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Connolly M.P.,University of Groningen | Hoorens S.,RAND Europe | Chambers G.M.,University of New South Wales
Human Reproduction Update | Year: 2010

Background: Despite the growing use of assisted reproductive technologies (ART) worldwide, there is only a limited understanding of the economics of ART to inform policy about effective, safe and equitable financing of ART treatment. Methods: A review was undertaken of key studies regarding the costs and consequences of ART treatment, specifically examining the direct and indirect costs of treatment, economic drivers of utilization and clinical practice and broader economic consequences of ART-conceived children. Results: The direct costs of ART treatment vary substantially between countries, with the USA standing out as the most expensive. The direct costs generally reflect the costliness of the underlying healthcare system. If unsubsidized, direct costs represent a significant economic burden to patients. The level of affordability of ART treatment is an important driver of utilization, treatment choices, embryo transfer practices and ultimately multiple birth rates. The costs associated with caring for multiple-birth ART infants and their mothers are substantial, reflecting the underlying morbidity associated with such pregnancies. Investment analysis of ART treatment and ART-conceived children indicates that appropriate funding of ART services appears to represent sound fiscal policy. Conclusions: The complex interaction between the cost of ART treatment and how treatments are subsidized in different healthcare settings and for different patient groups has far-reaching consequences for ART utilization, clinical practice and infant outcomes. A greater understanding of the economics of ART is needed to inform policy decisions and to ensure the best possible outcomes from ART treatment. © The Author 2010. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.


Chalmers I.,James Lind Initiative | Bracken M.B.,Yale University | Djulbegovic B.,University of South Florida | Djulbegovic B.,H. Lee Moffitt Cancer Center and Research Institute | And 7 more authors.
The Lancet | Year: 2014

The increase in annual global investment in biomedical research-reaching US240 billion in 2010-has resulted in important health dividends for patients and the public. However, much research does not lead to worthwhile achievements, partly because some studies are done to improve understanding of basic mechanisms that might not have relevance for human health. Additionally, good research ideas often do not yield the anticipated results. As long as the way in which these ideas are prioritised for research is transparent and warranted, these disappointments should not be deemed wasteful; they are simply an inevitable feature of the way science works. However, some sources of waste cannot be justifi ed. In this report, we discuss how avoidable waste can be considered when research priorities are set. We have four recommendations. First, ways to improve the yield from basic research should be investigated. Second, the transparency of processes by which funders prioritise important uncertainties should be increased, making clear how they take account of the needs of potential users of research. Third, investment in additional research should always be preceded by systematic assessment of existing evidence. Fourth, sources of information about research that is in progress should be strengthened and developed and used by researchers. Research funders have primary responsibility for reductions in waste resulting from decisions about what research to do.


