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Background Value-based healthcare (VBHC) is a conceptual framework to improve the value of healthcare by health, care-process and economic outcomes. Benchmarking should provide useful information to identify best practices and therefore a good instrument to improve quality across healthcare organizations. This paper aims to provide a proof-of-concept of the feasibility of an international VBHC benchmarking in breast cancer, with the ultimate aim of being used to share best practices with a data-driven approach among healthcare organizations from different health systems. Methods In the VOICE community—a European healthcare centre cluster intending to address VBHC from theory to practice—information on patient-reported, clinical-related, care-process-related and economic-related outcomes were collected. Patient archetypes were identified using clustering techniques and an indicator set following a modified Delphi was defined. Benchmarking was performed using regression models controlling for patient archetypes and socio-demographic characteristics. Results Six hundred and ninety patients from six healthcare centres were included. A set of 50 health, care-process and economic indicators was distilled for benchmarking. Statistically significant differences across sites have been found in most health outcomes, half of the care-process indicators, and all economic indicators, allowing for identifying the best and worst performers. Conclusions To the best of our knowledge, this is the first international experience providing evidence to be used with VBHC benchmarking intention. Differences in indicators across healthcare centres should be used to identify best practices and improve healthcare quality following further research. Applied methods might help to move forward with VBHC benchmarking in other medical conditions. [ABSTRACT FROM AUTHOR]

Due to limited resources and constant, ever-changing healthcare challenges, health economics is essential to support healthcare decisions while improving health outcomes. Economic evaluation methodology facilitates informed decision-making related to the efficient allocation of resources while positively impacting clinical practice. In this paper, we provide an overview of economic evaluation methods and a real-world example applying one method of economic evaluation (cost-utility analysis) in nursing research. [ABSTRACT FROM AUTHOR]

Experts in different fields have claimed that the UK has experienced a process of growing economic inequality since the 1970s. Following Fairclough's dialectal-relational approach, this paper presents a detailed, systematic analysis of the representation of homeless people and homelessness in The Guardian and Daily Mail from 2000 to 2018, in order to explore how these have been discursively represented over time. Therefore, our study addresses two specific research questions: How have homelessness and homeless people been represented in the UK press? Are there any discoursal changes in representation with the passing of time? The analysis, which has employed mostly qualitative but also quantitative (statistical) methods drawing on corpus-assisted discourse analysis, is informed by the theory of transitivity within Systemic Functional Linguistics. Results indicate that, within an overall negative representation of homeless people and homelessness in this period, there have been some significant discoursal changes over time. As such, this paper contributes to critical discourse studies and transitivity research on a relevant social problem, that of growing economic inequality in the UK. [ABSTRACT FROM AUTHOR]

Liberal theory has long fetishized state law as a fortress against disorder, anarchy, and private violence. To prevent violence writ large, it advocated, the nation-state should be endowed with its monopoly, as the impartial and rational guardian of civilization and social peace. Yet, as critics suggest, the normative binary of law/violence and the legal purity of the state is empirically untenable and, as such, remains an ideological construct sustained and perpetuated through law and its fictions. In this paper, I revisit these debates to reflect on legal fictions in the context of migration policing. I draw on ethnographic research I conducted with immigration and police officers in the UK. Amid the growing economies of illegality that rely on migrant labour which these officers are in charge of suppressing, their everyday work reveals spaces of legal murkiness and ambiguity. The paper explores the paradoxes, dilemmas and contradictions that such legal ambiguity gives rise to and their implications for state sovereignty. [ABSTRACT FROM AUTHOR]

The main goal of this paper is to improve the understanding of the spatial distribution of small-scale inshore fisheries (SSF) in coastal waters of the Bay of Biscay. The study used a participatory process, in which fishers, regional administration, and researchers were involved in supplying the data. Displayed on a 1-km2 grid, the data for effort and catch composition, variable costs, revenue, and profits at each site show the spatial patterns of the main SSF metier activities. This information indicates the economic value of the fishing grounds and the cost of reaching those areas, which can reveal possible trade-offs for more distant fishing grounds. Trammelnet vessels are widely dispersed, following economic incentives, while longliners also demonstrate high mobility, using many fishing sites, though the economic incentive does not always lead to high benefits. A narrow expansion range with activity close to the coastal area (trap, gillnet, and trammelnet users) suggests that the target-species stocks maintain their economic profitability even though it is lower than that in other coastal fleets. Such information helps develop a holistic approach to SSF management in this multi-use region by increasing the availability of high-quality multidisciplinary geospatial data, currently in short supply for this fleet. [ABSTRACT FROM AUTHOR]

Interest in the political economy of crime goes back to sociology's founding fathers, but the nature of the relationship between restrictive social security systems and crime remains contested. This paper exploits exogenous variation in the introduction of Universal Credit (UC) to local areas across England and Wales to address this question. We first use fixed effects models, with a range of controls, to show that as UC enrolments increase in a given area, so does the crime rate. We then use interrupted time series analysis to show that, despite UC being rolled out at different times in different places, its introduction in each local area coincides with a positive shift in the trend in crime. These findings hold for total crime, property crime and violent crime. Borrowing from Strain Theory and Routine Activities Theory, we suggest that changes to the pool of motivated offenders may help to explain these correlations. [ABSTRACT FROM AUTHOR]

The focus to date on interactive encounters has resulted in there being little research into monological texts and speeches produced in English as a lingua franca (ELF) contexts. They are, however, the very substance of what interpreters and translators increasingly deal with today. The quality of these language professionals' performance depends to a large extent on the input they receive. From a translation and interpreting studies (TIS) perspective, understanding what makes an ELF text or speech special and different seems paramount. In this paper, we present an innovative approach to exploring what is in an ELF text. We introduce the concepts of 'ELF density' and 'ELF dense spots' to capture and visualize types and tokens of ELF features as well as clusters they form at a local and more global level across stretches of text or speech and discuss a number of methodological challenges in determining ELF density. Based on a preliminary retrospective verbal protocol and interview analysis following 26 professional interpreters' renditions, we aim to demonstrate the concepts' added value for TIS, but also for non-TIS related applied linguistic tasks geared towards ELF. [ABSTRACT FROM AUTHOR]

