Bottom-up social enterprises in Romania. Case study – Retirees’ Mutual Aid Association

The purpose of this article is to present and analyze the organizational profile and distinctive development pattern of a successful bottom-up social enterprise in Romania, namely, the Retirees’ Mutual Aid Association (RMAA). Romania has recently rediscovered the world of social economy which brings together various organizations, from associations and foundations to cooperatives and commons, sharing a common interest in developing entrepreneurial activities to support social goals. In an ideological and public policy context which holds back the opening of the public market to the third sector and social economy actors, setting and running up such organizations remains a challenge. On the other hand, the isomorphic pressure exerted by the EU has resulted in a type of legislation targeted at social enterprises which focuses almost exclusively on work integration social enterprises. Nonetheless, Romania also features social enterprises that are not externally driven but developed bottom-up, starting from the needs of their members and of the communities in which they are established and developed. Using the data of extensive research conducted on social economy entities in Romania, we will present an organizational case study of a successful bottom-up social enterprise, namely RMAA.     

Complexity and inapproximability results for the Power Edge Set problem

We consider the single channel PMU placement problem called the Power Edge Set problem. In this variant of the PMU placement problem, (single channel) PMUs are placed on the edges of an electrical network. Such a PMU measures the current along the edge on which it is placed and the voltage at its two endpoints. The objective is to find the minimum placement of PMUs in the network that ensures its full observability, namely measurement of all the voltages and currents. We prove that PES is NP-hard to approximate within a factor (1.12)-\(\epsilon \), for any \(\epsilon > 0\). On the positive side we prove that PES problem is solvable in polynomial time for trees and grids.     

Face-to-Face wird überbewertet – Telefoncoaching aus Klienten- und Beraterperspektive

Claudia Bredt talks to Dr. Andreas Knierim about her experiences with telephone coaching from a client and consultant perspective. Claudia Bredt has been using the medium telephone for several years as a format for supervision and coaching. She combines face-to-face sessions with telephone consulting. At the same time, she has also experienced the good effects of telephone coaching herself as a client.     

Indirect Inference for Lévy‐driven continuous‐time GARCH models

We advocate the use of an Indirect Inference method to estimate the parameter of a COGARCH(1,1) process for equally spaced observations. This requires that the true model can be simulated and a reasonable estimation method for an approximate auxiliary model. We follow previous approaches and use linear projections leading to an auxiliary autoregressive model for the squared COGARCH returns. The asymptotic theory of the Indirect Inference estimator relies on a uniform strong law of large numbers and asymptotic normality of the parameter estimates of the auxiliary model, which require continuity and differentiability of the COGARCH process with respect to its parameter and which we prove via Kolmogorov's continuity criterion. This leads to consistent and asymptotically normal Indirect Inference estimates under moment conditions on the driving Lévy process. A simulation study shows that the method yields a substantial finite sample bias reduction compared with previous estimators.     

On estimands and the analysis of adverse events in the presence of varying follow‐up times within the benefit assessment of therapies

The analysis of adverse events (AEs) is a key component in the assessment of a drug's safety profile. Inappropriate analysis methods may result in misleading conclusions about a therapy's safety and consequently its benefit‐risk ratio. The statistical analysis of AEs is complicated by the fact that the follow‐up times can vary between the patients included in a clinical trial. This paper takes as its focus the analysis of AE data in the presence of varying follow‐up times within the benefit assessment of therapeutic interventions. Instead of approaching this issue directly and solely from an analysis point of view, we first discuss what should be estimated in the context of safety data, leading to the concept of estimands. Although the current discussion on estimands is mainly related to efficacy evaluation, the concept is applicable to safety endpoints as well. Within the framework of estimands, we present statistical methods for analysing AEs with the focus being on the time to the occurrence of the first AE of a specific type. We give recommendations which estimators should be used for the estimands described. Furthermore, we state practical implications of the analysis of AEs in clinical trials and give an overview of examples across different indications. We also provide a review of current practices of health technology assessment (HTA) agencies with respect to the evaluation of safety data. Finally, we describe problems with meta‐analyses of AE data and sketch possible solutions.     

Gender role orientation and gaming behavior revisited: examining mediated and moderated effects

The article presents results of a study that examined the influence of gender role orientations on gaming motivations, game genre preferences, and different play styles. Applying social role theory, it was hypothesized that femininity and masculinity influence gender-typed motivations (social interaction, competition, and challenge) and preferences (role-playing and action games) as well as gender-typed behavior (cooperative play and competitive play). After collecting empirical data through an online survey, hypotheses were tested by structural equation modeling. Moreover, moderating effects of sociodemographic characteristics (biological gender, age, and educational level) were examined. Findings provide evidence for the existence of gender-typed motives of play, genre preferences, and – mediated by motivations and preferences – gaming behavior. Group analyses support a biosocial model of gender-typed gaming behavior because gender-typing of motives, preferences, and play styles varies in strength and direction by biological gender, age, and educational level.     