News Article | October 29, 2016
Site: www.pressat.co.uk

Business needs to do more to rebuild trust and secure its place in society 27 October 2016: The IBE publishes today a survey showing that companies are perceived by the public as only interested in profits and neglect their broader obligation to deliver value. This is seen as a key reason why business has failed to restore trust. The financial crisis, corporate scandals and levels of public distrust have lowered the standing of business. It is no longer acceptable to say business is simply about generating profits for shareholders. Business needs to show how it contributes to social well-being wherever it operates. If business is to regain public trust, the IBE report suggests, a new approach to business leadership is needed which is based on consensus building, the ability to embed values and connect business to society. Philippa Foster Back CBE, IBE Director said: “The age of deference is over. A succession of scandals has undermined trust, and business is too often seen as purely interested in profit. Leaders who see themselves as individual superstars will not be able to deal easily with this. We need to look for new models – leaders who are connected with their employees and society and use this talent to facilitate good and sustainable results." In its first three decades, the IBE has focused on helping companies with the practicalities of taking an ethical approach. In reaching its 30th Anniversary, the IBE is reflecting on the business ethics challenges in today's environment through gathering the views of others. To help identify its priorities for the coming period, the IBE sought the views of opinion-leaders from various walks of life, including company chairmen and directors, the media and others involved in the business world, accountants and lawyers as well as its trustees and senior advisers. Each respondent was asked to answer three questions: 1. Why can’t business rebuild trust with the public? The lack of trust in business was frequently ascribed to the public perception that it was too focused on profit, the recurrence of scandals, controversy over executive pay and the taxation policies of multinationals. Business must become better aligned with the interests of society from which it derives its license to operate. Furthermore, boards must develop a more coherent sense of what their duties as set out in Section 172 of the UK Companies Act 2006 actually are. Profit becomes legitimate when it is earned through the delivery of real value and the genuine assumption of real risk. It is not legitimate when it is achieved by extracting value from the very customers it purports to serve. 2. What are the three biggest ethical challenges facing business? The question about the three biggest ethical challenges threw up a multitude of answers. While some homed in on specific issues like remuneration, taxation, the supply chain, diversity and cyber issues, others offered a more overarching view, choosing to focus on the need to build consensus within the organisation, to embed values that support positive choices, to be more open and to develop a track record of sticking to principles. Two themes stood out: customer focus and the need for statesmanship. Business needs customer champions within the leadership team so that leaders can see their business actions through the eyes of those who actually use their products. As to statesmanship, it was critical for business leaders to be able to work with others to build the basis of trust. We need to redefine successful leadership – engaged with ethical values, less iconic and with strength of character. 3. What should the IBE do over the next few years? As to future priorities for the IBE, there was a view that the IBE should be more vocal, do more to get ahead of the trend, to steer public debate, to help business engage with civil society and reflect an international view. It should tease out the looming issues facing business and seek to include the views of younger generations in thinking around ethics. It should be supportive of greater openness by companies, helping them to develop principles on which to base their activities and providing them with a safe environment where companies can come together and learn from each other. The report – The Institute of Business Ethics: The next thirty years – will be launched at an anniversary breakfast to be held at the Mansion House on Thursday 27th October – 30 years to the day since the IBE was launched at the same venue. The Lord Mayor, Alderman The Lord Mountevans and Sir Gerry Grimstone, Chairman of Standard Life and Deputy Chairman of Barclays, will join Philippa Foster Back CBE to talk about the changing business ethics landscape and what the future might look like. IBE’s Director, Philippa Foster Back CBE, said: “In response to the survey, the IBE has set out an ambitious programme for the next few years particularly in reaching out to new audiences, and new entrants to the workplace, drawing on their fresh approach to business and technology to help these with more entrenched views. There is much for us to do” Peter Montagnon, IBE Associate Director and the report’s author, said: “Business needs to do more to rebuild trust and secure its place in society. This is not just a question of addressing specific problems like remuneration and taxation, important though these are, but of instilling the right mind-set throughout business organisations. The challenge for business leaders is to develop a culture which takes their organisation beyond mere compliance with regulation. Companies wishing to thrive in the longer-term need a sense of purpose and a set of values that are aligned with society and the more demanding expectations of the public.” To obtain and advance copy of the report or to organise interviews with Philippa Foster Back CBE or Peter Montagnon, or to commission articles or comment please contact Katherine Bradshaw [email protected] or Alexandra Johnson, [email protected] 020 7798 6040 The Institute of Business Ethics: The next 30 years The Institute of Business Ethics (IBE) is a registered charity established in 1986 to promote high standards of business behaviour based on ethical values. We help organisations to strengthen their ethical culture through the sharing of knowledge and good practice.www.ibe.org.uk A brief history of the IBE can be found here http://www.ibe.org.uk/a-brief-history/81/54 As Director of the Institute, Philippa is responsible for implementing strategy, leading the team and ensuring that the Institute meets its charitable aims, for raising awareness and spreading best practice in the field of business ethics. She began her career at Citibank NA before joining Bowater in their Corporate Treasury Department in 1979, leaving in 1988 as Group Treasurer. She was Group Finance Director at DG Gardner Group, a training organisation, prior to joining Thorn EMI in 1993 as Group Treasurer until 2000. She speaks widely on business ethics issues, encouraging high standards of business behaviour based on ethical values. As Director she runs the IBE delivering with the team advisory work, publications, training, and events, all with the purpose of raising awareness and sharing of best practice of business ethics, in line with the IBE’s charitable aim. She has a number of external appointments, including at the Chartered Institute of Securities and Investment; RAND Europe; Barrier Biotech Ltd and is Chairman of the UK Antarctic Place-names Committee. In 2008 was a member of the Woolf Committee looking at business practices at BAE. In 2006 she was awarded the OBE for services to the Ministry of Defence where she was formerly a NED and Chair of the Defence Audit Committee. She won the M&S/BITC Sieff Award in 2008. In January 2014 she was awarded the CBE for services to UK Antarctic Heritage. Peter Montagnon joined the IBE as an Associate Director in September 2013. Prior to that he was Senior Investment Adviser at the Financial Reporting Council which he joined after almost ten years as Director of Investment Affairs of the Association of British Insurers. For two decades from 1980 Peter was a senior journalist at the Financial Times, including spells as Head of the Lex Column and in charge of coverage of the international capital markets. His last assignment, from 1994 to 2000, was as Asia Editor, responsible for the FT’s coverage of a region stretching from Pakistan to New Zealand. After graduating in Modern Languages from Cambridge University in 1972, he joined Reuters news agency as a financial journalist. At Reuters he completed assignments in Hong Kong, Zurich and Washington before joining the Financial Times. Peter served on the European Commission’s Corporate Governance Forum from 2005 to 2011. He is past Chairman of the Board of the International Corporate Governance Network, a visiting Professor in Corporate Governance at the Cass Business School of City University, London, a member of the Corporate Governance Advisory Board of the Norges Bank Investment Management and of the Board of the Hawkamah Institute for Corporate Governance, Dubai.


