Requirements for the characteristics of objectives.
\r\n\tThe aim of this book will be to describe the most common forms of dermatitis putting emphasis on the pathophysiology, clinical appearance and diagnostic of each disease. We also will aim to describe the therapeutic management and new therapeutic approaches of each condition that are currently being studied and are supposed to be used in the near future.
",isbn:null,printIsbn:"979-953-307-X-X",pdfIsbn:null,doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,hash:"278931ae110500350d8b64805c70f193",bookSignature:"Dr. Eleni Papakonstantinou",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/7934.jpg",keywords:"Atopic eczema, Interleukin, Topical corticosteroids, Hand eczema, Blisters, Pruritus, Irritant contact dermatitis, Allergic contact dermatitis, Discoid eczema, Sebaceous glands, Inflammatory dermatitis, Facial rash",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"February 5th 2019",dateEndSecondStepPublish:"March 19th 2019",dateEndThirdStepPublish:"May 18th 2019",dateEndFourthStepPublish:"August 6th 2019",dateEndFifthStepPublish:"October 5th 2019",remainingDaysToSecondStep:"2 years",secondStepPassed:!0,currentStepOfPublishingProcess:5,editedByType:null,kuFlag:!1,biosketch:null,coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"203520",title:"Dr.",name:"Eleni",middleName:null,surname:"Papakonstantinou",slug:"eleni-papakonstantinou",fullName:"Eleni Papakonstantinou",profilePictureURL:"https://mts.intechopen.com/storage/users/203520/images/system/203520.jpg",biography:"Dr. med. Eleni Papakonstantinou is a Doctor of Medicine graduate and board certified Dermatologist-Venereologist. She studied medicine at the Aristotle University of Thessaloniki, in Greece and she continued with her dermatology specialty in Germany (2012-2017) at the University of Magdeburg and Hannover Medical School, where she completed her dissertation in 2016 with research work on atopic dermatitis in children. During this time she gained wide experience in the whole dermatological field with special focus on the diagnosis and treatment of chronic inflammatory skin diseases and also the prevention and treatment of melanocytic and non-melanocytic skin tumors. Her research interests were beside atopic dermatitis and pruritus also the pathophysiology of blistering dermatoses. In addition to lectures at german and international congresses, she has published several articles in german and international journals and her work has been awarded with various prizes (poster prize of the German Dermatological Society for the project: 'Bullous pemphigoid and comorbidities' (DDG Leipzig 2016), 'Michael Hornstein Memorial Scholarship' (EADV Athens 2016), travel grant (EAACI Vienna 2016). Since 2017, she works as a specialist dermatologist in private practice in Dortmund, in Germany. Parallel she co-administrates an international dermatologic network, Wikiderm International and she writes a dermatology public guide for patients, as she is convinced that evidence-based knowledge has to be shared not only with colleagues but also with patients.",institutionString:"Private Practice, Dermatology and Venereology",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:null}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"16",title:"Medicine",slug:"medicine"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"270941",firstName:"Sandra",lastName:"Maljavac",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/270941/images/7824_n.jpg",email:"sandra.m@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"6550",title:"Cohort Studies in Health Sciences",subtitle:null,isOpenForSubmission:!1,hash:"01df5aba4fff1a84b37a2fdafa809660",slug:"cohort-studies-in-health-sciences",bookSignature:"R. Mauricio Barría",coverURL:"https://cdn.intechopen.com/books/images_new/6550.jpg",editedByType:"Edited by",editors:[{id:"88861",title:"Dr.",name:"R. Mauricio",surname:"Barría",slug:"r.-mauricio-barria",fullName:"R. 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Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"878",title:"Phytochemicals",subtitle:"A Global Perspective of Their Role in Nutrition and Health",isOpenForSubmission:!1,hash:"ec77671f63975ef2d16192897deb6835",slug:"phytochemicals-a-global-perspective-of-their-role-in-nutrition-and-health",bookSignature:"Venketeshwer Rao",coverURL:"https://cdn.intechopen.com/books/images_new/878.jpg",editedByType:"Edited by",editors:[{id:"82663",title:"Dr.",name:"Venketeshwer",surname:"Rao",slug:"venketeshwer-rao",fullName:"Venketeshwer Rao"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"4816",title:"Face Recognition",subtitle:null,isOpenForSubmission:!1,hash:"146063b5359146b7718ea86bad47c8eb",slug:"face_recognition",bookSignature:"Kresimir Delac and Mislav Grgic",coverURL:"https://cdn.intechopen.com/books/images_new/4816.jpg",editedByType:"Edited by",editors:[{id:"528",title:"Dr.",name:"Kresimir",surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"51974",title:"Procedure for the Award of Contracts and Contracting in Public Passenger Transport",doi:"10.5772/64820",slug:"procedure-for-the-award-of-contracts-and-contracting-in-public-passenger-transport",body:'\nProperly concluded contractual relationship allows the creation of a strong partnership through which the authorities can pursue their policy objectives. Such a partnership should prevent from neglecting fulfilment of the tasks or abusing position of one from parties. The key factor for providing public transport services is an adequate regulatory framework and contracting conditions that should be set to support the competitive behaviour of bidders—service providers.
\nThe regulatory framework consists of three levels [1]:\n
Strategic (setting basic objectives to be achieved: transport policy, public budgets, intermodality, etc.).
Tactical (emphasis mainly on design of services and fares, requirements for staff, vehicles, additional services).
Operational (ensuring the service provision in the market according to objectives: sale activities, information for the public, deployment of vehicles, maintenance).
In the process of preparing and contracting, the attention must be paid to aspects such as [2]:\n
setting the rights and obligations of the parties,
addressing the issue of infrastructure ownership and ownership of service provider (transport means and depots),
risk allocation between the parties,
responsibility for planning and design of services to be provided (freedom which be given to the operator in designing and making changes in services),
scope of contract,
structure of payment (it should represent a balance between profit and reward for realised performance),
method of monitoring and controlling a fulfilment of public service obligations.
It should be noted that a proper adjustment of these aspects by authorities helps to operators improve efficiency of service provision and reduce costs.
\nThe provision of public transport services requires on the one hand the availability of particular assets (such as infrastructures and vehicles), and on the other hand the management of those assets in combination with personnel.
\nThere are several possibilities of ownership [3]:\n
public ownership,
mixed ownership majority private partner of more than 50% or minority private partner of less than 50%,
private ownership.
Infrastructure ownership and ownership of service provider can be separated according to following ways (and the ownership can be organised differently for each part):\n
vertical integration (where operator owns infrastructure),
vertical separation (where operator does not own infrastructure).
In the case of vertical separation, it is necessary to address an issue of infrastructure management. The infrastructure can be managed by [3]:
\noperator or
authority organises infrastructure management separately from operator who provides passenger transport services.
In case that the transport operator manages infrastructure, a combination of ownership and usage may result in: [1, 4]:
\nDelegated management where the operator acts independently from the authority and uses the assets provided by the authority. These assets may be provided based on various arrangements, for example “for free” or based on a contract regarding publicly owned infrastructure or through a leasing company.
