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Vaccines against human papillomavirus (HPV) are available in Europe since 2006. They have been highly effective in preventing infection and disease caused by the vaccine types. Clinical efficacy data are available for cervical, vulvovaginal and anal precancer and invasive cervical cancer. Disease reduction is best with early vaccination and a coverage of more than 70%. Gender-neutral vaccination provides direct protection for all men and improves the coverage. A good coverage is followed by herd protection of the unvaccinated men and women. School-based programs appear to be most effective; under the age of 15 years, two doses with an interval of 6–12 months are sufficient. From the age of 15 years, the standard regimen with three doses is recommended. A broad catch-up program for young adult women and men improves the effectiveness. The vaccines are also effective in sexually active women and men with previous but cleared infections. Vaccination in addition to local treatment of HPV-related disease appears to reduce recurrent or subsequent HPV-related disease. Combination of HPV vaccination and screening with HPV testing is the most effective approach to prevention of cervical cancer. The screening intervals may increase in the vaccinated cohorts. The upper age limit for vaccination remains to be evaluated, is country specific and depends on cost-effectiveness. The European Society of Gynaecologic Oncology and the European Federation for Colposcopy strongly support gender-neutral vaccination programs for children and young adolescents, with a catch-up program for young adults. • Human papillomavirus (HPV) vaccination is highly effective in preventing cervical disease caused by the vaccine types. • It further reduces the burden of other HPV-related cancers, such as anal, oropharyngeal, vulvar and vaginal cancer. • School-based programs appear to be more cost-effective. • The vaccines have excellent safety profile. [ABSTRACT FROM AUTHOR]

The development of human papillomavirus (HPV)-based screening should detect more pre-cancerous changes and so reduce the incidence and mortality from cervical squamous carcinoma and cervical adenocarcinoma. However, many more women are high risk HPV (hrHPV) screen positive compared to cytology-based screening, especially in younger age-women. A variety of tests have become available which may triage into those hrHPV test-positive women who need immediate referral to colposcopy from those who need early repeat HPV tests or recall on the basis of their disease status. We performed a literature review of publications and a manual search from 2010, reporting cytology, HPV partial genotyping, dual-staining and DNA methylation for triage of hrHPV positive tests, including their comparative performance between these methods as well as the effectiveness of some triage combinations with reference to HPV-based screening services in Europe. Cost effectiveness and the structure of triage algorithms for colposcopists also have been considered. From one report evaluating four options for triage as single options or as combined algorithms, partial genotyping for HPV 16 and 18 with dual-staining yielded the highest risk of cervical intraepithelial neoplasia grade three or worse within an HPV positive population and with an acceptable colposcopy rate. From a separate paper, this option appeared cost effective. However, publications were difficult to compare objectively. All options have their merits but a combination triage involving any two of cytology, HPV partial genotyping or dual-staining seems most efficient at present. HPV vaccination may impact upon the performance of future partial genotyping. DNA Methylation may become an acceptable future option. [ABSTRACT FROM AUTHOR]

End-of-life vehicles (ELV) represent a relevant waste source in Europe, even if ELV recycling is a priority of the European Union waste legislation and Environment Action Programmes (EAPs). End-of-Life Tires (ELTs) constitute a relevant portion of ELV waste. Textile fibre, which is a relevant portion of the ELT material, is considered as a special waste (European Waste Catalogue – EWC code 19.12.08). The main problem related to textile fibre is its contamination with rubber which does not allow to obtain a pure product economically and qualitatively useable. The aim of this paper is to illustrate an innovative technology for ELT fibre's recycling, which allows to transform textile fibre into a useful secondary raw material for different applications. In particular, the use of ELT fibre as additive for bituminous conglomerates has been investigated. The different processes have been analysed from an environmental point of view, applying the Life Cycle Assessment methodology. It came up there is an impact reduction in case the ELT fibre is reused as additive for bituminous conglomerates, instead of disposing it (through incineration). Moreover, the financial and economic sustainability of the related technological process has been evaluated to check whether the process is sustainable in the long term. Starting from the results of the Life Cycle Assessment, economic performance indicators have been calculated, by applying the European Commission methodology for cost-benefit analysis. According to the present cost-benefit analysis, in the medium and long term the system is financially viable, and the high economic profitability makes the process economically sustainable. Furthermore, a sensitivity analysis as well as a risk assessment have been carried out in order to identify critical variables, evaluate risks and define risk mitigation measures. According to the sensitivity analysis performed, the project is not highly risky since even in the worst scenario the possible loss is moderate. Based on the results of this analysis, it can be concluded that this ELT fibre's recycling system can be replicated across Europe, conveniently fostered by national policies (such as subsidies, value added tax etc.). • A crucial technological add-on to existing installations is illustrated. • The aim is to transform ELT textile fibre into a useful secondary raw material for different applications. • ELT fibre's reuse presents a reduced environmental impact in comparison to the fibre's incineration. • The high economic profitability makes this recycling system economically sustainable. [ABSTRACT FROM AUTHOR]