Nolte E.,RAND Europe | Nolte E.,London School of Hygiene and Tropical Medicine | McKee M.,London School of Hygiene and Tropical Medicine
Health Policy | Year: 2011

Background: There has been growing interest in the comparison of health system performance within and between countries, using a range of different indicators. This study examines trends in amenable mortality, as one measure of health system performance, in sixteen high-income countries. Methods: Amenable mortality was defined as premature death from causes that should not occur in the presence of timely and effective health care. We analysed age-standardised rates of amenable mortality under age 75 in 16 countries for 1997/1998 and 2006/2007. Results: Amenable mortality remains an important contributor to premature mortality in 16 high-income countries, accounting for 24% of deaths under age 75. Between 1997/1998 and 2006/2007, amenable mortality fell by between 20.5% in the US and 42.1% in Ireland (average decline: 31%). In 2007, amenable mortality in the US was almost twice that in France, which had the lowest levels. Conclusions: Amenable mortality continues to fall across high-income nations although the USA is lagging increasingly behind other high income countries. Despite its many limitations, amenable mortality remains a useful indicator to monitor progress of nations. © 2011 Elsevier Ireland Ltd.


News Article | November 11, 2015
Site: www.nature.com

The UK government’s austerity policies are soon expected to deliver swingeing cuts in some departments. In the teeth of those prospects, British researchers, and an influential parliamentary science and technology committee, have lobbied hard to make the case that even a flat research budget, after five continuous years of the same, would be a betrayal of the country’s needs. How successful they have been, and how worthy of exception the government considers them to be, will become clear only when UK spending plans are announced on 25 November. On page 144, we explore the worrisome prospects. As if that wasn’t enough, last week the government began a consultation over its proposed restructuring of the way it administers higher-education funding (see go.nature.com/c97sww). It announced that it wants to abolish the Higher Education Funding Council for England (HEFCE), the body that distributes £1.6 billion (US$2.4 billion) of ‘quality related’ research money to universities. Those core funds would still be administered separately from the more-responsive funding by the UK research councils, probably by a research-funding organization that would be responsible for both areas. The case for those particular changes has not been adequately made, but other aspects of the proposals have virtues. The government is tackling two scandals in the UK higher-education system: its relative neglect of quality standards in teaching, and its inadequacies in contributing to social mobility. Another positive feature is that the government supports the continuation of the Research Excellence Framework (REF) for assessing research quality and impact, despite the proposed abolition of HEFCE, which successfully implemented that process. It is worth taking stock of the REF — not least because its results strengthened the case for research investment by government. True, many academics hated the REF, which required them to submit large quantities of information to justify their funding. But an inspection of the REF’s outcomes, and of the retrospective reviews of the process by international members of the REF assessment panels (see go.nature.com/q919oe), suggests that it has many strengths. Take the database of nearly 7,000 case studies of the societal impacts of academic research (see http://impact.ref.ac.uk/casestudies). The diversity of the impacts in terms of (for example) health, sustainability, education and economic growth — in the United Kingdom and beyond — is remarkable and inspiring. And there is no reason to suppose that identifying these outcomes is the equivalent of the impacts tail wagging the research dog. In the REF, the assessment panels gave the societal case studies a mere 20% weighting, whereas academic performance had a 65% weighting. No one could sensibly maintain that the outcomes are necessarily predictable and should be required as a basis for funding in future. What does make sense is that the research community can help to ensure a maximal return on taxpayers’ money by becoming aware of impacts pathways, and by broadening its outlook on its roles. As the case studies show, this can happen even in areas of research that are unapologetically fundamental. A study by the independent consultants RAND Europe estimates that the REF impacts-submissions process cost universities about £55 million (see go.nature.com/dzwbjn). That may seem to justify the concerns of academics and politicians about the burden. But set against the £1.6-billion budget that it relates to, one might even describe this 3.4% overhead as a bargain — especially given that the assessment system may become more efficient, and given the virtues of encouraging such impacts. Mindful of the burdens, the government is evidently tempted to try to find a cheaper method of assessment of both academic and societal impacts using metrics. As is made clear by the REF panels, by a RAND analysis of the impacts evaluation (go.nature.com/yysa6m) and by an independent assessment of metrics in research (go.nature.com/rfrgql), this temptation should be avoided. Insightful review of both types of outputs is the only way to do justice to them. The impacts case studies provide welcome ammunition to the case for supporting research in all disciplines, and some government departments have been deploying them in that spirit. Readers who care about UK higher education should give their own responses to the proposals before 15 January 2016, at go.nature.com/l3rrtx.