Public management where the assets are owned by the authority and transport services are provided by a public operator. Such provision of transport services may be ensured based on an in-house contract.
In the third case which represents operators who provide assets. they are also responsible for service operation by using these assets. The contract based on which services are provided may take various forms and scope ranged from simple bus service contracts (where operators provide bus services by using their own buses) to more complex contracts (e.g. DBOT contracts—Design, Build, Operate and Transfer). Other type of contracts may represent infrastructure-concession contracts where operators may decide to some extent about the design of the assets and service realisation or PPPs contracts (Public–Private Partnership).
The process of public service procurement is complex and consists of several procedural steps, which must be done from authorities’ position (see Figure 1) [3]. The basis of each process should be sufficient preparation. Good preparation can bring quality in services provided and effective use of public funds. Therefore, this part of the procurement process cannot be underestimated from the position of a public authority. In the first step, it is necessary to set the basic strategic objectives based on identified requirements of the public. Further, the services to be provided are characterised and designed. The services should be defined with respect to the criteria by which it will be possible to evaluate to what extent (range) a candidate (public service operator) is able to fulfil the provision of transport services. Last but not least, it is important to develop framework conditions of public service contract. Further step is related to award procedure, which can represent the direct award of contract or a competitive tendering. In the last step, a public authority implements the control procedures during contractual period whether a service operator meets its obligations.
\nProcedure of public authority while contracting [3].
The first essential step in the procurement is to determine the demand for public services—public passenger transport. Public service requirements can be found out by using different methods. One of the methods is an interview with passengers or potential passengers. The person responsible for obtaining information firstly selects a group of citizens who will be asked to answer simple questions. Ranking of requirements for public services in terms of quality and quantity is compiled at the end based on the answers [5].
\nAnother method of identifying requirements of passengers is a form of questionnaire. The first step in creating a questionnaire is to determine the existing problem in public services. Information about the problem can be obtained based on written complaints or verbal manifestations of citizens. Further, it is necessary to determine the objectives and indicators of questionnaire and to select a group of people to be queried. The advantage of questionnaires is fast obtaining the information in a short time and at relatively low costs. The questionnaires are sent directly to citizens or may be in the form of anonymous questionnaires.
\nBy gathering information on requirements for public services, the strategic objectives can be determined.
\nThe transport policy addresses public passenger transport and its objective is to ensure the sustainable development of mobility, coordination of public passenger transport with individual transport and improvement of road safety. Regarding the provision of public passenger transport, it is also necessary to take into account other policies such as social, environmental policy.
\nTypical strategic objectives within public transport are [3, 6]:\n
Transport policy:\n
enhance total transport situation,
reliability of services,
ensure mobility,
increase market share of public transport within the intermodal market: influence the modal split, for example also by parking policy,
traffic safety,
link individual with public transport.
Social policy—support for specific target groups:\n
people with low incomes,
people with limited mobility,
employees of the operator,
pupils, students and apprentices,
young and elderly,
accessibility for all layers/generations of the population.
Environmental policy:\n
efficient energy use,
quality of life in urban areas,
reduce emission of pollutants, for example reduction in global warming gas emissions,
noise reduction,
protection of vulnerable rural areas.
Structural and economic policy (regional development)—enhancing services within specific areas:\n
infrastructure policy—establishing capacities, regulations for use and financing the public transport infrastructure,
regional structure,
support for small- and medium-sized enterprises,
site-related factors,
location trends,
land-use policy.
Budgetary aspects.
Subsequently, the strategic objectives should be confronted with the local conditions.
\nTo be able to properly transform strategic objectives into tactical means (service concepts), the relevant local circumstances (constraints) have to be identified and taken into account. Numerous aspects, tasks and competencies can have an impact on public transport.
\nFirstly, it is appropriate to analyse the local organisation of a concerned territory and to gain a good overview of the current distribution of tasks, competencies and responsibilities between the operators and the public authorities. Some further aspects to analyse are legal and economic aspects and the existing market structure as well as the existing transport system and geographical aspects [3].
\nSignificant local circumstances (constraints) include [4, 6]:\n
Existing local organisation of public transport:\n
localisation of information and skills,
localisation of decision-making powers for policy-making (strategic level) service design (tactical level) and operational decisions (operational level),
identification of roles and duties of public authorities and service operators.
Legal restrictions:\n
existing contractual regulations,
existing awarding and contracting procedures,
right of initiative,
overcompensation,
national/local legal framework,
EU legal framework.
Economic restrictions:\n
financial/budgetary aspects,
ability to bear risk by the authority,
economic situation of the operator market (including ability to bear risk).
Market structure of service operators:\n
capabilities,
number and size,
efficiency,
ownership.
Existing transport system:\n
vehicles,
network design,
infrastructure, for example existing railways, existing depots,
existing databases, for example passenger data, modal split figures,
level of quality of public transport services.
Spatial/geographical restrictions.
The further step prior to the conclusion of public service contract is a characterisation of services and definition of requirements for services. It is also necessary to divide the tasks, competencies and responsibilities between the operators and the public authorities in order to ensure efficient provision of public service.
\nIn order to reach the decision on an adequate level of competence of service operator when designing services, it is recommended to answer the following preliminary questions first [5]:\n
Which interests are in conflict with each other?
Which interests need to be harmonised (and how)?
To what extent can a natural overlap between the commercial and other interests of the operator, the interests of the public as well as the interests of the authorities be expected?
It is necessary to note that the allocation of responsibilities determines the appropriate risk allocation between the operator and the authority. Whoever takes the opportunities and risk is the party most appropriate to influence the corresponding features.
\nDecision-making on service design (i.e. tactical decisions) can be organised in different ways. It should be distinguished between two basic periods:\n
The period during which the contractual relation between operator and authority is established.
The period during which the contract is realised.
For each of these two periods, fundamental organisational decisions have to be taken as to the allocation of initiative power and decision power to the authority and to the operator [3].
\nWithin the first period of establishment of the relation, service design can be determined [2]:\n
by the operator through the bid that he delivers to the authority; in the context of awarding, this is also known as “functional” awarding,
in a negotiated way between the operator and the authority during the contracting process; this intermediate way to organise things is also known as “negotiated” or
by the authority prior to contracting; in the context of awarding, thesis also known as “constructive” awarding.
During the second period of contract realisation, service redesign can also be organised in different ways [1]:\n
It can be determined by the authority, or
It can be determined by the operator:\n
the operator may only have the possibility to suggest amendments to the network, whereas the authority remains in charge of deciding upon the implementation of those changes after conducting a check on the desirability and/or financial consequences of the change or
the operator may have the freedom to modify services autonomously as he wishes (indeed, within specific norms of network accessibility specified by the authority within the contract).
Technical specifications and conditions are understood to be the determination of characteristics and requirements, which must be fulfilled in the bids submitted by tenderers in order to obtain a contract. Technical conditions are part of the tender documentation. Technical conditions may be determined either by the form of references to the documents, standards, regulations and acts or by the form of requirements for parameters of expected utility, for example setting requirements for performance, capacity.
\nIndividual characteristics and requirements for services must be set so that none of the tenderers and candidates is discriminated and the principles of transparency, economy and efficiency must be applied.