Summary: This article reports on findings that indicate how First Nations musical activities function as cultural determinants of health. Drawing on early findings from a 3-year Australian Research Council funded project titled The Remedy Project: First Nations Music as a Determinant of Health, we detail Australian and Ni Vanuatu First Nations musicians' reported outcomes of musical activity using a First Nations cultural determinants of health framework. The broader findings indicate that our respondents see musical activity as actively shaping all known domains of cultural health determinants, and some surrounding political and social determinants. However, this paper focusses specifically on the political and economic determinants that emerged in analysis as the most dominant subthemes. We argue that this study provides strong impetus for continued investigation and reconceptualization of the place of music in cultural health determinant models. Lay Summary: This article looks at how making and performing music, recording music and listening to music helps the health of First Nations peoples in Australia and Ni Vanuatu. Music is an important part of the lives of First Nations peoples from these places and so research was done to try to understand why it is meaningful. Music can be used as an outlet for personal feelings, and can also be a way that groups of people can express common concerns. First Nations musicians talked about how music makes them feel, and how music is used to strengthen relationships between people, and between people and their culture. Musicians also talked about how music helps them express their political and economic goals. The findings backed up existing First Nations' models of health that say that health for First Nations People's needs to be thought about in a holistic way. The findings also showed that the relationship between music and health needs to be studied more so that we can better understand how it helps maintain links with the past, gives a guide for the present and opens options for the future. Graphical Abstract [ABSTRACT FROM AUTHOR]

Background Persons with HIV and tuberculosis (TB) co-infection require transaminase monitoring while on hepatotoxic medications. A novel paper-based, point-of-care transaminase test is in development at an anticipated cost of $1 per test. Methods To project long-term clinical outcomes and estimate the cost-effectiveness of using a paper-based fingerstick test to monitor for drug-induced liver injury (DILI), as compared with automated testing and with no laboratory monitoring. The design was a decision analytic model, including deterministic and probabilistic sensitivity analyses. Data sources were observational cohorts and a validation study of the paper-based test. The target population was HIV/TB co-infected persons in South Africa on antiretroviral therapy who were initiating TB therapy. Interventions: (1) clinical (no laboratory) monitoring; (2) monitoring using the paper-based test with a ≥120 IU/mL threshold for positivity; (3) monitoring using the paper-based test with a ≥200 IU/mL threshold for positivity; (4) monitoring using the paper-based test using 1 of 3 categories: <120 IU/mL, 120 to 200 IU/mL, and >200 IU/mL (“bin placement”); (5) monitoring using automated ALT testing using the same 3 categories (“automated testing”). The outcome measures were discounted quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs). Results The ICER of automated testing was $5180/QALY. Use of the paper-based test with the bin placement strategy was cost-effective compared with clinical monitoring alone. Conclusion At its current performance, monthly DILI monitoring by bin placement using the paper-based test was cost-effective, compared with clinical monitoring, in HIV/TB co-infected persons in South Africa. [ABSTRACT FROM AUTHOR]

International research and collaboration has been a part of the National Cancer Institute's (NCI) mission since its creation in 1937. Early on, efforts were limited to international exchange of information to ensure that US cancer patients could benefit from advances in other countries. As NCI's research grant portfolio grew in the 1950s, it included a modest number of grants to foreign institutions, primarily in the United Kingdom and Europe. In the 1960s, the development of geographic pathology, which aimed to study cancer etiology through variations in cancer incidence and risk factors, led to an increase in NCI-funded international research, including research in low- and middle-income countries. In this paper, we review key international research programs, focusing particularly on the first 50 years of NCI history. The first NCI-led overseas research programs, established in the 1960s in Ghana and Uganda, generated influential research but also struggled with logistical challenges and political instability. The 1971 National Cancer Act was followed by the creation of a number of bilateral agreements with foreign governments, including China, Japan, and Russia, to support cooperation in technology and medicine. Although these agreements were broad without specific scientific goals, they provided an important mechanism for sustained collaborations in specific areas. With the creation of the NCI Center for Global Health in 2011, NCI's global cancer research efforts gained sustained focus. Because the global cancer burden has evolved over time, increasingly impacting low- and middle-income countries, NCI's role in global cancer research remains more important than ever. [ABSTRACT FROM AUTHOR]

How do public health advocates and practitioners encourage policy actors to address the social determinants of health? What strategies can be used to elevate healthy social policies onto government agendas? In this paper, we examine the case of Australia's first national paid parental leave scheme, announced in 2009 after decades of policy advocacy. This scheme provides job-protected leave and government-funded pay at the minimum wage for 18 weeks for eligible primary care givers on the birth of an infant, and has been shown to reduce health inequities. Drawing on documentary sources and interviews (n  = 25) with key policy actors, this paper traces the evolution of this landmark social policy in Australia, focusing on the role of actors, institutions and policy framings in setting the policy agenda. We find that advocates strategically deployed three different framings—for economy, gender equality and health—to drive paid parental leave onto the Government's agenda. They navigated barriers linked to power, gender ideology and cost, shifting tactics along the way by adopting different frames in various institutional settings and broadening their coalitions. Health arguments varied in different institutional settings and, at times, advocates selectively argued the economic or gender equality framing over health. The case illustrates the successful use of strategic pragmatism to provoke action, and raises broader lessons for advancing action on the social determinants of health. In particular, the case highlights the importance of adopting multiple synergistic policy framings to draw support from non-traditional allies and building coalitions to secure public policy change. [ABSTRACT FROM AUTHOR]

R.S. Peters and Paul Hirst were the most influential figures in philosophy of education in the 1960s, 1970s and 1980s. The claim in this paper is that their rationalist's approach was often misleading and unilluminating. They believed they were preparing children for life beyond school, but to a large extent they failed because they did not take into account the diversity of values and practices of life in general. The paper contains some reflections by Rush Rhees, a student of Wittgenstein, on some of their writings. Rhees had first met Wittgenstein when he attended his classes in 1936. They formed a lifelong friendship, and Rhees subsequently devoted much of his life to the dissemination, interpretation, and criticism of Wittgenstein's work. The reflections discussed here derive primarily from views Rhees expressed in the 1970s. [ABSTRACT FROM AUTHOR]

