Clinical characteristics,treatment patterns,and socio-economic burden of COPD in Bulgaria

Background: While the impact of COPD in Western-Europe is known, data from Eastern-Europe is scarce. This study aimed to evaluate clinical characteristics, treatment patterns, and the socio-economic burden of COPD in Eastern-Europe, taking Bulgaria as a reference case.

Methods: A representative sample of Bulgarian patients with COPD was randomly chosen by pulmonologists, based on the following inclusion criteria: COPD diagnosis with at least 1 year of living with COPD, ≥40 years of age, and use of COPD medication. Patient characteristics, treatment, quality-of-life, healthcare resource use, and costs were systematically assessed.

Results: A total of 426 COPD patients were enrolled. Approximately 69% were male, 40% had occupational risk factors, 45% had severe and 11% had very severe COPD. Mean CAT scores were 13.80 (GOLD A), 21.80 (GOLD B), 17.35 (GOLD C), and 26.70 (GOLD D). Annual per-patient costs of healthcare utilization were €579. Yearly pharmacotherapy costs were €693. Indirect costs (reduced and lost work productivity) outnumbered direct costs three times.

Conclusions: Bulgaria has relatively high percentages of (very) severe COPD patients, resulting in considerable socio-economic burden. High smoking rates, occupational risk factors, air pollution, and a differential health system may be related to this finding. Eastern-European COPD strategies should focus on prevention, risk-factor awareness, and early detection.     

Spatial variations in nutrients and other physicochemical variables in the topographically closed Lake Baringo freshwater basin (Kenya)

Spatial physicochemical parameters were determined from 39 sampling sites distributed throughout Lake Baringo during December 2010. Mean values of temperature, dissolved oxygen concentration and electrical conductivity decreased successively with depth, while the pH remained constant. Only the turbidity values increased marginally with depth. Of the surface water parameters, mean (range) values of dissolved oxygen (DO), pH, electrical conductivity, water transparency and turbidity were 6.9 (4.5–8.4) mg L^?1, 8.3 (7.8–8.5), 573 (556–601)μS cm^?1, 33 (28–37) cm and 43.3 (32.7–54.6) NTU, respectively. Mean and range values of total nitrogen (TN), nitrate‐nitrogen(NO₃‐N), ammonia nitrogen (NH₄‐N), total phosphorus (TP) and soluble reactive phosphorus (SRP) were 788.4 (278–4486) μg L^?1, 4.5 (2.4–10.0) μg L^?1, 42.6 (33.8–56.3) μg L^?1, 102.9 (20.3–585.3) μg L^?1 and 23.5 (15.2–30.5) μg L^?1, respectively. Dissolved silica concentrations ranged from 19.7 to 32.7 mg L^?1, with a mean value of 24.7 mg L^?1. The chlorophyll‐a concentrations were quite low, ranging from 1.4 to 4.9 μg L^?1, with a mean value of 4.2 μg L^?1. In contrast to previous reported values, a key finding in the present study is a relatively high water transparency, indicating a relatively clear water column, due possibly to the fact that the sampling was conducted during the dry period. The nutrient levels remained low, and the chlorophyll‐a concentration also was an almost all time low value. A TP value of 20 μg L^?1 and higher confirms strongly eutrophic conditions prevailing in the lake, with an extremely low potential for fish production and low species diversity, consistent with other studies. The results of the present study, therefore, reinforce the database for future management and monitoring plans for the Lake Baringo ecosystem, which lies adjacent to known geothermally active zones and a saline Lake Bogoria.     

The response of phytoplankton and zooplankton to river damming in three cascading reservoirs of the Tana River,Kenya

River damming reduces the ecological heterogeneity of ecosystems, with a resultant shift of communities adapted to lotic conditions to those better adapted to the newly created lentic environment. Whereas the response of phytoplankton and zooplankton community composition and structure to river damming has been extensively studied in individual reservoirs, this study assessed three cascading reservoirs on the Tana River, Kenya. A total of five sampling campaigns were carried out in 2011, 2012 and 2013 for different sampling sites within each of the reservoirs, as well as upstream and downstream of the reservoirs. Plankton communities within each of the three reservoirs, and upstream of the reservoirs, were compared, indicating (i) the disappearance of 13 phytoplankton and 2 zooplankton taxa; (ii) the appearance (invasion) by 26 phytoplankton and 33 zooplankton taxa; and (iii) an opportunistic presence of 7 phytoplankton and 6 zooplankton taxa. Thirty‐two genera of potentially harmful algae were also encountered, suggesting a potential future threat of harmful algal blooms. A significant reduction in phytoplankton diversity and taxa evenness was also observed, as well as increases in overall abundance in the reservoirs, compared to the river upstream of the study reservoirs. However, these ecological indices were restored to the original levels observed upstream of the study reservoirs at sites hundreds of kilometres downstream of the reservoirs.     