Daly A.,RAND Europe | Hess S.,ITS Leeds | Train K.,University of California at Berkeley
Transportation | Year: 2012

Random coefficient models such as mixed logit are increasingly being used to allow for random heterogeneity in willingness to pay (WTP) measures. In the most commonly used specifications, the distribution of WTP for an attribute is derived from the distribution of the ratio of individual coefficients. Since the cost coefficient enters the denominator, its distribution plays a major role in the distribution of WTP. Depending on the choice of distribution for the cost coefficient, and its implied range, the distribution of WTP may or may not have finite moments. In this paper, we identify a criterion to determine whether, with a given distribution for the cost coefficient, the distribution of WTP has finite moments. Using this criterion, we show that some popular distributions used for the cost coefficient in random coefficient models, including normal, truncated normal, uniform and triangular, imply infinite moments for the distribution of WTP, even if truncated or bounded at zero. We also point out that relying on simulation approaches to obtain moments of WTP from the estimated distribution of the cost and attribute coefficients can mask the issue by giving finite moments when the true ones are infinite. © 2011 Springer Science+Business Media, LLC.


Robertson R.,Commonwealth Fund | Burge P.,RAND Europe
Journal of Health Services Research and Policy | Year: 2011

Objectives: To understand the impact on equity of giving patients a choice of provider. Methods: A postal survey of 5997 patients in four areas of England about choice at their recent referral and, using a discrete choice experiment, how they would choose in hypothetical situations. Binary logistic regression and a series of multinomial and nested logit models were used to analyse the data to discover whether patients with particular characteristics were more likely to: think choice is important; be offered a choice; and, choose a non-local provider. Results: The response rate was 36%. Choice was more important to older patients aged 51-80 years, patients from non-white backgrounds, women, those with no qualifications and those with a bad past experience of their local hospital. There were no significant differences in who was offered a choice in terms of education, age group or ethnicity. In both real and hypothetical situations patients with no formal qualifications and those living in urban centres were more likely to choose their local hospital, and patients with a bad or mixed past experience at the local hospital were more likely to choose an alternative. In hypothetical choices those who do not normally travel by car and without Internet access were more likely to choose their local hospital irrespective of that hospital's characteristics. Conclusions: More educated, affluent patients were no more likely to be offered a choice than other population groups, but there does appear to be a social gradient in who chose to travel beyond the local area for treatment. If these results were replicated across England, there is at least the potential risk that when local hospitals are failing, patient choice could result in inequitable access to high quality care, rather than enhancing equity as the policy's architects had hoped. © The Royal Society of Medicine Press Ltd 2011.