Abstract: Environmental policies in Europe have successfully eliminated the most visible and immediate harmful effects of air pollution in the last decades. However, there is ample and robust scientific evidence that even at present rates Europe’s emissions to the atmosphere pose a significant threat to human health, ecosystems and the global climate, though in a less visible and immediate way. As many of the ‘low hanging fruits’ have been harvested by now, further action will place higher demands on economic resources, especially at a time when resources are strained by an economic crisis. In addition, interactions and interdependencies of the various measures could even lead to counter-productive outcomes of strategies if they are ignored. Integrated assessment models, such as the GAINS (Greenhouse gas – Air pollution Interactions and Synergies) model, have been developed to identify portfolios of measures that improve air quality and reduce greenhouse gas emissions at least cost. Such models bring together scientific knowledge and quality-controlled data on future socio-economic driving forces of emissions, on the technical and economic features of the available emission control options, on the chemical transformation and dispersion of pollutants in the atmosphere, and the resulting impacts on human health and the environment. The GAINS model and its predecessor have been used to inform the key negotiations on air pollution control agreements in Europe during the last two decades. This paper describes the methodological approach of the GAINS model and its components. It presents a recent policy analysis that explores the likely future development of emissions and air quality in Europe in the absence of further policy measures, and assesses the potential and costs for further environmental improvements. To inform the forthcoming negotiations on the revision of the Gothenburg Protocol of the Convention on Long-range Transboundary Air Pollution, the paper discusses the implications of alternative formulations of environmental policy targets on a cost-effective allocation of further mitigation measures. [Copyright &y& Elsevier]

The European Energy Efficiency Directive requests the application of high quality and cost effective energy audits across Europe. The potential of up to 20% of energy savings shall be realized to follow the strategy of smart, sustainable, and inclusive growth. A number of barriers must be tackled to implement the Directive, especially among small and medium sized enterprises (SMEs). A large number of cost effective energy efficiency measures remains unimplemented because of financial reasons, a lack of information, and limited in-house skills. Information measures, audits, capacity buildings are suggested as potentially effective measures to support implementation of energy efficiency measures. Within the work described in this paper, an auditing approach was developed, focusing on modelling the energy consumption of an SME. The model of the energy consumption is built using simple MS Excel tools, dividing the process into unit operations and attributing annual consumption to these units, from measurements or by calculation. Consumption is linked to drivers of consumption and corresponding losses, thus developing an understanding of the origin of energy consumption, priorities, and the potential for reduction. The approach simultaneously addresses the needs for the identification of measures, capacity building, information and awareness raising. The auditing approach was tested with 280 companies in Austria, Bulgaria, Cyprus, Italy, Romania, Slovakia and Spain. A wide range of energy efficiency measures was identified and implemented, partly consisting of no-cost options, but partly also innovative technical solutions. Over EUR 10 million investments with a simple payback time of less than three years were triggered. 6500 toe per year of primary energy savings were realized, as well as greenhouse gas emission reductions of 13,500 tonnes per year. [ABSTRACT FROM AUTHOR]