Background Developing age-friendly communities is a significant global policy issue. The WHO (2007) age-friendly cities and communities initiative has had a significant influence on the development of Ireland's Age-Friendly Programme. With research on such programmes still at an early stage, this paper critically examines the utilisation of the WHO age-friendly planning framework in an Irish context. It explores older adults' experience of living in two towns in an 'age-friendly' county and, in parallel, examines stakeholders' perspectives on the development of the county's age-friendly programme. This multi-perspectival approach facilitates an assessment of how the age-friendly county programme addresses older residents' needs, and illustrates how the WHO conceptual and planning framework has worked in an Irish context. Methods The paper reports on a study which employed a mixed-method, qualitative case-study research design, using a constructivist grounded theory approach to explore the lived experience of older adults, and a case-study framework for the stakeholder perspective. Results The research identifies salient social and cultural dimensions of the day-to-day lived experience of older people which, although they impact on the age-friendliness of the places in which they live, are neglected in the WHO framework. It also identifies a unique combination of economic, political, cultural, and organisational factors which have impacted on age-friendly programme development in Ireland. Conclusion In critically analysing use of the WHO age-friendly model, the paper suggests ways in which the model can be modified to better accommodate the diverse experience of older adults not only in Ireland, but also in other geographic and cultural contexts. [ABSTRACT FROM AUTHOR]

Faster and more widespread implementation could help more patients to benefit more quickly from known effective treatments. So could more effective implementation of better assessment methods, service delivery models, treatments and services. Implementation at scale and 'descaling' are ways for hospitals and health systems to respond to rising demands and costs. The paper proposes ways to provide leaders with the information that would help them to decide whether and how to scale up a proven improvement. We draw on our knowledge of the improvement and implementation literature on the subject and on our experience of scale up programs in Kaiser Permanente, in Swedish county health systems, and in international health. We describe a '3S' scale up infrastructure and other ingredients that appear necessary for successful widespread improvement, and list the resources that we have found useful for developing scale up programs. The paper aims to encourage more actionable research into scale up, and shows the opportunities for researchers to both advance implementation and improvement science and contribute to reducing suffering and costs in a more timely and effective way. [ABSTRACT FROM AUTHOR]

Background There is an increasing number of older persons experiencing transfer episodes between residential and acute care facilities (Griffiths et al. 2014). Current transfer documentation is diverse; often only containing basic information and very little person centred patient information. The objective of this HSE National Clinical Programme for Older People funded study was to develop a national person centred transfer tool, for use during patient transfer between residential and acute services. Following an extensive literature review, focus group interviews with stakeholders and input from an expert panel, a pilot transfer document was developed. This paper reports on the pilot study of this document. Methods Researchers, in consultation with the expert panel, developed questionnaires. Questionnaires were quantitative, with three open-ended questions. Of the 28 residential settings and 3 acute settings that were contacted, 26 residential and 3 acute settings (93%) participated in the study. The pre-pilot questionnaire asked staff in residential settings their perceptions on current transfer documentation (n=875). The post-pilot questionnaire asked staff in residential and acute care settings their thoughts on the new transfer document which was used for the pilot (n=1085). Results Findings suggest that staff agree that the new transfer tool is person centred, contains relevant patient information and could help communication between healthcare professionals in these settings. Findings also indicate that the length of time to complete the document is of concern, particularly in an emergency and there were suggestions from staff in residential care services that some sections could be prepopulated. Conclusion In order to have a transfer document that is efficient, and person centred, there is a need for it to be available electronically and easy for staff to fully complete particularly in an emergency transfer. [ABSTRACT FROM AUTHOR]

What exactly is reasoning? While debate on this question is ongoing, most philosophers seem to agree on at least the following: reasoning is a mental process operating on contents, which consists in adopting or revising some of your attitudes in light of others. In this paper, I argue that this characterisation is mistaken: there is no single mental phenomenon that satisfies both of these conditions. Instead, I characterise two distinct mental phenomena, which I call 'deducing', on the one hand, and 'reasoning' or 'inference' on the other, to play each of these roles. Recognising this division of labour is essential to developing a better understanding of our rational economy. [ABSTRACT FROM AUTHOR]

When a regional sponsor of militant movements experiences profound domestic instability, what happens to its clients? This paper explores this question by examining the case of Syria and its clients using a principal- agent approach. It examines three types of principal--single, collective, and multiple--focusing on the varying effects that these relationships have on the agents involved and arguing that each type of principal presents prospective agents with a trade-off between a loss of autonomy and a loss of internal cohesion. By comparing the effects of Syrian sponsorship on nonstate actors who have served as Syrian agents at various points in the evolution of the regime, I demonstrate that each type of principal has distinct advantages and risks for its agents. The paper concludes by outlining five possible outcomes of the current uprising in Syria for the Asad regime's clients, based on the uprising's impact on the regime as a principal. [ABSTRACT FROM AUTHOR]

Introduction: The demand for alternative nicotine/tobacco products is not well established. This paper uses a behavioral economic approach to test whether smokers have differential demand for conventional factory-made, electronic, and very low nicotine content cigarettes (FMCs/ECs/VLNCs) and uses the prospective cohort design to test the predictive validity of demand indices on subsequent use of commercially available FMCs and ECs.Methods: Daily smokers (≥16 years) from the Netherlands completed an online survey in April 2014 (N = 1215). Purchase tasks were completed for FMCs, ECs, and VLNCs. Participants indicated the number of cigarettes they would consume in 24 h, across a range of prices (0-30 euro). The relationship between consumption and price was quantified into four indices of demand (intensity, Pmax, breakpoint, and essential value). A follow-up survey in July 2015 measured FMC and EC use.Results: At baseline, greater demand was observed for FMCs relative to ECs and VLNCs across all demand indices, with no difference between ECs and VLNCs. At follow-up, greater baseline FMC demand (intensity, essential value) was associated with lower quit rates and higher relapse. EC demand (Pmax, breakpoint, essential value) was positively associated with any EC use between survey waves, past 30 day EC use, and EC purchase between waves.Conclusions: Smokers valued FMCs more than ECs or VLNCs, and FMCs were less sensitive to price increases. Demand indices predicted use of commercially available products over a 15 month period. To serve as viable substitutes for FMCs, ECs and VLNCs will need to be priced lower than FMCs.Implications: Purchase tasks can be adapted for novel nicotine/tobacco products as a means to efficiently quantify demand and predict use. Among current daily smokers, the demand for ECs and VLNCs is lower than FMCs. [ABSTRACT FROM AUTHOR]

This article reviews the impact of digital technologies on Chinese newspapers. The diffusion of the smartphone has precipitated severe economic problems for the printed press. There have been falls in both readership and advertising revenues, which have had an effect on the structure of provincial-level press groups. The decline in economic viability has been felt most acutely by the commercially-oriented titles, while the more politically-oriented papers have led the way in finding new sources of funding. These sources tend to tie journalism more tightly to political and economic power, and lead to commercial goals replacing journalistic ones. This shifting balance of economic power has important consequences for the possibility of independent and critical journalism. The empirical material is specific to China, but it highlights more general theoretical questions as to the political economy of the media. [ABSTRACT FROM AUTHOR]