EU involvement in TEN development: network effects and European value added

The recent White Paper emphasises once more that the Trans-European transport network (TEN) is a key element in European Union (EU) policy, yet that its realisation is jeopardised by the lack of an integrated approach during evaluation and funding of cross-border infrastructure. Despite the intervention of the EU in conceptualising the TEN, subsidiarity and continued use of conventional evaluation procedures mean that most assessment of individual TEN components is still undertaken in relatively narrow, national terms. The primary objective of this paper is to explore how the international character of the TEN may be recognised and incorporated in still predominantly national evaluation processes, and which evaluation horizons may be broadened based on the concepts of network effects and European value added (EVA). We present some examples of EVA and discuss EU involvement in projects with potentially high EVA, either by co-ordinating bilateral negotiations for compensation between Member States or by co-financing projects that support the achievement of strategic EU transport policy objectives.     

Bank profitability during recessions

This paper contributes to the literature on the relation between bank profitability and economic activity. When allowing for stronger co-movement of bank profit with economic activity during deep recessions, we find a much larger impact of output growth on bank profitability than commonly found in the literature. Among the different components of bank profit, loan losses are the main driver of this result. We also find long-term interest rates in previous years to be important determinants of bank profit in times of high economic growth. Our findings are robust to the use of aggregate or individual bank data.     

Protected Areas in an era of global–local change

This review article advances debate and research on the global–local nexus that shapes, and increasingly determines, the existence of Protected Areas (PAs) and their function as areas of high conservation value as well as tourism destinations. The demands on PAs have grown from an initial focus on facilitating recreation experiences and species and habitat protection, to more inclusive and participatory approaches that seek to safeguard ecological services whilst also supporting regional and national livelihoods. We propose that the simultaneous analysis of global and local drivers of change will generate a deeper understanding of impact processes and response implications. To this end, a draft framework for better understanding the global–local nexus of PAs is developed and tested through a Delphi sketching approach to 20 experts in least developed, newly industrialised and developed countries. Key challenges, implications and opportunities for PA management and governance, and for tourism development at local and global levels (and their interactions), are discussed in follow-up papers to this review, including research priority areas, the measurement of tourism numbers, economic impact modelling, private PAs, the changing roles of zoning, the need for flexible, inclusive and accountable governance structures, and for better understanding of tourist behavioural change mechanisms.     

Raw water quality weight factors: Vaal basin, South Africa

Weight factors (WFs) were developed for surface raw water pollution indicator variables in Vaal River's Upper and Middle Vaal sub-basins, in South Africa. The overall objective was to formulate a quantifiable ranking system to indicate importance of pollutant variables given their established effects on human and environmental health. Multi-criteria decision analysis (MCDA) was applied to qualitative data that were obtained from South Africa's target water quality ranges as well as from literature which represented expert opinion. The human and environmental health effect choice sets were ranked from 1 to 5 on nine pollutant variable criteria: NH3/NH4+, Cl-, conductivity (EC), dissolved oxygen (DO), pH, F-, NO3-/NO2-, PO4(3-) and SO4(2-). The weighted-sum method (WSM) then assigned highest and lowest normalised weights (NWs) to F- and Cl-, respectively, for human health effects (?hh) alternative. Highest and lowest NWs were assigned to NH3/NH4+ and EC, respectively, for environmental health effects (?eh) alternative. After aggregating the ?hh and ?eh WFs, resultant values ranked the variables from highest to lowest as follows: F->NO3-/NO2->/NH3/NH4+>DO>pH>SO4(2-)>PO4(3-)>EC>Cl-. The results represented the importance of variables given their established effects on human and environmental health. It was concluded that WFs provided a quantifiable barometer which could signal harmful exposure to elucidate negative effects of using polluted surface raw water in the study area. The values could be incorporated into water quality models like water quality indices. The approach could be used to develop WFs for other sites, taking into account issues like the site's pollution variables of concern as well as using a ranking key constructed from established literature.     

Interaction of human and physical capital in a model of endogenous growth

A model of development is presented where growth is initially driven by physical capital accumulation, as in the neoclassical model. After a critical level of physical capital is reached, the economy takes off and enters a stage of sustained growth driven by human capital accumulation. The link between these two stages is provided by the assumption that private incentives for human capital accumulation increase with the average levels of human and physical capital. At the early stages of development, these incentives are low so the level of human capital stays stagnant until sufficient physical capital is accumulated. Other results are that some economies may reach a steady state of physical capital before a take-off is possible. This is especially likely for economies in which agents have low savings propensities. Such economies remain stuck in a no-growth equilibrium forever. Economies that do grow may experience endogenous cycles if the return to investment in human capital is sufficiently increasing in the level of physical capital.     

Oligopoly in loan and deposit markets: an econometric application to the Netherlands

Summary This paper presents evidence on the degree of oligopoly in Dutch loan and deposit markets. Using cointegration tests, dynamic specifications are developed for the demand for mortgages, the supply of savings deposits and the associated interest rates. Simultaneous estimation of this model over the period 1957–1990 reveals that in recent years, both markets were significantly more oligopolistic than in Cournot equilibrium. However, competition for mortgages has significantly intensified since the late 1950s. The degree of oligopoly in the market for savings deposits, on the other hand, shows a significant rise over the sample period, probably owing to increased market concentration.This paper, which is a revised version of chapter 4 of my (unpublished) Ph.D. thesis, has greatly benefited from the comments by Lex Hoogduin, Gerard Korteweg and two anonymous referees of this journal. Thanks are also due to Coby Hogewoning and Gwan Tjia, who assisted in collecting the data. All errors and opinions are mine.