\nThe objectives should not be specified too general. It is favourable if the concretisation of subject of the contract in the form of objectives is a part of tender documentation. This contributes to the improvement of evaluation process, award procedure as well as control process. Correct determination of objectives is an assumption for easier definition of evaluation criteria. Requirements for the characteristics of objectives are presented in Table 1.
Characteristic of objectives | \nDescription | \nExample | \n
---|---|---|
Verifiability | \nAn objective can be verified | \nTechnical parameters | \n
Quantifiability | \nAn objective can be measured | \nNumber of kilometres travelled, hours of operation | \n
Objectivity | \nAn objective relates directly to the purpose of contract | \nQuality of the carriage of passengers | \n
Consistency | \nMutual continuity of objectives | \nReduction the transport impact on the environment by promoting public transport | \n
Requirements for the characteristics of objectives.
A public authority must determine evaluation criteria, which reflect the expectations that are to be achieved through public transport services. The evaluation criteria can be distinguished in terms of type and kind. Individual types and kinds of evaluation criteria with stated examples are presented in Table 2.
\n\n\nIn order to determine to what extent the feature of quality is fulfilled, it is necessary to find a way to measure particular feature of quality. Transformation of qualitative criteria into quantitative criteria is performed due to the measurability of quantitative criteria. The intensity of quality can be measured, for example, by using ten-point scale. Interval of scoring is compiled from the unsatisfactory quality up to the perfectly satisfactory quality [7].
\nTypes of evaluation criteria | \nKinds of evaluation criteria | \nExamples | \n
---|---|---|
Quantitative | \nCost | \nThe lowest offer price repairs and maintenance operating costs return on investment | \n
\n | Utility | \nTechnical level technical parameters environmental impact | \n
\n | Time | \nInterchanges continuity time of transport | \n
qualitative | \nQuality | \nSafety and comfort caring for passenger | \n
Types and kinds of evaluation criteria.
Basically, the forms of individual contracts differ in an allocation of risks between contractual parties and the resulting structure of payments.
\nThere is a methodology, not only in the SR, but also in other countries, on the basis of which the reasonable profit is determined as percentage of economically justified costs. But in this case, the operators are not motivated to save up the costs and it is also contrary to the policy of the European Union. The reasonable profit for services, which are provided in public interest, should be based on the risk assumed by operator. Therefore, an analysis of the risks existing in providing public transport services is needed.
\n\n\nThe risks existing in providing public transport services can be categorised [2]:\n
Systematic risks—such risks include political risks (government decisions, changes in government policy…), international risks (changes in foreign exchange rates…), economic risks (price development, population purchasing power…), interest rate changes, inflation risk and risk of unforeseen events.
Unsystematic risks are the risks associated with the revenue of company and its ability to cover liabilities. These risks may be influenced by an investment project quality, deployment environment, qualified management, etc.
Existing risk can be also further divided into two groups—cost and revenue risks (see Figure 2).
\nClassification of the risks in public passenger transport.
The cost risks are associated with a cost calculation when contracting in public economic interest. In public service contract, it is necessary to agree on a price for realised performance, which consists of the costs and profits of public service operator. In the case that the operator assumes the cost risk, it is necessary to agree on a scope of realised performance for the contract period and economically justified costs per unit of the realised performance between operator and authority. The cost risks can be divided into two groups [5]:\n
Operational cost risks which are related to the difference of the anticipated costs calculated and the actually observed costs after performance realisation. The reasonable profit must depend on an allocation of this risk. When the operator does not assume the risk and after realisation of performance he proves eligibility of costs to authority for the purpose of compensation, the operator takes no cost risk for the performance realisation. In the case that the agreed unit costs in public service contract are final, the operator assumes the cost risk and this should be reflected in appropriate level of reasonable profit. The operational cost risks can be further divided as follows:\n
External operational cost risks—the risk that cannot be influenced by the operator at all (e.g. cost increasing due to flooding streets in the event of natural disasters). This group can also include the risk which can be influenced by operator indirectly or only in small extent (e.g. changes in energy prices during the contract period, change in employees’ costs, etc.).
Internal operational cost risks—the risk that can be influenced by the operator, for example the costs of maintaining of vehicle fleet (the operator can decide on the maintenance process in order to avoid failure of vehicle and higher costs).
Investment cost risks are related to the difference of the anticipated life of the fixed assets of the operator. While providing public passenger transport, it is primarily the means of transport and infrastructure (e.g. bus and tram stops, tram tracks). The reasonable profit must depend on which party assumes the risk of the difference of actual net book value of fixed assets at the end of a contract period compared with anticipated net book value.
The revenue risks are associated with the difference between expected revenues from operation of public passenger transport and actually achieved revenues at the end of contract period. These risks may be taken either by authority or operator and in this regard there must be appropriately set a profit level of the operator. When the authority assumes the revenue risk, a contractual relationship between the authority and the operator, which sets a compensation for realised performance, is based on the following formula [6]:\n
UC—costs per unit of realised performance,
RP—reasonable profit for the operator expressed per performance unit,
P—the realised performance,
R—revenue achieved when realising performance.
When there are agreed final costs per unit in public service contract, which cannot be changed during a contract period, the cost risks are fully borne by the operator. The revenue risks are borne by the authority. This means that if operator’s revenue is decreasing, the compensation from authority’s party is increasing.
\nWhen the operator assumes the revenue risk, in the contract there is determined in addition to realised performance also absolute amount of compensation, which cannot be changed during a contract period. The compensation is based on anticipated costs and revenue, while changes in costs and revenue pose a risk of the operator. A part of the compensation is a reasonable profit of the operator resulting from cost and revenue risk of realised performance.
\nThe cost risks are not usually related with interventions of public authorities (with an exception of changes in tax burden of the operator), and currently, they are usually transmitted to operators. In the case of revenue risks, it is possible to define influence of public authorities on revenue risks; the risks can be divided into two groups:\n
revenue risk associated with a decrease in demand—it is a risk related to the changes in number of passengers carried when providing public passenger transport. In the case that the authority bears the revenue risk, it is necessary to appropriately involve the operator in compliance with required quality because the amount of the compensation in this case does not depend on the number of passengers carried (In the SR, this risk is very significant because the demand for public passenger transport expressed in passenger kilometres (pskm) is decreasing annually in road and railway transport). When it comes to the revenue risk associated with a decrease in demand, it is necessary to distinguish territories in which the transport services are operated. The development of number of passengers carried depends to some extent on the interventions of public authorities, which can indirectly influence the number of passengers carried through a fulfilling their strategic objectives which can be economic, environmental, social and governmental.
revenue risk associated with a change in passenger structure—it is the risk of revenue change because of a change in passenger structure. For example, when the selected groups of passengers (students, pensioners) travel with special fares, an increase in number of those passengers while keeping the total number of passengers causes a decrease in total revenue for providing transport services. The good solution is setting an appropriate pricing policy of transport services. However, it is important to monitor the impact of price changes on the demand, which varies considerably for particular groups of passengers. In the Slovak Republic, the discounted fares known as saver tickets (half price of a full fare ticket) are for young people aged 6 to 15 and students to 26, and fares known as “other fares”[1] - are for: senior citizens over 70 (€ 0.20 per every 50 km, severely disabled people (half fare travel), parents travelling to visit their physically or mentally disabled, chronically ill children nourished in special facilities in Slovakia (half fare travel). The public passenger transport fare is regulated by public authorities that decide which specific groups of passengers will be entitled to reduced fares; and therefore, the revenue risk associated with the change in passenger structure can be classified as the risks associated with interventions by public authorities.
