Suchergebnisse

The author of the article made an investigation on Ukrainian and international aspects of the civil society institutions' role in the activities of public administra-tion. Essentially, civil society institutions serve as the in-struments of civil society required to provide democracy, represent different views, participate in the political pro-cess, and others. Accordingly, civil society institutions participate in different fields of public relations, namely: healthcare, justice, finance, education, ecology, interna-tional relations, safety, social politics. Public administra-tion is an institute, by which the stated is governed with. In addition, there is a necessity for a dialogue between these institutes. In this vein, the author gives examples of the legal regulation of the relations between civil soci-ety institutions and public administration, thus focusing on the problems of such relations. Among the main prob-lems are the lack of civic culture, the fact that people are generally hesitant to the possibility of influencing state and political processes, credibility gap, legal nihilism, bu-reaucratic obstacles.Thus, different ways of the stimulation for public ad-ministration synergy within the civil society institutions are represented and characterized. Civil society institu-tions, including public organizations, play an important role in providing the rule of law. This is being done par-ticularly via the public control, audit, legal protection, analysis, and many other methods. Thus, it is the crucial task of the public administration to promote the activities of civil society institutions in various ways.The author therefore concludes that the most essential prerequisite of the rule of law state is the formation of a civil society in which the free and comprehensive develop-ment of each person, the functioning of democratic civil institutions that ensure freedom of speech and informa-tion, are guaranteed though the power of public opinion and public morality, free elections, existence of the le-gal opposition and multi-party system. All the foregoing makes the usurpation of power impossible.The author offers the ways to solve the problematic aspects of public participation in government, especially by improving the regulatory framework, providing an ef-fective mechanism for citizens to appeal, simplifying and ensuring transparency of mechanisms for public partici-pation in public administration, establishing the respon-sibility of public administration entities for avoiding par-ticipation of civil society institutions in activities where it is provided by law, etc. ; Автором статті було проведено дослідження ролі інститутів громадянського суспільства в діяльності пу-блічної адміністрації крізь призму українського та між-народного досвіду. По суті, інститути громадянського суспільства виступають інструментами, необхідними для забезпечення демократії в державі, представляють різні погляди, захищають інтереси громадян, беруть участь у політичних процесах тощо. Відповідно, інсти-тути громадянського суспільства задіяні в різних сфе-рах суспільних відносин, таких як: охорона здоров'я, правосуддя, фінанси, освіта, екологія, міжнародні від-носини, безпека, соціальна політика тощо. Автор наводить приклади правового регулювання відносин між інститутами громадянського суспільства та суб'єктами публічного адміністрування, акцентую-чи увагу на проблемах таких відносин. Серед основних із них: відсутність громадянської культури; слабке інформування людей про можливість впливати на дер-жавні та політичні процеси; брак довіри; правовий нігілізм; бюрократичні перешкоди. Інститути грома-дянського суспільства, в тому числі громадські орга-нізації, відіграють важливу роль у забезпеченні верхо-венства права. Цьому сприяють, зокрема, громадський контроль, аудит, правовий захист, аналіз та багато інших методів. Отже, вирішальним завданням публіч-ного адміністрування є сприяння діяльності інститутів громадянського суспільства різними способами.Автор робить висновок, що найважливішою переду-мовою верховенства права є формування громадян-ського суспільства, в якому гарантується вільний та всебічний розвиток кожної людини, функціонування демократичних інститутів, що забезпечують свободу слова та інформації, сила громадської думки і суспіль-ної моралі, вільні вибори, існування легальної опозиції та багатопартійності. Усе сказане вище робить узурпа-цію влади неможливою.Автор пропонує шляхи вирішення проблемних аспектів участі громадськості в публічному адміні-струванні, зокрема шляхом вдосконалення норматив-но-правової бази, забезпечення ефективного механізму оскарження, забезпечення прозорості механізмів уча-сті громадськості в публічному адмініструванні та їх спрощення, встановлення відповідальності суб'єктів публічного адміністрування за ухилення від сприяння участі інститутів громадянського суспільства в їхній діяльності та процесах прийняття рішень, якщо це передбачено законом тощо.Автором статті було проведено дослідження ролі інститутів громадянського суспільства в діяльності пу-блічної адміністрації крізь призму українського та між-народного досвіду. По суті, інститути громадянського суспільства виступають інструментами, необхідними для забезпечення демократії в державі, представляють різні погляди, захищають інтереси громадян, беруть участь у політичних процесах тощо. Відповідно, інсти-тути громадянського суспільства задіяні в різних сфе-рах суспільних відносин, таких як: охорона здоров'я, правосуддя, фінанси, освіта, екологія, міжнародні від-носини, безпека, соціальна політика тощо. Автор наводить приклади правового регулювання відносин між інститутами громадянського суспільства та суб'єктами публічного адміністрування, акцентую-чи увагу на проблемах таких відносин. Серед основних із них: відсутність громадянської культури; слабке інформування людей про можливість впливати на дер-жавні та політичні процеси; брак довіри; правовий нігілізм; бюрократичні перешкоди. Інститути грома-дянського суспільства, в тому числі громадські орга-нізації, відіграють важливу роль у забезпеченні верхо-венства права. Цьому сприяють, зокрема, громадський контроль, аудит, правовий захист, аналіз та багато інших методів. Отже, вирішальним завданням публіч-ного адміністрування є сприяння діяльності інститутів громадянського суспільства різними способами.Автор робить висновок, що найважливішою переду-мовою верховенства права є формування громадян-ського суспільства, в якому гарантується вільний та всебічний розвиток кожної людини, функціонування демократичних інститутів, що забезпечують свободу слова та інформації, сила громадської думки і суспіль-ної моралі, вільні вибори, існування легальної опозиції та багатопартійності. Усе сказане вище робить узурпа-цію влади неможливою.Автор пропонує шляхи вирішення проблемних аспектів участі громадськості в публічному адміні-струванні, зокрема шляхом вдосконалення норматив-но-правової бази, забезпечення ефективного механізму оскарження, забезпечення прозорості механізмів уча-сті громадськості в публічному адмініструванні та їх спрощення, встановлення відповідальності суб'єктів публічного адміністрування за ухилення від сприяння участі інститутів громадянського суспільства в їхній діяльності та процесах прийняття рішень, якщо це передбачено законом тощо. ; Автором статті було проведено дослідження ролі інститутів громадянського суспільства в діяльності пу-блічної адміністрації крізь призму українського та між-народного досвіду. По суті, інститути громадянського суспільства виступають інструментами, необхідними для забезпечення демократії в державі, представляють різні погляди, захищають інтереси громадян, беруть участь у політичних процесах тощо. Відповідно, інсти-тути громадянського суспільства задіяні в різних сфе-рах суспільних відносин, таких як: охорона здоров'я, правосуддя, фінанси, освіта, екологія, міжнародні від-носини, безпека, соціальна політика тощо. Автор наводить приклади правового регулювання відносин між інститутами громадянського суспільства та суб'єктами публічного адміністрування, акцентую-чи увагу на проблемах таких відносин. Серед основних із них: відсутність громадянської культури; слабке інформування людей про можливість впливати на дер-жавні та політичні процеси; брак довіри; правовий нігілізм; бюрократичні перешкоди. Інститути грома-дянського суспільства, в тому числі громадські орга-нізації, відіграють важливу роль у забезпеченні верхо-венства права. Цьому сприяють, зокрема, громадський контроль, аудит, правовий захист, аналіз та багато інших методів. Отже, вирішальним завданням публіч-ного адміністрування є сприяння діяльності інститутів громадянського суспільства різними способами.Автор робить висновок, що найважливішою переду-мовою верховенства права є формування громадян-ського суспільства, в якому гарантується вільний та всебічний розвиток кожної людини, функціонування демократичних інститутів, що забезпечують свободу слова та інформації, сила громадської думки і суспіль-ної моралі, вільні вибори, існування легальної опозиції та багатопартійності. Усе сказане вище робить узурпа-цію влади неможливою.Автор пропонує шляхи вирішення проблемних аспектів участі громадськості в публічному адміні-струванні, зокрема шляхом вдосконалення норматив-но-правової бази, забезпечення ефективного механізму оскарження, забезпечення прозорості механізмів уча-сті громадськості в публічному адмініструванні та їх спрощення, встановлення відповідальності суб'єктів публічного адміністрування за ухилення від сприяння участі інститутів громадянського суспільства в їхній діяльності та процесах прийняття рішень, якщо це передбачено законом тощо.

The purpose of the article is to present the specific relationship between the EU, which is a unique international organisation, and its Member States, which are the source of integration and, paradoxically, its natural limit. The article contains an analysis of provisional measures imposed on Poland by the Court of Justice of the European Union (CJEU) as an example of a judicial and autonomous control mechanism concerning Member States and their obligations under EU law. Case European Commission v. Poland (2017) serves as a central element of the considerations. On 27 July 2017, the CJEU imposed a temporary injunction against logging in the Polish Bialowieza Forest, a UNESCO World Heritage Site and the last old-growth forest in Europe, while the case is being tried with the final Court decision expected in December 2017. Nevertheless, the Polish minister of the environment said on 31 July that the Polish government will ignore the ruling and that the logging will continue in tune with the "protective measures" for the forest, since the Bialowieza Forest seems to be under attack from the Spruce Bark Beetle. This species of beetle is a pest which colonises primarily spruce trees (Ips typographus for the lovers of the Latin language). The assumption made in the article is that provisional measures (applied under EU procedural law) have dogmatic roots in the tradition of civil proceedings in Member States. What is involved here are national procedures aimed at securing a claim in certain circumstances which establish a prima facie case on the inefficiency of the future decision. The specificity of provisional measures results from the specificity of EU law, which, in order to be effective, requires a judicial review. Provisional measures are one of the tools to guarantee its effectiveness. Despite relatively strict conditions for the applicability of provisional measures by the CJEU, they can help ensure effectiveness of UE law. The measures imposed to stop the destruction of the Białowieża Forest can be an example here. ; The following paper constitutes a part of the research conducted within the framework of the statutory research at the Faculty of Law of the University of Warsaw. ; Robert Grzeszczak: r.grzeszczak@wpia.uw.edu.pl ; Mateusz Muchel: m.muchel@wpia.uw.edu.pl ; Robert Grzeszczak - University of Warsaw ; Mateusz Muchel - University of Warsaw ; Annexes to the Communication from the Commission to the European Parliament and the Council: A new EU Framework to Strengthen the Rule of Law, Annex I: The Rule of law as a foundational principle of the Union (Brussels, 11.3.2014, COM(2014) 158, final. ; Azoulai, L. "Integration through law" and us. (2016). International Journal of Constitutional Law, 14(2), 449–463. ; Belgium v. European Commission, T131/16 (19 July 2016), EU:T:2016:427. ; Cambridge Healthcare Supplies v. European Commission T-137/00 R (31 October 2000). ; Comité Central d'Entreprise de la SA Vittel and Comité d'Etablissement de Pierval v. European Commission, T-12/93 R (6 July 1993). ; Comité Central d'Entreprise de la Société Générale des Grandes Sources and others v. European Commission, T-96/92 R (15 December 1992). ; Commission Regulation (EU) No 312/2014 of 26 March 2014 establishing a Network Code on Gas Balancing of Transmission Networks (BAL NC). ; Consolidated versions of the Treaty on European Union and the Treaty on the Functioning of the European Union (OJ C 326, 26.10.2012). ; Convention on the Protection of Human Rights and Fundamental Freedoms of Rome (4 November 1950). Retrieved from: https://www.echr.coe.int/Documents/Convention_ENG.pdf. ; Council Directive 92/43/EEC of 21 May 1992 on the conservation of natural habitats and of wild fauna and flora (OJ 1992 L 206, p. 7), as most recently amended by Council Directive 2013/17/EU of 13 May 2013 (OJ 2013 L 158). ; Czachór, Z. (2013). Kryzys i zburzona dynamika Unii Europejskiej [Crisis and disturbed dynamics of the European Union]. Warszawa: Dom Wydawniczy i Handlowy ELIPSA. ; Directive 2009/147/EC of the European Parliament and of the Council of 30 November 2009 on the conservation of wild birds (OJ 2010 L 20). ; Euroalliages v. European Commission, T-132/01 (8 July 2003). ; European Commission acts to defend judicial independence in Poland. (n.d.) Retrieved from: http://europa.eu/rapid/press-release_IP-17-5367_en.htm. ; European Commission v. Poland C-441/17. (2017). ECLI:EU:C:2017:877. ; Evonik Degussa v. European Commission, C162/15 PR (2 March 2016). EU:C:2016:142 ; Grzeszczak, R. & Karolewski, I.P. (2017). Bialowieza Forest, the Spruce Bark Beetle and the EU Law Controversy in Poland. Retrieved from: http://verfassungsblog.de/bialowieza-forest-the-spruce-bark-beetle-and-the-eu-law-controversy-in-poland/ ; Habermas, J. (2005). Faktyczność i obowiązywanie. Teoria dyskursu wobec zagadnień prawa i demokratycznego państwa prawnego [Between Facts and Norms: Contributions to a Discourse Theory of Law and Democracy]. Warszawa: Wydawnictwo Naukowe Scholar. ; Hänseler GmbH v. European Commission, T-83/00 R, (31 October 2000). ; Hans-Martin Tillack v. European Commission, T-193/04 (4 October 2006). ; Iżykowski, M. (1985). Przesłanki zabezpieczenia powództwa. Palestra, 29/11(335). ; Jack Hanning v. European Parliament, C 176/88 R (11 July 1988). ; Jakubecki, A. (2017). Kodeks postępowania cywilnego. Komentarz aktualizowany. Tom II [Code of Civil Procedure. Comment updated. Vol. II]. Warszawa: C. H. Beck. ; Kingdom of Belgium v. European Commission, C-142/87 R (15 June 1987). ; Kmieciak, Z. (2010). Postępowanie administracyjne i sądowoadministracyjne a prawo europejskie. Wolters Kluwer. ; Lambert and others v. France. 2015, June 5. European Court of Human Rights, No 46043/14. ; Lenaerts, K., Arts, D., Maselis, I & Bray, R. (2006). Procedural Law of the European Union. London: Sweet and Maxwell. ; Poland approves large-scale logging in Europe's last primeval forest (2016, March 26). The Guardian. Agence France-Presse. Retrieved from: https://www.theguardian.com/environment/2016/mar/26/poland-approves-large-scale-logging-in-europes-last-primevalforest. ; Poland v. European Commission, T883/16 R (21 July 2017). ECLI:EU:T:174. ; Rosas, A. & Arnati L. (eds.). (2012). EU Constitutional Law. An introduction. Oxford: Oxford University Press. ; Satya Prakash v. Commission of the EAEC, C-65-63 R (25 June 1965). ; Shapiro, M. (1980). Comparative Law and Comparative Politics. Southern California Law Review, 53(2), 537-542. ; Shaw, J., More, G. (1995). New Legal Dynamics of European Union. Oxford: Oxford University Press. ; Sofrimport SARL v. European Communities, C-152/88 (10 June 1988). ; Statute of the Permanent Court of International Justice, provided for in article 14 of the Covenant of the League of Nations (Journal of Laws of 1923, no 106, item 839). ; Statute of the International Court of Justice. Retrieved from: http://www.icj-cij.org/en/statute. ; The Act of 17 November 1964 – Code of Civil Procedure (Journal of Laws of 2018, item. 155, as amended). ; UNESCO Word Heritage Centre, Outstanding Universal Value, 02.04.2018 Retrieved from: https://whc.unesco.org/en/list/33 ; Weatherill, S. (1995). Law and Integration in the European Union. Oxford: Oxford University Press. ; Weiler, J.H.H. (1991). The Transformation of Europe. The Yale Law Journal, 100(8), 2403-2483. ; WHC.17/41.COM/18 Decisions adopted by the World Heritage Committee at its 41st session (Cracow, Poland). ; Wyrok Sądu Najwyższego [Judgment of the Supreme Court], No. V CZ 105/12. (2013, April 17). ; Żurek, K. (2000). Środki tymczasowe jako przejaw funkcjonowania efektywnej ochrony prawnej w systemie prawnym Unii Europejskiej. In. Biernat, S. (Ed.), Studia z prawa Unii Europejskiej. Kraków: Wydawnictwo Uniwersytetu Jagiellońskiego. ; 2 ; 1 ; 21 ; 35