Safe and reliable traffic management is vital for uninterrupted and successful operation of the European rail network, where mixed traffic (i.e. freight and passenger) services are run. Although rail freight derailment is infrequent, its consequences can be severe and may result in different forms of costs, including infrastructure; rolling stock; traffic disruptions; injuries and fatalities. The objective of this research paper is to conduct a cost benefit analysis (CBA) to identify cost effective mitigation techniques for efficient rail freight traffic management in Europe, by 2050. Reviewing previous derailments and studies, eight sets of derailment causes are analysed and, for each of them, sets of mitigation techniques are aimed at for their alleviation. The study finds that the highest cumulative costs of derailment are associated with ‘wheel failure’, while the lowest cumulative cost is identified for ‘excessive track width’. Regarding mitigation techniques, the lowest cumulative benefits are demonstrated for ‘track height’ interventions, whereas ‘wheel failure’ alleviation demonstrates the highest benefits, in value terms (all by 2050). In most cases, the benefit to cost ratio did not exceed 2.6; in two cases (‘track height’ and ‘rail failures’) the ratio remained below 1 – a negative outcome where cost is higher than benefit. The study suggests that the most cost-efficient interventions are those applied to ‘hot axle box and axle rupture’ and ‘spring and suspension failure’. [ABSTRACT FROM AUTHOR]

Abstract: This paper looks at the calculation of composite flight hours used input to performance benchmarking of European air navigation service providers. The way the en-route part of the composite flight hours is obtained, potentially rewards busy air navigation service providers serving larger airports with additional composite flight hours, thus making them more productive and financially cost-efficient. We also examine the financial effect of the methodology and link it to economic cost-effectiveness. [Copyright &y& Elsevier]

Abstract: The age of European existing building stock and the very low growth rate make energy retrofit a critical issue at the moment. The spreading of good practices is strongly hampered by their cost effectiveness. National legislation thermal requirements for retrofitting works play a fundamental role. If they are too strict, the initial economic investment could be too high if compared with energy savings achievable. The paper refers to a case study of improving fabric thermal performance of stone masonry buildings located in Cagliari – Italy. They were built in 1950s. The economic feasibility of different energy efficiency retrofits is evaluated. Two different scenarios are analyzed: the former according to the earlier Italian legislation (valid from 2006 to 2008), the latter according to the latest and strictest measures (valid from 2010). The results show that heavy thermal performance upgrades, even though compulsory, are not completely cost-effective in a mild Mediterranean climate area as far as payback time is concerned. National subsidy policies can improve the economic return on the investment. The impact of present Italian incentives has also been evaluated. [Copyright &y& Elsevier]

An increasing share of the daily meals served in Europe is prepared out-of-home by professionals in foodservice. The quality of such meals is highly debated. This paper presents and discusses obstacles to improving quality in a cost-effective way and suggests solutions: 1) Modularisation of the meal production in order to transfer labour-intensive operations from the kitchens to the industry; 2) Systemic use of a new concept: thawing during distribution, which improves shelf-life and reduces waste; 3) Supply chain modelling to improve delivery schedules and reduce environmental impact. Existing food legislation complies with the suggested approaches. [Copyright &y& Elsevier]

Abstract: A key element of the European Water Framework Directive is the role that economic tools and principles have been assigned in achieving its objectives. This has raised important research and implementation questions that have set the water agenda in Europe in the last ten years and will continue to do so. This paper examines these key questions and reviews the progress that has been made in addressing them. Key research-policy challenges ahead are identified. These include addressing “wicked” problems, such as the operationalisation of the ecosystem service approach; challenging assumed principles for cost-effectiveness and disproportionality; and effectively co-constructing knowledge with stakeholders. [Copyright &y& Elsevier]

Abstract: This paper presents a mixed activity-based costing decision (MABCD) model for green airline fleet planning under the constraints of the European Union Emissions Trading Scheme (EU ETS), in which activity-based costing (ABC) model is incorporated with a modified product-mix decision model for total operating costs of individual flights under EU ETS constraints. A numerical example for comparing cost-effectiveness between the B747-400 airline and the A380 airline in one of the busiest route between Asia and Europe is demonstrated. It is shown that subject to different changes of revenue tone kilometers (RTK), the cost trends of carbon emissions and the changes in profits of different flight routes appear to be similar. Moreover, it is also shown that when the RTK are higher, a choice of a wider-bodied aircraft could lead to higher profits. Finally, it is shown that without the pre-assumptions of considering more complicated routes and financing methods, a self-purchased aircraft appears to contribute more profits. [Copyright &y& Elsevier]