The authority has to decide upon how to allocate risks between contracting parties appropriately. Risk can have a negative effect on the outcome of contracting, especially when using competitive awarding [3]:\n
The higher the risk, the lower the number of bidders (high entry barriers).
A very high level of risk, resulting out of a high level of uncertainty, may result in a higher danger of insolvency for operators in case of a full realisation of the risk.
The higher the risk, the higher the risk premium the operator is calculating (increasing the subsidy to be paid by the authority).
Therefore, from a very schematic point of view, risk can be classified as follows [1]:\n
High risk—High uncertainty and/or critical for operator in case of realisation (operators will calculate a high risk premium).
Low risk—Predictable for operators and/or not critical for operators in case of realisation (operators will calculate a low risk premium).
Unbearable risk—Unpredictable and critical for operator in case of realisation (risk not bearable for operators—market entry barrier).
A contract form and payment structure is dependent on a way of the risk allocation. The contract forms are as follows:\n
Management contract—operator bears no risk; cost and revenue risk is borne by authority that pays the economically justified costs to operator. Those costs are accounted in the end of period. This means that the risk from difference between anticipated and actual costs is borne by authority, which bears also the risk from difference between anticipated and actual revenue. In this case, the level of reasonable profit of operator should relate only to numb capital during providing transport services because he bears no risk. The reasonable profit, in this case, must include, in addition to the numb capital, also a reward for assuming the cost risk.
Gross cost contract—operator bears cost risk; the risk from difference between anticipated and actual costs in the end of period and the authority bears the risk from difference between anticipated and actual revenue.
Net cost contract—operator bears cost and revenue risk. In this case, the operator bears the risk from difference between anticipated and actual costs/revenue, which are identified in the end of contract period. The authority pays only compensation, which is agreed before realised performance to operator. This means that the authority bears no risk.
The essential advantages and disadvantages of gross and net cost contracts are presented in Table 3.
\n | Advantages | \nDisadvantages | \n
---|---|---|
Gross cost contract | \n
| \n
| \n
Net cost contract | \n
| \n
| \n
Advantages and disadvantages of gross and net cost contracts.
Determination of reasonable profit as a percentage of costs is economically incorrect in a regulated sector. The reasonable profit must relate to the risk that is borne by operator in regard to realised performance. This means that the level of reasonable profit must be higher in case of the operator bearing cost and revenue risks in comparison with the operator bearing only cost risks while keeping the same range of performance.
\nBased on the previous analysis of risk allocation, the level of reasonable profit can be defined as follows [1]:\n
Operator bears no cost or revenue risks—the risks associated with providing transport services are borne only by authority; and therefore, the level of reasonable profit should relate only to the capital used by operator when providing transport services. A reward for provided capital of operator should depend on profitability level of capital invested in terms of deposits with guaranteed returns. The reasonable profit in management contracts is calculated according to following formula:\n
CO—capital invested by operator for providing transport services,
p—capital profitability.
Operator bears cost risks—the level of reasonable profit must consist of two parts: the reward for provided capital of operator (the same as mentioned above) and the reward corresponding to the cost risks. The reasonable profit when contracting for public interest and where operator bears cost risk is possible to determine according to following formula [6]:\n
RCi—risk of assumed value of i’s cost item in percentage expression from cost item value,
n—number of operator’s cost items,
i—i’s cost item of operator,
P—realised performance.
It is necessary to define the way of risk determination of estimated values of individual cost items in relation to reasonable profit. The risk can be calculated by using the relationship for determination of safety surcharge to net premiums.
Operator bears cost and revenue risks—the level of reasonable profit must consist of three parts: the reward for provided capital of operator (mentioned above), the reward corresponding to the cost risks (mentioned above) and the reward corresponding to revenue risks. The reasonable profit when contracting for public interest and where operator bears cost and revenue risks is possible to determine according to following formula [6]:\n
m—number of passenger groups which are different by fare level,
Rj—assumed revenue of j’s passenger group in unit expression,
RTi—revenue risk of j’s passenger group expressed in percentages.
Determining revenue risk is done by an analogous method such as in case of determining cost risk. Revenue risk is possible to determine at standard deviation level of income change per individual groups of passengers in observed period.
\nIn terms of the scope of the contract, a public authority can decide on:\n
route contracts—used for a specific bus line or can include a group of shorter bus lines located close to each other,
network contracts—these contracts cover whole city territory and network of city public transport or they are related to more transport modes such as metro, bus and tram,
sub-network contracts—related only to a certain part of city (e.g. suburb of city) and only one mode of transport.
The contract size has an influence on efficiency. The contract size has an influence on efficiency. Related to matters of risk, this aspect mainly affects the market entry possibilities and might result in an overly elevated complexity level for the respective service operators.
\nNetwork contracts [3]:\n
increase the need to select long term contracts,
provide integrated public transport services delivered by one operator to passengers,
produce market entry barriers for small- and medium-sized companies,
account for a great operational complexity,
enable net cost contracts,
provide substantial optimising opportunities to the operator and therefore may increase efficiency levels,
might be more difficult to monitor.
Route contracts [3]:\n
low market or no market entry barriers exist for small- and medium-sized operators,
integration of public transport services needs to be realised through other organisations (authority or related body),
in case of dependency on the performance of other operators, net cost contracts are not recommended,
provide fewer optimising opportunities.
Sub-network contracts
\nSub-network contracts provide a compromise between network contracts and route contracts if required.
\nWhen designing the length of contract period, the public authority should take into account the level of revenue risk borne by the operator in order to allow him to develop market activities for increasing the number of passengers.
\nChanges in external factors, political aims or passenger needs can lead to a need for amendments to service design during contract period. Therefore, certain flexibility should be incorporated in contracts.
\nContracts should contain appropriate variations and termination clauses [3]:\n
Enable service redesign by the operator autonomously when using net cost contracts (with functionally designed minimal standards) while preventing negative financial impact to authority.
Enable the authority and the operator to terminate (or at least renegotiate) the contract in case of major unforeseen changes with major commercial influence.
Check whether there will be major changes during the contract time (e.g. a new bus lane within the centre during the contract period) and insert suitable agreement procedures on how to deal with these circumstances.
Enable service redesign by the operator after approval of the authority under all awarding models, based upon fixed price list and limitations (e.g. limited increase in vehicle-km) to reduce risk for the operator and the authority.
Insert arbitration clauses to avoid unproductive conflicts.
Enable service redesign by the authority in case of constructive design, based upon fixed price list and limitations (e.g. limited increase in vehicle-km) to reduce the risk for the operator (and the authority).
