This study compares the “at-home” and “while travelling” sustainable food practices of national park visitors in the US Intermountain West through an in-person survey. Results show that tourist's sustainable food practices do not carry over into their national park experience. Specifically, they shop for and consume fewer local foods and participate in fewer food-related activities when travelling, such as farmers' market and local farm visits. When divided into groups of low, medium and high sustainable food practices at home, the medium and high-level groups exhibited a significant reduction in sustainable food practices while travelling. This likely stems from poor promotion of local foods and food related events, lack of linkages between the tourism and food industries, as well as limited recognition of local food labelling schemes and interest in local culture by visitors. These results imply that local foods and culinary experiences do not currently play an essential role in national park experiences in the US Intermountain West. It raises important questions. Is there a link between sustainability practices at home and when on vacation? Should national park managements widen their environmental remits by becoming involved in local food production and promotional practices? 相似文献
The view of the commons as archaic, ‘backward’ and ‘irrational’ institutions for the management of resources has now been revised in favour of a more positive one, for both past and present societies. Indeed, it is clear that the commons had multifarious ecological and economic benefits for both medieval and early modern rural societies in Western Europe. That being the case, many scholars have seen the increasing expropriation of the commons in the transition to the early modern period as a sign of increasing inequality characterizing pre‐industrial Europe, and many have lamented the loss of communal grazing privileges connected to processes such as land enclosure – pushing poor peasants into the ‘abyss’ with the removal of their final form of welfare. However, in this paper it is argued that the social distribution of the benefits to the commons were rarely, if ever, entirely equitable. In fact, in many historical contexts the benefits of the commons could also be highly restricted – crystallizing and entrenching stratifications themselves, and even serving as the ‘vehicle’ of further inequality. The expropriation of the commons did not necessarily make Western European rural societies any more unequal. 相似文献
Gonzalez et al. (2012) apply the Unified Theory of Acceptance and Use of Technology (UTAUT, Venkatesh et al., 2003) to the issue of adoption of continuous auditing (CA) by internal auditors. The authors make a very convincing case for the slow evolution of CA and propose that this can be explained by the four factors contained in the UTAUT as well as annual sales and voluntariness of use. They find, in their revised model, that effort expectancy and social influence directly impact intentions to use the technology, while performance expectancy is moderated by annual sales and social influence is moderated by voluntariness of use. Interestingly, the authors also identify geographical differences in these influences. I offer commentary on these findings and suggest avenues for future research in the domain of technology adoption and use in accounting. 相似文献
Objective: The purpose of this study was to determine the cost effectiveness (from a payer’s perspective) of adding clostridial collagenase ointment (CCO) to selective debridement compared with selective debridement alone (non-CCO) in the treatment of stage IV pressure ulcers among patients identified from the US Wound Registry.Methods: A 3-state Markov model was developed to determine costs and outcomes between the CCO and non-CCO groups over a 2-year time horizon. Outcome data were derived from a retrospective clinical study and included the proportion of pressure ulcers that were closed (epithelialized) over 2 years and the time to wound closure. Transition probabilities for the Markov states were estimated from the clinical study. In the Markov model, the clinical outcome is presented as ulcer-free weeks, which represents the time the wound is in the epithelialized state. Costs for each 4-week cycle were based on frequencies of clinic visits, debridement, and CCO application rates from the clinical study. The final model outputs were cumulative costs (in US dollars), clinical outcome (ulcer-free weeks), and incremental cost-effectiveness ratio (ICER) at 2 years.Results: Compared with the non-CCO group, the CCO group incurred lower costs ($11,151 vs $17,596) and greater benefits (33.9 vs 16.8 ulcer-free weeks), resulting in an economically dominant ICER of ?$375 per ulcer. Thus, for each additional ulcer-free week that can be gained, there is a concurrent cost savings of $375 if CCO treatment is selected. Over a 2-year period, an additional 17.2 ulcer-free weeks can be gained with concurrent cost savings of $6,445 for each patient.Conclusions: In this Markov model based on real-world data from the US Wound Registry, the addition of CCO to selective debridement in the treatment of pressure ulcers was economically dominant over selective debridement alone, resulting in greater benefit to the patient at lower cost. 相似文献
The Milwaukee County General Assistance Medical Program implemented strategies to improve the delivery of care to its patients that include patient education and a Nurse Telephone Line. The partnership between a county-funded program and an academic health center has been very productive and resulted in improvements to the program that benefit underserved patients. The outcomes of these educational strategies are described. 相似文献
Telaprevir (T, TVR) is a direct-acting antiviral (DAA) used for the treatment of genotype 1 chronic hepatitis C virus (HCV) infection. The sustained virological response (SVR) rates, i.e., undetectable HCV RNA levels 24 weeks after the end of treatment, is what differentiate treatments. This analysis evaluated the cost-effectiveness of TVR combined with pegylated interferon (Peg-IFN) alfa-2a plus ribavirin (RBV), with Peg-IFN and RBV (PR) alone or with boceprevir (B, BOC) plus Peg-IFN alfa-2b and RBV, in naïve patients.
Methods:
A Markov cohort model of chronic HCV disease progression reflected the pathway of naïve patients initiating anti-HCV therapy. SVR rates were derived from a mixed-treatment comparison including results from Phase II and III trials of TVR and BOC, and trials comparing both PR regimens. SVR has significant impact on survival, quality-of-life, and costs. Incremental cost per life year (LY) gained and quality-adjusted-life-year (QALY) gained were computed at lifetime, adopting the (National Health Service) NHS perspective. Cost and health outcomes were discounted at 3.5%. Uncertainty was assessed using deterministic and probabilistic sensitivity analyses. Sub-group analyses were also performed by interleukin (IL)-28B genotype and fibrosis stage.
Results:
Higher costs and improved outcomes were associated with T/PR relative to PR alone, resulting in an ICER of £12,733 per QALY gained. T/PR retained a significant SVR advantage over PR alone and was cost-effective regardless of IL-28B genotype and fibrosis stages. T/PR regimen ‘dominated’ B/PR, generating 0.2 additional QALYs and reducing lifetime cost by £2758. Sensitivity analyses consistently resulted in ICERs less than £30,000/QALY for the T/PR regimen over PR alone.
Limitations:
No head-to-head trial provides direct evidence of better efficacy of T/PR vs B/PR.
Conclusion:
The introduction of TVR-based therapy for genotype 1 HCV patients is cost-effective for naïve patients at the £30,000 willingness-to-pay threshold, regardless of IL-28B genotype or fibrosis stage. 相似文献
Intercompany financing transactions are becoming increasingly important to multinational enterprises (MNEs) as they expand internationally. Corporate treasurers of MNEs have many responsibilities, including the management of international capital structure and cost of capital, the financing of cross‐border acquisitions, foreign direct investment, international capital budgeting and cash management, management of foreign exchange and transactional risk, and port‐folio and investment management. This article focuses on a corporate function, transfer pricing, that is potentially relevant to each of these activities. Whenever a payment crosses borders in a treasury context—whether to provide a loan, purchase a receivable, provide a guarantee, sweep cash, factor a receivable, provide a hedge or insurance product—a transfer pricing issue is present. Transfer pricing is often viewed as a taxation issue and thus the responsibility of the corporate tax department. This article challenges that view, and makes the case that an integrated, multi‐functional approach to MNE treasury planning in the context of transfer pricing can be an important component in improving the efficiency of cross‐border financial management. The paper uses conceptual and empirical information as well as numerical examples to illustrate relevant tax and transfer pricing concepts for policy planners and others responsible for MNE treasury and tax planning. 相似文献