Abstract: What are the health impacts of retirement? As talk of raising retirement ages in pensions and social security schemes continues around the world, it is important to know both the costs and benefits for the individual, as well as the governments’ budgets. In this paper we use the Survey of Health, Ageing and Retirement in Europe (SHARE) dataset to address this question in a multi-country setting. We use country-specific early and full retirement ages as instruments for retirement behavior. These statutory retirement ages clearly induce retirement, but are not related to an individual''s health. Exploiting the discontinuities in retirement behavior across countries, we find significant evidence that retirement has a health-preserving effect on overall general health. Our estimates indicate that retirement leads to a 35 percent decrease in the probability of reporting to be in fair, bad, or very bad health, and an almost one standard deviation improvement in the health index. While the self-reported health seems to be a temporary impact, the health index indicates there are long-lasting health differences. [Copyright &y& Elsevier]

Abstract: This paper combines engineering and social science approaches to enhance our understanding of industrial energy efficiency and broaden our perspective on policy making in Europe. Sustainable development demands new strategies, solutions, and policy-making approaches. Numerous studies of energy efficiency potential state that cost-effective energy efficiency technologies in industry are not always implemented for various reasons, such as lack of information, procedural impediments, and routines not favoring energy efficiency. Another reason for the efficiency gap is the existence of particular values, unsupportive of energy efficiency, in the dominant networks of a branch of trade. Analysis indicates that different sectors of rather closed communities have established their own tacit knowledge, perceived truths, and routines concerning energy efficiency measures. Actors in different industrial sectors highlight different barriers to energy efficiency and why cost-effective energy efficiency measures are not being implemented. The identified barriers can be problematized in relation to the social context to understand their existence and how to resolve them. [Copyright &y& Elsevier]

Abstract: The existing and emerging international and European policy framework for the reduction of ship exhaust emissions dictates the need to produce reliable national, regional and global inventories in order to monitor emission trends and consequently provide the necessary support for future policy making. Furthermore, the inventories of ship exhaust emissions constitute the basis upon which their external costs are estimated in an attempt to highlight the economic burden they impose upon the society and facilitate the cost–benefit analysis of the proposed emission abatement technologies, operational measures and market-based instruments prior to their implementation. The case of Greece is of particular interest mainly because the dense ship traffic within the Greek seas directly imposes the impact of its exhaust emission pollutants (NOx, SO2 and PM) upon the highly populated, physically sensitive and culturally precious Greek coastline, as well as upon the land and seas of Greece in general, whereas the contribution of Greece in the global CO2 inventory at a time of climatic change awareness cannot be ignored. In this context, this paper presents the contribution of Greece in ship exhaust emissions of CO2, NOx, SO2 and PM from domestic and international shipping over the last 25 years (1984–2008), utilizing the fuel-based (fuel sales) emission methodology. Furthermore, the ship exhaust emissions generated within the Greek seas and their externalities are estimated for the year 2008, through utilizing the fuel-based (fuel sales) approach for domestic shipping and the activity-based (ship traffic) approach for international shipping. On this basis, it was found that during the 1984 to 2008 period the fuel-based (fuel sales) ship emission inventory for Greece increased at an average annual rate of 2.85%. In 2008, the CO2, NOx, SO2 and PM emissions reached 12.9 million tons (of which 12.4 million tons of CO2) and their externalities were found to be around 3.1 billion euro. With regard to shipping within the Greek seas, the utilization of the fuel-based (fuel sales) analysis for domestic shipping and the activity-based (ship traffic) analysis for international shipping shows that the ship-generated emissions reached 7.4 million tons (of which 7 million tons of CO2) and their externalities were estimated at 2.95 billion euro. Finally, the internalization of external costs for domestic shipping was found to produce an increase of 12.96 and 2.71 euro per passenger and transported ton, respectively. [Copyright &y& Elsevier]