Empowering refugees and asylum seekers in the Italian agriculture sector by linking social cooperative entrepreneurship and social work practices

The present study investigated the potential of social cooperative activities and social work practices in the Italian agriculture sector in promoting sustainable integration forms for refugees and asylum seekers. The study adopted a qualitative approach using case study as the main research method. As the results show, the complexity and diversity of needs of refugees and asylum seekers make collaboration between formal and informal actors increasingly necessary for generating a common knowledge and support networks. The article argues that integrated approaches to refugees’ socio‐economic integration are needed to free them from the need for assistance and thereby help them regain their autonomy. The case study presented gives insight into the potential of small‐step experiences towards sustainable development and, linked to this, the integration of refugees and asylum seekers based on self‐organisation and cooperation, considering the well‐being of all citizens in the broader context.     

Containing uncertainty: sexual values and citizenship

This essay reflects on one dimension of the challenge of being a queer ethicist. Can we have norms/values without liberal assumptions that might undo the important contributions of queer theory? The reemergence of appeals to "citizenship" in lbgt and queer debates serves as illustrations of this question. Reading Weeks's Invented Moralities: Sexual Values in an Age of Uncertainty(1995), while considering various scholars who have engaged the issue of sexual citizenship since, enables me to illustrate some of the issues that emerge around ethics and queerness at this particular moment. My argument is that attempts to offer constructive ethical engagement in the end often contain challenges rather than successfully address them. Critically examining Weeks's intervention into what he sees as our "loss" of moral authority and ethical concerns to the right wing is helpful for queer ethical conversations that consider available theoretical and philosophical models of claiming citizenship as a way of claiming values in uncertain times. Weeks (1995; 1998), Richardson (2000), Bell and Binnie (2000), and Phelan (2001) provides helpful guides to the struggle with tensions that faces us in lbgt/queer debates of citizenship.     

Worker Remittances and Capital Flows to Developing Countries

Worker remittances constitute an increasingly important channel for the transfer of resources to developing countries. Behind foreign direct investment, remittances are the second‐largest source of external funding for developing countries. Yet, literature on worker remittances has traditionally focused on the impact of remittances on income distribution within countries, on the determinants of remittances at a micro‐level, or on the effects of migration and remittances for specific countries or regions. Macroeconomic determinants and effects of remittances have received more attention only recently. Hence, the focus of this paper is on the macroeconomic determinants of remittances and on differences in these determinants between remittances and other capital flows. We find that remittances respond more to demographic variables while private capital flows respond more to macroeconomic conditions.     

Ethics of resource allocation: instruments for rational decision making in support of a sustainable health care

Objective: In all western countries health care budgets are under considerable constraint and therefore a reflection process has started on how to gain the most health benefit for the population within limited resource boundaries. The field of “ethics of resource allocation” has evolved only recently in order to bring some objectivity and rationality in the discussion. In this article it is argued that priority setting is the prerequisite of ethical resource allocation and that for purposes of operationalization, instruments such as “need assessment” and “health technology assessment (HTA)” are essential worktools for making more rational decisions. Thresholds (deduced from the need assessment and HTA) are—within this context—guiding but not binding principles. Method: Discussion of theoretical concepts of not only priority setting, need assessment and HTA complemented by practical examples for showing the challenges and the need, but also the chances of a more explicit and transparent policy of resource allocation in health care. Results: Priority setting in health care is based on the values of equity, justice and solidarity. Health packages decisions are determined from medical need (the severity of the condition) and/or the appropriateness of medical interventions (their cost-effectiveness). With growing awareness that originally effective and cost-effective services and programmes are eventually provided inappropriately, the focus is shifting towards the organisational aspects of provision and application. Therefore, need assessment is based on the distinction of health care needs from demand, supply, or actual care. Additionally HTA provides the evidence on health care interventions in a way that it becomes obvious who benefits from an intervention and who definitely does not benefit, but eventually is harmed. Conclusions: Health services research on effective and cost-effective interventions and research/monitoring of performance that the effective and cost-effective services are provided appropriately are of increasing importance for guiding the decision-making process on priority setting and need assessment. Effective healthcare for all is sustainable, if we start to put expenditures in perspective and focus health policies and research strategies on managing expectations through patient information and a more realistic notion of medical advancements and, on the other hand, on encouraging need-based and cost-effective innovations.