Globaalien trendien vaikutuksesta on monissa maissa on harjoitettu politiikkaa, jonka mukaan korkeakoulut nähdään taloudellisen kasvun kannalta tärkeinä toimijoina. Erityisesti yrittäjyyteen liittyvät toimintapolitiikat ovat muovanneet yliopistojen kehittymistä kohti proaktiivisempia toimintatapoja ja vähäisempää riippuvuutta valtionrahoituksesta. Tämän tutkimuksen tarkoituksena oli analysoida muutosprosessia, joka liittyy yrittäjämäisen yliopiston toimintamallin kehittämiseen valtion yrittäjyyden edistämiseen tähtäävän toimintapolitiikan puitteissa. Muutosprosessin taustalla olevien seikkojen ymmärtämiseksi tässä tutkimuksessa hyödynnettiin erityisesti institutionalisoitumisen ja yrittäjämäisen yliopiston käsitteitä. Käyttämällä National University of Singapore (NUS) yliopistoa tutkittavana tapauksena, tutkimuksen tutkimuksessa keskityttiin niiden vaikuttavien tekijöiden ja niiden laajuuden tunnistamiseen, jotka vaikuttavat yrittäjämäisen yliopiston toimintamallin institutionalisoitumisen taustalla. Tutkimuksessa institutionalisoituminen määriteltiin yksilöitä koskevaksi tilaksi liittyen tarpeeseen hyväksyä ja sitoutua tiettyihin NUS yliopiston omaksumiin käytäntöihin. Yrittäjämäisen yliopiston mallia käsiteltiin muutosprosessin kontekstissa sisältäen 1) laitosten, tiedekuntien ja erillisyksikköjen toiminnan ja käytännöt liittyen tulonhankinta-aktivititeetteihin; 2) yliopistotason toiminnot jotka kytkeytyvät kansalliseen yrittäjyyden edistämiseen liittyvään toimintapolitiikkaan; 3) eri toimijoiden roolit ja kontribuutiot yrittäjämäisten toimintojen kehittämisessä ja 4) akateemisen yhteisön sitoutuneisuuden yliopiston tehtävien, aktiviteettien ja tavoitteiden yhdistämisessä valtion yrittäjyyden edistämisen toimintapolitiikkaan. Tutkimuksessa hyödynnettiin metodina kehysanalyysiä. Tätä käytettiin välineenä monitulkintaisten kysymysten ja tilanteiden tulkintaan, mukaan lukien keinojen etsinnässä yrittäjämäisen yliopiston muutosprosessin haasteisiin. Kehysten tunnistaminen toimi apuna valtion korkeakouluihin kohdistaman politiikan toimeenpanon onnistuneisuuden selvittämisessä etenkin sen suhteen missä määrin yrittäjyyden edistämiseen liittyvän toimintapolitiikan ideaalit toteutuvat yliopiston rakenteiden ja johtamisen tasolla. Tutkimuksen lähtökohtana oli myös tuoda esille monitieteistä lähestymistapaa korkeakoulukontekstiin liittyvien asioiden ja tilanteiden analysoinnissa soveltamalla erityisesti terveydenhuoltosektorin kontekstissa kehitettyä institutionalisoitumisen viitekehystä sekä ympäristökonfliktien tutkimuksen piirissä kehitettyjä kehyskategorioita. Tutkimuksessa hyödynnettiin laadullisen kehysanalyysiin lähestymistapaa institutionalisoitumisen asteen selvittämiseksi NUS-yliopistossa. Seuraavat ympäristökonfliktien tutkimuksesta johdetut kehyskategoriat ohjasivat analyysiä: identiteettikehys, karakterisointikehys, valtakehys sekä riski- ja informaatiokehys. Tutkimuksen empiirinen aineisto koostui kahdesta aineistotyypistä, haastatteluista ja dokumenteista. Kaikkiaan tutkimuksen puitteissa toteutettiin 18 eri tieteenalojen (luonnontieteet, tekniset tieteet, liiketalous, yhteiskuntatieteet ja humanistiset tieteet) edustajien haastatteluita. Haastattelut toteutettiin etupäässä NUS-yliopiston Kent Ridgen ja Timahin kampuksilla. Yrittäjämäisenä yliopistona NUS-yliopiston voitiin todeta osallistuvan aktiivisesti kaupallistamistoimintoihin ja yrittäjyyskoulutukseen. Yliopiston vuonna 2006 tapahtuneen yhtiöittämisen jälkeen yliopistossa on toteutettu laajamittaisia muutoksia jotka ovat kohdistuneet yliopiston toiminnallisen ja taloudellisen joustavuuden lisäämiseen. Dokumenttiaineiston perusteella yliopisto on huolellisesti suunnitellut ja toimeenpannut useita yrittäjyyttä ja yrittäjämäisyyttä täydentäviä toimintamalleja, resursseja, sisäisiä rakenteita ja tukitoimintoja muutosprosessin yhteydessä. Toisin kuin eurooppalaisten yliopistojen osalta, singaporelaisten yliopistojen yrittäjämäistymiseen liittyvä muutosprosessi ei johdu etupäässä valtiorahoituksen merkittävästä vähentymisestä. Itse asiassa yrittämäisyyttä tukevien toimenpiteiden resursoinnissa on ollut jatkuvaa kasvua erityisesti niillä tieteenaloilla, jotka kytkeytyvät Singaporen strategisille kasvualoille (mm. biotekniikka, ympäristö- ja vesitekniikka sekä interaktiivinen ja digitaalinen media). Mainittavaa on, että tutkimusaineiston analyysin perusteella voitiin osoittaa suuri määrä erilaisia henkilöstön käsityksiä yrittäjämäisen yliopistomallin institutionalisoitumisesta NUS-yliopistossa. Kehysten avulla voitiin kuvata tieteenalakohtaisia eroavaisuuksia, institutionaalisia järjestelyitä, joidenkin tieteenalojen haavoittuvuuksia liittyen näiden rooliin osana yrittäjämäistä yliopistoa sekä riskikäsityksiä, jotka heijastelivat NUS-yliopiston jäsenten yrittäjämäistymisprosessin tukemiseen liittyviä valintoja. Institutionalisoituminen prosessina sisältää tyypillisesti vaiheita tai kehitysasteita. Erityisesti NUS-yliopiston visiossa, missiossa sekä strategiassa ilmenevä "yrityshengen" käsite on tutkimuksen kannalta erittäin keskeinen, koska se havainnollistaa yrittäjämäisten yliopistojen muuttuvaa ja mukautuvaa luonnetta monimutkaisina toimijoina ja koska se on myös vaikuttanut yrittäjämäisen yliopistomallin institutionalisoitumiseen siirryttäessä vaiheesta toiseen. NUS-yliopiston henkilöstö valikoiden soveltaa yrittäjämäisen yliopiston merkityksiä tavalla joka on heidän omien tavoitteiden ja aloitteiden kannalta relevanttia. Kokonaisuudessaan tämän tutkimuksen perusteella voidaan todeta, että yrittäjämäisen yliopistomallin institutionalisoituminen NUS-yliopistossa on dynaaminen mutta edelleen käynnissä oleva prosessi. Tämä johtuu siitä, että NUS-yliopistossa on tarve käsitellä toiminnallisia haasteita samaan aikaan kun se pyrkii saavuttamaan yrittäjämäisyyteen liittyviä tavoitteitaan. ; Global trends influence many countries in introducing policies that enjoin higher education institutions as partners for economic growth. Entrepreneurship policies in particular, have shaped the transition of universities to become more proactive institutions and less dependent from government funding. The purpose of this study was to analyze the university's transformation in building up the entrepreneurial university model based on the government's policy framework in promoting entrepreneurship. In order to understand the drivers of transformation, the concepts of institutionalization and the entrepreneurial university were utilized in this research. The research questions were focused on determining the extent and factors that contribute to the institutionalization of the entrepreneurial university model by taking the National University of Singapore (NUS) as a case study institution. In this study, institutionalization was defined as a condition confronting individuals of the need to accept and commit to certain practices that have been adopted by the university. The entrepreneurial university was tackled in terms of the transformation of the university which encompasses: 1) the behavior and practices within departments, faculties, and independent institutes concerning their approach to income-generating activities; 2) the institutional activities' link to the national policy on entrepreneurship; 3) the roles and contributions of various actors in cultivating entrepreneurial activities at the university; and 4) the commitment of the academic community to align the tasks, activities, and goals of the university with the government's policy framework on entrepreneurship. The method of frame analysis was utilized in this study as a tool in interpreting complex issues and situations, including means to explore solutions in the course of entrepreneurial university transformation. Uncovering frames helped in examining the success of the government in implementing policies on higher education institutions in relation to embracing entrepreneurial ideals in their overall structure and management. This study has presented a multidisciplinary approach in analyzing various issues and situations in higher education: namely, the framework of institutionalization from the healthcare sector and the categories of frames from environmental conflict research. A qualitative approach to frame analysis was applied to analyze the institutionalization situation at NUS. This study was guided by four categories of frames derived from environmental conflict research: identity frames, characterization frames, power frames, and risk and information frames. Empirical data for this study consisted of two main sources: interviews and documents. Eighteen interviewees participated in this study, which represent various disciplines - including science, engineering, business, social science, and the humanities. The interviews were mostly held at NUS's Kent Ridge and Bukit Timah campuses. As an entrepreneurial university, NUS was found to be actively involved in commercialization activities and entrepreneurship education. Since the university's corporatization in 2006, massive changes have occurred to address issues of operational and financial flexibility. Documents revealed that the policies, resources, internal structure, and the support functions to complement entrepreneurial activities were earnestly planned and implemented throughout the transformation of NUS. Compared to European universities, the entrepreneurial transformation of Singaporean universities was not mainly caused by massive decrease in government funding. In fact, there has been continuous increase in resources to facilitate entrepreneurial activities, especially in disciplines that are aligned to Singapore's strategic growth areas (i.e., biomedical sciences, environmental and water technologies, and interactive and digital media). More importantly, the analysis of the data featured the myriad perceptions of institutional members on the institutionalization of the entrepreneurial university model at NUS. Frames were found to depict disciplinary differences, institutional arrangements, vulnerability of some disciplines in their role within the entrepreneurial university, and risk perceptions that reflected the choices of institutional members in supporting the entrepreneurial transformation. Institutionalization as a process typically involves stages or phases. The "spirit of enterprise" was a crucial statement in the vision, mission, and strategy of NUS because it depicts the varying and malleable notions of an entrepreneurial university and also affects the institutionalization of the entrepreneurial university model in terms of moving into another phase. As such, institutional members selectively adapt the meaning of entrepreneurial university that is more relevant to their intentions or initiatives. Overall, the current study found that the institutionalization of the entrepreneurial university model at NUS is something dynamic but is still in progress because of the need to address various operational barriers while working towards achieving entrepreneurial goals.

