had PPROM or intact membranes at time of scan, and on latency to delivery were performed. Fractional anisotropy, apparent diffusion coefficients and T2* placental values, from two models including a combined T2*-IVIM model separating fast- and slow-flowing (perfusing and diffusing) compartments. This study included 23 women who delivered preterm and 52 women who delivered at term. Placental T2* was lower in the T2*-apparent diffusion coefficient model (p < 0.001) and in the fast- and slow-flowing compartments (p = 0.001 and p < 0.001) of the T2*-IVIM model. This reached a higher level of significance in the preterm prelabour rupture of the membranes group than in the membranes intact group. There was a reduced perfusion fraction among the cases with impending delivery. Placental diffusion-relaxation reveals significant changes in the placenta prior to preterm birth with greater effect noted in cases of preterm prelabour rupture of the membranes. Application of this technique may allow clinically valuable interrogation of histopathological changes before preterm birth. In turn, this could facilitate more accurate antenatal prediction of preterm chorioamnionitis and so aid decisions around the safest time of delivery. Furthermore, this technique provides a research tool to improve understanding of the pathological mechanisms associated with preterm birth invivo.

Contrasting approaches to very highcapacity network regulation and policy: a comparative analysis of France, Portugal, Spain and the UK (2008–2020)

Purpose The purpose of this paper is to examine the factors that may have contributed to different levels of very high-capacity network (VHCN) coverage, with a particular focus on the role of regulation and State aid. Design/methodology/approach A comparative empirical study based on multiple case studies was conducted in France, Portugal, Spain and the UK. Findings Although France, Portugal and Spain initially adopted similar regulatory strategies for VHCN deployment, the outcomes differed significantly. The UK, with a more demanding regulation, achieved a residual coverage. This study highlights the importance of the regulatory approach to VHCN access in balancing private and public investment and emphasizes the importance of State aid in the policy agenda for nationwide VHCN deployment projects. Research limitations/implications Research on complex phenomena, such as the impact of regulation on investment or the effectiveness of State aid procedures, may focus on specific events to the detriment of others, which could bias the results. Practical implications The findings of this study provide insights for policymakers involved in State aid decisions and regulators by understanding the importance of timely State aid interventions, efficient governance and the impact of regulation on investment incentives. Originality/value This paper extends the literature on the impact of regulation on investment incentives and State aid as a tool to complement private investment for VHCN deployment through in-depth case studies.

Access to Environmental Justice under the Aarhus Convention: Evaluating the Contemporary Hurdles for ENGOs in Challenging State Aid Decisions under EU Law

Access to Environmental Justice under the Aarhus Convention: Evaluating the Contemporary Hurdles for ENGOs in Challenging State Aid Decisions under EU Law

Continuity and change in Saudi Arabia’s development and humanitarian aid

This paper delves into the motivations and drivers behind Saudi Arabia’s foreign aid, shedding light on the interplay between geopolitics, religious affinity, and strategic objectives. Drawing on newly released empirical data from the Saudi Aid Platform (SAP) dataset, encompassing 47 years of aid delivery, the study seeks to answer the long-standing debate surrounding the factors shaping Saudi Arabia’s foreign aid decisions. The study focuses on two pivotal periods: the Bosnian War and the post-Arab Spring era. By examining Saudi aid allocations during these periods, we investigate the influence of foreign policy and geostrategic objectives versus the humanitarian needs of the recipients. Religious ideology, geopolitical interests, and strategic objectives drive Saudi Arabian aid. The study reveals that Saudi Arabia adopts a value-neutral strategic approach. The research contextualises these findings within geopolitical events, regional dynamics, and internal governance changes, providing insights into the factors influencing Saudi Arabia’s aid allocation decisions. By examining Saudi Arabian aid’s historical patterns and drivers, this study contributes to a deeper understanding of one of the world’s largest foreign aid providers. Additionally, it offers valuable insights for shaping effective aid strategies and policies in the future.

Revisiting the standing debate before the EFTA Court through the lens of post-Lisbon EU devlopments regarding locus standi

The Lisbon Treaty broadened and relaxed the standing requirements before the EU Court of Justice by adding a third class of acts amenable to judicial review. In the meantime, the EU has moreover been found in breach of the Aarhus Convention twice for shortcomings in access to justice for environmental organisations. Hence, the Aarhus Regulation, which implements the Aarhus Convention at Union level, was revised in 2021, and possible further amendments with regard to state aid decisions are being examined at the moment. The current standing requirements before the EFTA Court by contrast still reflect the situation prevailing in the European Union before those EU pillar evolutions. This article revisits four judgments of the EFTA Court in light of these developments and analyses how the EFTA Court has dealt with the existing discrepancies before, and might or might not be able to deal with them in the future.