Background This paper provides the socio-economic context of the MIGHEAL study, the results of which are presented in this special issue. The aim of the MIGHEAL study was to compare the physical and mental health of the native and migrant populations of Greece in the wake of the economic crisis that commenced in 2008. Methods The background of the migrant population of Greece is described, drawing on population censuses of Greece and data on residence permits held by foreigners. Then the migrant and native populations are compared with respect to several socio-economic outcomes, using Eurostat data on unemployment and the risk of poverty. Results The settled migrant population of Greece is largely of Central and Eastern European origin, resulting from the massive migrant inflowsthat started at the beginning of the 1990s after the collapse of socialist regimes in the area. Before the economic crisis, migrant unemployment was lower than that of natives, but after its onset, the unemployment of migrants surpassed that of natives. Prior to the crisis, migrants were already subject to greater risk of poverty than natives, but the gap widened considerably subsequent to the crisis. Conclusion The Greek institutional framework has restricted access to citizenship for both first- and second-generation migrants while conditions for permit renewal are onerous, rendering citizenship an important factor differentiating socio-economic outcomes. The different outcomes observed among the native and migrant populations after the onset of the Greek economic crisis create concerns regarding health inequalities between the two populations. [ABSTRACT FROM AUTHOR]

There are three main areas of social and economic policy that influence health: the welfare state, industrial organization (unions), and labor regulation. Public health literature and analysis traditionally focuses on the taxing and spending of the welfare state. This paper presents highlights from the extensive literature in political economy in order to argue that industrial relations and workplace regulation are political and crucial to public health. The routes by which they influence public health include wage inequality, workplace health and safety, political engagement and investment in human capital. The magnitude of impact can be impressive: the United Kingdom's taxation and spending have about as much redistributive impact as that of Sweden, but that is not enough to compensate for the inequality produced by the UK's liberal labor market. The trend across wealthy countries has been to weaker unions and less workplace regulation and we can see this as a likely cause of public health problems and health inequalities into the future. [ABSTRACT FROM AUTHOR]

Despite the growing rates of obesity and diet-related non-communicable diseases, globally, public health attention has only relatively recently turned to the links between trade agreements and the nutritional risks associated with it. Specific trade agreements appear to have played an influential role in the volume and types of foods entering different countries, yet there is currently no systematic and objective monitoring of trade agreements for their impacts on food environments. Recently, INFORMAS was set up to monitor and benchmark food environments, government policies and private sector actions within countries and globally. One of its projects/modules focuses on trade policy and in particular the food-related aspects of trade agreements. This paper describes the INFORMAS trade protocol, an approach to collecting food-related information about four domains of trade: trade in goods; trade in services and foreign direct investment; domestic supports, and policy space. Specifically, the protocol is tested in Fiji. The development and testing of this protocol in Fiji represents the first effort to set out a framework and process for objectively monitoring trade agreements and their impacts on national food supply and the wider food environment. It has shown that entry into WTO trade agreements contributed to the nutrition transition in Fiji through the increased availability of imported foods with varying nutritional quality. We observed an increase in imports of both healthy and less healthy foods. The application of the monitoring protocol also highlights challenges for data collection associated with each trade domain that should be considered for future data collection and analysis in other low and middle income countries. [ABSTRACT FROM AUTHOR]

Background Tobacco use is a leading but preventable cause of non-communicable diseases and premature death. The legislature has a key role in setting tobacco control policies. Smoking trends are decreasing thanks to the introduction of effective tobacco control policies in Turkey and these policies may have been shaped by how politicians' interpreted social problems that were prominent during the development and implementation of tobacco regulations. Aim This paper explores the long-term national relationship between tobacco consumption, tobacco control policies and the associated political discourse in Turkey, considering the varying influences through national leadership on this important public health agenda. This relationship is studied by comparing a time series analysis of tobacco consumption trends with a policy analysis of the minutes of deliberations at the Grand National Assembly of Turkey (GNAT). Methods This study uses Bayesian time series analysis in order investigate whether the tobacco control policies and related activities influenced the annual per adult cigarette consumption in Turkey. We used a novel method to identify change points in tobacco trends and whether they correspond with key policy changes intended to alter usage after adjusting for the effect of other non-policy related covariates, such as the purchasing power. The policy analysis included an examination of the minutes of deliberations at the GNAT—which is the Turkish parliament and unicameral Turkish legislature—1 year before and 1 year after the break years associated with an increase or decrease in tobacco consumption. Results and recommendations Tobacco consumption increased with the encouragement of tobacco production and the entrance of multinational companies in the country in 1976 and 1993, respectively. The National Tobacco Law of 1996 and comprehensive amendments in 2008, including smoke-free public places and tax increases, appear to have helped reduce tobacco consumption in Turkey. The focus of Parliamentary discussions throughout this period changed, becoming less supportive of tobacco over time. However, throughout the period there remained discussions focussing on concerns around the implications for the economy and the privatization agenda, national agriculture and the welfare of farmers. Effective control appears to require certain political ingredients to be implemented: politicians who are well informed on tobacco control measures and understand the range of issues surrounding the policies (not only those directly health-related); and supportive public health information in the community. Evidence-based public health policy should be introduced to the politicians. [ABSTRACT FROM AUTHOR]

This paper explores economic aspects of a recent proposal to shift fisheries to a "Balanced Harvesting" (BH) strategy, as a means to achieve the goal, set by the Convention on Biological Diversity and related to the Ecosystem Approach to Fisheries, of "conservation of ecosystem structure and functioning" within fishery ecosystems. Studies indicate that a BH strategy-broadening the range of species and sizes caught in the aquatic ecosystem, and lowering exploitation rates for some conventionally targeted species-may provide improved ecological performance relative to conventional harvesting strategies. However, the potential economic implications have received little attention to date. This paper provides a preliminary economic assessment of BH, focusing on six main themes: (i) assessing benefits and costs, (ii) factors affecting the economics of BH, (iii) economic issues in implementing the ingredients of BH, (iv) effects of incremental and/or partial implementation of BH, (v) transition options within the harvesting sector of the fishery, and (vi) distributional impacts arising across fisheries, fleet sectors, and fishing gears, and between the present and the future. [ABSTRACT FROM AUTHOR]