The upcoming General Data Protection Regulation at EU level to be implemented in 2018 will represent a history achievement data time when the Europe is laying the foundations of a single digital market. In the context of Big Data and eHealth, it is convenient to tackle the influence of the current EU regulation related to health data. This research was conceived from the idea of assessing the influence of the right to personal data protection, born in Europe and projected in the last decades in other regions such as Latin America. Privacy and data protection in the era of Big Data are not per se guaranteed. lt is the citizens themselves who are asking for a harmonized protection within the EU; this health data regulatory framework can be regarded as a data protection model in eHealth internationally. 2016 represented the 10th anniversary of the international Data Protection Day, a celebration that was established by the committee of ministers of the Council of Europe and the European Commission to raise awareness amongst citizens. In order to contribute to this scientific progress, an undetermined number of databases and tools are deployed, with a varied and technically complex set of systems applied to several scientific disciplines. The use of these resources, diverse and fragmented in many cases, has led the EU to develop a number of initiatives to standardize the access and management of both information and systems, representing what I call a benchmark model. This research aims at shedding light on the engine of this model and its implications beyond Europe, looking at Latin America, based on the cultural, linguistic and commercial cooperation links with Spain. lt is about assessing the current magnitude of concepts such as Big Data, eHealth, data protection and electronic health records, after 50 years of progress in the area of data protection, when in the heart of Europe, first regulation of personal data protection was born. The European Union is the most regulated jurisdiction when it comes to data protection, and it is the European citizens themselves who have promoted legal changes and the defence of their rights. The law provides special privileges to health data. Scientific research and health care within the eHealth environment require a stable framework, with legal certainty, in which the European Commission has been working extensively. This doctoral research splits in three stages: -Stage one refers to a deep review of the former and state-of-the-art investigations on this matter to gain an integrated and global knowledge, focusing on the European framework, analysing the evolution of data protection towards full integration in the EU, surrounding health and new technologies, in the light of the attitudes of European citizens towards data protection and electronic identity, while comparing the personal data protection cultures, within the EU, related to a harmonized legal framework. -Latin America has no integrated regional legal system, but appears to be largely following the EU model of consumer privacy. To confirm the current tendency, in stage two I have compared the six largest EU economies and Latin America and analysed the advantages of convergence with the EU policy, while identifying the influence of the EU framework. -In stage three I have investigated the existing barriers towards alignment with the EU framework, from the Latin-American experience, in order to develop an international framework. Hence, healthcare data are very precious but they trigger colossal privacy and security issues, I conclude that the privacy policy appears to play a pivotal role within the future strategy of the businesses dealing with data of European citizens. The special protection that health data receive in Europe is trendsetting while the EU emerges as a model of global data protection regime. ; A partir de 2018 se pone en práctica en la UE una nueva regulación de protección de datos, lo que representará un hito histórico, ahora que Europa sienta las bases legales del mercado único digital. En el entorno del Big Data en eHealth conviene evaluar la influencia de la actual regulación de la UE respecto a los datos de salud. Esta investigación surge de la idea de analizar la influencia del derecho a la protección de datos personales, nacido en Europa y proyectado en las últimas décadas en otras zonas geográficas como América Latina. La privacidad en tiempos del Big Data no está per se garantizada. El marco regulatorio de datos de salud en la UE se puede considerar un modelo de protección de datos a escala internacional. En 2016 se celebró el décimo aniversario del Día Internacional de la Protección de Datos, establecido a iniciativa del Comité de Ministros del Consejo de Europa y la Comisión Europea para concienciar a todos los ciudadanos. Para contribuir a estos avances en la ciencia, se despliegan múltiples bases de datos y herramientas, con sistemas que son variados y complejos técnicamente, aplicados a diferentes disciplinas científicas. El uso de estos recursos, diversos y fragmentados en muchas ocasiones, ha conducido a la UE a desarrollar distintas iniciativas para la normalización del acceso y el tratamiento de la información y los sistemas, dando lugar a lo que podemos calificar como un modelo de referencia. Esta investigación pretende arrojar luz en cuanto al motor de este modelo y sus implicaciones fuera del territorio europeo, especialmente teniendo en consideración la experiencia en América Latina. Se trata de valorar la magnitud que hoy tienen conceptos como Big Data, eHealth, protección de datos e historia clínica electrónica, después de casi 50 años de avances en materia de protección de datos, desde que, en el seno de Europa, apareció la primera regulación de protección de datos de carácter personal. La Unión Europea es la jurisdicción más regulada en materia de protección de datos y son los propios ciudadanos europeos los que han impulsado los cambios legislativos y la defensa de sus derechos. La ley protege de forma especial los datos de salud. La investigación científica y la atención sanitaria en el entorno de eHealth también requieren un marco de trabajo estable, con seguridad jurídica, en el que ha trabajado la Comisión Europea. Las fases de esta investigación son tres:-Partiendo de una amplia revisión del estado del arte para obtener una visión integral, esta primera fase se ha centrado en el marco europeo analizando la evolución de la protección de datos hacia su plena integración en el seno de la UE, en el contexto de la salud y las nuevas tecnologías, a través de las actitudes sobre protección de datos e identidad electrónica de los ciudadanos europeos, y comparando la cultura sobre datos de carácter personal, dentro de la UE, hacia la adaptación a un marco legal armonizado.-En la segunda fase se analizan las seis principales economías de la UE, y se compara con las seis mayores economías de Latinoamérica, para atender a las ventajas de la convergencia de terceros países con la política europea, y concluir con la influencia de la regulación de la UE.-Una vez analizada la interrelación del marco europeo (UE) y latinoamericano, se abordan en una tercera fase las dificultades a las que se enfrentan terceros países, desde el ejemplo latinoamericano, a la hora de desarrollar un marco armonizado. Se concluye que los datos de salud son muy preciados, pero conllevan enormes problemas relativos a la privacidad y la seguridad, por lo que la política sobre privacidad se presenta como una materia que va a desempeñar un papel estratégico especialmente en las empresas que traten datos de ciudadanos europeos. La especial protección que reciben los datos de salud en Europa marca tendencia a la vez que la UE se erige como modelo internacional de protección de datos. ; Postprint (published version)

The management of occupational health and safety (OHS) in the workplace imposes a regulatory, moral and economic obligation on organisations, while the successful management of OHS contributes to both employees' well-being and organisational performance. Hence, aspects of OHS are increasingly embodied in the overall management system of organisations and included in the managerial activities. Managers at different organisational levels play a significant role in improving OHS, with their commitment to OHS being generally considered one of the most important factors that influence successful OHS management and culture. Nevertheless, the management of OHS may be very dependent on individual managers within organisations, whereas it should actually be based on regulatory requirements and organisation-specific OHS policies and procedures. There exists a need to support managers so as to achieve real advances in OHS. In order to support both organisations and managers in the continuous improvement of OHS, information regarding effective OHS management is needed. Accordingly, information is required concerning the challenges that managers face, as well as how they can best be supported in relation to OHS management. This study discusses the management of OHS as an aspect of managerial work and from managers' point of view. The qualitative study aims to develop new knowledge regarding the challenges and necessary support associated with managing OHS, as well as to suggest organisational measures that can be applied to support managers' OHSrelated work. The results are based on the prior OHS literature and three empirical substudies. In sub-study 1, thematic interviews (n=17) and qualitative inquiries (n=55) were carried out with top, middle and frontline managers from three public service organisations (a governmental expert organisation, a municipal social and healthcare service unit and a public vocational education organisation). In sub-study 2, thematic interviews (n=49) were carried out with middle and frontline managers from five industrial companies (a chemical processing company, an energy production company and three industrial service companies). In sub-study 3, a literature review and related categorisation were supplemented with thematic interviews (n=17) in a governmental expert organisation. The results of the sub-studies were used in the construction of a conceptual framework of organisational measures intended to support managers with regards to OHS management. The study approaches OHS management from the managers' viewpoint, which has only rarely been studied. According to the participating managers, the most challenging OHS management situations found in public organisations are related to the psychosocial risks contained within the work environment. The managers considered their employees' mental overload, instances of negligence and the consideration of individual needs to be difficult OHS issues to manage. Due to the current economic situation and the associated lack of resources, the managers perceived both pressure and concern in relation to their employees' well-being. In the industrial organisations, managerial overload, production pressure and role conflicts were perceived as the main factors that hinder the managers' commitment to OHS. However, the managers did not request more resources from upper management, presumably due to the tight economic situation. In order to cope with difficult OHS situations, the managers focused on individual relations and emotional support from their immediate superior, their colleagues, and OHS and human resources (HR) professionals. The conceptual framework of organisational measures intended to support managers in OHS management includes top management support regarding OHS management, uniform and simple OHS procedures, and the systematic development of OHS management. Developing consistent OHS attitudes and commitment among all the managers requires strong support on the part of top management. An emphasis on leadership development is important for managers to be able to motivate their employees' OHS participation and compliance and, hence, improve OHS performance. Existing management development practices, for example, management training, can provide easy ways to incorporate OHS management and leadership perspectives into general management development. Developing the support, resources and understanding of managers in relation to OHS may considerably improve both employees' well-being and the performance of organisations. This dissertation contributes to the research by providing new knowledge regarding OHS management from the managers' point of view, in the organisational context and in relation to organisational performance. Moreover, it provides a research-based conceptual framework for evaluating and developing OHS management within various organisations. The dissertation also provides a practical contribution by discussing OHS management as an integral part of general management and by pointing out the managers' central role in improving OHS. Moreover, it suggests practical organisational measures to support managers and promote their consistent commitment to OHS. ; Työterveyden ja -turvallisuuden (TTT) johtamiselle on organisaatioissa lainsäädännön asettamia, moraalisia ja taloudellisia velvoitteita, ja onnistunut TTT-johtaminen tukee työntekijöiden hyvinvointia ja organisaatioiden suorituskykyä. TTT-näkökohdat sisältyvät yhä enenevissä määrin organisaatioiden johtamisjärjestelmiin ja esimiesten tehtäviin. Eri organisaatiotasojen esimiehillä on merkittävä rooli TTT:n edistämisessä, ja heidän sitoutumisensa työterveyden ja turvallisuuden kehittämiseen on yksi tärkeimmistä tekijöistä TTT-johtamisen onnistumisessa. Kuitenkin joissain organisaatioissa TTTjohtaminen on hyvin henkilösidonnaista, kun sen pitäisi perustus lainsäädännön vaatimuksiin ja organisaation TTT-politiikkaan ja menettelytapoihin. Esimiehiä on tarpeen tukea, jotta TTT:ssä voidaan saavuttaa aitoa kehitystä. Jotta organisaatioita ja esimiehiä voidaan tukea TTT:n jatkuvassa kehittämisessä, tarvitaan tietoa tehokkaasta TTT-johtamisesta. Lisäksi tietoa tarvitaan niistä vaikeuksista, joita esimiehet kokevat ja niistä keinoista, joilla esimiehiä voidaan tukea TTT-johtamisessa. Tämä tutkimus tarkastelee TTT-johtamista osana esimiestyötä esimiesten näkökulmasta. Tämän laadullisen tutkimuksen tavoitteena on tuottaa uutta tietoa niistä vaikeuksista ja tuen tarpeista, joita esimiehet kokevat TTT-johtamisessa. Lisäksi tutkimuksessa esitetään organisatorisia keinoja, joilla esimiehiä voidaan tukea TTTjohtamisessa. Tulokset perustuvat TTT-johtamisen aiempaan tutkimukseen ja kolmeen empiiriseen osatutkimukseen. Osatutkimuksen 1 aineistona olivat eri organisaatiotasojen esimiesten teemahaastattelut (n=17) ja laadulliset kyselyt (n=55) kolmessa julkisessa organisaatiossa (valtion asiantuntijaorganisaatio, kunnallinen sosiaali- ja terveyspalvelujen yksikkö sekä ammatillinen oppilaitos). Osatutkimuksen 2 aineistona olivat keskijohdon ja lähiesimiesten teemahaastattelut (n=49) viidessä teollisessa organisaatiossa (kemianteollisuus, energiantuotanto sekä kolme teollisten palvelujen tarjoajaa). Osatutkimuksessa 3 kirjallisuuden perusteella laadittua luokittelua täydennettiin teemahaastatteluilla (n=17) valtion asiantuntijaorganisaatiossa. Näiden osatutkimusten tulosten perustella rakennettiin viitekehys niistä organisatorisista keinoista, joilla esimiehiä voidaan tukea TTT-johtamisessa. Tässä tutkimuksessa TTTjohtamista tarkastellaan esimiesten omien kokemusten ja tuen tarpeen näkökulmista, joita on aiemmin tutkittu varsin vähän. Esimiesten kokemat vaikeat tilanteet TTT-johtamisessa liittyivät julkisella sektorilla tyypillisesti työympäristön psykososiaalisiin riskeihin. Esimiehet pitivät vaikeina johtamistilanteina erityisesti työntekijöiden henkistä ylikuormittumista, laiminlyöntejä ja yksilöllisten tarpeiden huomioimista. Nykyisestä taloustilanteesta ja resurssien niukkuudesta johtuen esimiehet kokivat painetta ja kantoivat huolta työntekijöiden hyvinvoinnista. Teollisissa organisaatioissa esimiesten oma ylikuormittuminen, tuotannolliset paineet sekä rooliristiriidat olivat tekijöitä, jotka vaikeuttivat esimiesten sitoutumista TTT-johtamiseen. Esimiehet eivät kuitenkaan vaatineet lisää resursseja ylemmiltä esimiehiltä oletettavasti kireästä taloustilanteesta johtuen. Selviytyäkseen vaikeissa tilanteissa esimiehet keskittyivät henkilösuhteisiin ja hakivat emotionaalista tukea omalta esimieheltään, työtovereiltaan sekä TTT- ja henkilöstöasiantuntijoilta. Viitekehys organisatorisista keinoista esimiesten tukemiseksi TTT-johtamisessa sisältää ylimmän johdon tuen TTT-johtamiseen, yhtenäiset ja yksinkertaiset TTT-toimintatavat sekä suunnitelmallisen TTT-johtamisen kehittämisen. Esimiesten yhtenäisten TTTasenteiden ja sitoutumisen kehittäminen edellyttää ylimmän johdon vahvaa tukea. Johtajuuden korostaminen on tärkeää, jotta esimiehet osaavat motivoida työntekijöitä noudattamaan turvallisuusohjeita ja osallistumaan turvallisuuden kehittämiseen ja siten parantamaan TTT-tasoa. Olemassaolevat johtamisen kehittämisen käytännöt, kuten johtamiskoulutus, voivat tarjota luontevan keinon sisällyttää TTT-johtamisen ja – johtajuuden näkökulmat yleiseen johtamisen kehittämiseen. Kehittämällä esimiesten tukea, resursseja ja ymmärrystä liittyen TTT-johtamiseen voidaan organisaatioissa parantaa merkittävästi työntekijöiden hyvinvointia ja suorituskykyä. Tämä tutkimus tuottaa uutta tietoa TTT-johtamisesta esimiesten näkökulmasta organisaatiokontekstissa ja suhteessa organisaation suorituskykyyn. Lisäksi tutkimus tarjoaa käytäntöön perustuvan viitekehyksen TTT-johtamisen arvioimiseen ja kehittämiseen erilaisissa organisaatioissa. Tutkimus tarkastelee TTT-johtamista olennaisena osana muuta johtamista ja korostaa esimiesten keskeistä roolia TTT-tason parantamisessa. Lisäksi tutkimus esittää käytäntöön perustuvia organisatorisia keinoja esimiesten tukemiseen ja heidän sitoutumisensa edistämiseen.

