Location: London or Manchester, England, UK
Closing Date: 5 September 2008

Full time 37.5 hrs/week, Band 8b £43,221 + HCAS where appropriate

The National Institute for Health and Clinical Excellence is the primary source of clinical practice guidance for the NHS in England and Wales. Our work includes producing evidence-informed clinical guidelines, appraising technologies for clinical and cost effectiveness, issuing guidance on the use of interventional procedures, and producing guidance on public health interventions and programmes.

We’re looking for an enthusiastic individual to work within the Centre for Clinical Practice, which is responsible for developing a substantive programme of guidelines through seven external National Collaborating Centres and one internal team. This is an opportunity to contribute to some of the most exciting challenges in NHS policy making, within an innovative, evolving organisation that will support your on-going professional development.

This is an important leadership role: working closely with the other health economics technical adviser and reporting to the Associate Director (Methodology), you will be responsible for further developing the use of health economics in clinical guideline development. This will involve taking a lead on supporting colleagues in several external National Collaborating Centres (NCCs) as well as within NICE, reviewing the economic and other technical aspects of draft clinical guidelines, and leading the development of the health economic methods used in NICE clinical guidelines. You will be encouraged to maintain and develop your practical skills and theoretical knowledge.

You will have:

• A Doctorate in a relevant quantitative health related area or equivalent experience.
• Experience with conducting health economic modeling to support decision making
• Excellent written and verbal communication skills
• An understanding of the principles of evidence-based health care and critical appraisal

The ability to work independently to tight deadlines and establish good working relationships with a range of professionals and work flexibly as part of a team is essential. Applications for secondments will be considered.

For an informal discussion, contact:

Phil Alderson, Associate Director Methodology), Centre for Clinical Practice

Francis Ruiz, Guidelines Technical Adviser (health economics), Centre for Clinical Practice For more information and applying online please visit http://www.jobs.nhs.uk/ quoting reference number 907-69

Closing Date: 5 September 2008

Interview Date: 19 September 2008

Location: UK

Mapi Values is currently seeking a Senior Research Associate for our Market Access team in the UK. The successful candidate will work on a stimulating variety of projects to develop high quality deliverables that will help our clients’ products gain access to international markets.

Requirements

Applicants should be able to offer:

• Excellent verbal and written communication skills, including the ability to write scientific and commercially-focused documents that are of high quality;
• A track record of delivering good quality work to stringent deadlines and to work well both within a team and independently;
• Experience of conducting research from initial concept through to stages of implementation and reporting;
• Ability to relate well to clients from the pharmaceutical industry, demonstrating insight into market access issues;
• Flexibility, proactivity and the facility to think critically and take appropriate action;
• Experience of preparing publications, value dossiers, HTA submissions and other documents to support pharmaceutical products in gaining access to markets, preferably within the pharmaceutical industry or a consultancy would be advantageous;
• A good degree in a relevant area. Experience of health economics is advantageous, but not a necessity;

If you meet the above requirements, are enthusiastic with a ‘can do’ attitude, and want to progress your career in health outcomes research in a dynamic environment, we want to hear from you. We offer a professional but friendly working environment in our UK offices based in the charming village of Bollington, close to Manchester. Please apply in writing, explaining why you feel you are suited to this post, and enclosing your CV, to:

Lesley Brooks - Office Manager
Mapi Values, Adelphi Mill, Grimshaw Lane,
Bollington, Macclesfield, Cheshire SK10 5JB, UK
e-mail: lesley.brooks@mapivalues.com

Mapi Values is an internationally renowned company with offices in the UK, France, the Netherlands and the USA, offering strategic consultancy and tactical solutions in Health Economics & Outcomes Research

Location: Switzerland

Salary on Application

Background: This is a rare opportunity to join a rapidly expanding Biotech company in Switzerland. Our client operates over several exciting therapeutic areas in novel drugs, and is currently looking for a Market Access Director for their European market.

Primary Duties: This is a highly pivotal role within the company developing European pricing and reimbursement strategies and overseeing several specialists in pricing, health economics and outcomes research providing leadership and taking the lead in value propositions.

This role will involve both strategic and hands on elements with the successful candidate developing relationships with key opinion leaders and influencing reimbursement decisions.

This director level position is extremely broad and very important to the client. This is your opportunity to shine in a position that will put you well within the upper echelons of your chosen field.