This paper draws on theories of socio-economic change stemming from political economy and economic sociology to examine the financialization of the US forest products industry. I argue that the widespread adoption of shareholder value norms of corporate governance constitutes one of the core ideological foundations for explaining how the financialization of non-financial firms was accomplished. At the same time, I suggest that economic sociologists' emphasis on the role of shareholder value ideology tends to obscure the concrete realities of contemporary capitalism and the socio-economic relations that underlie managerial conceptions of control. In this paper, I adopt a dialectical methodology that works at multiple levels of abstraction in order to highlight the internal relationship that exists between managerial conceptions of control and the material processes of capital accumulation. Using data mined from corporate proxy statements, I show that increases in concentrated stock ownership among institutional investors and the use of incentive-based compensation--among other important factors--underlie the adoption of shareholder value strategies in the US forest products sector. I then demonstrate how the pursuit of shareholder value reshaped the US forest products in the interests of the financial community while undermining long-term stability of the industry and the people who depend on it. [ABSTRACT FROM AUTHOR]

This paper focuses on the China/Pakistan Economic Corridor (CPEC) arrangement between Pakistan and China from a legal and policy standpoint. It takes into account the Chinese Silk Road Economic Belt and 21st Century Maritime SilkRoad Vision under whichCPECis set. The paper highlights the relevance of the application of both Pakistani law and international law to CPEC. In particular the paper focuses on some fundamental legal questions, for example the very legal character of CPEC. The discussion on the fundamental legal questions is followed by the various streams of legal frameworks that have a bearing on CPEC including the Pakistani Constitution and world trade and international investment norms. The purpose of this paper is to provide a framework of issues raised by CPEC. It is not intended as an exhaustive analysis of all the issues raised. [ABSTRACT FROM AUTHOR]

New systemic therapies have prolonged the lives of men with metastatic castration-resistant prostate cancer (mCRPC). Use of these therapies in the adjuvant setting when the disease may be micrometastatic and potentially more sensitive to therapies may decrease mortality from prostate cancer. However, the conduct of adjuvant prostate cancer clinical trials is hampered by taking longer than a decade to reach the meaningful endpoint of overall survival (OS) and the fact that many men never die from prostate cancer, even if they relapse. A validated intermediate clinical endpoint (ICE) in prostate cancer that is a robust surrogate for OS has yet to be defined. This paper details the plans, process, and progress of the international Intermediate Clinical Endpoints in Cancer of the Prostate (ICECaP) working group to pool individual patient data from all available clinical trials of radiation or prostatectomy for localized disease and conduct the requisite analyses to determine whether an ICE can be identified. This paper further details the challenges and the a priori statistical analytical plans and strategies to define an ICE for adjuvant prostate cancer clinical trials. In addition, a brief review of the health economic analyses to model the benefits to patients, society and manufacturers is detailed. If successful, the results from this work will provide a robust surrogate for OS that will expedite the design and conduct of future adjuvant therapy trials using new agents that have proven activity in mCRPC. Moreover, it will also define the health economic benefits to patients and societies. [ABSTRACT FROM AUTHOR]

This paper develops a theoretical account of the reconstruction of workforce downsizing as a shareholder-value strategy since the 1980s. This account has two components. First, building on resource-dependence theory, I suggest that growing corporate dependence on institutional investors makes firms susceptible to their demand for greater returns, especially when these institutional investors are blockholders and resistant to counter-pressure from managers. Second, building on Fligstein's theory of conceptions of control, I suggest that the rise of shareholder value reorients managerial behavior, by changing the decision context in a way that induces managers to maximize shareholder value. Crucial to constructing this new decision context are a set of agency-theory prescriptions for reforming corporate governance. My analysis of downsizing announcements, drawing on a sample of 714 US firms between 1981 and 2006, shows that both the pressure from institutional investors and the new decision context encourage firms to downsize more frequently. By demonstrating how both pressure from investors and changed managerial decision contexts have contributed to the prevalence of workforce downsizing, this paper makes a strong case for the financialization of the American corporation, and contributes to the sociological research on growing job insecurity and income inequality over the past three decades. [ABSTRACT FROM AUTHOR]

Some recent papers have concluded that authoritarian regimes have faster economic growth than democracies. These supposed growth benefits of autocracies are estimated using data sets in which growth rates rely heavily on data reported by each government. Governments have incentives to exaggerate their economic growth figures, however, and authoritarian regimes may have fewer limitations than democracies on their ability to do so. This paper argues that growth data submitted to international agencies are overstated by authoritarian regimes compared to democracies. If true, it calls into question the estimated relationship between government type and economic growth found in the literature. To measure the degree to which each government's official growth statistics are overstated, the economic growth rates reported in the World Bank's World Development Indicators are compared to a new measure of economic growth based on satellite imaging of nighttime lights. This comparison reveals whether or not dictators exaggerate their true growth rates and by how much. Annual GDP growth rates are estimated to be overstated by 0.5-1.5 percentage points in the statistics that dictatorships report to the World Bank. [ABSTRACT FROM AUTHOR]

The objective of this paper was to derive economic weights for performance and survival traits of growing pigs including feed conversion ratio (FCR), daily feed intake (DFI), ADG, postweaning survival of the growing pig (SG), and carcass fat depth at the P2 site (CFD). An independent model was developed for each trait to derive economic values directly based on a typical Australian production system. This flexible approach may be used to customize economic values for different production systems and alternative trait combinations in breeding objectives. Discounted genetic expressions were used as a means of taking into account differences in frequency and timing of expression of traits to obtain economic weights. Economic values for SG were derived based on a costsaving and a lost-revenue approach. The correct formulation of the economic value of ADG depends on how feed cost is included in the breeding objective. If FCR is defined as a breeding objective trait, then savings in feed costs through earlier slaughter should not be counted in the economic value of ADG. In contrast, if DFI is included in the breeding objective instead of FCR, then feed-cost savings through earlier slaughter need to be attributed to the economic value for ADG, as a benefit from faster ADG. The paper also demonstrates that economic weightings in indexes for FCR can potentially be overestimated by 70% when it is assumed that DFI or FCR records taken from a limited duration test period reflect the corresponding trait over the full lifetime of the growing pig destined for slaughter. Postweaning survival of the growing pig was the most important breeding objective trait of growing pigs. The relative importance of each breeding objective trait in a sire-line index based on the genetic SD of each trait was 44.5, 27.0, 17.4, and 11.1% for SG, FCR, ADG, and CFD, respectively Further studies to better clarify the extent of genetic variation that exists in SG under nucleus-farm and commercial-farm conditions are warranted, given the high economic importance of this survival trait of growing pigs. [ABSTRACT FROM AUTHOR]