Ochrona środowiska jako cel uzasadniający pomoc inwestycyjną na rzecz portów lotniczych

The goal of this paper is to determine whether and under what circumstances environmental protection can be considered as an objective of common interest justifying investment aid to airports. It begins by presenting the principles for examining the compatibility of investment aid to airports with EU law. In this context, the main focus will be on a comparative analysis of the two guidelines issued by the European Commission on eligibility conditions for such aid. It then outlines the development of the concept of environmental protection in the EU legal order. It also discusses the most important environmental impacts of airports, and methods to reduce the negative effects of their operation. The next section reviews the Commission’s main State Aid decisions on improving the environmental performance of airports, allowing us to draw conclusions on how such investments are assessed in practice. The main goal of this section is to critically examine the Commission’s current approach to assessing pro‑environmental investments at airports. The analysis leads to the formulation of two postulates of de lege ferenda. The first proposes adding a fourth objective of common interest concerning environmental protection to point 84 of the Guidelines on State Aid to Airports and Airlines. The paper then outlines the reasons for this change, which will, in particular, provide an appropriate legal basis for the approval of pro‑environmental State Aid and enhance legal certainty for both aid providers and beneficiaries. It will also reflect how environmental protection is rising up the agenda of the European Union, and help to achieve the objectives of the European Green Deal. The addition of an environmental objective will also aid EU cohesion. The second postulate indicates the need to change the way in which the eligible objectives of investment aid to airports are set out, from points to exemplary. The paper argues that the inclusion of only three eligible objectives of common interest for investment aid to airports leads to a limitation of the scope of Article 107(3)(c) TFEU; it is therefore incompatible with EU law.

More and better clinical trials in health care: focusing on people, not just systems and processes.

More and better clinical trials in health care: focusing on people, not just systems and processes.

Determinants of bilateral official development assistance

ABSTRACT According to the World Bank 2017 statistics, the inequalities between rich and poor countries have increased despite an 80% increase in the official development assistance volume. This persisted, even under the Millennium Development Goals (MDGs) regime (2000–2015), a period during which developing countries’ needs were assumed to be at the centre of the international community’s actions. Thus, one may question the effectiveness of aid and the real motivations of donor countries. This article aims to examine the factors that determine the bilateral official development assistance (BODA) allocation by using more recent data, and with an emphasis on whether donor countries have put into place a wish from the MDGs to largely take into account the needs of recipient countries in their ODA allocation decisions. Among other results, we show that the needs of recipient countries are taken into account by only small donors (in terms of volume) in their aid decisions. The major ODA providers do not follow the trend. Thus, rowing in line with the MDGs, putting the needs of recipient countries at the centre of BODA allocation was mainly limited to small ODA donors. Donor interest was is put forward by most of the donor countries.

Fiscal state aid law as a tool against harmful tax competition in the EU: déjà vu?

Abstract The theme of this article is the relationship between harmful tax competition measures and prohibited fiscal State aid. The aim of this article is to present a targeted examination of the use of State aid rules against national tax measures, eg tax schemes and tax rulings, following the adoption of the EU Code of Conduct for Business Taxation in 1997. The fiscal State aid decisions and judgments to be covered are divided into two parts: the first fiscal aid wave of the (early) 2000s and the second (ongoing) fiscal aid wave, which most notably includes the Apple, Fiat, Starbucks, and Amazon cases. It is argued that an important factor connecting the two fiscal State aid waves is the link they share with the EU’s fight against harmful tax competition.

U.S. Democracy Aid and the Conditional Effects of Donor Interests, Media Attention and Democratic Change, 1975-2010

Democracy promotion emerged as a US foreign policy priority during the late 20th century, especially after the Cold War. Scarce resources, however, require policymakers to make difficult choices about which countries should receive democracy aid and which ones should not. Previous studies indicate that a variety of factors shape democracy aid allocations, including donor strategic interests and democratic openings within potential recipient states. Research has also shown that media coverage plays a significant role in these decisions. We model the conditional effects of media attention and regime shifts on US democracy aid decisions, controlling for other recipient and donor variables. We argue that these factors are contingent on the salience, in terms of broad interest profiles, of a particular country for policymakers. The donor’s overall level of interest in a potential recipient systematically shapes the effects of media attention on democracy assistance. Broadly speaking, low-interest conditions elevate the agenda-setting impact of media attention and regime conditions/shifts while high-interest conditions reduce that effect. To assess these contingent relationships, we examine US democracy aid from 1975-2010. Our results support our argument and present a more nuanced explanation of the relationship between the media’s agenda-setting role, recipient characteristics and donor interests.