News Article | November 30, 2016
Site: www.chromatographytechniques.com

A lack of sleep among the U.S. working population is costing the economy up to $411 billion a year, which is 2.28 percent of the country's GDP, a new report finds. According to researchers at the not-for-profit research organization RAND Europe, part of the RAND Corporation, sleep deprivation leads to a higher mortality risk and lower productivity levels among the workforce, putting a significant damper on a nation's economy. A person who sleeps on average less than six hours a night has a 13 percent higher mortality risk than someone sleeping between seven and nine hours, researchers found, while those sleeping between six and seven hours a day have a seven percent higher mortality risk. Sleeping between seven and nine hours per night is described as the "healthy daily sleep range." In total, the U.S. loses just over 1.2 million working days a year due to sleep deprivation among its working population. Productivity losses at work occur through a combination of absenteeism, employees not being at work and presenteeism, where employees are at work but working at a sub-optimal level. The study "Why Sleep Matters - The Economic Costs of Insufficient Sleep" is the first of its kind to quantify the economic losses due to lack of sleep among workers in five different countries - the U.S, UK, Canada, Germany and Japan. The study uses a large employer-employee dataset and data on sleep duration from the five countries to quantify the predicted economic effects from a lack of sleep among its workforce. "Our study shows that the effects from a lack of sleep are massive. Sleep deprivation not only influences an individual's health and wellbeing but has a significant impact on a nation's economy, with lower productivity levels and a higher mortality risk among workers," says Marco Hafner, a research leader at RAND Europe and the report's main author. "Improving individual sleep habits and duration has huge implications, with our research showing that simple changes can make a big difference. For example, if those who sleep under six hours a night increase their sleep to between six and seven hours a night, this could add $226.4 billion to the U.S. economy." The U.S. has the biggest financial losses (up to $411 billion, which is 2.28 percent of its GDP) and most working days lost (1.2 million) due to sleep deprivation among its workforce. This was closely followed by Japan (up to $138 billion, which is 2.92 percent of its GDP, and around 600,000 working days lost). Germany (up to $60 billion, which is 1.56 percent of its GDP, and just over 200,000 working days lost) and the U.K (up to $50 billion, which is 1.86 percent of its GDP, and just over 200,000 working days lost) have similar losses. Canada was the nation with the best sleep outcomes, but still has significant financial and productivity losses (up to $21.4 billion, which is around 1.35 percent of its GDP, and just under 80,000 working days lost). To improve sleep outcomes, the report outlines a number of recommendations for individuals, employers and public authorities: Individuals - Set consistent wake-up times; limit the use of electronic items before bedtime; and physical exercise during the day. Employers - Recognize the importance of sleep and the employer's role in its promotion; design and build brighter workspaces with facilities for daytime naps; combat workplace psychosocial risks; and discourage the extended use of electronic devices after working hours. Public authorities - Support health professionals in providing sleep-related help; encourage employers to pay attention to sleep issues; and introduce later school starting times.


News Article | November 30, 2016
Site: www.eurekalert.org

A lack of sleep among the U.S. working population is costing the economy up to $411 billion a year, which is 2.28 percent of the country's GDP, a new report finds. According to researchers at the not-for-profit research organisation RAND Europe, part of the RAND Corporation, sleep deprivation leads to a higher mortality risk and lower productivity levels among the workforce, putting a significant damper on a nation's economy. A person who sleeps on average less than six hours a night has a 13 percent higher mortality risk than someone sleeping between seven and nine hours, researchers found, while those sleeping between six and seven hours a day have a 7 percent higher mortality risk. Sleeping between seven and nine hours per night is described as the "healthy daily sleep range". In total, the U.S. loses just over 1.2 million working days a year due to sleep deprivation among its working population. Productivity losses at work occur through a combination of absenteeism, employees not being at work, and presenteeism, where employees are at work but working at a sub-optimal level. The study - 'Why Sleep Matters - The Economic Costs of Insufficient Sleep'- is the first of its kind to quantify the economic losses due to lack of sleep among workers in five different countries - the U.S, UK, Canada, Germany, and Japan. The study uses a large employer-employee dataset and data on sleep duration from the five countries to quantify the predicted economic effects from a lack of sleep among its workforce. Marco Hafner, a research leader at RAND Europe and the report's main author, says: "Our study shows that the effects from a lack of sleep are massive. Sleep deprivation not only influences an individual's health and wellbeing but has a significant impact on a nation's economy, with lower productivity levels and a higher mortality risk among workers." He continues: "Improving individual sleep habits and duration has huge implications, with our research showing that simple changes can make a big difference. For example, if those who sleep under six hours a night increase their sleep to between six and seven hours a night, this could add $226.4 billion to the U.S. economy." The U.S. has the biggest financial losses (up to $411 billion, which is 2.28 percent of its GDP) and most working days lost (1.2 million) due to sleep deprivation among its workforce. This was closely followed by Japan (up to $138 billion, which is 2.92 percent of its GDP, and around 600,000 working days lost). Germany (up to $60 billion, which is 1.56 percent of its GDP, and just over 200,000 working days lost) and the U.K (up to $50 billion, which is 1.86 percent of its GDP, and just over 200,000 working days lost) have similar losses. Canada was the nation with the best sleep outcomes, but still has significant financial and productivity losses (up to $21.4 billion, which is around 1.35 percent of its GDP, and just under 80,000 working days lost). To improve sleep outcomes, the report outlines a number of recommendations for individuals, employers and public authorities: Individuals - Set consistent wake-up times; limit the use of electronic items before bedtime; and physical exercise during the day. Employers - Recognise the importance of sleep and the employer's role in its promotion; design and build brighter workspaces with facilities for daytime naps; combat workplace psychosocial risks; and discourage the extended use of electronic devices after working hours. Public authorities - Support health professionals in providing sleep-related help; encourage employers to pay attention to sleep issues; and introduce later school starting times. The report is in part based on VitalityHealth's Britain's Healthiest Workplace study, in which RAND Europe and the University of Cambridge conducted analysis and research support. The report - Why Sleep Matters - The Economic Costs of Insufficient Sleep - involves independent research and analysis from RAND Europe. RAND Europe is a not-for-profit organization whose mission is to help improve policy and decision-making through research and analysis. Our clients include European institutions, governments, charities, foundations, universities and private sector firms with a need for impartial research. We combine deep subject knowledge across diverse policy areas including health, science and innovation; defense, security and infrastructure; and home affairs and social policy. Combined with proven methodological expertise in evaluation, impact measurement and choice modeling, we are able to offer quality-assured research and analysis, unbiased insights and actionable solutions that make a difference to people's lives. http://www.