Qualifications: For this position we would expect you to have a higher degree in health economics and a considerable level of experience within industry.

For this or any other Pharmacoeconomics opportunities please contact:

Austen Morgan
HEOR, Pricing and Market Access Specialist
NonStop Pharma Recruitment Economics Team
economics@nonstop-pharma.com
Alternatively, please call on +44 (0)207 234 0550

NonStop operate on strict procedures and will not actively market your details without your express permission and direction.

Location: Germany

Job Background: NonStop’s client is a leading international consultancy with operations in over 90 countries and projects in the pharmaceutical industry worldwide. Are you an experienced Health Economist looking for a new challenge? This opportunity will allow you to grow and take your career to another level!

Job Primary Details: You will mainly be involved in the development of HTA reports and dossiers. Furthermore you will get involved in the execution of national and international studies in Health Economics and Outcomes Research. This position is ideally suited to Health Economists with strong technical skills who enjoy economic modelling. For very experienced candidates the option of project management exists. This role will allow you to develop your career and strengthen your reputation in the industry.

Experience: You background should be in the life sciences, medicine, pharmacy or health economics and you must have a proven track record of achievements in technical modelling. Knowledge of European and International Healthcare Systems would be advantageous. All candidates must speak German to at least conversational level and must be eligible to work in Germany/hold a valid working visa.

A full job description is available for this role for suitable candidates.

For a confidential discussion and to find out more about this role please contact NonStop Pharma quoting the reference numbers on 0044 (0)207 9402102, alternatively you can e-mail Yella Martin on economics@nonstop-pharma.com

Location: Europe

Salary on Application

Build a European Team in Europe - Health Economics HEOR Director

Background: One of the world’s leading Pharmaceutical services providers is looking to recruit a Senior Director of Health Economics and Outcomes Research. Our client requires an experienced heavy weight candidate with considerable industry experience for a role that will be extremely important in the development of our clients European operations.

Primary Duties: For this position we are looking to recruit candidates with experience in both hands on and strategic Health Economics to build a team for Health Economics and Outcomes Research in the UK. You will act as a technical lead and source of expertise for all aspects of study design, modelling, and scope for research projects. If you are looking for a role that will grow as you develop this surely has to be the position for you in a company that continues to go from strength to strength and is very well regarded in the market place.

Qualifications:

• Higher Degree in Health Economics or related subject.
• Strong technical and strategic skills in Health Economics and Outcomes Research.
• Extensive experience within industry or consultancy

For this or any other Pharmacoeconomics opportunities please contact:

Austen Morgan
HEOR, Pricing and Market Access Specialist
NonStop Pharma Recruitment Economics Team
economics@nonstop-pharma.com
Alternatively, please call on +44 (0)207 234 0550

NonStop operate on strict procedures and will not actively market your details without your express permission and direction.

Location: UK

An exciting opportunity has arisen for an Associate Director of Market Access based in the UK. The main responsibilities involves providing leadership on all phases of project delivery, including business development, proposal writing, undertaking qualitative interviews, analysis and presenting final results.

Responsibilities

• Leadership and management of teams on a project basis
• Actively contributing to and participating in the business development and activities
• Contributing to the general management of the company as required.
• Depending on your experience, this could involve staff development and appraisals

Duties

• To develop and agree the appropriate process and methodology for the project in hand with the Chief Executive and, where appropriate, other members of the team
• To develop project proposals, including worked-through costings, using established templates
• To develop and agree project and analysis plans
• To execute projects, including the following tasks:
  • Project management
  • Managing the project team as appropriate
  • Client liaison
  • Qualitative research
  • Analysis of research findings
  • Development of results presentation and recommendations
  • Presentation of results
  • Client feedback
• To identify and develop new business opportunities
• As a member of the management team:
  • Actively participate in management executive meetings
  • Contribute to the development of functional strategies
  • Contribute to product development
  • contribute to staff development and appraisal

Stelfox operates on a very simple maxim:

Find out what people want and give it to them.

The primary focus of each Stelfox consultant is to cultivate a relationship with both client and candidate based on professionalism, speed and accuracy. The latter being the obvious competitive advantage offered by Stelfox afforded through the knowledge and experience of each individual consultant.