It is necessary to note that the longer the contract period, the more increases the need for flexibility of the contract. In case of high uncertainty about future developments (e.g. major changes within the coming years without any sufficient expectations on the influence on the contractual outcome), a short contract period is recommended (maybe including extension options) [1].
\nIn terms of decision-making on contract period, it can be recommended as follows [5]:\n
Decision based on trade-off between flexibility (short-term contract) and increasing incentive to make capital investments (long-term contract).
Use of short-term contracts in case of high uncertainty about future development (e.g. net cost contract with high uncertainty about development of the ridership).
Avoiding too short contract periods as this causes increasing uncertainty (which may result in lower interest of operators on that contract).
Use of long-term contracts in case of high specific investment needs with long amortisation periods, including review dates on the performance.
Avoiding too long contract periods in case of competitive awarding to secure competition within the market.
Use of longer-term contract when substantial market action is required from the operator (take account of longer lead times to develop measures and to reap the profit of their implementation).
Use of short-term contracts in case of the need for increased flexibility.
Avoiding too long contract periods to be able to recalibrate contract clauses according to market development.
Payments which are paid to operators in return for service provision may represent variable, fixed payments or their combination. However, it is important to determine a clear and verifiable payment structure in order to avoid misunderstandings and disputes between contracting parties during the contract period. It should be also noted that financing of infrastructure should be separated from operation financing due to transparency reasons [3].
\nPayments may flow not only from an authority to an operator but also in opposite direction from an operator to an authority. The situation is dependent on the market conditions. For example, the award of a very profitable service contract to the service operator through a competitive tendering may bring the situation of payments flowing from the operator to the authority. However, as many public transport services cannot be provided on a commercial basis, the payments which are paid to service operators from authorities are more usual in practice. The situation also depends on the structure of the additional incentives, which may be included in individual public service contracts.
\nThe amount of the payment to be paid depends on various factors. These factors relate to the type and scope of a particular public service contract, which is awarded to a particular operator [1].
\nTo reduce the risk level, it is recommended to include a lump sum payment. Inclusion of variable payments, which represent incentive-based payments into a public service contract, may motivate the operator to achieve the objective set by the authority.
\nAs previously mentioned, the structure of payments must be determined in a clear manner. It is recommended to reduce complexity as much as possible in favour of a simple payment structure. This may also reduce the level of risks and avoid the high entry barriers to the market.
\nIn general, the candidates (tenderers) are understood to be the entities who offer a solution of bids (public service contract). Transport services may be provided after the conclusion of public service contract between the successful tenderer and competent authority (public authority). The main objective of a tenderer is to gain a competitive advantage over the other tenderer and thus succeed in a competitive tendering.
\nProcedure of service providers in competitive tendering should consist of the following steps:\n
analysis of own position in competitive market,
analysis of the needs and requirements of the public,
analysis of technical conditions, the subject and criteria of the public contract,
compilation of the bid and its submission.
Success rate of a tenderer is dependent on the quality and quantity of services offered. The tenderer as an economical subject acts as a competitor in relation to other tenderers and towards the contracting authority as a potential provider of services. The tenderers, who wish to be involved in competitive tendering for public services for the first time, should perform an analysis of the competitive environment in a given sector of services. This analysis includes an analysis of strengths and weaknesses, and the opportunities and threats. Thanks to the analysis, the tenderers may find out their position in the market or look for ways to improve or retain that position.
\nIn the case that tenderer already participated in competitive tendering in previous periods, he may have plenty of information for predicting the capabilities and behaviour of the competitors. The tenderer should already be familiar with the evaluation criteria as well as their weights of importance. He should be able to create his own evaluation system, the results of which are depicted on the matrix of strengths and weaknesses. On this basis, it is then possible to evaluate own chances of tenderer or take action to improve existing conditions.
\nIn the case that tenderer is able to identify the exact needs of the public, he has an advantage over the competition. The first step is to identify deficiencies in area of public passenger service, for example number of joints, accessibility of stops, points of transfer, continuity. According to these findings, a tenderer is able to create the concepts and plans for increasing the number of passengers in the future, which may increase the likelihood of success in a competitive tendering.
\nIn terms of technical conditions of contract, a potential provider of transport services must examine in detail the technical conditions, characteristics and requirements for transport services.
\nTechnical conditions may be distinguished as follows [2]:\n
technical conditions in relation to expected fulfilment of public contract,
technical conditions promulgated by contracting authority.
Precise definition of the subject of public contract is a certain orientational point to obtain the public contract by a tenderer. Subject of fulfilling the public contract is defined in the tender documents. In the case that tender documents do not contain the subject of public contract, a contracting authority is obligated to send to a tenderer the subject of public contract in written or electronic form within the period stipulated by the Act.
\nContent of the bid should be drafted so that a tenderer is able to demonstrate:\n
financial position,
technical competency,
professional competency.
The tenderer is obliged to draw up a bid based on the instructions for compiling bids that are contained in tender documents. He is obligated to comply with all the requirements specified in those instructions in order to succeed in competitive tendering.
\nIt would be appropriate from tenderer’s position to nominate the person responsible for compilation and submission of bids.
\nFrom the position of public authorities that plan funds for providing public transport services, the net cost contracts appear to be the most advantageous. Under this contract form, all the risks, cost and revenue, are borne by the operator. The authority pays to operator a financial amount that is fixed determined at the beginning of a contract period and stated in the contract. In this case, the public transport services in a given area are provided only by selected operator through a license. Such an operator has the option to set the level of fares because he also assumes revenue risks.
\nThe gross cost contract is advantageous for operators because they do not bear the risk of revenue decreases, which is usually associated with the factors that cannot be influenced by operators.
\nBased on mathematical modelling of a price regulation and determination of business reasonable profit in network industries, Fendekova and Fendek [8], they mathematically model an approach of the enterprise in regulated sector and they define two approaches that can be applied in providing public transport services:\n
Approach of enterprise applying return on investment—the approach encourages an enterprise to use a high volume of capital in order to achieve the maximum permitted reasonable profit. The enterprise has no incentive to use more efficient combination of inputs, for example supporting employment in comparison with an end in itself investment in facilities.
Approach of enterprise applying increasing the volume of outputs—in this case, if the authority does not have the possibility or manpower for verifying effectiveness of providing public transport service, the operator will seek to realise also inefficient performance.
The operator assumes all cost risks under gross cost contracts in providing public transport services, whereas the authority bears revenue risks related to a decrease in the number of passengers. Documents for optimisation of public transport services are available for the operator and in case that the authority does not have sufficient access to the data about the number of passengers on particular bus routes, he is not able to optimise public transport services. It is necessary to continuously optimise providing public transport services when the number of passengers decreases. In terms of business interest, the operator who bears no revenue risk is willing to operate also the buses without any demand because the authority bears the risk that bus will not be used by passengers. For example, if there was abolition of a production plant into which the operator provides transport services for employees and the authority did not change a transport license, the operator would continue in providing transport services because a decrease in revenue (in this case to the zero level) would be compensate by the public authority assuming revenue risk.