News Article | December 1, 2016
Site: www.biosciencetechnology.com

A lack of sleep among the U.S. working population is costing the economy up to $411 billion a year, which is 2.28 percent of the country's GDP, a new report finds. According to researchers at the not-for-profit research organisation RAND Europe, part of the RAND Corporation, sleep deprivation leads to a higher mortality risk and lower productivity levels among the workforce, putting a significant damper on a nation's economy. A person who sleeps on average less than six hours a night has a 13 percent higher mortality risk than someone sleeping between seven and nine hours, researchers found, while those sleeping between six and seven hours a day have a 7 percent higher mortality risk. Sleeping between seven and nine hours per night is described as the "healthy daily sleep range". In total, the U.S. loses just over 1.2 million working days a year due to sleep deprivation among its working population. Productivity losses at work occur through a combination of absenteeism, employees not being at work, and presenteeism, where employees are at work but working at a sub-optimal level. The study - 'Why Sleep Matters - The Economic Costs of Insufficient Sleep'- is the first of its kind to quantify the economic losses due to lack of sleep among workers in five different countries - the U.S, UK, Canada, Germany, and Japan. The study uses a large employer-employee dataset and data on sleep duration from the five countries to quantify the predicted economic effects from a lack of sleep among its workforce. Marco Hafner, a research leader at RAND Europe and the report's main author, says: "Our study shows that the effects from a lack of sleep are massive. Sleep deprivation not only influences an individual's health and wellbeing but has a significant impact on a nation's economy, with lower productivity levels and a higher mortality risk among workers." He continues: "Improving individual sleep habits and duration has huge implications, with our research showing that simple changes can make a big difference. For example, if those who sleep under six hours a night increase their sleep to between six and seven hours a night, this could add $226.4 billion to the U.S. economy." The U.S. has the biggest financial losses (up to $411 billion, which is 2.28 percent of its GDP) and most working days lost (1.2 million) due to sleep deprivation among its workforce. This was closely followed by Japan (up to $138 billion, which is 2.92 percent of its GDP, and around 600,000 working days lost). Germany (up to $60 billion, which is 1.56 percent of its GDP, and just over 200,000 working days lost) and the U.K (up to $50 billion, which is 1.86 percent of its GDP, and just over 200,000 working days lost) have similar losses. Canada was the nation with the best sleep outcomes, but still has significant financial and productivity losses (up to $21.4 billion, which is around 1.35 percent of its GDP, and just under 80,000 working days lost). To improve sleep outcomes, the report outlines a number of recommendations for individuals, employers and public authorities: Individuals - Set consistent wake-up times; limit the use of electronic items before bedtime; and physical exercise during the day. Employers - Recognize the importance of sleep and the employer's role in its promotion; design and build brighter workspaces with facilities for daytime naps; combat workplace psychosocial risks; and discourage the extended use of electronic devices after working hours. Public authorities - Support health professionals in providing sleep-related help; encourage employers to pay attention to sleep issues; and introduce later school starting times.

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