Coastal Vulnerability Assessment: A Case Study of the Nigerian Coastline

Coastal regions are one of the essential spots on the earth as they are hosts to various important ecosystems, natural resources and the increasing population. Based on their proximity to the seas, they are mainly affected by sea-level rise, which is one of the adverse effects of climate change. This has resulted in associated hazards, such as beach erosion, flooding, coastal inundation, habitat destruction, saltwater intrusion into ground water aquifers and ecosystem imbalance. This study quantifies and classifies the vulnerability of the Nigerian coastline to these threats using the analytical hierarchical approach. This involved calculating the coastal vulnerability index (CVI) employing physical and geomorphological variables, and socioeconomic indicators that characterized the coastline vulnerability. The Nigerian coast was divided into seventeen (17) segments based on geomorphic units. The different vulnerability variables were assigned ranks ranging from 1 to 5, with 5 indicating the highest and 1 indicating the lowest vulnerabilities. The geomorphological and physical parameters include coastal slope, bathymetry, geomorphology, wave height, mean tidal range, shoreline change rate and relative sea-level rise, while the socioeconomic parameters include population, cultural heritage, land use/land cover and road network. The calculated CVI values (Saaty method) ranged from 11.25 to 41.66 with a median value of 23.60. Based on Gornitz approach, the calculated measures ranged between 3.51–4.77 and 3.08–5.00 for PVI and SoVI, respectively. However, the aggregated coastal vulnerability index computed using this approach ranged from 3.29 to 4.70. The results obtained from both approaches showed that 59–65% of the entire Nigerian coastline is under moderate to high vulnerability to sea-level rise. Data indicted how the coastal populations are highly vulnerable to both physical–geomorphological and socioeconomic stressors. Coastal vulnerability maps, highlighting the physical–geomorphological and socioeconomic vulnerability status of Nigerian coastline were also generated. The information from this study will assist coastal planners in identifying vulnerable segments in the study area and subsequently aid decisions that would mitigate the predicted impacts in the region.

The dynamics of US foreign aid decisions

The dynamics of US foreign aid decisions

College Costs, Financial Aid, and Student Decisions

College Costs, Financial Aid, and Student Decisions

Judicial Review of the State Aid Decisions on Advance Tax Rulings: A Last Resort to Safeguard the Rule of Law

In this article, the author provides a critical examination of various decisions addressing whether advance tax rulings on intra-group transfer pricing policies granted to multinational enterprises are illegal State aid under articles 107 and 108 of the Treaty on the Functioning of the European Union. Further, the author looks at whether the aid recovery process in these cases could be deemed to be contrary to the EU principles of legal certainty and the protection of legitimate expectations.

Costly Signals?

Developed states increasingly turned to democracy assistance strategies as the Cold War came to an end. A number of recent studies conclude that such aid positively affected democratization in recipients. But, like foreign aid, democracy assistance allocations are subject to change, sometimes dramatically. In foreign aid, sudden, sizable reductions – or aid shocks (e.g., Nielsen et al. 2011) – can have severe consequences, precipitating conflict in the recipient state. How do democracy aid shocks affect recipient states? This analysis examines the effects of sudden withdrawals of democracy aid – or democracy aid shocks – by the U.S. on recipient regime behavior, specifically, their treatment of citizens and civil society groups. We argue that democracy aid shocks trigger repressive action by recipients resulting in harmful human rights practices by the regime. Examining U.S. democracy aid to the developing world from 1982-2013, we find that, after controlling for other relevant factors likely to affect the human rights practices of a regime, democracy aid shocks are associated with subsequent repression of human rights in the recipient state. Our analysis thus sheds light on an external factor affecting human rights practices within states, as well as an important element of the consequences of democracy aid decisions. We conclude by assessing the implications for democracy promotion strategies and human rights behavior.

European Union and United Kingdom Competition Law Developments in the Aviation Sector: January to June 2021