\nThis approach assumes that a fare level is also determined in the public service contract. The deficiencies of such contracts may be addressed by contractual clause based on which the authorities have an access to the electronic data on the number of passengers in real time and thus they can obtain materials to optimise the transport services.
\nUnder these contracts, the operators assume not only cost risk but also revenue risk related to providing transport services. The authority grants a license for providing public transport services to the operator that is then entitled to provide public transport services in a given served area with an exclusion of other operators (during the license period). Following from the analysis processed by van de Velde [3], the net cost contracts are rarely awarded as route contracts because the operator determines a fare level and he becomes a monopoly for providing public transport services in a given served area during the licence period. The following mathematical model defines a procedure of such operator in relation to providing transport services.
\nAssume that the operator is a company that aims to make a profit. Based on a license and a public service contract—net cost contract, the operator provides a range of transport services bounded by demand of q. Start from a general assumption which is acceptable in any type of market structure, the consumption of a product offered in the market is described by a price-demand function that expresses willingness of consumer to buy q units of services provided at given price—p.\n
Technological conditions of the operator are expressed through the real cost function:\n
The equation presents the amount of minimum costs of n which are spent by producer in the production of q units of goods, while it is assumed that a price -demand function p(q) is continuous and twice differentiable real function. It is also envisaged that the price-demand function of consumer is constructed in order to clearly motivate the consumer to buy q units of services at market price—p—because the consumer feels the maximum rate of usefulness from consumer strategy realisation in this combination of price and demand. Analogously, the cost function describes a process of providing services by operator so that quantifies the minimum of total production cost—n for an optimal combination of production factors required to produce q units of provided services.
\nWhile optimal consumer behaviour is described by price—demand function p(q), the optimal operator behaviour is described by a profit function π(q), which is formulated as the difference between revenue and costs of company corresponding to a certain production volume of q:\nwhere a continuous and twice differentiable real function of company revenue r(q) is defined as the product of price and supply volume, that is:\n
A company operating in every type of market structure (a competitive company as well as a monopoly) seeks in a decision-making process such a combination of price and supply of its product that guarantees a maximum level of the profit. This means that the operator also provides transport services in such a way that ensures the maximum profit. Analytically, this approach can be expressed as follows:\n
For optimising profit function, it is necessary that the function would reach its maximum at certain point of supply—q, that is that the first derivative of the profit function at this point is zero:\n
In the Eq. (10), rm(q) is a marginal revenue function of the operator and nm(q) is a marginal cost function. Based on Eq. (10), it can be seen that a company generally achieves a maximum profit for a volume of q when the marginal revenue equal to marginal costs, that is a solution to the equation:\n
Then, it is possible to calculate such a price—pp that maximises profit of the operator at the optimal level of supply qp:\n
In the case of the operator who operates in non-regulated sector (e.g. long-distance transport), where the competition exists, the approach described in previous relationships (equations) cannot be applied. The operator accepts the price—pK at the level of his marginal costs—and he offers the production volume—qK at that price. This means that the following relationship applies:\n
On the other hand, a monopoly due to its dominant position in the market can influence the price of its product so that to achieve higher profit in comparison with competing companies. The monopoly determines an optimal price—pM based on the optimisation solution Eq. (9) and based on relationships Eqs. (11), (12), that is:\n
Based on above mentioned, the operator operating in a monopoly position can provide fewer services at a higher price compared to competitors. The approach is shown in Figure 1 based on which the following applies:\n
It can be concluded based on Figure 3 that the operator operating in a competitive market would provide services in a volume of qK at the price—pK. If the average unit costs per unit of provided services are defined as:\n
Monopoly and competitive company.
Then the price of provided services will not cover even the average costs of the operator because:\n
If the operator provides public transport services in such a case, the loss of operator will be at the level of (according to the Eq. (9)):\n
If the operator acted as a monopoly in the same market, he would provide public transport services at the level of qM at price—pM and he would achieve, under these conditions, a profit—πM at the level (Figure 3):\nbecause the following applies for the monopoly:\n
While providing public transport services, the operator in a monopoly position achieves higher profit in comparison with the operator who operates in the market of perfect competition. If the public authority decides on a net cost contract, according to which the providing transport services is in the competence of the operator, there will be the risk of lower quality or the risk of lower performance than in comparison with the case of gross cost contract.
\nThe public authorities tend to issue a license for one operator to provide public transport services for whole served area and consequently to conclude a net cost contract. Under this contract, the decision on an organisation of public transport service including pricing is in the competence of the operator. However, it is important to note that this procedure can lead to reducing quality of providing services.
\nThe objective of this review was to assess whether there is a correlation between hindlimb proximal suspensory ligament desmopathy (hindlimb PSD) and sacroiliac dysfunction (SID), and provide an understanding of the current thought process of examining these disorders. There are several studies examining the coexistence of back pain and poor performance, however for the most part, the discussion focusses on the efficacy of diagnostic techniques of the thoracolumbar region with some recognition of influencing factors [1, 2, 3]. Some authors have assumed a correlation between the two disorders in their treatment programmes [4, 5] but none quantified the association or correlation of the two conditions. There are limited studies that have looked at the structure of the sacroiliac region and applied those principles to locomotion [2] however there are many text books that describe the structure alone [6, 7]. This chapter explores the two conditions and explores the background and present theories behind hindlimb PSD and SID.
The sacroiliac joint lies deep within the pelvis of the horse, made up of the sacrum (five vertebrae fused together) and the surrounding ligaments. It is known as an atypical synovial joint [2] and a cartilaginous joint [7]. The iliac surface has fibrocartilage coverage, with the sacral surface lined with hyaline cartilage, thus creating a modified symphysis [8]. There is great variation in the joint form from L shaped to C shaped either being relatively flat or concaved, although most are at an angle of 30° [2].
The sacroiliac joint lies between the ilium wings, forming a synchondrosis that is held in place by a multitude of ligaments. These ligaments are called the dorsal and ventral sacrosciatic ligaments and the broad sacrotuberous ligament [7]. The dorsal sacrosciatic ligament has two elements, a band that runs from the dorsal tuber sacrale to the apex of the sacral spinous processes; with the lateral dorsal sacrosciatic ligament running from the tuber sacrale and ilial wing to the sacral crest on the lateral aspect. The broad sacrotuberous ligament runs from the sacrum and transverse processes of the 1st and 2nd caudal vertebrae to the ischiatic spine and tuber ischium [2, 7]. The function of this joint is to provide a relatively inelastic structure that is capable of asymmetric pelvic deformation during movement [2, 9]. The muscle structure of the back plays significant influential roles in both anatomy and biomechanics.
The movement of the horses back differs depending on the location and mediolateral swing of body mass; dorsoventral movement is seen with the greatest being middle of the back (40–47 mm per peak per stride) with a reduction cranially and caudally [10, 11, 12]. The natural movement of the lumbosacral area and the hindlimb produce a sinusoidal movement of no more than 4° within each stride cycle. Extension within this sinusoidal curve starts just moments before ground contact with the hoof, with the hindlimb at maximal protraction. In the sound horse this means that movement of the sacroiliac joint is minimal as longissimus dorsi is inactive in the impact and support phase of the flight arc of the hoof, in theory resulting in a stable joint [12, 13, 14]. Having said that linear regression revealed a significant deviation in movement over Lumbar 1 and Sacral 3 correlated to increasing speed [12]. This indicated that the movement of the back and sacroiliac joint is complex [2] and changes with every change in pace (Figure 1) [11].
