Although the fanciful notion that the Black Death bypassed the Low Countries has long been rejected, nevertheless a persistent view remains that the Low Countries experienced only a ‘light touch’ of the plague when placed in a broader European perspective, and recovered quickly and fully. However, in this article an array of dispersed sources for the Southern Netherlands together with a new mortmain accounts database for Hainaut show that the Black Death was severe, perhaps no less severe than other parts of western Europe; that serious plagues continued throughout the fourteenth and fifteenth centuries; and that the Black Death and recurring plagues spread over vast territories—including the countryside. The previous conception of a ‘light touch’ of plague in the Low Countries was created by the overprivileging of particular urban sources, and a failure to account for the rapid replenishment of cities via inward migration, which obscured demographic decimation. We suggest that the population of the Low Countries may not have recovered faster than other parts of western Europe but instead experienced a greater degree of post‐plague rural–urban migration. 相似文献
To evaluate the implementation of a mixed virtual and in-person brief intervention for young people, aged 12–25 years, presenting to a large urban mental health service in crisis with suicidal ideation and/or self-harm. 相似文献
The Sustainable Energy Authority of Ireland (SEAI) administers the Better Energy Homes scheme to provide a financial incentive for home owners to engage in energy efficiency retrofits. This study analyses data from the scheme and Building Energy Rating data for participants to the scheme to examine the value for money achieved by households. In addition, this research identifies which retrofit combinations provide greatest value for money, in terms of energy efficiency gains, for the grant provider. We utilize an error-in-variables approach to model the variation in benefits accruing to households of varying characteristics. We find that household and grant provider surplus can be maximized in the short term by retrofitting less energy efficient and larger homes, timber or steel frame homes and houses rather and apartments. The types of retrofits leading to the greatest surplus for both household and grant provider include cavity wall insulation paired with either a boiler with heating controls or heating controls only retrofit. 相似文献
Can economically efficient outcomes be obtained and sustained in the absence of externally enforced property rights? We study the evolutionary properties of a game that exhibits two well-defined Nash equilibria: one generates an inefficient outcome while the other set generates an efficient outcome supported by the potential for retaliation. Although standard forward-looking refinements eliminate the efficient equilibrium, neither equilibrium type satisfies strict evolutionary stability criteria. However, both types of equilibrium define strategies that are neutrally stable, which makes them vulnerable to drift in dynamic environments. We conduct computer simulation experiments in which players learn adaptively via a tournament selection mechanism called sophisticated experimentation. Our simulations demonstrate that while the system spends a disproportionately high proportion of time in the inefficient equilibrium set, the efficient equilibrium is pervasive as the system drifts back and forth between the equilibrium sets, never settling on one or the other. 相似文献
Telaprevir (TVR,T) and boceprevir (BOC,B) are direct-acting antivirals (DAAs) used for the treatment of chronic genotype 1 hepatitis C virus (HCV) infection. This analysis evaluated the cost-effectiveness of TVR combined with pegylated interferon (Peg-IFN) alfa-2a plus ribavirin (RBV) compared with Peg-IFN alfa-2a and RBV (PR) alone or BOC plus Peg-IFN alfa-2b and RBV in treatment-experienced patients.
Methods:
A Markov cohort model of chronic genotype 1 HCV disease progression reflected the pathway of experienced patients retreated with DAA therapy. The population was stratified by previous response to treatment (i.e., previous relapsers, partial responders, and null responders). Sustained virologic response (SVR) rates were derived from a mixed-treatment comparison that included results from separate Phase III trials of TVR and BOC. Incremental cost per life year (LY) gained and quality-adjusted-life-year (QALY) gained were computed at lifetime, adopting the NHS perspective. Costs and health outcomes were discounted at 3.5%. Uncertainty was assessed using deterministic and probabilistic sensitivity analyses. Sub-group analyses were carried out by interleukin (IL)-28B genotype.
Results:
Higher costs and improved outcomes were associated with T/PR relative to PR alone for all experienced patients (ICER of £6079). T/PR was cost-effective for each sub-group population with high SVR advantage in relapsers (ICER of £2658 vs £7593 and £20,875 for partial and null responders). T/PR remained cost-effective regardless of IL-28B sub-type. Compared to B/PR, T/PR prolonged QALYs by 0.57 and reduced lifetime costs by £13,960 for relapsers. For partial responders T/PR was less costly but less efficacious than B/PR, equating to an ICER of £128,117 per QALY gained.
Limitations:
No head-to-head trial provides direct evidence of better efficacy of T/PR vs B/PR.
Conclusion:
T/PR is cost-effective compared with PR alone in experienced patients regardless of treatment history and IL-28B genotype. Compared to B/PR, T/PR is always cost-saving but only more effective in relapsers. 相似文献
The Federal Energy Regulatory Commission's Order 636 fundamentally altered the regulatory and operational environment of the natural gas industry in 1992, as the culmination of several directives aimed at relaxing regulation and fostering competition. We hypothesize that gas pipeline firms subsequently changed their operational and financial behavior in ways consistent with reduced balkanization, increased competition, and reduced expense preference behavior. Our results indicate that these firms have become more homogeneous financially but less so operationally. We find evidence that the marginal profitability of various pipeline activities has responded more to financial market conditions than to the regulatory environment. 相似文献
Recognising the potential conservation impact, zoos regularly ask their visitors to undertake pro-wildlife behaviour. This paper presents the results of two studies undertaken to address the question: how often during a visit should visitors be asked? Study 1 sought to a) determine individuals' personal thresholds and b) the point where the number of different behaviours requested began affect visitors' experiences. Study 2 sought the same, but focused on requests for the same behaviour. Results suggest that few respondents' personal thresholds were crossed (2.5% in Study 1 and 9% in Study 2). In neither study did many respondents (2.5% in Study 1 and 2.8% in Study 2) feel that the number of requests negatively affect their overall zoo experience. While there are caveats, we conclude that there appears little cause for concern about asking zoo visitors on multiple occasions to act in support of wildlife. Indeed, such requests may improve experiences. 相似文献
In the past industry has had to rely on a number of “rules of thumb” to provide a means of reasonable analysis for many design, operation, safety and similar issues. The lack of readily available computing facilities made the use of “rules of thumb” a necessary part of doing business in the hydrocarbon processing industry. And these “rules of thumb” have proven useful and allowed many tasks to be accomplished successfully. Today, however, availability of mainframe computers or desktop computing facilities has provided a tool that has decreased the need to rely on “rules of thumb.” And in many cases processing improvements can only be accomplished by replacing “rules of thumb” with more rigorous analysis. In the ethylene oxide producing/consuming industry a widely-used “rule of thumb” concerns the storage of ethylene oxide water solutions. A well-publicized “rule” stated that solutions in excess of 1-2 weight percent ethylene oxide in water should not be stored [1]. This “rule” is certainly valid in many situations. However, this guideline may be unnecessarily restrictive in other cases. The impact of several key process parameters impacts the amount of ethylene oxide in water than can be safely stored. This study will show that higher concentrations of ethylene oxide in water can be safely stored under the right circumstances. The study will also discuss the key variables that determine whether aqueous ethylene oxide solutions can be safely stored. Finally, a methodology used in determining how much ethylene oxide in water can be safely stored will be outlined. 相似文献