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Objective: This study aimed to identify diets with improved nutrient quality and environmental impact within the boundaries of dietary practices. Design: We used Data Envelopment Analysis to benchmark diets for improved adherence to food-based dietary guidelines (FBDG). We then optimised these diets for dietary preferences, nutrient quality and environmental impact. Diets were evaluated using the Nutrient Rich Diet score (NRD15.3), diet-related greenhouse gas emission (GHGE) and a diet similarity index that quantified the proportion of food intake that remained similar as compared with the observed diet. Setting: National dietary surveys of four European countries (Denmark, Czech Republic, Italy and France). Subjects: Approximately 6500 adults, aged 18–64 years. Results: When dietary preferences were prioritised, NRD15·3 was ~6 % higher, GHGE was ~4 % lower and ~85 % of food intake remained similar. This diet had higher amounts of fruit, vegetables and whole grains than the observed diet. When nutrient quality was prioritised, NRD15·3 was ~16 % higher, GHGE was ~3 % lower and ~72 % of food intake remained similar. This diet had higher amounts of legumes and fish and lower amounts of sweetened and alcoholic beverages. Finally, when environmental impact was prioritised, NRD15·3 was ~9 % higher, GHGE was ~21 % lower and ~73 % of food intake remained similar. In this diet, red and processed meat partly shifted to either eggs, poultry, fish or dairy. Conclusions: Benchmark modelling can generate diets with improved adherence to FBDG within the boundaries of dietary practices, but fully maximising health and minimising GHGE cannot be achieved simultaneously. [ABSTRACT FROM AUTHOR]

Abstract: Small and regional airports frequently suffer from limited traffic given minimum fixed infrastructure requirements and insufficient revenues to cover their costs. The question is whether such airports could be structured, managed and possibly financially supported in order to survive efficiently. Efficient operations contribute to decreasing the financial dependency of airports on subsidies or the likelihood of foreclosure. This paper applies data envelopment analysis, assuming that the aeronautical output is exogenous, in order to estimate the relative efficiencies of a set of 85 European regional airports over the last decade. We estimate the potential savings and revenue opportunities to be in the order of 50% and 25% respectively because cost increases were in excess of any changes in demand over the timeframe. Using second stage regressions we examine the reasons for poor performance, which include discretionary variables such as the failure to search for commercial opportunities or to produce ground-handling and fueling activities in-house. We also note that belonging to an airport system reduces efficiency in the order of 5%. Finally, the break-even passenger throughput over the last decade more than doubled to 464 thousand, however airports behaving efficiently could have covered their annual operating budget with a mere 166 thousand passengers annually. [Copyright &y& Elsevier]

Objective To measure the relative efficiency of primary care (PC) in turning their structures into services delivery and turning their services delivery into quality outcomes. Design Cross-sectional study based on the dataset of the Primary Healthcare Activity Monitor for Europe project. Two Data Envelopment Analysis models were run to compare the relative technical efficiency. A sensitivity analysis of the resulting efficiency scores was performed. Setting PC systems in 22 European countries in 2009/2010. Main Outcome Measures Model 1 included data on PC governance, workforce development and economic conditions as inputs and access, coordination, continuity and comprehensiveness of care as outputs. Model 2 included the previous process dimensions as inputs and quality indicators as outputs. Results There is relatively reasonable efficiency in all countries at delivering as many as possible PC processes at a given level of PC structure. It is particularly important to invest in economic conditions to achieve an efficient structure–process balance. Only five countries have fully efficient PC systems in turning their services delivery into high quality outcomes, using a similar combination of access, continuity and comprehensiveness, although they differ on the adoption of coordination of services. There is a large variation in efficiency levels obtained by countries with inefficient PC in turning their services delivery into quality outcomes. Conclusions Maximizing the individual functions of PC without taking into account the coherence within the health-care system is not sufficient from a policymaker's point of view when aiming to achieve efficiency. [ABSTRACT FROM AUTHOR]