This paper examines a topic of continuing interest for demographers and sociologists of the family: which factors promote relationship stability among couples. Two competing theories have been highly debated to explain how relative earnings relate to relationship quality and stability. The neoclassical economic theory posits that specialization of home and work duties leads to stability because partners fill complementary roles. Gender scholars propose an alternative explanation, suggesting that when couples violate the traditional male-breadwinner model, they experience relationship strain and are more likely to experience a breakup. Using the new How Couples Meet and Stay Together (HCMST) data set, this paper offers a unique perspective on the debate, by comparing same-sex couples to heterosexual couples. The paper presents three sets of analyses to determine how relative earnings relate to relationship stability. The first analysis employs discrete-time event history models to assess the likelihood of breakup for both heterosexual and same-sex cohabiting couples. Next, the paper presents results predicting self-reported relationship quality among married and cohabiting couples. The final analysis focuses on non-cohabiting couples from wave I of the HCMST survey and examines the likelihood of entering cohabitation in subsequent survey waves. Results demonstrate that the economic or specialization model does not hold in same-sex relationships, suggesting that the effect of earnings equality is dependent upon gender norms in heterosexual relationships. When earnings power is disentangled from gender, as in the case of same-sex couples, equality in earnings promotes stability. [ABSTRACT FROM PUBLISHER]

Objective: Pall Mall gained significant brand share in the cigarette market between 2002 and 2013. We sought to determine whether demographic shifts occurred among the participants reporting Pall Mall as their usual brand during this time span.Method: We examined National Survey of Drug Use and Health (NSDUH) data from 2002-2014. Demographic characteristics included age, education, ethnicity, income, and cigarette use (cigarettes per day, daily/non-daily smoking, and nicotine dependence). We also examined RJ Reynolds investor reports and shareholder documents to determine the impact of tobacco marketing on the growth of Pall Mall.Results: Over 2002-2014, Pall Mall has gained among smokers 26 to 34 years of age. More Pall Mall smokers in 2014 report higher incomes (over $75000), and also report lower scores on measures of cigarette dependence, compared to 2002. Pall Mall smokers over time seem to share characteristics of premium cigarette brands smokers.Conclusion: The profile of the typical Pall Mall smoker has changed as the brand has gained market share. An association exists between brand positioning and economic forces, which has contributed to an increase in the market share for Pall Mall.Implications: It is well known that cigarette marketing drives the sale of tobacco products. The growth in the market share of Pall Mall serves as an excellent example to demonstrate how economic uncertainty paired with brand positioning and advertising worked together to serve as a catalyst for the rapid growth observed for this brand. This paper also looked at various demographic changes that occurred among Pall Mall smokers over a 12 year period and compared them to smokers of all other cigarette brands. The results of this analysis demonstrate the importance of monitoring trends over time among cigarette smokers. [ABSTRACT FROM AUTHOR]

Background: Consistent evidence shows the importance of preventing smoking at young ages, when health behaviours are formed, with long-term consequences on health and survival. Although tobacco control policies and programmes targeting adolescents are widely promoted, the cost-effectiveness of such interventions has not been systematically documented. We performed a systematic review on the cost-effectiveness of policies and programmes preventing tobacco consumption targeting adolescents. Methods: We systematically reviewed literature on the (i) cost and effectiveness of (ii) prevention policies targeting (iii) smoking by (iv) adolescents. PubMed, Web of Science, Cochrane, CEA-TUFTS, Health Economic Evaluations, Wiley Online Library, Centre for Reviews and Dissemination Database, the National Institute for Health and Care Excellence and Google Scholar databases were used, and Google search engine was used for other grey literature review. Results: We obtained 793 full-text papers and 19 grey literature documents, from which 16 studies fulfilled the inclusion criteria. Of these, only one was published in the last 5 years, and 15 were performed in high-income countries. Eight analyzed the cost-effectiveness of school-based programmes, five focused on media campaigns and three on legal bans. Policies and programmes were found to be cost-effective in all studies, and both effective and cost-saving in about half of the studies. Conclusions: Evidence is scarce and relatively obsolete, and rarely focused on the evaluation of legal bans. Moreover, no comparisons have been made between different interventions or across different contexts and implementation levels. However, all studies conclude that smoking prevention policies and programmes amongst adolescents are greatly worth their costs. [ABSTRACT FROM AUTHOR]

In order to fully assess the potential of a photovoltaic (PV) application on a building's façade, the amount of energy generated and the cost of the PV installation must be analysed during the design process to enable the designer, investor and end-user to make decisions regarding the implementation of renewable technologies. This paper focuses on the financial evaluation of a vertical PV façade system on a high-rise building in Malaysia, using the System Advisor Model developed by the National Renewable Energy Laboratory of Malaysia, based on five possible design scenarios that all use an amorphous silicon heterojunction module with a nominal efficiency of 15.6%. According to our financial analysis, the payback period for a vertical PV system would be about 12 years, while that of a horizontal system would be 6 years. On average, a PV system on a vertical façade would be able to save 8400-17 000 USD each month compared to a PV roof installation (about 5200 USD each month). This shows that PV installations on vertical façades of high-rise buildings could be implemented in Malaysian climate conditions. With a careful design approach, this could open up a new demographic in the Malaysian built environment and Renewable Energy industries. [ABSTRACT FROM AUTHOR]

Objectives: This paper explores, from the patients' perspective, the likely impact of the Australian after-hours house-call (AHHC) medical services on emergency department (ED) presentations. This has become imperative given the significant cost difference between patient presentations to either the AHHC or ED and their practical implications for health care funding.Design, setting and participants: A cross-sectional, self-reported survey of all 10 838 patients in Australia known to have patronized AHHC services over the last week of January 2016.Main outcome measure: The study used a validated, self-completion questionnaire, dispatched through a mixture of online and postal methods.Results: A total of 1228 questionnaires were returned, of which 1211 included all relevant sections of the survey (11.2% response rate). Four hundred and eighty-six patients (40.1%) indicated that they would have gone to the ED on the same day or night of their illness had the AHHC not been available, with the elderly (≥65) and children (<16) accounting for nearly two-thirds of these (64.6%). Following their AHHC consultations, 103 (8.5%) patients eventually attended the ED, meaning that the service prevented 383 patients from attending the ED, a decrease of 78.8%. Stratification based on location showed that this impact was seen across all states and territories in Australia where AHHC services exist, ranging from a reduction of 73.9% in Western Australia to 85.0% in Tasmania. Similarly, the impact cuts across all patient demographics, including age ranges, gender and social divides.Conclusions: Based on our respondents' reports, AHHC services appear to be associated with a reduction in ED visits in Australia, with the impact cutting across all regions and patient demographics. [ABSTRACT FROM AUTHOR]