Schematic of the right lateral view of the pelvis showing the position of the sacroiliac joint between the wings of the ilium and wing of the sacrum and the sacrotuberous ligament (adapted from [2]).
The movement within the joint is assumed to be little [15] due to the middle gluteal and surrounding ligaments holding it in place. Despite this, a series of studies of the human sacroiliac joint revealed adaptations to forces transmitted through the joint; which was seen as roughened areas on the contrasting surfaces [16]. Comparable studies of the equine sacrum have looked at nutational forces to determine the degree of movement and suggested there is limited movement [2]. However, another investigation raised the interesting point that when the sacrotuberous ligament was cut there was a marked increase in movement [2]. This would seem obvious, as its function is to reduce movement but does suggest that ligament damage or laxity could cause increased asymmetrical movement which in itself could have an adverse effect on the soft tissue structures of the distal limb.
The structure of the third interosseous muscle, also known as the suspensory ligament, the middle interosseous muscle or the interosseous ligament, is relatively straight forward. It originates from the proximal palmer surface of the metacarpal bones, running distally where just proximal to the sesamoid bones it bifurcates inserting on to each of the two sesamoid bones. From here it travels as the extensor branch joining the common digital extensor tendon. Even though it is termed a muscle, it is believed that once the horse matures it becomes completely collagenous in nature [7]. However, this is an over simplification as others describe the ligament as having a reduction of muscle fibres [17], while still retaining some which reduce with increased age [18, 19]. Muscle fibres quantitation showed a difference of 40% between the Thoroughbreds and Standardbreds with the Thoroughbred having less muscle fibres than its counterpart, with more muscle content being found in the hindlimb suspensory ligament than the forelimb [20]. It was also noted that the proximal region of the suspensory ligament contained less muscular tissue [19, 21]. This work also showed that the number of muscle fibres reduced with increased work intensity, thus suggesting that the suspensory ligament becomes less elastic and more susceptible to strain with increased work load (Figure 2).
Schematic left lateral view showing the interosseous ligament of the hindlimb (adapted from Budras et al. [6]).
The composition of the interosseous muscle is something of a hybrid, with the majority being collagen fibres but approximately 10% being type I muscle fibres and less than 5% type II muscle fibres. The suspensory ligament is defined by the infrequent fibroblasts embedded in the collagen matrix. These fibres are dispersed differently throughout the length of the ligament. Proximally, they are grouped as loose fascicles medially and laterally with the greater concentration just below the surface. As it reaches the three quarter mark they become less distinct, fewer in number with reduced striations. Interestingly these fibres are arranged pinnately between 45 and 80° [17, 22, 23] leading to theories that high forces are created because of the greater pinnate angle in order to stabilise the joint and indications that its purpose is anti-fatigue and postural support [24]. This was supported further by the suggestion that the elasticity of the lower limb, creating a vibration of 30–40 Hz, needs damping to reduce the likelihood of damage to tendons or bones and that this is achieved through these short muscle fibres [25, 26]. Due to the elastic nature of the suspensory ligament, it is unable to cope with sudden surges in force and is not built to deal with increased amounts of fatigue [27, 28]. It has also been noted that as the age of the horse increases so does the stiffness of a tendon unit which in turn could induce a change in kinematics [29].
It is commonly understood that tendons and ligaments play an important role in elastic strain energy during locomotion. Humans and ungulates have evolved to have more efficient locomotory systems; with equine evolution determining the distal limb muscle mass would not only be challenging to manoeuvre but very costly in terms of energy expenditure. Thus we see tendons and ligaments in the distal limb as a means of storing elastic energy [25, 28, 30, 31, 32, 33]. In order for the horse to utilise this mechanism within the suspensory ligament the energy from the ground reaction force is stored as strain energy to retract the limb [27, 32] helping to produce the break over point [34].
The function of the suspensory ligament is to stabilise the metacarpophalangeal joint and hindlimb in preventing hyper flexion in locomotion but also to act as part of the stay apparatus in preventing collapse of the fetlock joint when immobile [35, 36] effectively acting as passive control [17, 28]. However, the suspensory ligament differs slightly in its role compared to the other tendons of the distal limb. For example, the maximal stress the superficial digital flexor tendon (SDFT) and deep digital flexor tendon (DDFT) functions at is 40–50 MPa (mega-pascal units) compared to the suspensory ligament functioning at 18–25 MPa when in gallop; of course this is maximal output and decreases with decreased speeds. To gain a relative perspective, muscles work at 200–240 MPa. By comparison this seems quite small but provides an elastic energy saving of 25% for the suspensory ligament and 40% for the SDFT and DDFT which translates into an energy saving of 1.23 J/Kg at trot and 6 J/Kg at the gallop [33]; thus reducing metabolic expenditure [25, 31].
Biewener [31] calculated the peak activity stress mean standard deviation on the fore and hindlimb suspensory ligament with 53 ± 14% from walk to trot and 23 ± 19% into gallop. When ground reaction forces are considered and coupled with an increase in pace, the change in stress has an astonishingly small mean of 4%. This could be due to the kinematic calculation methods or potentially due to the biomechanical nature of the suspensory ligament. As the hoof makes contact with the ground, the suspensory ligament briefly stretches as a reaction to the ground reaction force and the sinking action of the metacarpal-phalangeal joint. The ligament then shortens to create an anti-hyperextension force. This elastic strain energy depends greatly upon the tendon shape and volume. These are varied as the suspensory ligament bifurcates distally resulting in a greatly reduced cross sectional area, leaving it under greater stress and strain [25, 31]. The elastic property of the lower limb is also heavily influenced by the individual gait pattern of each horse.
In order to understand the process of veterinary examination and its resultant observations; it is imperative to fully understand the kinematics and kinetics of the locomotion of the horse. The structure and function of the cursorial musculoskeletal systems have evolved to provide structures and patterns of movement that favour acceleration, manoeuvrability speed and endurance [30, 37, 38] which has been harnessed over centuries for various disciplines such as racing and dressage.
It is also important to note the influence central pattern generators (CPG) and proprioception have on the biomechanics of the horse. The regulated rhythm of a pace is created by the CPG neurons which are capable of generating the stimuli and therefore a rhythmic motor behaviour. Even though some believe that the CPG neurons are capable of producing this regulatory rhythm without stimulus, sensory feedback is still required [39, 40]. Minute differences the timings or intensity of these impulses of the right and left central pattern generators cause asymmetrical movement [41]. Horses that have modified their locomotory movement in an attempt to compensate for discomfort or pain of either hindlimb PSD or SID will in effect cause the CPG neurons to adapt their “pacemaker” like outputs; thus creating a new norm for the horses locomotion [38].