Abstract: Economics is about problems of choice. In erosion control, both public authorities and private land users are faced with such problems. What is the impact of erosion, both on-site and off-site, and to what extent can this impact be quantified? If we conceptualize this impact in terms of sustainability, how can we compare one type of effect against another? The former question can be answered only by natural scientists, the latter by economists and other social scientists. Weighing different aspects of sustainability requires value judgments, and economists are sometimes accused of having a jaundiced view of reality, wrongly supposing that decisions are based on rationality and denying the importance of emotion. However, let us assume that there is some mileage to be gained out of attempting to estimate the cost of erosion in an economic sense—which consists of converting the various effects into a common denominator: euros. If we can predict the impact of erosion control measures on erosion rates, we can know the benefit of these measures. The cost also needs to be calculated, not in terms of money but in terms of resources expended (which could have been used for other purposes) and in terms of possible negative impacts of erosion control (for instance, increased use of herbicides in reduced-tillage systems). There are important other considerations which economists may study. Firstly, there is the comparison of present versus future costs and benefits: how much can we sacrifice today for higher sustainability tomorrow? Secondly, there is the issue of private versus public costs and benefits: how do the goals of private land users differ from (those of?) the public good, how can this help us to predict land users’ behaviour, and what incentives would be appropriate to make them behave in such a way as to maximize the public good? Thirdly, how do we deal with uncertainty and risk? These problems loomed large in a study to support an extended impact assessment for the EU Soil Thematic Strategy, in 2005. Whereas much research has been done on erosion and its impact, much of this is on a small scale. The extent of the problem on a national, let alone a continental or a global scale, is still poorly known. The paper discusses how these problems were faced, which is not the same as saying they were resolved. [Copyright &y& Elsevier]

Abstract: The paper discusses an assessment tool, used for the energy, economic and environmental evaluation of Thermal Insulation Solutions (TIS). The results of the assessment undertaken with this tool can take the form of a simple rating system in order to enable users to perform comprehensive comparisons amongst various building materials and TIS. A ranking expressed by A, B and C classes is used for energy, environmental and economic parameters. By evaluating the materials, the tool supports the users to make decisions, depending on preferences or priorities such as the energy efficiency achieved, the total cost and the environmental performance. The assessment tool is applied for the double cavity wall and the External Thermal Insulation Composite Systems (ETICS) as they are used throughout Europe, both in new constructions and in the renovation of existing buildings. [Copyright &y& Elsevier]

This paper presents an environmental evaluation of building envelopes, made of three different technologies: a traditional air-cavity wall, a plus-insulated wall (with an external cork covering), and a ventilated wall (with external brick panels fixed on extruded frames). An environmental accounting method, namely Emergy Evaluation (EE), was performed for assessing environmental resource use (energy and material flows), both directly and indirectly, for the construction of a façade (1000m2). Then, energy use during the building lifetime was assessed as a constant inflow to the building depending on the thermal skills of building envelopes, besides thermal efficiency of air-conditioning system. In particular, this energy inflow is needed for maintaining constant indoor climate conditions (18°C) and has to balance heat dissipation through envelopes (heat loss in winter and heat gain in summer). Outcomes were compared with an Energy Analysis (EA) based on an embodied energy accounting. Finally, costs for manufacturing walls (with enhanced performance) and benefits (energy saving) were compared in a unique balance, through both EA and EE. Moreover, outcomes were obtained for three scenarios corresponding to three geographic locations (Berlin in northern Europe, Barcelona on the Mediterranean coast and Palermo in the south of Italy). Results highlighted that performances of building envelopes depend on technologies relative to external climate conditions. Different environmental accounting methods, such as EE and EA, provided outcomes with some difference that are not contradictory to each other but complementary. [Copyright &y& Elsevier]

Abstract: Vascular support structures are an important tool for treating valve stenosis. A large population of patients are treated for valvular disease and the principal mode of treatment is the use of percutaneous valvuloplasty. Stent devices are proving to be an improved treatment method; these devices now account for 20% of treatments in Europe. This new technology provides highly effective results at minimal cost and with reduced hospital stays. Accurate and reliable structural analysis provides essential information to the design team in an environment where in vivo experimentation is extremely expensive or impossible. This paper describes the design of a new vascular support structure (stent), to provide designers with estimates of the critical parameters which are essential. Stainless steel stents are preferred to be used as balloon-expanded prostheses as they are cost-effective. [Copyright &y& Elsevier]