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Zusammenfassung Ziel: In allen Ländern des Westens ist die Haushaltslage im Gesundheitswesen heute äußerst angespannt, weshalb nun ein Reflexionsprozess begonnen hat, wie mit begrenzten Haushaltsmitteln der größtmögliche gesundheitliche Nutzen für die Bevölkerung erzielt werden kann. Erst in jüngster Zeit ist die “Ethik der Mittelzuweisung” als Arbeitsgebiet entwickelt worden, mit dem Ziel, eine gewisse Objektivität und Rationalität in die Diskussion zu bringen. In diesem Artikel argumentieren wir, dass eine ethische Mittelzuweisung Prioritätssetzungen erfordert und dass Instrumente wie Bedarfeinschätzung (Need Assessment) und Bewertung medizinischer Verfahren [Health Technology Assessment (HTA)] wesentliche Arbeitswerkzeuge zur Erzielung rationaler Entscheidungen sind. Schwellenwerte (abgeleitet aus Need Assessment und HTA) dienen in diesem Zusammenhang als leitende, jedoch nicht bindende Prinzipien. Methode: Diskussion theoretischer Begriffe der Prioritätssetzung, Bedarfeinschätzung und HTA, ergänzt durch praktische Beispiele zur Darstellung der Herausforderungen des Bedarfs nach, aber auch der Chancen für eine explizitere und transparentere Politik der Mittelzuweisung im Gesundheitswesen. Ergebnisse: Prioritätssetzung im Gesundheitswesen basiert auf den Werten Gleichheit, Gerechtigkeit und Solidarität. Entscheidungen über Versorgungspakete richten sich nach der medizinischen Bedarfslage (Schwere der Erkrankung) und/oder der Angemessenheit medizinischer Eingriffe (Kosteneffektivität). Mit der wachsenden Erkenntnis, dass ursprünglich effektive und kosteneffektive Leistungen und Programme am Ende unangemessen bereitgestellt werden, richtet sich die Aufmerksamkeit mehr auf Organisationsaspekte der Bereitstellung und Anwendung. Need Assessment basiert daher auf der Unterscheidung zwischen Bedarf im Gesundheitswesen und Nachfrage, Angebot oder tatsächlicher Versorgung. HTA fasst dann die Evidenz zu Eingriffen seitens des Gesundheitswesens zusammen, sodass offenbar wird, wem ein Eingriff nützt und wem er mit Sicherheit nicht nützt, sondern am Ende schadet. Schlussfolgerungen: Forschungen der Gesundheitsdienste zu effektiven und kosteneffektiven Eingriffen sowie die Erforschung/Erfolgskontrolle einer angemessenen Bereitstellung effektiver und kosteneffektiver Dienste sind von wachsender Bedeutung für die Information des Entscheidungsprozesses zur Prioritätssetzung und Bedarfseinschätzung. Eine effektive Gesundheitsversorgung für alle bleibt tragbar, sofern wir beginnen, Ausgaben in Perspektive zu setzen und gesundheitspolitische Entscheidungen und Forschungsstrategien darauf ausrichten, Erwartungen zu lenken, indem wir die Patienten informieren und eine realistischere Einschätzung medizinischer Fortschritte fördern, und uns zugleich auf bedarfsorientierte und kosteneffektive Innovationen konzentrieren.

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Résumé Objectif : Dans tous les pays occidentaux, les budgets de santé publique sont soumis à de fortes contraintes, ce pourquoi un processus de réflexion a commencé sur la question de savoir comment obtenir avec des moyens limités la plus grande utilité possible pour la population en termes de santé. Ce n’est que récemment que « l’éthique de l’allocation des ressources » a été développée pour apporter une certaine part d’objectivité et de rationalisme dans la discussion. Le présent article soutient que l’attribution de priorités est la condition préalable indispensable à l’allocation des ressources et que des instruments tels que l’évaluation des besoins (need assessment) et l’évaluation des technologies de la santé (ETS/HTA) sont des outils essentiels pour parvenir à des décisions plus rationnelles. Les valeurs seuils (déduites de l’évaluation des besoins et de l’ETS) servent dans ce contexte de principes directeurs, mais non contraignants. Méthode : Discussion sur les notions théoriques d’attribution de priorités, d’évaluation des besoins et d’ETS, complétée par des exemples pratiques mettant en évidence les défis et les besoins, mais aussi les chances d’une politique d’allocation des ressources de santé plus explicite et transparente. Résultats : L’attribution des priorités dans le domaine de la santé se base sur les valeurs d’équité, de justice et de solidarité. Les décisions relatives à des ensembles thérapeutiques sont déterminées par le besoin médical (gravité de la maladie) et/ou le caractère opportun des interventions médicales (efficacité des coûts). Avec la prise de conscience que des services et des programmes initialement opérationnels et efficaces en termes de coûts sont appliqués de manière inappropriée, l’attention se porte sur les aspects organisationnels de l’attribution et de l’application. L’évaluation des besoins se base par conséquent sur la distinction entre les besoins de santé provenant de la demande, de l’offre et de l’approvisionnement effectivement fourni. L’évaluation des technologies de la santé procède à une synthèse des preuves faisant apparaître qu’une intervention de santé est utile à un patient, lui est en toute certitude inutile, voire préjudiciable. Conclusions : Les recherches des services de santé sur les interventions efficaces en termes de thérapie et de coûts, de même que la recherche/le suivi des performances sur une fourniture appropriée de services efficaces en termes de thérapie et de coûts revêtent une importance croissante pour guider le processus décisionnel sur l’attribution des priorités et l’évaluation des besoins. Une couverture de santé efficace pour tous n’est viable que si nous commençons à mettre les dépenses en perspective et à concentrer les politiques de la santé et les stratégies de recherche sur la gestion des attentes, en informant les patients et en promouvant une estimation plus réaliste des progrès médicaux, et d’autre part en encourageant les innovations fondées sur les besoins et sur le rendement des coûts.