Hintergrund und Ziele: Aufgrund hoher Informationsasymmetrien zwischen Patienten und behandelnden Ärzten haben Patienten nur geringe Möglichkeiten, die Behandlung im Krankenhaus und deren Erfolgsaussichten ex ante einzuschätzen. Qualitätstransparenz kann helfen, Informationsasymmetrien zu reduzieren und Patientenmündigkeit zu stärken. Jedoch ist das Wissen über Qualitätstransparenz und deren Wirkung fragmentiert, veraltet und im deutschen Kontext nur ansatzweise vorhanden. Die Qualität im Krankenhaus soll gesteigert werden, doch ist der Zusammenhang zwischen vielen Strukturfaktoren und Ergebnisqualität unzureichend erforscht. Diese Forschungsarbeit soll die wissenschaftliche Grundlage für den politischen Diskurs zu Transparenz und Verbesserung von Behandlungsqualität im Krankenhaus ausbauen und konkrete Empfehlungen für die Weiterentwicklung der Qualitätssicherung und den Ausbau qualitätsfördernder Strukturfaktoren in Deutschland geben. Methodik: Als primäre empirische Grundlage fungiert eine umfassende Datenbank, welche die in Deutschland verfügbaren Struktur-, Prozess- und Ergebnisdaten auf Krankenhaus- und Fachabteilungsebene integriert. Zusätzlich werden Nutzerdaten des weisse-liste.de Public Reporting Portals verwendet. Methodisch interdisziplinär nutzt diese Arbeit verschiedene Ansätze und Techniken aus der Versorgungsforschung, der Gesundheitsökonomie und Big Data Marketing Forschung. Zum einen werden Qualitätstransparenzsysteme qualitativ untersucht. Dabei stehen insbesondere die Messung, Veröffentlichung und Incentivierung von Behandlungsqualität im Krankenhaus im Mittelpunkt eines internationalen Vergleiches. Zum anderen untersuchen Regressionsanalysen und eine stochastische Analyse der Effizienzgrenzen den Einfluss bestimmter Strukturfaktoren auf Qualität und Effizienz in der Krankenhausversorgung. Als Zielvariable wird primär Ergebnisqualität betrachtet. Ergebnisse: Kapitel 1 untersucht die Einflussfaktoren auf Behandlungsqualität aus Patienten- und Leistungserbringersicht und erläutert die Konzepte Qualitätssicherung und Public Reporting. Als internationale Vergleichsarbeit identifiziert Kapitel 2 gesundheitspolitische Ansätze zur Steigerung von Qualitätstransparenz in fünf OECD Ländern. Unter anderem spielen Regierungen eine zentrale Rolle in der Etablierung von Standards und Anreizen für Qualitätstransparenz und integrierte Datensysteme in der Gesundheitsversorgung. Qualitätstransparenz benötigt einen stärkeren Fokus auf Ergebnisqualität und sollte sich auf Krankenhaus- und Leistungsbereichsebene konzentrieren, um Vergleichbarkeit und sinnvolle Wahlmöglichkeiten für Patienten zu garantieren. Kapitel 3 richtet den Fokus auf Deutschland und zeigt große Unterschiede in der risiko-adjustieren Qualität zwischen Krankenhäusern auf nationaler und regionaler Ebene für ausgewählte Notfall- und elektive Leistungsbereiche. Je nach Leistungsbereich liegt das risiko-adjustierte Mortalitäts- bzw. Komplikationsrisiko bis zu 50-mal höher in Krankenhäusern mit schlechter Qualität im Vergleich zu den qualitativbesten Krankenhäusern. Kapitel 4 untersucht Nutzerverhalten in der Krankenhaussuche auf dem Public Reporting Portal "WeisseListe.de". Die Nutzung ist im Zeitraum von 2013 bis 2015 um 38% auf 2 750 Nutzer pro Tag angestiegen. Nutzer suchen insbesondere Qualitätsinformationen für onkologische und orthopädische Leistungsbereiche, doch sind für nur 5 der 20 meistgesuchten Leistungsbereiche Prozess- oder Ergebnisindikatoren verfügbar. Dicht besiedelte Gebiete in Westdeutschland mit höherer Krankenhausdichte weisen eine stärkere Portalnutzung auf als Ost- oder Süddeutschland. Unterschiedliche Nutzergruppen mit spezifischen Charakteristika konnten identifiziert werden und verdeutlichen die Notwendigkeit für nutzerorientiertes Public Reporting. Kapitel 5 untersucht den systematischen Einfluss von Spezialisierung der Krankenhausinfrastruktur und -prozesse und von Zertifizierung auf Qualität am Beispiel der Schlaganfallbehandlung. Krankenhäuser mit einer Stroke Unit haben eine 6% geringere Schlaganfallsterblichkeit. Ein zusätzlicher systematischer Einfluss für ein Stroke Unit Zertifikat kann nicht festgestellt werden. Kapitel 6 richtet den Fokus auf den Krankenhausmarkt als Ganzes und analysiert den Einfluss von Qualitätswettbewerb auf die Behandlungsqualität in den Leistungsbereichen Schlaganfall, Herzinfarkt und Hüft-Total-Endoprothetik. Ein signifikanter Einfluss von Krankenhauswettbewerb auf die Qualität der Versorgung kann nicht festgestellt werden, was möglicherweise auf das weiterhin unzureichende öffentliche Bewusstsein für Qualitätsunterschiede und gegenläufige Effekte durch Krankenhauszentralisierung und Spezialisierung zurückzuführen ist. Letztlich kombiniert Kapitel 7 Qualität und Ressourceneffizienz in einer neuen Methode zur Bestimmung qualitätsadjustierter technischer Krankenhauseffizienz. Dabei werden deutliche Effizienzpotentiale identifiziert, welche insbesondere durch Spezialisierung und Konzentration von Leistungen zu adressieren sind. Fazit: Die Arbeit verdeutlicht Verbesserungspotentiale im Qualitätstransparenzsystem und in der Versorgungsqualität und Effizienz deutscher Krankenhäuser. Neben den aktuellen Bestrebungen im Rahmen des Krankenhausstrukturgesetzes kann ein internationaler Best Practice Austausch, Qualitätssicherung mit tatsächlichen Konsequenzen für schlechte Qualität, ein stärkerer Fokus auf Ergebnisqualität, Spezialisierung und Zentralisierung in der Versorgung, eine nutzenorientierte Verbesserung des Public Reportings und eine weitere Stärkung des Qualitätswettbewerbs die Versorgungsqualität in Deutschland nachhaltig steigern. ; Background and objectives: Due to large information asymmetries between patients and physicians, patients often have limited opportunity to assess treatment options, process of care and their prospective treatment outcomes in advance. Quality of care transparency can help to reduce information asymmetries and increase patient autonomy. Yet, the scientific knowledge around quality of care transparency and its effects on outcomes is fragmented, outdated and, in the German context, rudimentary. In order to enhance quality transparency and to improve hospital outcome quality, the dynamics around quality of care transparency and the relationship between important structural factors and outcomes must be better understood. This research project aims to expand the scientific foundation for policymaking on quality transparency and quality improvement in hospital care. The goal is to provide concrete policy recommendations for improvement of quality transparency and the expansion of quality-enhancing structural factors in the German hospital sector and beyond. Methods: The empirical foundation for this project is a comprehensive database, which integrates the available structural, procedural and outcome quality metrics at both a hospital and medical department level. In addition, website data for the weisse-liste.de public reporting portal is used. Based on an interdisciplinary health economics approach, this project employs different methodologies from health systems research, health economics and big data e-commerce marketing research. First, this project investigates quality of care transparency systems qualitatively by analyzing how they measure, report and incentivize better outcomes. Second, this project uses regression analysis and stochastic efficiency modeling to examine the influence of certain structural factors on quality and efficiency in hospital service delivery. Outcome quality, as opposed to process quality, is the main focus and dependent variable. Results: Chapter 1 examines the factors impacting quality of care on the patient demand side and the care provider supply side, as well as reviews quality assurance and public reporting in the German context. As an international comparison, Chapter 2 examines health policy approaches to enhance quality of care in five mature OECD health systems. Among others, the results suggest governments play an essential role in establishing standards and incentives for quality of care transparency and integrated IT systems in heath service delivery. Furthermore, quality transparency needs a stronger emphasis on outcome quality and should focus at the medical condition and hospital level to ensure patients are empowered with accessible and meaningful information to guide healthcare decisions. Chapter 3 sets the focus on Germany and uncovers large differences in risk-adjusted outcomes between hospitals—both at a national and regional level—as well as for emergency and elective conditions. Depending on the treatment area, the risk-adjusted mortality or complication risk is up to 50 times higher in hospitals with poor outcome quality, relative to hospitals with the best outcome quality of care. Chapter 4 examines website user patterns for the hospital search function of the public reporting portal weisse-liste.de. Between 2013 and 2015, usage of the website increased by 38% annually, to 2,750 user sessions per day. In particular, users searched for quality of care information for oncological and orthopedic treatment areas. Process and outcome quality metrics are only available for 5 of 20 most searched-for treatment areas. In Western Germany, users from densely populated areas with a high number of hospitals conducted relatively more searches than users in Southern and Eastern Germany. From the website data, user groups with distinct characteristics could be identified and confirm the need for customized public reporting options. Chapter 5 evaluates the systematic influence of hospital certification, hospital infrastructure, and process specialization on stroke care outcome quality. Hospitals with a dedicated stroke unit have, on average, a 6% lower risk-adjusted 30-day stroke mortality, ceterius paribus. However, a stroke unit certification showed no systematic influence on 30-day stroke mortality. Chapter 6 focuses on the provider market at large—examining the influence of provider competition on outcomes for hip replacement surgery, and stroke and heart attack emergency care. The influence of provider competition on outcomes remains unclear and insignificant, which can be partially attributed to currently insufficient awareness about outcome differences and where to access the right information. It also hints at the potentially countervailing outcomes influences of hospital centralization and specialization. Chapter 7 combines the concepts of quality and efficiency of care in hospital service provision in a new stochastic frontier analysis model, estimating quality-adjusted technical hospital efficiency. Large inefficiencies are identified, which can be addressed in part through specialization and concentration in care delivery. Conclusions: This research project illustrates substantial potential for improvement in the German quality transparency system, as well as opportunities to enhance the quality of care and efficiency in German hospital service delivery. Possible solutions to increase quality of care in Germany may include, among others: an international best practice exchange, stronger focus on outcome quality, actual regulatory consequences for hospitals with insufficient quality of care, specialization and centralization in hospital care, a user oriented public reporting system, and a substantial strengthening of hospital quality of care competition.