The Stelfox team know exactly what type of individuals and skillset each of our clients repeatedly look for.

Please contact Ann-Sofie Brandt for details of this or any other opportunities on 01273-727-930 or ann-sofie@stelfoxuk.com

Location: UK based

My client is one of the fastest growing US pharmaceutical companies with ambitious plans for expansion in to Europe. With an exciting potential blockbuster in the pipeline it is exciting times for this organisation. With being a forward thinking company and knowing there will be Market Access issues this position is on of the first to be created.

The job-holder in this role will drive, manage and support the multiple elements that will need to be constructed and integrated to achieve successful reimbursement in Europe. The over arching objective of this role is to minimize, as far as possible, the delay between obtaining regulatory approval and subsequently ensuring rapid market access to both patients and physicians.

Core responsibilities

• Assist in internal pricing discussions and in developing a global pricing strategy
• Set up and manage external pricing partnerships and third parties
• In partnership with Health Outcomes team, lead development of value messages and value communication tools for payors and reimbursement agencies
• Identify key stakeholders for P&R and market access in major EU markets
• Determine their specific information needs and requirements to tailor health outcomes data appropriately
• Within markets determine the sequence to engage with stakeholders and optimum timings
• Produce “master” reimbursement strategy plan for key EU markets
• Work with affiliates and country managers to action this plan to deliver success at the local level
• Manage external partners to assist in facilitating access and with all “non-technical” P&R needs.

Technical Skills, Competencies & Qualifications

• Looking for someone to rise to a unique challenge
• Previous experience in healthcare industry with ideally a hospital / orphan / specialised product
• Experience in global / regional (EU) market access role or possible local market / affiliate experience and interaction with P&R stakeholders (national, regional, hospital).
• Familiar with needs of P&R stakeholders in major EU markets
• Strong strategic and analytical thinking - to be able to pull together a pan-European reimbursement plan.
• Excellent influencing and relationship building skills.
• Fluency in English. Foreign language skills are a plus.

Feel free to contact Simon Rose on +44 (0) 207 922 7155 (Direct Line) or email simon.rose@hayspharma.com for more information. If this role does not suit you but you are interested in hearing about other positions Simon has positions across Europe at different levels.

Location: USA or Canada

My client is well reputed, independently owned consultancy looking to expand its business to North America. They are a one stop shop offering a wide range of services and currently working with the majority of the leading Pharmaceutical and Medical Devices Company.

This rare opportunity In will support the General Manager in developing a technical department with sufficient skills in decision analytic modelling, health technology appraisals, value dossiers and publishing health economic studies.

Core Responsibilities:

• Build, lead and mentor a brand new team
• Build relationships with internal and external stakeholders
• Have a strong technical background

Experience / Qualifications:

• Relevant postgraduate degree
• Previous line responsibilities
• Excellent communication both written and verbal
• A strong understanding in the US healthcare system

Feel free to contact Simon Rose on +44 (0) 207 922 7155 (Direct Line) or email simon.rose@hayspharma.com for more information. If this role does not suit you but you are interested in hearing about other positions Simon has positions across Europe at different levels.

Location: Home Counties, UK

This is an excellent opportunity to join a leading, niche Biopharma based at their UK affiliate. My client is a rapidly expanding and developing their Market Access and Pricing department. This purpose of the role is to focus on all market access issues related to in line brands

Purpose of Role:

• Provide leadership in developing and implementing Market Access strategies
• Provide process and technical expertise in Health Technology Appraisal submissions
• Has and establishes relationships with health economic opinion leaders, and reimbursement agencies within the UK and Ireland health care systems
• Works in collaboration with government affairs colleagues to influence national reimbursement policies

Main Responsibilities:

• Leadership of Health Technology Appraisal (HTAs) submissions
• Provides support to the Marketing strategies Initiates the most effective and timely strategy to obtain
• In collaboration with government affairs colleagues initiates and organizes high level events to support Market Access activities
• In collaboration with Clinical Research and European Health Economic colleagues provides input to global clinical development plans to ensure delivery of data necessary for optimal reimbursement

Main Job Qualifications/Requirements:

• Previous experience in the UK health care or pharmaceutical industry
• Post graduate qualification in health economics, health policy or relevant experience
• Is a very good internal and external communicator
• Proven project management skills
• Flexible team member with positive attitude and ability to prioritise projects
• Ability to influence and persuade both internal and external stakeholders

Feel free to contact Simon Rose on +44 (0) 207 922 7155 (Direct Line) or email simon.rose@hayspharma.com for more information. If this role does not suit you but you are interested in hearing about other positions Simon has positions across Europe at different levels.