Background: Healthy ageing and health promotion (HP) actions for older people have become an important health sector priority. At the same time, the application of economic evaluation methods in the field of health interventions in order to support allocative decision processes is of growing importance. The aims of the review were to analyze what the existing evidence is on cost-effectiveness of HP and/or primary prevention (PP) programmes for older people whilst providing deeper insight into methodological aspects of such studies, their overall quality and issues related to practical implementation of results. Methods: Systematic review of contemporary evidence (2000-15). Studies' eligibility criteria included target population 65 years old or older; interventions classified as HP or PP; a full economic evaluation conducted. The search strategy included five electronic databases and Internet websites of institutions or projects related to the topic. Quality assessment of the studies was based on the 'Drummond checklist'. Results: After screening 6450 records, 29 papers were included, the vast majority of which (22) focus on fall prevention strategies. In this area, there are examples of good and moderate quality studies which confirm the cost-effectiveness of diverse physical activity interventions in fall prevention. The existing studies are characterized by huge differences in the methods applied as well as overall quality which limits the comparability and generalizability of the results. Conclusions: There is a need for development and implementation of economically driven studies, with methods adjusted to particular character of HP and/or PP strategies for older population. [ABSTRACT FROM AUTHOR]

Introduction: The U.S. military offers comprehensive scholarships to medical students to help offset costs in exchange for either reserve or active duty service commitments. Our goal was to describe to what degree newly admitted students to Michigan State University's College of Human Medicine were aware of and interested in these opportunities.Materials and Methods: We surveyed 176 newly admitted students at the beginning and immediately following a presentation on military medicine opportunities. We collected anonymous paper surveys from program attendees and entered the data into Stata v13.1. The project was submitted for institutional review board review and deemed to not involve human subjects. Tests of association were performed using Chi-square test of independence and Fisher's exact test where needed.Results: Our cohort was 49% female, 51% male, and over 90% were less than 30 years of age. Only 14% reported having family involved in the military. Our results indicated that over 90% of students were aware of these programs but less than 3% took advantage of the offerings. Despite 65% reporting somewhat or significant concerns over debt, financial concerns were not statistically associated with scholarship interest level. Instead, having a family member in the military was the most significant positive predictor of interest (47% compared with 17%, p < 0.01). Among those expressing disinterest, 66% cited apprehension over control of their lives as their primary concern.Conclusion: Recruiters may wish to emphasize benefits of military service aside from financial support. Career vignettes and summaries may offer better insight into the service experience for those lacking familiarity thereby potentially increasing interest and applications. Focus groups with current scholarship awardees may inform recruitment strategies. [ABSTRACT FROM AUTHOR]

Despite the increasing salience of issues related to free trade, research on citizen preferences over trade is sparse, and largely limited to economic explanations related to objective exposure. The present paper extends this literature by examining the psychological sources of the protectionist impulse. More specifically, I theoretically and empirically examine how citizens’ chronic needs for security and certainty, key traits identified by recent work in the political realm, influence their preferences for protectionism. Examining data from three different national surveys in the U.S. context, I find strong support for the role of these dispositions. In addition to extending our understanding of the antecedents of trade preferences, the present paper has implications for the study of personality and politics, suggesting heterogeneity in the relationship of dispositions to ideology across issue domains. I also discuss the broader implications for American politics, arguing that these findings suggest latent tensions within contemporary party coalitions. [ABSTRACT FROM PUBLISHER]

This paper uses a sample of articles published in the period 1999-2013 by economists affiliated to Portuguese institutions to examine the impact of co-authorship on the quality of academic research. We build a unique database to characterize the role played by distinct affiliations and educational backgrounds in this process, while controlling for experience and individual quality levels. Mentoring relationships are identified as a possible source of negative bias on the measurement of teamwork productivity, which we proxy and quantify here. The empirical results also suggest that co-authorship across domestic institutions does not carry any significant impact on research quality, but international collaboration enhances it. A doctorate earned abroad is shown to directly improve publication outcomes, besides making it easier to establish partnerships across frontiers. These findings underscore the importance of accessing external knowledge networks, offering relevant policy insights for a large number of small and less developed countries. [ABSTRACT FROM AUTHOR]

Background: Financial difficulties in childhood may be associated with immediate and long-term consequences for mental health. The aim of the current paper is to investigate the association between childhood financial difficulties and adult depression, and assess the relative contribution of financial difficulties in childhood to symptoms of adult depression across different age groups. Methods: Using three age cohorts (25-40, 41-59, 60-75) from 19 countries in the European Social Survey Round 7 (N=18 401), multi-level and country-wise OLS regression analyses were used to investigate the association between financial difficulties in childhood and adult depression, while adjusting for age, education, gender, highest education in family, level of family conflict, number of social meetings and marital status. Results: Financial difficulties in childhood was found to be influential predictors of depression scores for 25-40 year olds in 10 out of 19 countries in fully adjusted models. In older participants, depression scores were mostly influenced by frequency of social meetings and marital status. There was great variation in the pattern of influential risk factors across countries, and the predicted effect childhood financial difficulties had on adult depression scores. Conclusion: Childhood financial difficulties as predictors of depression appear to, by themselves, exert the strongest influence in younger adults. There was, however, large variation between countries in the magnitude of associated risk, and in the pattern of risk factors contributing to adult depression, which underscores the need to account for country-level factors when aiming to gain knowledge about mental health. [ABSTRACT FROM AUTHOR]

To systematically review evidence on the influence of specific marketing components (Price, Promotion, Product attributes and Place of sale/availability) on key drinking outcomes (initiation, continuation, frequency and intensity) in young people aged 9-17.~Aim~Objective~MEDLINE, EMBASE, SCOPUS, PsychINFO, CINAHL and ProQuest were searched from inception to July 2015, supplemented with searches of Google Scholar, hand searches of key journals and backward and forward citation searches of reference lists of identified papers.~Methods~Methods~Forty-eight papers covering 35 unique studies met inclusion criteria. Authors tended to report that greater exposure to alcohol marketing impacted on drinking initiation, continuation, frequency and intensity during adolescence. Nevertheless, 23 (66%) studies reported null results or negative associations, often in combination with positive associations, resulting in mixed findings within and across studies. Heterogeneity in study design, content and outcomes prevented estimation of effect sizes or exploration of variation between countries or age subgroups. The strength of the evidence base differed according to type of marketing exposure and drinking outcome studied, with support for an association between alcohol promotion (mainly advertising) and drinking outcomes in adolescence, whilst only two studies examined the relationship between alcohol price and the drinking behaviour of those under the age of 18.~Results~Results~Despite the volume of work, evidence is inconclusive in all four areas of marketing but strongest for promotional activity. Future research with standardized measures is needed to build on this work and better inform interventions and policy responses.~Conclusion~Conclusions [ABSTRACT FROM AUTHOR]