The upcoming General Data Protection Regulation at EU level to be implemented in 2018 will represent a history achievement data time when the Europe is laying the foundations of a single digital market. In the context of Big Data and eHealth, it is convenient to tackle the influence of the current EU regulation related to health data. This research was conceived from the idea of assessing the influence of the right to personal data protection, born in Europe and projected in the last decades in other regions such as Latin America. Privacy and data protection in the era of Big Data are not per se guaranteed. lt is the citizens themselves who are asking for a harmonized protection within the EU; this health data regulatory framework can be regarded as a data protection model in eHealth internationally. 2016 represented the 10th anniversary of the international Data Protection Day, a celebration that was established by the committee of ministers of the Council of Europe and the European Commission to raise awareness amongst citizens. In order to contribute to this scientific progress, an undetermined number of databases and tools are deployed, with a varied and technically complex set of systems applied to several scientific disciplines. The use of these resources, diverse and fragmented in many cases, has led the EU to develop a number of initiatives to standardize the access and management of both information and systems, representing what I call a benchmark model. This research aims at shedding light on the engine of this model and its implications beyond Europe, looking at Latin America, based on the cultural, linguistic and commercial cooperation links with Spain. lt is about assessing the current magnitude of concepts such as Big Data, eHealth, data protection and electronic health records, after 50 years of progress in the area of data protection, when in the heart of Europe, first regulation of personal data protection was born. The European Union is the most regulated jurisdiction when it comes to data protection, and it is the European citizens themselves who have promoted legal changes and the defence of their rights. The law provides special privileges to health data. Scientific research and health care within the eHealth environment require a stable framework, with legal certainty, in which the European Commission has been working extensively. This doctoral research splits in three stages: -Stage one refers to a deep review of the former and state-of-the-art investigations on this matter to gain an integrated and global knowledge, focusing on the European framework, analysing the evolution of data protection towards full integration in the EU, surrounding health and new technologies, in the light of the attitudes of European citizens towards data protection and electronic identity, while comparing the personal data protection cultures, within the EU, related to a harmonized legal framework. -Latin America has no integrated regional legal system, but appears to be largely following the EU model of consumer privacy. To confirm the current tendency, in stage two I have compared the six largest EU economies and Latin America and analysed the advantages of convergence with the EU policy, while identifying the influence of the EU framework. -In stage three I have investigated the existing barriers towards alignment with the EU framework, from the Latin-American experience, in order to develop an international framework. Hence, healthcare data are very precious but they trigger colossal privacy and security issues, I conclude that the privacy policy appears to play a pivotal role within the future strategy of the businesses dealing with data of European citizens. The special protection that health data receive in Europe is trendsetting while the EU emerges as a model of global data protection regime. ; A partir de 2018 se pone en práctica en la UE una nueva regulación de protección de datos, lo que representará un hito histórico, ahora que Europa sienta las bases legales del mercado único digital. En el entorno del Big Data en eHealth conviene evaluar la influencia de la actual regulación de la UE respecto a los datos de salud. Esta investigación surge de la idea de analizar la influencia del derecho a la protección de datos personales, nacido en Europa y proyectado en las últimas décadas en otras zonas geográficas como América Latina. La privacidad en tiempos del Big Data no está per se garantizada. El marco regulatorio de datos de salud en la UE se puede considerar un modelo de protección de datos a escala internacional. En 2016 se celebró el décimo aniversario del Día Internacional de la Protección de Datos, establecido a iniciativa del Comité de Ministros del Consejo de Europa y la Comisión Europea para concienciar a todos los ciudadanos. Para contribuir a estos avances en la ciencia, se despliegan múltiples bases de datos y herramientas, con sistemas que son variados y complejos técnicamente, aplicados a diferentes disciplinas científicas. El uso de estos recursos, diversos y fragmentados en muchas ocasiones, ha conducido a la UE a desarrollar distintas iniciativas para la normalización del acceso y el tratamiento de la información y los sistemas, dando lugar a lo que podemos calificar como un modelo de referencia. Esta investigación pretende arrojar luz en cuanto al motor de este modelo y sus implicaciones fuera del territorio europeo, especialmente teniendo en consideración la experiencia en América Latina. Se trata de valorar la magnitud que hoy tienen conceptos como Big Data, eHealth, protección de datos e historia clínica electrónica, después de casi 50 años de avances en materia de protección de datos, desde que, en el seno de Europa, apareció la primera regulación de protección de datos de carácter personal. La Unión Europea es la jurisdicción más regulada en materia de protección de datos y son los propios ciudadanos europeos los que han impulsado los cambios legislativos y la defensa de sus derechos. La ley protege de forma especial los datos de salud. La investigación científica y la atención sanitaria en el entorno de eHealth también requieren un marco de trabajo estable, con seguridad jurídica, en el que ha trabajado la Comisión Europea. Las fases de esta investigación son tres:-Partiendo de una amplia revisión del estado del arte para obtener una visión integral, esta primera fase se ha centrado en el marco europeo analizando la evolución de la protección de datos hacia su plena integración en el seno de la UE, en el contexto de la salud y las nuevas tecnologías, a través de las actitudes sobre protección de datos e identidad electrónica de los ciudadanos europeos, y comparando la cultura sobre datos de carácter personal, dentro de la UE, hacia la adaptación a un marco legal armonizado.-En la segunda fase se analizan las seis principales economías de la UE, y se compara con las seis mayores economías de Latinoamérica, para atender a las ventajas de la convergencia de terceros países con la política europea, y concluir con la influencia de la regulación de la UE.-Una vez analizada la interrelación del marco europeo (UE) y latinoamericano, se abordan en una tercera fase las dificultades a las que se enfrentan terceros países, desde el ejemplo latinoamericano, a la hora de desarrollar un marco armonizado. Se concluye que los datos de salud son muy preciados, pero conllevan enormes problemas relativos a la privacidad y la seguridad, por lo que la política sobre privacidad se presenta como una materia que va a desempeñar un papel estratégico especialmente en las empresas que traten datos de ciudadanos europeos. La especial protección que reciben los datos de salud en Europa marca tendencia a la vez que la UE se erige como modelo internacional de protección de datos. ; Postprint (published version)

In hierdie artikel word riglyne aangebied om 'n program wat gemik is op die beskerming en bevordering van Suid-Afrikaanse sielkundiges se welstand te ontwikkel. Die sosio-ekonomiese situasie in Suid-Afrika lei daartoe dat sielkundiges leef en werk in gemeenskappe wat gekenmerk word deur misdaad, armoede, siekte en maatskaplike euwels, wat hierdie riglyne vir die verryking van sielkundiges se welstand 'n noodsaaklikheid maak. Hierdie studie benadruk dat welstand nie outomaties plaasvind nie, maar dat dit strategies ontwikkel moet word. Die navorsers het die welstandskonsepte betekenis, veerkragtigheid en positiewe affek van Suid-Afrikaanse sielkundiges ondersoek en waardevolle temas geïdentifiseer wat aanduidend is daarvan dat spesifieke bevoegdhede, soos selfsorg, bewustheid, liefdevolle goedheid en selfdeernis, noodsaaklik is vir die bevordering van welstand. Deur die bevordering van welstand tot op 'n vlak van florering, kan sielkundiges net blote bestaan verbysteek en 'n rykdom van lewenservaring ondervind ; The question in well-being research has changed from why people become ill to how people can experience a good and full life despite life problems, and this article addresses that specific question in relation to South African psychologists. Investment in the well-being of health professionals is crucial, as their professional contribution is vital to the effective provision of health services. Psychologists have been referred to as happiness facilitators and their work involves assisting with clients' well-being and mental health. It is therefore important to provide guidelines for South African psychologists to sustain and enhance their own well-being, and this makes the present research necessary and important. Social, economic and political problems are endemic to South Africa, while there exists a severe shortage of qualified health-care professionals, with a mere 0,32 psychologists per 100 000 people of the population. In addition, mental health-care budgets are disproportionately low in comparison with the high prevalence of mental disorders in South Africa. While the availability of psychologists as a resource in the South African health care sector is rather low, mental illness is very prevalent, with an estimated 16,5% of the population requiring mental health services, of whom a mere 25% actually receive mental health-care. This information clearly needs to be taken into account considering the impact that it may have on psychologists in terms of workload and functioning. Many researchers have investigated the spill-over effect between people's work and personal lives. Although psychologists implement strategies such as professional boundaries to prevent spill-over, certain types of spill-over still occur. Spill-over is an especial reality for psychologists, as they bring the tools of their trade, namely themselves, to each of their life roles. Psychotherapy works in two directions: while psychologists affect their clients they are also affected by their clients, which may impact psychologists' well-being. The American Psychological Association (APA) indicated that psychologists need measures to protect them against occupational stress. However, despite the clear need for such measures, this need is often ignored. The recommendations of the APA for psychologists towards self-care include awareness in order to avoid becoming overwhelmed by the challenges posed by their profession. Psychologists are also encouraged to identify mechanisms to reduce stress and foster proper self-care. In South Africa the word self-care does not even appear in the Health Professions Act (1974) that regulates psychologists' professional behaviour. Although many psychologists dedicate themselves to caring for others, it is questionable whether they are able to create a sustainable balance between client care and self-care with a view to experiencing well-being. Psychologists work long and inconvenient hours, have an unstable income when working in private practice, work with difficult cases such as homicide and suicide and are frequently faced with clients' exhausted medical aids. The limitations and problems experienced by psychologists as a result of scope of practice in psychology has led to legal action on the part of practitioners to attempt to have their experience and knowledge acknowledged and to be reimbursed for their services by medical aids. Complete mental health protects people against physical disease. The maintenance and promotion of mental health is therefore as important as the prevention and treatment of mental illness. Well-being can be promoted and protected via the strengthening of psychological capacity and by paying attention to possible threats to health. When such efforts are undertaken, it may ensure the experience of psychologists' well-being, as well as impact the level of service delivery to clients. Enhancing the well-being of psychologists will therefore contribute positively to the mental health sector in South Africa. The big question in positive psychology is how well-being can be advanced and how life problems can be survived. The central question of this article corresponds to the stated question of positive psychology: How can the well-being of South African psychologists be promoted while practical solutions are found for the career-specific problems experienced by them? This focus on well-being and intentional activities makes positive psychology an ideal paradigm for the development of guidelines for enhancing South African psychologists' well-being. This article is based on a thesis titled "The well-being of South African psychologists: a mixed method study" by the first author, Erika Hitge. The thesis consisted of a literature study and a qualitative and quantitative study pertaining to the well-being of South African psychologists (henceforth "psychologists", unless stated otherwise) and conclusions and recommendations. The researcher investigated well-being constructs namely meaning, resilience and positive affect of psychologists and valuable themes were identified indicating that specific skills and competencies are crucial aspects relative to the enhancement of well-being. The study emphasised that well-being does not occur automatically, but has to be strategically cultivated. It is suggested that enhancing well-being and experiencing flourishing can assist people in moving beyond mere existence to experiencing a well-lived life. The guidelines for the promotion of the well-being of psychologists are based on data forthcoming from the results of the mixed-method study, along with existing literature. Psychologists' well-being and character strengths need to be compared through pre- and post-testing to establish whether the guidelines and the resulting programme do indeed promote the well-being of local psychologists. Participants in the programme should be interviewed to establish the strengths and limitations of the programme. Once a pilot study has been conducted and the above steps have been executed to refine the programme, it will be possible to make recommendations to the Health Professions Council of South Africa (HPCSA) and the Psychological Society of South Africa (PSYSSA) with a view to national application of this well-being programme. Aspects that should be incorporated into a well-being programme for psychologists are flourishing, character strengths, self-care, self-compassion, mindfulness, lovingkindness, work content and context, relationships and personal resources. The suggested programme consists of 13 sessions. These guidelines constitute an attempt to avoid focusing on what is negative and problematic regarding the work of psychologists, such as exhaustion, burnout, isolation and compassion fatigue. Instead, these guidelines focus on well-being as a motivation to accept the positive and negative dimensions of life and still to experience well-being through enhanced self-care. Practising these guidelines may result in a more meaningful life in which people use their best strengths in the service of both their own and others' well-being. Deciding to use these guidelines may require a willingness to be flexible and to grow increasingly towards acting on life, as opposed to merely consuming wellness. Designing a well-being programme for South African psychologists can also assist in promoting and protecting the well-being of these healthcare professionals through enabling psychologists to apply specific skills, such as practising of character strengths, career-sustaining behaviours and self-care, mindfulness, lovingkindness and self-compassion, with due consideration of the relevant context