Location: New York, New York, United States

Required Travel: 0-10%

Columbia Law School has the following openings:

Associate Director

The Associate Director will counsel and advise J.D. and some LL.M. students on job search strategies as well as design and administer career path panels and workshops for J.D. students. The incumbent will also assist with the overall administration of the Office and will be responsible for specific projects and responsibilities unique to this position.

Assistant Director of Career Services

The Assistant Director will administer J.D. focused programs and web based resources for the J.D. students. The incumbent also assists with the counseling of international LL.M. students as well as managing some of the recruitment events for the Office.

Both positions report to the Dean of Career Services.

Minorities are encouraged to apply for all positions listed.

For a more detailed job description with requirements, as well as instructions on how to apply for the position, please use the following quick find link:

• Associate Director
• Assistant Director

Columbia University is an Equal Opportunity/Affirmative Action Employer

Location: Home Counties, UK

Our client, the world’s largest biotechnology company, discovers and develops important therapeutics which bring meaningful improvement to the lives of people all over the world. Science-based and patient-driven, they aspire to be the best human therapeutics company, building their success on innovation, team work, risk-taking and the pursuit of excellence.

Head of Health Economics

Responsibilities:

• Review of Affiliate’s health economics priorities, allocation of HE resources in line with business strategy
• Planning and delivery of health economics policies and activities for the UK and Ireland Affiliate
• Act as strong local partner in shaping the expression of product value on global and international matrix teams
• Management and continuous improvement of the UK Affiliate health economics processes, aligned with the matrix
• Direct and manage HTA submissions to NICE, SMC and AWMSG, and coordination of delivery of constituent components

Senior Manager Health Economics

Responsibilities

• Design and delivery of HTA models for current and future products
• Delivery of NICE, SMC and AWMSG submissions
• Training of staff on value proposition elements
• Supporting the Affiliate Business Units in the use of HTA data with customers
• Management and coordination of external consultants and business partners
• Execution of data generation and analysis projects

Feel free to contact Simon Rose on +44 (0) 207 922 7155 (Direct Line) or email simon.rose@hayspharma.com for more information. If this role does not suit you but you are interested in hearing about other positions Simon has positions across Europe at different levels.

Location: Atlanta, Georgia, USA

Health Economist or Health Policy Researcher: Serves both as a researcher & a scientific officer in Economics and Health Service Research Team, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, conducting research and providing expert consultation on economic evaluation and policy research related to the prevention and control of diabetes. Independently designs and conducts research to examine the cost and effectiveness of interventions and health policies designed to prevent and control diabetes. Develops grants, contracts or cooperative agreements with institutions of higher education, health care organizations, and other governmental and non-governmental health agencies. Applicants should have a strong quantitative background, strong ability to analyze large national survey and medical claim data, excellent writing and oral communication skills, and a desire to work in a multidisciplinary research team of epidemiologists, health service researches, biostatisticians on issues related to chronic diseases prevention and health promotion. Applicants should also have a Ph.D. in economics or applied economics, health policy, health service research, or a related discipline. Several years of experience in economic evaluation and health policy research are preferred but not required.

Competitive salary and benefits. The review of applications will begin on September 15, 2008. Applications received by that time will receive full consideration.

Applicants may submit a curriculum vita or resume to Dr. Ping Zhang, 4770 Buford Highway, NE, Mail Stop K-10, Atlanta, Georgia 30341 or e–mail: Pzhang@cdc.gov.

Location: Aarhus, Denmark
Closing date: 15 September 2008

The Department of health services, Faculty of Health Sciences, University of Aarhus - Denmark invites applications for a vacant position as Assistant Professor. The position is to be filled by September 1, 2008 or as soon as possible thereafter for a duration of three years, after which it will be announced as a position op Associate Professor or re-announced as an Assistant Professor position.