As a direct result of the Coronavirus disease 2019 (COVID-19) pandemic, and the support measures initiated by EU Member States to compensate airlines for lost revenues, a review of the EU competition law developments the first half of 2021 continues to be dominated by State aid cases. This article summarizes the main developments over the past six months and provides the reader with an overview of the details of each of these developments. The first six months of 2020 have continued to be dominated by State aid cases, be it decisions by the European Commission (‘Commission’) to approve State aid applications, appeals of those or previously decided State aid cases, or the handing down of judgments from the General court. It is to be expected that for years to come, State aid decisions will form a significantly greater part of the competition law diet. In the six-month period, looking only at COVID-19 pandemic related cases/decision: at least sixteen Commission State aid decisions related to compensating undertakings for the direct or indirect effects of the COVID-19 pandemic; twelve Commission State aid decisions were appealed to the General court (mostly by Ryanair); and we are now seeing a significant number of judgments from the General Court relating to some of the Commission’s COVID-19 State aid decisions. In this period, Ryanair scored equal numbers of successful and unsuccessful appeals. Taking a quick look at the State aid applications submitted to the Commission State, a number of measures were submitted under Article 107(2)(b) of the Treaty on the Functioning of the European Union (‘TFEU’), which enables the Commission to approve State aid granted to compensate specific companies or specific sectors for the damages directly caused by ‘exceptional occurrences’. Few could ever contest that the COVID-19 pandemic would not qualify as an ‘exceptional occurrence’ it was an extraordinary, unforeseeable event having a significant economic impact globally. As a result, the interventions by the Member States to compensate for the damages directly linked to the COVID- 19 pandemic were considered justified. The Commission is also empowered to assess State aid measures requested by Member States under Article 107(3)(b) TFEU, which enables it to approve State aid granted to promote the execution of an important project of common European interest or to remedy a serious disturbance in the economy of a Member State. Again, few would dispute that the COVID-19 pandemic caused serious disturbances in the economies of EU Member States. The final main mechanism to consider State aid is the Temporary Framework specifically set up by the Commission to enable the quick approval of State aid providing that the measures fell within defined parameters. In relation to mergers, there are only five mergers mentioned, of which one reference the abandonment out of the Air Canada/Air Transat transaction after an in-depth investigation lasting more than eleven months. It should be noted that as a direct result of commitments regularly imposed by the Commission in State aid decisions under the Temporary Framework, recipients of State aid (like Air France, TUI, Finavia, Riga Airport etc.) are in principle prohibited from acquiring shares in competing or related markets, and this may have a dampening effect on merger activities in the aviation sector.

A quality improvement project to improve attendance to the physical health clinic at Southwark team for early psychosis

AimsThe aim of this project was to improve the booking and attendance of patients under Southwark Team for Early Psychosis (STEP) into the physical health clinic.BackgroundSTEP is an Early Intervention Service which provides treatment to 230 adults (18-65 years) with first episode psychosis in the community. In line with national and trust guidance, physical health checks are completed at baseline, 3 months, 6 months and annually, through a weekly physical health clinic run by the core trainee (CT). This is an essential opportunity to assess and monitor patients’ physical health and aid decisions regarding psychotropic medications, which is particularly important given the increased morbidity and mortality in this group and their reduced engagement with health services. It was noted that attendance to the clinic was poor and there was no guidance about how to communicate the results to the General Practitioner (GP).MethodData on the number of clinic appointments booked and attended were collected over 3 defined 9 week intervals between 17/09/18 and 29/07/19. The interventions were implemented prior to the third round of data collection and included an educational session to the STEP team and a protocol for booking and running the clinic to be used by the CT. We devised a physical health questionnaire to be completed by patients on arrival, which includes a summary of the Maudsley guidelines for antipsychotic monitoring. Finally, we created a template letter to communicate the results to the GP.ResultFollowing the interventions, the percentage of available clinic slots booked increased from an average of 27.8% to 100%. The proportion of slots attended reduced from an average of 80% to 50%. However, the absolute number of patients booked into clinic increased from an average of 10 patients over 9 weeks pre-intervention, of which an average of 8 patients attended, to 36 patients post-intervention, of which 18 attended.ConclusionWe observed full utilisation of available clinic slots post-intervention and an increase in the absolute number of patients attending. Given the ongoing use of the protocols developed, we expect these changes to be sustainable. The number of patients attending could be further increased by training additional staff to run the clinic more often and more flexibly. The number of Did-Not-Attends could be reduced by care-coordinators sending reminder texts prior to the appointments.

Access to justice in State aid: how recent legal developments are opening ways to challenge Commission State aid decisions that may breach EU environmental law

Access to justice in State aid matters is very limited. In particular, the admissibility test before the Court of Justice of the EU excludes private parties who are not market operators. The recent CJEU ruling in the Hinkley Point C case and the findings of the Aarhus Convention Compliance Committee call into question the adequacy of the current system. The findings demand an opening for non-market actors, including non-governmental organisations, to allege breaches of EU environmental law by the beneficiary of a State aid measure and consequently, the incompatibility of the aid measure with the internal market.

Commission

This overview highlights the Commission’s (i) presentation of the European Semester Autumn Package, (ii) agreement with G20 Leaders to devise a fair, sustainable and modern international tax system by mid-2021, (iii) launch of a preliminary consultation on administrative cooperation for crypto-assets and e-money, (iv) welcome of the adoption of the EU Long-Term Budget for 2021-2027, (v) status of the infringement procedure regarding Greek inheritance tax rules, (vi) State aid decisions on the Polish State aid scheme and Italian corporate tax exemptions for ports, and (vii) endorsement of implementing decisions on the EU-UK Withdrawal Agreement.