This paper presents the findings from a critical interpretive synthesis that explored the assumptions influencing music therapists writing about their work with refugees. Music therapy literature suggests that the profession appears to be uniquely suited to address the healthcare needs of the refugee population by transcending cultural and language barriers which often mitigate access to other services. However, when working with individuals characterised by trauma and whose identities have been dictated by political power, it is essential that music therapy practices oppose these forces and provide opportunities for empowerment. Therefore, eleven papers describing music therapy practice with refugees from the international literature were examined and interrogated to determine the assumptions embedded within the language used by music therapists. The synthetic construct of a neo-colonial music therapist emerged from the data and informed subsequent analysis. The concepts of refugees as a homogenous group defined by a dominant narrative of trauma, and musical improvisation as a universal language appeared to be influential in the ways music therapists were reporting on their work. These findings are discussed along with considerations for a music therapy practice that promotes empowerment and advocates for the voices of the refugee population. ; 本稿は、音楽療法士が難民とのしごとを記述する際に影響を与えている前提について探り、批判的・解釈的統合を行った結果を呈示するものである。音楽療法の文献は、この職業が、他のサービスではしばしば接近を阻んでしまう文化的言語的障壁を乗り越えることで、難民領域のヘルスケアのニーズに対処する独自的な適合性を持っていることを示唆している。しかしながら、アイデンティティを政治的パワーによって決定づけられ、心的外傷という特徴を持つ人々と向き合うには、音楽療法実践がこうした力に抗する地点に立ち、エンパワメントの機会をもたらすことが必須である。そこで、国際的文献の中から難民との音楽療法実践を記述している11の論文を検証して調べ、音楽療法士によって用いられた言語の中に埋め込まれている前提を特定する。データとそれに続いて行われた情報に基づく分析からは、「新植民地主義的音楽療法士」の統合的構成要素が浮かび上がった。「心的外傷のナラティブが主要な部分を占めることによって定義される均質的グループとしての難民」と「ユニバーサル言語としての音楽即興」という概念が、音楽療法士がそのしごとを報告する仕方に影響を与えているとみられる。これらの発見と、エンパワメントを促したり難民の人々の声を代弁するような音楽療法実践とを考え合わせ、議論される。 ; Cet article présente les résultats d'une synthèse interprétative critique qui a exploré les hypothèses qui influent sur les musicothérapeutes qui écrivent sur leur travail avec les réfugiés. Littérature en musicothérapie suggère que la profession semble être apte de façon unique pour répondre aux besoins de santé de la population réfugiée en transcendant les barrières culturelles et linguistiques qui atténuent souvent l'accès à d'autres services. Cependant, lorsque l'on travaille avec des individus caractérisés par un traumatisme et dont l'identité a été dictée par le pouvoir politique, il est essentiel que les pratiques de musicothérapie opposent ces forces et offrent des possibilités d'autonomisation. Par conséquent, onze articles décrivant la pratique de la musicothérapie avec les réfugiés de la littérature internationale ont été examinés et interrogés pour déterminer les hypothèses incorporées dans la langue utilisée par les musicothérapeutes. La construction synthétique d'un musicothérapeutenéo-colonialea émergé à partir des données et a informé l'analyse ultérieure. Les concepts de réfugiés comme un groupe homogène défini par un récit dominant de traumatisme, et de l'improvisation musicale comme un langage universel semblent avoir une influence sur la façon musicothérapeutes signalaient sur leur travail. Ces résultats sont discutés avec des considérations pour une pratique de la musicothérapie qui favorise l'autonomisation et plaide pour la voix de la population réfugiée. ; Questo documento presenta i risultati di una sintesi critica interpretativa, la quale ha esplorato i presupposti di influenza sui musicoterapisti che scrivono il loro lavoro con i profughi. La letteratura musicoterapica suggerisce che la professione appaia adatta unicamente per indirizzare la popolazione di rifugiati alle esigenze sanitarie, in modo da trascendere le barriere culturali linguistiche che spesso moderano l'accesso ad altri servizi. Tuttavia, quando si lavora con individui caratterizzati da un trauma e le cui identità sono state dettate dal potere politico, è essenziale che le pratiche di musicoterapia si oppongano a queste forze e forniscano opportunità per la responsabilizzazione. Perciò, undici documenti provenienti dalla letteratura internazionale sulla pratica musicoterapica con i profughi sono stati esaminati e interrogati per determinare i presupposti del linguaggio utilizzato dai musicoterapisti. Dai dati è emerso il costrutto sintetico di un musicoterapista neo-coloniale fornendo informazioni per una successiva analisi. I concetti di profughi come un gruppo omogeneo definito da una narrazione dominante di traumi, e improvvisazione musicale come linguaggio universale, sembravano essere influenti nei modi con cui i musicoterapisti hanno riportato il loro lavoro. Questi risultati sono stati discussi insieme a considerazioni per una pratica musicoterapica che promuova responsabilizzazione e sostenitori per le voci dei profughi. ; In diesem Artikel werden die Ergebnisse einer kritisch-interpretativen Synthese präsentiert, die die Annahmen, die Musiktherapeuten bei ihrem Schreiben über ihre Arbeit mit Flüchtlingen beeinflusst, untersucht. Musiktherapieliteratur suggeriert, dass die Profession durch die Überschreitung von kulturellen und sprachlichen Barrieren, die oft den Zugang zu anderen Angeboten erschweren, einzigartig erscheint die Bedürfnisse der Population der Flüchtlinge zu adressieren. Hingegen ist es in der Arbeit mit Individuen, die von Trauma charakterisiert sind und deren Identität von Macht diktiert wurde, essentiell, dass Musiktherapiepraxis sich diesen Kräften entgegensetzt und Möglichkeiten für Empowerment bietet. Deswegen wurden 11 Artikel internationaler Literatur zur Musiktherapiepraxis mit Flüchtlingen untersucht um die Annahmen zu ermitteln, die in die Sprache eingebettet ist, die Musiktherapeuten benutzen. Das synthetische Konstrukt des Neo-kolonialen Musiktherapeuten entstand aus dem Datenmaterial und der nachfolgenden Analyse. Das Konzept der Flüchtlinge als eine homogene Gruppe durch das dominante Narrativ des Traumas definiert und musikalische Improvisation als universelle Sprache schienen Einfluss darauf zu haben in welcher Art Musiktherapeuten von ihrer Arbeit berichten. Diese Erkenntnisse werden mit Überlegungen zu Musiktherapiepraxis die Empowerment fördert und die sich für die Stimme der Flüchtlingspopulation einsetzt diskutiert.

Targeted therapies and the consequent adoption of "personalized" oncology have achieved notable successes in some cancers; however, significant problems remain with this approach. Many targeted therapies are highly toxic, costs are extremely high, and most patients experience relapse after a few disease-free months. Relapses arise from genetic heterogeneity in tumors, which harbor therapy-resistant immortalized cells that have adopted alternate and compensatory pathways (i.e., pathways that are not reliant upon the same mechanisms as those which have been targeted). To address these limitations, an international task force of 180 scientists was assembled to explore the concept of a low-toxicity "broadspectrum" therapeutic approach that could simultaneously target many key pathways and mechanisms. Using cancer hallmark phenotypes and the tumor microenvironment to account for the various aspects of relevant cancer biology, interdisciplinary teams reviewed each hallmark area and nominated a wide range of high-priority targets (74 in total) that could be modified to improve patient outcomes. For these targets, corresponding low-toxicity therapeutic approaches were then suggested, many of which were phytochemicals. Proposed actions on each target and all of the approaches were further reviewed for known effects on other hallmark areas and the tumor microenvironment Potential contrary or procarcinogenic effects were found for 3.9% of the relationships between targets and hallmarks, and mixed evidence of complementary and contrary relationships was found for 7.1%. Approximately 67% of the relationships revealed potentially complementary effects, and the remainder had no known relationship. Among the approaches, 1.1% had contrary, 2.8% had mixed and 62.1% had complementary relationships. These results suggest that a broad-spectrum approach should be feasible from a safety standpoint. This novel approach has potential to be relatively inexpensive, it should help us address stages and types of cancer that lack conventional treatment, and it may reduce relapse risks. A proposed agenda for future research is offered. (C) 2015 The Authors. Published by Elsevier Ltd. ; Funding Agencies|Terry Fox Foundation Grant [TF-13-20]; UAEU Program for Advanced Research (UPAR) [31S118]; NIH [AR47901, R21CA188818, R15 CA137499-01, F32CA177139, P20RR016477, P20GM103434, R01CA170378, U54CA149145, U54CA143907, R01-HL107652, R01CA166348, R01GM071725, R01 CA109335-04A1, 109511R01CA151304CA168997 A11106131R03CA1711326 1P01AT003961RO1 CA100816P01AG034906 R01AG020642P01AG034906-01A1R01HL108006]; NIH NRSA Grant [F31CA154080]; NIH (NIAID) R01: Combination therapies for chronic HBV, liver disease, and cancer [AI076535]; Sky Foundation Inc. Michigan; University of Glasgow; Beatson Oncology Centre Fund; Spanish Ministry of Economy and Competitivity, ISCIII [PI12/00137, RTICC: RD12/0036/0028]; FEDER from Regional Development European Funds (European Union), Consejeria de Ciencia e Innovacion [CTS-6844, CTS-1848]; Consejeria de Salud of the Junta de Andalucia [PI-0135-2010, PI-0306-2012]; ISCIII [PIE13/0004]; FEDER funds; United Soybean Board; NIH NCCAM Grant [K01AT007324]; NIH NCI Grant [R33 CA161873-02]; Michael Cuccione Childhood Cancer Foundation Graduate Studentship; Ovarian and Prostate Cancer Research Trust, UK; West Virginia Higher Education Policy Commission/Division of Science Research; National Institutes of Health; Italian Association for Cancer Research (AIRC) [IG10636, 15403]; GRACE Charity, UK; Breast Cancer Campaign, UK; Michael Cuccione Childhood Cancer Foundation Postdoctoral Fellowship; Connecticut State University; Swedish Research Council; Swedish Research Society; University of Texas Health Science Centre at Tyler, Elsa U. Pardee Foundation; CPRIT; Cancer Prevention and Research Institute of Texas; NIH National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); NIH National Institute on Alcohol Abuse and Alcoholism (NIAAA); Gilead and Shire Pharmaceuticals; NIH/NCI [1R01CA20009, 5R01CAl27258-05, R21CA184788, NIH P30 CA22453, NCI RO1 28704]; Scottish Governments Rural and Environment Science and Analytical Services Division; National Research Foundation; United Arab Emirates University; Terry Fox Foundation; Novartis Pharmaceutical; Aveo Pharmaceutical; Roche; Bristol Myers Squibb; Bayer Pharmaceutical; Pfizer; Kyowa Kirin; NIH/NIAID Grant [A1076535]; Auckland Cancer Society; Cancer Society of New Zealand; NIH Public Service Grant from the National Cancer Institute [CA164095]; Medical Research Council CCU-Program Grant on cancer metabolism; EU Marie Curie Reintegration Grant [MC-CIG-303514]; Greek National funds through the Operational Program Educational and Lifelong Learning of the National Strategic Reference Framework (NSRF)-Research Funding Program THALES [MIS 379346]; COST Action CM1201 `Biomimetic Radical Chemistry; Duke University Molecular Cancer Biology T32 Training Grant; National Sciences Engineering and Research Council Undergraduate Student Research Award in Canada; Charles University in Prague projects [UNCE 204015, PRVOUK P31/2012]; Czech Science Foundation projects [15-03834Y, P301/12/1686]; Czech Health Research Council AZV project [15-32432A]; Internal Grant Agency of the Ministry of Health of the Czech Republic project [NT13663-3/2012]; National Institute of Aging [P30AG028716-01]; NIH/NCI training grants to Duke University [T32-CA059365-19, 5T32-CA059365]; Ministry of Education, Culture, Sports, Science and Technology, Japan [24590493]; Ministry of Health and Welfare [CCMP101-RD-031, CCMP102-RD-112]; Tzu-Chi University of Taiwan [61040055-10]; Svenska Sallskapet for Medicinsk Forskning; Cancer Research Wales; Albert Hung Foundation; Fong Family Foundation; Welsh Government A4B scheme; NIH NCI; University of Glasgow, Beatson Oncology Centre Fund, CRUK [C301/A14762]; NIH Intramural Research Program; National Science Foundation; American Cancer Society; National Cancer Center [NCC-1310430-2]; National Research Foundation [NRF-2005-0093837]; Sol Goldman Pancreatic Cancer Research Fund Grant [80028595]; Lustgarten Fund Grant [90049125, NIHR21CA169757]; Alma Toorock Memorial for Cancer Research; National Research Foundation of Korea (NRF); Ministry of Science, ICT & Future Planning (MSIP), Republic of Korea [2011-0017639, 2011-0030001]; Ministry of Education of Taiwan [TMUTOP103005-4]; International Life Sciences Institute; United States Public Health Services Grants [NIH R01CA156776]; VA-BLR&D Merit Review Grant [5101-BX001517-02]; V Foundation; Pancreatic Cancer Action Network; Damon Runyon Cancer Research Foundation; Childrens Cancer Institute Australia; University Roma Tre; Italian Association for Cancer Research (AIRC-Grant) [IG15221]; Carlos III Health Institute; Feder funds [AM: CP10/00539, PI13/02277]; Basque Foundation for Science (IKERBASQUE); Marie Curie CIG Grant [2012/712404]; Canadian Institutes of Health Research; Avon Foundation for Women [OBC-134038]; Canadian Institutes of Health [MSH-136647, MOP 64308]; Bayer Healthcare System G4T (Grants4Targets); NIH NIDDK; NIH NIAAA; Shire Pharmaceuticals; Harvard-MIT Health Sciences and Technology Research Assistantship Award; Italian Ministry of University; University of Italy; Auckland Cancer Society Research Centre (ACSRC); German Federal Ministry of Education and Research (Bundesministerium fur Bildung und Forschung, BMBF) [16SV5536K]; European Commission [FP7 259679 "IDEAL"]; Cinque per Mille dellIRPEF-Finanziamento della Ricerca Sanitaria; European Union Seventh Framework Programme (FP7) [278570]; AIRC [10216, 13837]; European Communitys Seventh Framework Program FP7 [311876]; Canadian Institute for Health Research [MOP114962, MOP125857]; Fonds de Recherche Quebec Sante [22624]; Terry Fox Research Institute [1030]; FEDER; MICINN [SAF2012-32810]; Junta de Castilla y Leon [BIO/SA06/13]; ARIMMORA project [FP7-ENV-2011]; European Union; NIH NIDDK [K01DK077137, R03DK089130]; NIH NCI grants [R01CA131294, R21 CA155686]; Avon Foundation; Breast Cancer Research Foundation Grant [90047965]; National Institute of Health, NINDS Grant [K08NS083732]; AACR-National Brain Tumor Society Career Development Award for Translational Brain Tumor Research [13-20-23-SIEG]; Department of Science and Technology, New Delhi, India [SR/FT/LS-063/2008]; Yorkshire Cancer Research; Wellcome Trust, UK; Italian Ministry of Economy and Finance Project CAMPUS-QUARC, within program FESR Campania Region; National Cancer Institute [5P01CA073992]; IDEA Award from the Department of Defense [W81XWH-12-1-0515]; Huntsman Cancer Foundation; University of Miami Clinical and Translational Science Institute (CTSI) Pilot Research Grant [CTSI-2013-P03]; SEEDS You Choose Awards; DoD [W81XVVH-11-1-0272, W81XWH-13-1-0182]; Kimmel Translational Science Award [SKF-13-021]; ACS Scholar award [122688-RSG-12-196-01-TBG]; National Cancer Institute, Pancreatic Cancer Action Network, Pew Charitable Trusts; American Diabetes Association; Elsa U. Pardee Foundation; Scientific Research Foundation for the Returned Oversea Scholars, State Education Ministry and Scientific and Technological Innovation Project, Harbin [2012RFLX5011]; United States National Institutes of Health [ES019458]; California Breast Cancer Research Program [17UB-8708]; National Institutes of Health through the RCMI-Center for Environmental Health [G1200MD007581]; NIH/National Heart, Lung, and Blood Institute Training Grant [T32HL098062]; European FP7-TuMIC [HEALTH-F2-2008-201662]; Italian Association for Cancer research (AIRC) Grant IG [11963]; Regione Campania L.R:N.5; European National Funds [PON01-02388/1 2007-2013]