The Department of Health Services Research was founded in 2005. The staff includes a Professor (MD), a part time Associate Professor (economist), a full time Assistant Professor (economist) and a Data Manager. The Department undertakes research on Danish and international health systems. The staff participate in a joint research programme using Danish public social and health registers, including a follow-up since 1990 of a systematic sample of 200,000 inhabitants of Northern Jutland and Mid Jutland, Denmark. The programme focuses on the interaction between the health system, target populations and health service utilisation from the perspectives of health economics, organisation, sociology, population epidemiology and clinical epidemiology.

The Assistant Professor will naturally play a role in the continued development of the Department and its research with the register-based programme, in collaboration with other university departments and departments of planning and management of the health and social services in the regions and municipalities of Denmark. The Department also provides an opportunity to participate in cost-effectiveness studies and economical evaluations in general, as well as international health projects. The Assistant Professor will become a member of the Department’s and the Institute’s scientific team and contribute to education and research with publications on health services research in international and Danish media.

Applicants must hold a Master’s and a PhD degree in Economics, and have experience - or at least be interested in health economics research. A knowledge of and proficiency in econometrics are essential, as well as good cross-disciplinary interpersonal skills. The candidate should be eager to adopt the main ideas and terminologies of associated professions in the field of public health.

The Assistant Professor will take part in the Institute’s educational programmes, including the planning, teaching, and individual and cross-disciplinary group-based supervision. At present, this primarily involves the Master of Public Health (MPH) and the Ph.D. programmes at the Institute. Participation in the University’s teaching courses for Assistant Professors is obligatory.

The conditions of employment are based on the agreement between The Ministry of Finance and The Federation of Graduate Employee Unions. Remuneration will include an additional pension based bonus of DKK 57.866,54 (April 2008 level). Further information is available in the regulations of 13. june 2007 concerning academic positions at Danish universities.

The guidelines of the Faculty for the Assessment Committee may be requested from the Secretariat of the Faculty of Health Sciences, Vennelyst Boulevard 9, DK-8000 Aarhus C, Denmark, or on: http://www.health.au.dk/stillingsopslag.

The application should include a curriculum vitae, a complete list of the applicant’s scientific publications highlighting which publications the applicant wishes to be included in the assessment, and information about teaching experience. Three copies of each of these publications should be included with the application. The Assessment Committee can decide to include material which has not been submitted in their evaluation. In this event, the applicant will be informed and asked to send the material, or otherwise to withdraw the application. Furthermore, the application should include a description of the applicant’s previous research with reference to the enclosed publications, together with a short description of future research plans. Guidelines concerning writing an application can be found on http://www.health.au.dk/stillingsopslag or, alternatively, requested from the Faculty Secretariat.

Regardless of age, gender, race, religion or ethnic background all potential applicants are encouraged to apply for the position.

Further information about the position can be obtained from Professor. Dr. med. Anders Foldspang (tel. +45 89423181 ), or by email af@mph.au.dk

When the Assessment Committee has completed its evaluation, applicants will receive the part of the evaluation which concerns them.

Four copies of the application, together with three copies of the publications to be assessed, should be sent to The Faculty of Health Sciences, Vennelyst Boulevard 9, DK-8000 Aarhus C, Denmark. Applications must reach the Faculty Secretariat before 12 noon on September 15th. 2008.

The application should be marked 2008-212/2-279

The University of Aarhus has 35,000 students, 8,500 members of staff and a turnover of DKK 4.8 billion in 2008. The university’s strategy and development contract are available at http://www.au.dk/en/strategy

Location: London, England, UK

Background to the company:

Total Healthcare Solution (THS) is a specialist pricing, reimbursement and market access consultancy. Founded 13 years ago the group is one of the longest established independent consultancies in the field. The group currently employs 16 staff in its offices in London. Success of the THS business model has been based on maintaining a focus on high quality deliverables to our clients and senior involvement in all stages of our projects is central to our ethos. By focusing on quality we have been able to secure both consistently high rates of repeat business and proposal conversion.

