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The coffee market is distinguished for being volatile and uncertain in terms of domestic and international prices. Arabica and Robusta coffee are produced in 23 provinces of Ecuador. A decade-long decline of coffee production prompted the Ecuadorian government to launch a public program for replanting coffee trees towards the end of 2011. A grower's decision to enter, remain in or exit the coffee sector is based on fluctuating profits from each year's harvest sale. We analyzed the hypothesis whereby the coffee grower's decision to leave the sector is explained by volatile and uncertain prices. This paper aimed to evaluate the coffee sector with an application of Real Option Analysis for the period 2002-2012. We also defined entry (H) and exit (L) prices for Arabica and Robusta coffee for the analyzed period. Our findings revealed high H and L prices encourage growers to leave the sector for the most part of the analyzed period. High H and L prices resulted from high variable cost due to increasing wages for farm workers. The Ecuadorian government is developing a policy to help growers make production more efficient, encouraging them to remain in the sector in the long run.

BACKGROUND: Although second opinions are rather restricted to the surgical disciplines, they have become more and more important to the health system in the last 20 years. The demand has been triggered by rising health costs and the economization of the field. The Internet has also made a considerable contribution to the demand for patient-initiated second opinions. Given these developments, it is surprising that second opinions have not become more important in the field of psychiatry. This article highlights the special situation of second opinions in psychiatry, discusses possible barriers to the adoption of second opinions in psychiatry, and the potential for greater use of second opinions in this field. OBJECTIVE: In psychiatry, second opinions have been neglected by the typical drivers of innovations in health care, including insurers and other commercial drivers as well as psychiatrists and patients themselves. This review identifies current barriers to widespread adoption of second opinions in psychiatric practice, discusses the benefits of second opinions that have been demonstrated in other disciplines, and outlines the potential gains to be realized through use of second opinions in psychiatry. METHODS: Literature in the area was reviewed through a search of the main medical databases. This literature review was supported by in-depth interviews with health care personnel and insurers. CONCLUSIONS: Second opinions are rarely obtained in psychiatry and there is little literature on this subject. The stigmatization of psychiatric disorders and patients and the uniqueness of the patient-doctor relationship in psychiatry, especially in psychotherapeutic care, may pose considerable obstacles to the use of second opinions in this field. In addition, more stakeholders, such as social workers, government agencies and regulators, health care and disability insurers, and social security agencies, are involved in the mental health compared with the somatic health sector, which may make it more difficult to ...

Involuntary hospitalization is a frequently discussed intervention physicians must sometimes execute. Because this intervention has serious implications for the citizens' civil liberties it is regulated by law. Every country's health system approaches this issue differently with regard to the relevant laws and the logistical processes by which involuntary hospitalization generally is enacted. This paper aims at analyzing the regulation and process of involuntary hospitalization in New York (United States) and Zurich (Switzerland). Comparing the respective historical, political, and economic backgrounds shows how notions of risk and liberty are culture-bound and consequently shape legislation and local practices. It is highly relevant to reconsider which criteria are required for involuntary hospitalization as this might shape the view of society on psychiatric patients and psychiatry itself. Furthermore, this article discusses the impact that training and experience of the person authorized to conduct and maintain an involuntary hospitalization has on the outcome.