Translating Resilience: A Framework to Enhance Communication and Implementation / Patricia H. Longstaff, Syracuse University, Thomas G. Kowslowski, University of Frieburg, and Will Geoghegan, Syracuse University -- Characteristics of Complex Socio-Technical Systems and Guidelines for their Management: The Role of Resilience / Tarcisio Abreu Saurin, Angela Weber Righi, Federal University of Rio Grande do Sul, and Éder Henriqson, Pontificia Universidade Católica do Rio Grande do Sul -- The Stress-Strain Model of Resilience Operationalizes the Four Cornerstones of Resilience Engineering / David D. Woods, The Ohio State University, Yong Jie Chan, Defense Science & Technology Agency, and John Wreathall, The WreathWood Group -- Turning Variability into Emergent Safety: the Resilience Matrix for Providing Strong Responses to Weak Signals / Fabrizio Bracco, Tommaso Francesco Piccinno, University of Genova, and Giorgio Dorigatti, Ormes Consulting srl -- Regulating Interactions across Multiple Centres of Control: An Airline Operations Control Perspective / Kenneth E. Igbo, Peter G. Higgins, Swinburne University of Technology, Simon Dunstall, CSIRO Mathematics Informatics & Statistics, and Peter J. Bruce, Swinburne University of Technology -- Episodic Adaptations and Trade-offs: Examples From the Victorian Construction Industry. / Manikam Pillay and David Borys, University of Ballarat -- To Rule, or not to Rule is not the question (for organizing change towards resilience in an integrated world) / Tor Olav Grøtan, SINTEF and Norwegian University of Science and Technology (NTNU) -- Structure, Agency, and Resilience / Garth S. Hunte, University of British Columbia, Robert L. Wears, University of Florida and Imperial College London, and Christiane C Schubert, Vanderbilt University -- Levels of Resilience: Moving from Resilience to Resilience Engineering / Robert L. Wears, University of Florida and Imperial College London, and J.Bradley Morrison, Brandeis University -- Under Dangerous Conditions- SAFETY Construction and Safety-Related Work On Board of Merchant Vessels / Gesa Praetorius and Monica Lundh, Chalmers University of Technology -- Assessing Behaviour towards Organizational Resilience in Aviation. / Michaela Heese, Austro Control GmbH, Wolfgang Kallus, and Christa Kolodej, University of Graz -- Are trade-offs experienced and if yes, how? Studying organizational resilience through operators' dilemmas / Dimitris Nathanael, Vassilis Tsagkas and Nicolas Marmaras, National Technical University of Athens -- Resilience engineering in healthcare: Moving from epistemology to theory and Practice / Janet Anderson, King's College London, A. Ross, and P. Jaye, St. Thomas's Hospital -- Resilience Approach for Medical Residents / Robert Bezemer and Ellen Bos, TNO -- Precepts of Resilience Engineering as Guidelines for Learning Lessons from the Fukushima-Daiichi Accident / Masaharu Kitamura, Research Institute for Technology Management Strategy and Tohoku University -- Inter-organisational safety culture challenges in nuclear power design / Luigi Macchi, E. Pietikäinen, P. Savioja, M. Liinasuo, M. Wahlström, and T. Reiman, VTT Technical Research Centre of Finland -- The Resilience Analysis Matrix (RAM): Visualizing functional dependencies in complex socio-technical systems. / Jonas Lundberg and Rogier Woltjer, Linköping University -- A Method for Visualizing Trade-offs in En-route Air Traffic Control Tasks / Daisuke Karikawa, Hisae Aoyama, Electronic Navigation Research Institute, Makoto Takahashi, Tohoku University, Kazuo Furuta, The University of Tokyo, Akira Ishibashi, Safety Management Laboratory, and Masaharu Kitamura, Research Institute for Technology Management Strategy -- Considering Trade-offs when Assessing Resilience / Eric Rigaud and ChristopheMartin, MINES ParisTech CRC -- Performance variability: Black and white or shades of grey? / Miranda Cornelissen, Monash University, Paul M. Salmon, University of the Sunshine Coast, Roderick McClure, Monash University, and Neville A. Stanton, University of Southampton -- How the Simplification of Work Can Degrade Safety: A Gas Company Case Study / Hortense Blazsin, Franck Guarnieri, and Christophe Martin, MINES ParisTech -- Analysis of the human role in the resilience of air traffic management. / Sybert H. Stroeve, Bas A. van Doorn, and Mariken H.C. Everdij, National Aerospace Laboratory NLR -- The relevance of resources for resilience at different organizational levels within the military deployment cycle / Wim Kamphuis and Roos Delahaij, TNO -- Sociotechnical Systems Issues in Worker Safety: Implications for Managing System Tradeoffs / Lawrence J. Hettinger, Marvin J. Dainoff, Michelle M. Robertson and Yueng-Hsiang Huang, Liberty Mutual Research Institute for Safety -- Identifying Imbalances in a Portfolio of Safety Metrics: The Q4-Balance Framework for Economy-Safety Tradeoffs / David D. Woods, The Ohio State University, Ivonne Herrera, SINTEF, Matthieu Branlat, 361 Interactive LLC, and Rogier Woltjer, Swedish Defence Research Agency -- Planning Measuring Resilience Potential and Early Warnings (SCALES) / Ivonne A. Herrera, A. Vennesland, SINTEF, A. Pasquini and S. Silvagni, Deep Blue SrL -- Understanding Resilience in Flight Operations: "Find the story behind flight safety reports and learn from successes." / Arthur Dijkstra, ADMC -- Sending up a FLARE: Enhancing resilience in industrial maintenance through the timely mobilization of remote experts / Elizabeth Lay, Calpine Corporation, and Matthieu Branlat, 361 Interactive LLC -- Training of Resilience Skills for Safer Railways: Developing a New Training Program on the Basis of Lessons from Tsunami Disaster / Shigeru Haga, Rikkyo University, Osamu Onodera, Tomoko Yamakawa, Akio Oishi, Yuichi Takeda, Ken Kusukami, East Japan Railway Company, and Toshiko Kikkawa, Keio University -- Reducing the Potential for Cascade: Recognizing and Mitigating Situations that Threaten Business Viability / Katherine E. Walker, David S. Deary, and David D. Woods, The Ohio State University -- Balancing efficiency and safety in maritime traffic management when approaching a port / Fulko van Westrenen, Umantec -- Developing Resilience Signals for the Dutch Railway System / Willy Siegel, University of Twente, and Jan Maarten Schraagen, TNO/ University of Twente -- Trade-offs in the planning of rail engineering work / Pedro Ferreira, CIGEST, ISG-Business School, John Wilson, Brendan Ryan, Sarah Sharples, University of Nottingham, and Theresa Clark, High Speed 2 -- Resilience in ATM operations: Incorporating Robustness and Resilience in Safety Assessment / Rogier Woltjer, Jonas Haraldsson, Swedish Defence Research Agency, Ella Pinska-Chauvin, EUROCONTROL, Tom Laursen, IFATCA & NAVIAIR, and Billy Josefsson, NORACON/LFV -- "Staying ahead of the aircraft" and Managing Surprise in Modern Airliners / Amy Rankin, Rogier Woltjer, Linköping University, Joris Field, National Aerospace Laboratory NLR, and David Woods, The Ohio State University -- UAS in (Inter)national Airspace: Resilience as a Lever in the Debate Proceedings of the Fifth Resilience Engineering Symposium / Gwendolyn C.H. Bakx, Netherlands Defence Academy, and James M. Nyce, Ball State University -- Trade-Offs as Symptoms of Mismatches Between Sociotechnical Systems: A Case Study involving Commercial Aviation and Air Traffic Control / David Moriarty, Zeroharm Solutions Ltd, and Steve Jarvis, Jarvis Bagshaw Ltd and Cranfield University -- To certify, to investigate or to engineer, that is the question / John Stoop, Kindunos -- Cognitive Demands of Staying in Control on Highly Automated Aircraft When Faced with Surprise / Shawn Pruchnicki and David Woods, The Ohio State University -- Applying Robustness Analysis of Dynamic Models to the Problem of Systems Resilience / Hei Chan, and Katsumi Inoue, Transdiciplinary Research Integration Center -- Assessing Rio de Janeiro Municipality's Natural Disaster Prevention Program against the UN's Hyogo Protocol / Armando M. de Souza, Paulo Victor R. Carvalho, Gilbert J. Huber, and José Orlando Gomes, Federal University of Rio de Janeiro -- Organisational Factors for Enhancing Train Drivers' Proactive Behaviours to Maintain the Normal Operation of Railway Services / Hidenori Fujino, Tomoko Horishita, and Tomoyuki Sonda, Safety Research Institute West Japan Railway Company, and Hiroyuki Yamaguchi, Kyushu University -- A Fuzzy Model to Assess Resilience for Safety Management / Cláudio H. S. Grecco, Cidade Universitária, Mario C. R. Vidal, and Carlos A. N. Cosenza, Universidade Federal do Rio de Janeiro, Isaac J. A. L. dos Santos and Paulo V. R. Carvalho, Cidade Universitária -- Customer Satisfaction Plays an Important Role: A Model to Improve Resiliency of ICT Service Maintainers / Chihiro Takayama, Momoko Nakatani, and Takehiko Ohno, NTT Service Laboratories, and Akinori Komatsubara, Waseda University -- Actions Contributed to Disaster Level Reduction of the Fukushima Accident / Makoto Takahashi, Tohoku University, and Masaharu Kitamura, Research Institute for Technology Management Strategy -- The Management and Evaluation of Change / Nick McDonald, Trinity College Dublin. Ireland