Purpose of the role

• To be the key lead on all phases of project delivery, including business development, proposal writing, undertaking qualitative interviews, analysis and presenting final results.
• All projects require leadership from a senior member of staff (Associate Director and/or Director, depending on project scope), project management from a senior consultant and support from junior staff members (e.g. Business Analyst).
• As Associate Director you will be expected to take a lead role in managing the key accounts to which you will be allocated. Because of our long-standing and close relationships with our clients, business development is typically undertaken as a parallel activity to servicing projects e.g. building relationships, responding to early client queries, explaining and highlighting our full service offering, tracking potential leads for future projects.
• Following a period of mentorship with either the Director or CEO (in order for you to gain a clear understanding of the THS business model and framework of project activity) it is expected that you will take full responsibility for projects within a relatively short period of time. We expect your skills and experience will enable you to effectively liaise and communicate with the rest of the THS team. Close interaction ensures that knowledge and experience is shared effectively and efficiently.
• The Total Healthcare Media writing team can be called on to assist in report writing, searches and ensuring that the integrity of any developed information is maintained.

Responsibilities

• Delivery of analysis and robust, challenge-proof recommendations for nominated projects - in line with client objectives and expectations, and on-budget
• Leadership and management of teams on a project basis Consultancy work necessitates the management of individuals for whom you will not have line responsibility. You will therefore work closely to facilitate the personal development of staff
• Actively contributing to and participating in the business development and activities
• Contributing to the general management of the company as required.

Depending on your experience, this could involve staff development and appraisals

Duties

• To develop and agree the appropriate process and methodology for the project in hand with the Chief Executive and, where appropriate, other members of the THS team
• To develop project proposals, including worked-through costings, using established templates
• To develop and agree project and analysis plans
• To execute projects, including the following tasks:
  • Project management
  • Managing the project team as appropriate
  • Client liaison
  • Qualitative research
  • Analysis of research findings
  • Development of results presentation and recommendations
  • Presentation of results
  • Client feedback
• To identify and develop new business opportunities
• As a member of the management team:
  • Actively participate in management executive meetings
  • Contribute to the development of functional strategies
  • Contribute to product development
  • Contribute to staff development and appraisal

Stelfox operates on a very simple maxim:

Find out what people want and give it to them.

The primary focus of each Stelfox consultant is to cultivate a relationship with both client and candidate based on professionalism, speed and accuracy. The latter being the obvious competitive advantage offered by Stelfox afforded through the knowledge and experience of each individual consultant.

The Stelfox team know exactly what type of individuals and skill set each of our clients repeatedly look for.

Please contact Ann-Sofie Brandt for details of this or any other opportunities on 01273-727-930 or ann-sofie@stelfoxuk.com

Location: Berkshire, England, UK

My client supplies thousands of medical products and services to almost every hospital and Trust in Great Britain. It is diverse company which covers Pharma, Devices and Delivery mostly dealing with critical care.

The position that I am recruiting for is new to the organisation with the objective to develop and implement the Health Economics and Quality of Life strategy for the UK and by:

Making best of the data that they have today through assisting the business to build financial models and business cases that position our current offerings as being of economic benefit as well as clinical benefit.

Working with Government Affairs and Public Policy team and the business to influence Governments, Key Opinion Leaders and Patient associations through the macro-economics advantages of our product and services.

Influencing my Clients Global and Europe to produce UK required data to support the introduction of new and developing technologies and services.

Developing UK pricing and reimbursement strategies for new and developing technologies and services.

Skills and qualifications

• English to business standard - written and spoken
• Understanding of Reimbursement Systems in key UK Markets.
• Experience in the practice, design and implementation of health economic studies including cost-minimisation, cost-effectiveness, cost utility, cost-benefit and cost-consequence analysis, as well as a solid foundation in the design and application of quality-of-life research and standards of care to pharmaceutical and device reimbursement.
• Effective written and oral communication skills.
• Ability to negotiate and influence senior level Country leadership teams.
• The ability to make effective independent decisions within a matrix environment under minimal supervision.
• Proficiency with Internet and multiple software applications including Microsoft Office, statistical and decision analysis software.
• Demonstrable record of collaborative working, and personal delivery to agreed timelines
• Experience of managing external suppliers.
• Advance degree in either - Health Economics, Public Health, Epidemiology, Pharmacy, Medical or Statistics.
• Prior experience with working in or with consultancy agencies, Pharma or Academia.
• Clear, decisive and strategic thinker, with the ability to translate strategy into commercial outcomes and actions

Feel free to contact Simon Rose on +44 (0) 207 922 7155 (Direct Line) or email simon.rose@hayspharma.com for more information. If this role does not suit you but you are interested in hearing about other positions Simon has positions across Europe at different levels.