Abstract: The current European regulation for electronic communications has been applicable since 2003 and is currently under a review that should lead to new rules applicable by 2010. This paper aims to assess the implementation of the current regulation and the proposals for reform tabled by the European Commission. It is argued that those proposals go in the right direction but should go further. First, the regulatory framework should clearly state that the objectives of regulators are to maximise the long-term welfare of European citizens. Secondly, the main body of economic regulation—the so-called Significant Market Power regime—should be based on a strong test aiming to identify structural market problems that cannot be efficiently dealt with by competition law. Thirdly, possible remedies applicable by the regulators should include structural and technological components, provided that a strict cost benefit analysis is undertaken. Fourthly, the institutional design should be improved by better aligning the incentives of the National Regulatory Authorities with the dynamic nature of the markets, by improving the checks and balances (in particular those provided by national courts and European Commission), and by improving coordination amongst the institutions (the national regulators and the national Courts). [Copyright &y& Elsevier]

REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals) is the new European chemical legislation which aims to assess risk or safety of tens of thousands of chemicals to improve the protection of human health and the environment. The chemical safety assessment process is of an iterative nature. First, an initial, worst-case assessment is conducted after which refinements are made until no risk has been estimated or the risk is adequately controlled. Wasting time and resources on additional testing and implementing risk management measures with low effect on risk conclusions should be avoided as much as possible. This paper demonstrates the usefulness of an intelligent data collection strategy based on a sensitivity (and uncertainty) analysis on the risk assessment model EUSES to identify and order the most important “within-EU-TGD-reducible” input parameters influencing the local and regional risk characterisation ratios. The ordering can be adjusted for the costs involved in additional testing (e.g. ecotoxicity, physico-chemical properties, emission estimates, etc.). The risk refinement tool therefore reduces the resources needed to obtain a realistic risk estimate (both less conservative and less uncertain) as efficient as possible. [Copyright &y& Elsevier]

Vertical separation in the rail industry is common in Europe, but evaluation of the policy has been insufficient. The main purpose of this paper is to explain one method of operation–infrastructure separation as practiced in the case of Kobe Kosoku, a unique rail infrastructure owning company in Japan, as well as to discuss practical coordination problems related to structuring separation. Our overall conclusion is that vertically separated systems do not have significant advantages over vertically integrated systems in terms of the maintenance costs of infrastructure. In fact, the results of our analysis of infrastructure maintenance costs indicate that vertically separated systems might not be significantly different from vertically integrated ones. [Copyright &y& Elsevier]

The paper develops a model to represent the cost structure of European railways based on a general index of technical change, which allows completely general estimation of productivity growth. The estimated model is based on a variable cost function for panel data, which allows for heterogeneity in spite of previous approaches in the railway economics and general index model literature which adopt the assumption of common technical parameters across countries. [Copyright &y& Elsevier]

Abstract: This paper uses the Luenberger productivity indicator to evaluate productivity changes of European airlines, combining operational and financial variables from 2000 to 2011. For comparative purposes the Malmquist index is estimated. Three low cost European airlines are inserted in the data set, Virgin Atlantic, EasyJet and Ryanair. [Copyright &y& Elsevier]

Utilizing case studies, the paper identifies the potential of artificial reefs as a tool to aid the rehabilitation of coastal ecosystems from an ecological perspective. It goes on to discuss how this potential can be constrained by the action of a complex array of legal frameworks and political processes which are not necessarily attuned to or supportive of the needs of habitat restoration (whether based on artificial reefs or other technologies). Apart from institutional inertia, one of the main reasons why support for habitat restoration projects may be lacking is that, while their costs may be expressed in monetary terms, their benefits rarely are. The paper concludes by exploring techniques by which both the benefits and costs of coastal rehabilitation may be monetized, thereby placing them on the same footing as other programs whose economic returns are more easily quantified. [ABSTRACT FROM AUTHOR]

Abstract: The reading of the paper by Jansen et al. in a recent issue of Vaccine (2008, October 16) showing the “decline in influenza-associated mortality among Dutch elderly following the introduction of a nationwide vaccination programme” was for us the opportunity to present the results of a recently conducted survey of national Flu vaccination policies at a meeting of Presidents and representatives from 24 National Geriatric Societies. Combined results of these two studies advocate for promoting efficient, cost-effective and sustainable vaccine programme endorsed by all the National governments in Europe. [Copyright &y& Elsevier]