背景:中國在發展城市社區衞生服務/基層醫療的過程中,基於當地經濟社會發展情況和特點,主要形成了政府辦政府管、院辦院管、以及私營三種模式。近年來中國學者對大陸社區衞生服務/基層醫療的研究主要關注于服務的基本現狀與功能的描述性研究,以及患者主觀層面的滿意度調查等,對城市社區衞生/基層醫療組織形式與服務模式建設的研究相對缺乏。初級衞生評價工具( Primary Care Assessment Tool, PCAT) 由美國約翰霍普金斯大學初級衞生保健政策中心開發,將初級醫療的五個核心方面進行量化,從患者對社區衞生服務/層醫療服務的客觀體驗角度出發,客觀評價醫療服務品質。本研究關注於基層醫療服務的過程層面,作為珠江三角洲六城市基層醫療研究項目的一部分,聯合廣州醫學院公共衛生與全科醫學學院,在廣東省衞生署以及香港智經研究中心的大力支持下,其他學者將研究基層醫療服務的結構和結果層面。 ; 目的:本研究關注從病人體驗角度出發,在城市社區衞生/基層醫療服務的過程層面,評價和比較三種不同的社區衞生服務/基層醫療模式,以及不同地區在實施國家初級衞生政策時的不同策略所導致的在初級醫療五個核心方面的差異。 ; 方法:首先,本研究進行了全面的文獻檢索,回顧了PCAT工具在全球和地區的應用。其次,本研究根據國際上認可的跨文化翻譯過程將PCAT(成人簡化版)翻譯成中文官方語言(普通話)並使其與中國國情相適應,並通過問卷的信度和效度分析,證明中文PCAT成人簡化版在評價社區衞生服務/基層醫療的過程層面方面具有較高的可靠性和有效性。進而,本研究採用多階段整群抽樣方法,在珠江三角洲六個城市的社區衞生中心,由訓練有素的調查員進行現場訪談。最後,本研究採用多元線性回歸和多元方差分析統計分析,評估和比較了不同城市和不同模式下,社區衞生服務/基層醫療服務五個核心方面的PCAT分數的差異。 ; 結果:中文PCAT(成人簡化版)包含了九個不同維度,從五個方面評價初級保健服務過程,具有良好的結構效度。克隆巴赫係數反映了問卷具有良好的內部一致性。本研究共調查了3,360名在社區衞生服務中心接受基層醫療服務的成人患者,問卷整體回收率達86.1。本研究基於PCAT 分數從不同城市和不同服務模式角度分別評價和比較了社區衞生服務/基層醫療服務的過程。研究發現,與院辦院管及私營模式相比,政府主導模式下的社區衞生服務/基層醫療服務使用者具有更好的病人體驗,主要是因為政府主導模式下,社區衞生服務在首診利用及基層醫療服務協調統籌維度層面達到更高的水準。 ; 結論:本博士論文研究確立了中文PCAT(成人簡化版)在評價社區衞生服務/基層醫療服務過程的可靠性和有效性。本研究率先在中國大陸採用PCAT 工具對廣東省珠江三角洲地區城市社區衞生服務/基層醫療模式開展了大規模調查。該項研究可以填補目前中國大陸在PCAT應用以及城市社區衞生服務/基層醫療模式研究方面的空白,探索適合中國國情的社區衞生/基層醫療服務發展道路,為中國大陸進一步發展及完善初級衞生體系提供翔實的政策依據。 ; Backgrounds: China's current healthcare reform has an overall goal towards re-strengthening primary care. Establishment and expansion of primary care network based on community health centres (CHCs) in urban areas has been prioritized. Due to various socio-economic status of local population and policy context across urban areas in mainland China, primary care is delivered by three main organisational models: government-owned CHCs, hospital-owned CHCs, and privately-owned CHCs with each model being adopted in various localities. This PhD study focuses on studying the process of primary care provided under different CHC models in the six cities of Pearl River Delta (PRD) and it is part of a larger study entitled "A Study of Comparing Primary Care Services among ...

Tobacco use is the leading preventable cause of death in South Carolina. Smoking-related medical costs amount to $1.1 billion each year, including $393 million for Medicaid. Tobacco growing in South Carolina declined by over 50 percent from 1997 to 2008. Tobacco accounted for less than 10% of the state's cash receipts from all crops in 2007. Despite the low levels of actual tobacco growing and the small role tobacco played in the state's economy in 2008, the cultural construct of being a "tobacco growing state" continued to have a disproportionately large impact on tobacco control policy making. Between 1997 and 2008, the tobacco industry lost its alliances with the Farm Bureau Federation and Commissioners of Agriculture, former staunch industry allies, because of negotiations over the Master Settlement Agreement, the buyout of the Tobacco Price Support system, and increasing purchase of foreign tobacco. Tobacco control Policy Score rankings of 2007/2008 legislators by knowledgeable tobacco control advocates revealed that legislators from the Pee Dee region, historically the stronghold of tobacco agriculture, were similar to the rest of the state's legislators in their attitudes towards tobacco control. Tobacco area legislators were formerly strong allies of the tobacco industry and historically worked with industry lobbyists to ensure defeat or manipulation of tobacco control bills. The 2007/2008 Policy Scores indicated that this was no longer the case. Tobacco control advocates should take advantage of the growing distance between tobacco companies and its former tobacco-growing allies and the decline in the actual importance of tobacco agriculture to challenge the rhetoric and resistance to tobacco control policies in the state. The tobacco industry built significant political influence in South Carolina through lobbyists, alliances with prominent trade associations, campaign contributions and other political expenditures. From 1996 to 2006, tobacco companies, trade associations and producers contributed a total of $680,541 to candidates for state office and to political parties. There is a measurable relationship between tobacco industry contributions and legislative behavior. As rated on a Policy Score scale from 0 to 10, with 10 being extremely receptive to tobacco control and 0 being extremely pro-tobacco industry, for every $1,000 received from the tobacco industry during the 2006 election cycle, a legislator's Policy Score decreased by 1.5 points. Democrats were on average 3.6 points more favorable towards tobacco control than Republicans, after controlling for campaign contributions. South Carolina was selected by the NCI in 1990 to participate in the 17-state ASSIST program. ASSIST funded tobacco control programming within the Department of Health and Environmental Control and established the state's first formal tobacco control coalition, the Alliance for a Smoke-Free South Carolina. The Alliance disbanded in 1997, leaving tobacco control advocacy disorganized and ineffective through 2003. ASSIST ended in 1999 and was replaced by a minimally-funded DHEC Tobacco Division supported primarily by about $1 million annually from the US Centers for Disease Control and Prevention. In 1998, the state signed the Master Settlement Agreement, securing approximately $70 million per year from the major cigarette companies. In 2000, the state securitized its settlement revenue, receiving a lump sum of $900 million up front in lieu of its annual payments through 2019. Refinancing in 2008 moved this date back to 2012. The 2000 General Appropriations bill set up 4 trust funds from the securitized MSA funds, with 73% ($574 million for healthcare), including tobacco control. Only $3.34 million of the MSA revenue was spent on tobacco control between 2000 and 2008. The state allocated an additional $6 million from the General Fund to the DHEC Tobacco Division between 2002 and 2008, with no state funding for the program between 2003 and 2006 and again in 2008. The Tobacco Division developed small-scale but innovative tobacco control programming, particularly community programs to promote policy change and the Rage Against the Haze youth movement. The DHEC leadership did not prioritize tobacco control between 2000 and 2008, although its support increased gradually due to efforts by the Tobacco Division, DHEC regional staff and the voluntary health groups. Funding requests remained at $2 million, significantly below the CDC recommended $62.2 million per year. Limitations by DHEC leadership on the role that DHEC staff play in local community-wide policy change efforts changed in 2007 to allow direct participation, but remained limited in scope. The voluntary health groups failed to prioritize increased funding for the DHEC Tobacco Division relative to their other lobbying focuses and continued in 2008 to act hesitantly in their lobbying of DHEC leadership to support tobacco control funding and policy change. In 2001, tobacco control advocates formed the South Carolina Tobacco Collaborative. It received 83% of its funding from the state health department, limiting its advocacy capacity. Increased funding from voluntary health groups and national partners between 2005 and 2008 allowed the Collaborative and the other prominent tobacco control advocacy groups, the South Carolina African-American Tobacco Control Network and the Smoke-Free Action Network, to increase advocacy between 2005 and 2008. These developments led to notable successes in clean indoor air policies and attempts to increase the state's tobacco tax. The cigarette tax in South Carolina remained the lowest in the nation in 2008, at 7 cents per pack. The last cigarette tax increase was in 1977, with nearly annual attempts to increase the tax defeated by coordinated efforts from the tobacco industry. Tobacco control advocates began to push for a cigarette tax increase in 2000, without success. Between 2006 and 2008, the Collaborative developed a well-funded and well-coordinated public education and lobbying campaign to support a cigarette tax increase. In 2008, the General Assembly passed a 50-cent increase, with $5 million of the annual revenue directed to the DHEC Tobacco Division, over active opposition from the tobacco industry and its allies. Governor Mark Sanford vetoed the bill for its lack of revenue neutrality, and Speaker of the House Bobby Harrell successfully prevented a veto override in the House. The 2006-2008 cigarette tax increase campaign showed that well-funded tobacco control advocacy could be successful over tobacco industry opposition in the legislature. The defeat of the increase bill demonstrated the need for stronger grasstops lobbying and relationship building with legislative leadership. Between 1977 and 1989, local policymakers passed 19 limited clean indoor air ordinances, building momentum for consideration of a state-level clean indoor air bill. In 1990, tobacco control advocates compromised with tobacco industry lobbyists to allow the passage of a weak statewide Clean Indoor Air Act, halting significant progress on clean indoor air through 2005. In 1996, the tobacco industry succeeded in using the Synar Amendment to integrate preemption into a youth access to tobacco amendment. The tobacco industry and tobacco control advocates assumed the provision also preempted local clean indoor air activity. Beginning in 1999, local policymakers in Charleston began to support local clean indoor air ordinance attempts despite assumed preemption. While Charleston did not pass an ordinance until 2006, news coverage of the city's efforts began a wave of consideration of local ordinances, eventually supported by state and local tobacco control advocates and the Municipal Association. Between May 2006 and December 2008, 21 local clean indoor air ordinances passed, 12 of which passed before the state Supreme Court rejected the argument that preemption applied to clean indoor air ordinances. Two localities were sued over their ordinances on preemption grounds, but won both cases in the Supreme Court. During the 2007/2008 legislative session, tobacco control advocates joined together to successfully defeat multiple attempts to institute express preemption through weak clean indoor air legislation supported by the tobacco industry. Given the success of local clean indoor air efforts, the strategy of tobacco control advocates developed during 2008 should be maintained: continue to promote comprehensive local smoke-free ordinances, while avoiding any action on clean indoor air in the General Assembly.

In Hidden Depths, Professor Penny Spikins explores how our emotional connections have shaped human ancestry. Focusing on three key transitions in human origins, Professor Spikins explains how the emotional capacities of our early ancestors evolved in response to ecological changes, much like similar changes in other social mammals. For each transition, dedicated chapters examine evolutionary pressures, responses in changes in human emotional capacities and the archaeological evidence for human social behaviours. Starting from our earliest origins, in Part One, Professor Spikins explores how after two million years ago, movement of human ancestors into a new ecological niche drove new types of collaboration, including care for vulnerable members of the group. Emotional adaptations lead to cognitive changes, as new connections based on compassion, generosity, trust and inclusion also changed our relationship to material things. Part Two explores a later key transition in human emotional capacities occurring after 300,000 years ago. At this time changes in social tolerance allowed ancestors of our own species to further reach out beyond their local group and care about distant allies, making human communities resilient to environmental changes. An increasingly close relationship to animals, and even to cherished possessions, appeared at this time, and can be explained through new human vulnerabilities and ways of seeking comfort and belonging. Lastly, Part Three focuses on the contrasts in emotional dispositions arising between ourselves and our close cousins, the Neanderthals. Neanderthals are revealed as equally caring yet emotionally different humans, who might, if things had been different, have been in our place today. This new narrative breaks away from traditional views of human evolution as exceptional or as a linear progression towards a more perfect form. Instead, our evolutionary history is situated within similar processes occurring in other mammals, and explained as one in which emotions, rather than 'intellect', were key to our evolutionary journey. Moreover, changes in emotional capacities and dispositions are seen as part of differing pathways each bringing strengths, weaknesses and compromises. These hidden depths provide an explanation for many of the emotional sensitivities and vulnerabilities which continue to influence our world today.

In Hidden Depths, Professor Penny Spikins explores how our emotional connections have shaped human ancestry.
Focusing on three key transitions in human origins, Professor Spikins explains how the emotional capacities of our early ancestors evolved in response to ecological changes, much like similar changes in other social mammals. For each transition, dedicated chapters examine evolutionary pressures, responses in changes in human emotional capacities and the archaeological evidence for human social behaviours.
Starting from our earliest origins, in Part One, Professor Spikins explores how after two million years ago, movement of human ancestors into a new ecological niche drove new types of collaboration, including care for vulnerable members of the group. Emotional adaptations lead to cognitive changes, as new connections based on compassion, generosity, trust and inclusion also changed our relationship to material things. Part Two explores a later key transition in human emotional capacities occurring after 300,000 years ago. At this time changes in social tolerance allowed ancestors of our own species to further reach out beyond their local group and care about distant allies, making human communities resilient to environmental changes. An increasingly close relationship to animals, and even to cherished possessions, appeared at this time, and can be explained through new human vulnerabilities and ways of seeking comfort and belonging. Lastly, Part Three focuses on the contrasts in emotional dispositions arising between ourselves and our close cousins, the Neanderthals. Neanderthals are revealed as equally caring yet emotionally different humans, who might, if things had been different, have been in our place today.
This new narrative breaks away from traditional views of human evolution as exceptional or as a linear progression towards a more perfect form. Instead, our evolutionary history is situated within similar processes occurring in other mammals, and explained as one in which emotions, rather than 'intellect', were key to our evolutionary journey. Moreover, changes in emotional capacities and dispositions are seen as part of differing pathways each bringing strengths, weaknesses and compromises. These hidden depths provide an explanation for many of the emotional sensitivities and vulnerabilities which continue to influence our world today.