This paper reports findings from six years of ethnographic and qualitative research on cannabis markets. Data include interviews with 60 cannabis dealers and 60 customers. The paper describes the vertical and horizontal organization of the cannabis economy, seen from the perspective of Norway. It further distinguishes between private, semi-public and public cannabis markets. The most important cultural influences in the cannabis economy are a non-commercial cannabis culture in private markets and a violent street culture in public markets. These coexist with a general market culture. The difference between markets and market cultures illustrates how illegal drug markets are performed, not 'natural', and thus the importance of economic sociology for the study of illegal drug markets. [ABSTRACT FROM AUTHOR]

The article focuses on attitude and reactions to the discovery and sale of the William Shakespeare's "Titus Andronicus", First Quarto edition, printed in 1594, which was discovered in 1904 by Petrus Johannes Krafft. It discusses the newspaper articles and private letters that projected peaked interest in volume's monetary value than the literary text. Topics include details of Krafft's letters to Lund University Library in Sweden and papers by librarian Evald Ljunggren and Henrik Schück.

Background: Research has shown that individual socio-economic circumstances throughout life affect health in older ages. However, little attention has been paid to the broad economic context affecting individual's life-chances. This paper examines whether economic downturns experienced during young and mid-adulthood have long-run effects on physical health. Methods: We exploit data on economic fluctuations in the period 1945-2010 in 11 European countries, linked to longitudinal data from three waves of the Survey of Health, Ageing and Retirement in Europe. We estimate a country fixed effect model assessing whether downturns experienced at 5-year intervals between ages 25 and 54 are associated with levels and onset of new limitations with Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in older age (55-80). Results: Experiencing an economic downturn at ages 45-59 is associated with increased risk of having at least one disability limitation in later-life (odds ratio [OR] for ADL = 1.66, 95% CI [Confidence Interval] 1.24, 2.22; OR for IADL = 1.46, 95% CI 1.10, 1.94). Economic downturns at ages 40-44 and 45-49 also increase the risk of a new functional limitation in later-life (OR for IADL ages 40-44 = 1.20, 95% CI 1.03, 1.40; OR for IADL ages 45-49 = 1.44, CI 1.10-1.88). Economic downturns experienced around these ages are also associated with significantly greater risks of smoking and excessive alcohol consumption as well as lower incomes in older age. Conclusions: Exposure to an economic downturn at ages 40-49 is associated with poorer health in older ages, possibly by increasing risk of unhealthy behaviours and low incomes persisting into older age. [ABSTRACT FROM AUTHOR]

It has been known for some time that consumers' identities influence purchasing decisions and people form strong identity connections, or "links," with products and brands. However, research has yet to determine whether identity-linked products are differentially treated at disposal in comparison to products that are not identity linked. Across seven studies, the current research shows that when an everyday product (e.g., paper, cups, aluminum cans) is linked to a consumer's identity, it is less likely to be trashed and more likely to be recycled. Further, the tendency to recycle an identity-linked product increases with the strength and positivity of the connection between the consumer and product (or brand). Finally, the disposal behavior can be explained by consumers' motivation to avoid trashing a product that is linked to the self because it is viewed as an identity threat. In sum, consumers will be more likely to recycle (rather than trash) a product if the product is linked to a consumer's identity. This occurs because placing an identitylinked product in the trash is symbolically similar to trashing a part of the self, a situation consumers are motivated to avoid. [ABSTRACT FROM AUTHOR]

Distance from markets and from the mental maps of urban-centric policy-makers means that small, remote settlements do generate economic practices locally. This paper draws on two case studies to argue that remote sustainability requires an emphasis on the local economy (the settlement and multi-settlement region), and that long-term strategies held at the local level by locals are most favourable to both economic and social life. While some settlements are clearly better positioned in terms of natural resources and opportunities, all settlements need access to supportive policy and infrastructure at national and regional levels. The paper argues that current economic policy facilitates national prosperity to the detriment of local economies. It points to the necessity for desert regions, of developing an internal economic agenda held by a local agency, in ways that bring both Aboriginal and settler cultures into economic expression. [ABSTRACT FROM PUBLISHER]

Integer programming (IP), also known as discrete optimization, is a way of modelling a very wide range of problems involving indivisibilities (e.g. yes/no investment decisions) and non-convexities (e.g. economies of scale and fixed cost allocation). Such problems arise in many areas; these are mentioned in the paper. However, IP demands ingenuity in both building models and in their solution. Much is still not properly understood. This paper investigates the question: ‘Is IP like Linear Programming (LP)? ’ The mathematical and economic properties of IP will be contrasted with LP. It will be suggested that the mathematics and economics of IP are still not properly understood. Many of the results which apply to LP do not apply to IP. It will be asserted that this lack of understanding reveals inadequacies in both the mathematics and economics. [ABSTRACT FROM PUBLISHER]

The authors assessed the utility and cost-effectiveness of using a World Wide Web-based questionnaire in a large prospective cohort study, the Black Women's Health Study (BWHS). In 1995, 59,000 African-American women were recruited into the BWHS through a paper questionnaire. Follow-up paper questionnaires have been mailed every 2 years since then. During the 2003, 2005, and 2007 questionnaire cycles, participants were given the option of completing a Web-based questionnaire. The cost of developing and processing a returned paper questionnaire was 4 times that of a returned Web questionnaire, primarily because of return postage costs and greater processing time for paper questionnaires. The proportion of respondents who completed a Web questionnaire doubled from 2003 to 2007, from 10.1% to 19.9%, but the characteristics of those completing the Web questionnaire remained the same. Web response was greatest at younger ages (20.9% of those aged <30 years) and declined with age to 3.6% among women aged 60 years or more. Web questionnaires were filled out more completely than paper questionnaires, regardless of the sensitivity of a question. The use of a Web questionnaire in the BWHS resulted in cost savings and more complete responses. Although there are advantages to using a Web questionnaire, the use of multiple means of soliciting questionnaire responses is still needed. [ABSTRACT FROM PUBLISHER]