Locomotion occurs as a result of torque at the hip joint [42, 43] and ground reaction forces exerted on the hoof which in gallop can be as much as 2.5 times the horses body weight [44, 45], with equal magnitude working in the opposite direction providing propulsion [46]. Therefore, it is worth considering the kinematic pattern of hoof placement, to determine how the pathology of SID and hindlimb PSD may occur. The structure and function of the cursorial musculoskeletal systems have evolved to provide structures and patterns of movement that favour acceleration, manoeuvrability speed and endurance [30, 37].
The hoof does not hit the ground with a total sole impact, but instead, as a measure of control, impacts the ground with the lateral edge. This reduces the concussive effect of the initial ground contact [47, 48]. It is important to remember that the hoof at ground contact is moving forward and downward during the initial loading phase [38]. The degree of impact when the hoof hits the ground is determined by several factors; the 57:43% split of vertical impulse for fore and hindlimb respectively [23, 38], the hoof mass, size and shape of the hoof, contact surface, type of shoe i.e. racing plate or hunter with or without grips or studs. These all influence the vertical and horizontal hoof velocity, and degree of slip [37, 38, 49]. The degree of lameness also has a large influence on interplay between hoof and ground reaction force [14].
Several studies have analysed hoof velocity [38, 44, 50], two of which have considered horizontal hoof velocity of fore and hindlimbs; one demonstrating the greatest being in the non-leading limb [49] and other the leading limb [51]. The hoof velocity and leading limb has important implications to the structures in the hindlimbs; if it is the forelimb the majority of the velocity will be absorbed by the thoracic sling, if it is the hindlimb the velocity can only end at the sacroiliac joint, although this is greatly simplified. Having said that, longitudinal velocity reduces (regardless of limb) as the horse starts to break in early stance phase. In this early phase the hindlimb suspensory ligament (third interosseous muscle) is at its peak inertial capacity to prevent hyper extension, while at the same time the pitch avoidance movement of raising the head and neck backwards increases forces on the pelvic limb, as the weight is shifted backwards in the late stance phase. This increases propulsion of the moment arms of the hindlimbs, creating oscillating forces though the hindlimb [28, 52]. These oscillating forces are created with hoof-ground impact causing the limb to vibrate in a craniocaudal movement at 30–40 Hz, the greatest impact being distal in the limb. The muscles of the hindlimb act as adequate shock absorbers however risk of soft tissue damage increases with the increase in loading cycles [26]. This suggests that the greater the work load and discipline level of the horse, the more likely they are to sustain an injury. One method of removing force is slipping or sliding. The hoof is designed to allow an element of slip as a natural method of dissipating energy [53] however if sliding continues in the right conditions this can increase the risk of damage to soft tissue structures. Coupled with the ground reaction forces, this means that there are two opposing forces meeting at the horizontal axis, namely the sacroiliac joint [51].
There are many variable factors when considering the relationship between hindlimb PSD and SID; one of which is the natural biological variation in every horse, in that no two are exactly the same in conformation which ultimately enhances or impedes function. Discipline desirable traits have been documented for enhancing performance, such as the warmblood breeds for dressage, with greater hock angle reducing the incidences of injury compare to those with smaller hock angles [54, 55]. However, this was refuted in a later study of 66 warmblood horses that had the supposedly undesirable tarsal joint angle of <155.50° [56]. This was agreed with in another study examining the hock angles of 194 Warmblood horses with hindlimb PSD [57]. Hobbs et al. [54] described a selection of horses that had variations between contralateral limbs conformation and those with bone morphology variance in contralateral limbs [58]. The results of these differences may induce compensatory movements in an attempt to redistribute the weight through the stride cycle. In an attempt to counter this, and stabilise the gait, the hindlimbs may start to load in a pattern similar to a lame horse. Having said that this load distribution pattern may come from the horses’ handedness. This raises the question, if the horse is not physiologically capable of creating vertical impulsion (due to straight hocks), how and where will this affect the soft tissue structures in the hindlimb?
Asymmetries come in many forms, however each will have a marked effect on the biomechanics of the horse and more importantly the ground reaction forces; in the horses attempt to maintain equilibrium [54]. Of course, this need to maintain stability has different ground reaction forces depending on breed. Elite dressage Lusitano horses had lower vertical impulses compared to their Dutch Warmblood counterparts in collected trot with a range of 1.64 ± 0.02 N/Kg and 1.90 ± 0.08 N/Kg respectively. However this evened out with a change from collected trot to passage, with minimal difference being seen. Nevertheless, the key point in this is that the centre of mass is moved closer to the hindlimbs in the higher movements. Heim and co-authors [11] demonstrated a significant difference between Franches-Montagnes stallions (n = 27) and a general populous of horses (n = 6) in the dorsoventral movement (p < 0.02) and mediolateral movement (p < 0.01) for the spine, although to say this is a generalisation of differing anatomical parts and their role in locomotion. There is also the influence of the rider to consider here; not only as their body mass is part of the calculation but as the elite rider is capable of re-balancing even the most uneducated of horses to maintain the uphill longitudinal balance that is required of a dressage horse [59]. Dyson and colleagues [60] refuted this in their pilot study of rider weight, in that the weight of the rider had a greater significance than body mass index. Although this situation is not definitive, as there are many influencing factors in this scenario. For example, the balance of the rider and the dynamics between saddle and rider, both of which have a role in distribution of forces. In essence if the rider is displaced by an ill-fitting saddle or the rider is inexperienced the horse has to re-balance itself in order to compensate [10, 44], which in itself produces compensatory locomotion. Another interesting factor relating to distribution of forces, body movement and rider interaction was demonstrated during the heavy and very heavy rider trials, as the horse demonstrated 3/8 lameness (based on the 0–8 grade lameness scale where 0 is sound and 8 is nonweightbearing) with these heavier riders [60]. The thoracolumbar width changed with weight of rider, from 3.9% with a light rider to 2.8% with a heavy rider. Heim et al. [11] noted that there was less mediolateral movement in the vertebrae when under saddle, with a difference of approximately 10 mm in the 3rd lumbar vertebrae as compared to an 8 mm difference in the movement of the tuber sacrale. This suggested that the horses may be bracing themselves against the movement of the heavier rider. However this was an observation and not a direct conclusion. It was also suggested that the interactive surface between horse and rider, the saddle, if not fitted correctly increased the mediolateral movement of the rider, which led to their conclusion that the closer contact the rider has with the horse the more likely they are to be working in equilibrium with them [10].
The conformation of the hoof capsule and the angle of the internal structures have a role to play in suspensory ligament desmopathy and limb kinematics. A significant level of research focusses on the correlation between the navicular bone angle and force applied to the deep digital flexor tendon [44, 61]. Although the research was not directed at the hindlimb suspensory ligament; their findings still shed light on this area due to the anatomical angle of bordering structure and limb kinematics. The shape of the hoof has been reported to change the kinetics and kinematics of the distal limb. Dyson et al. [61] reported that the distal phalanx to hoof wall angle and distal phalanx to horizontal angle were smallest for deep digital flexor tendon injuries at 52.27° ± 3.29 and 50.32° ± 3.70 (mean ± SD) respectively. However, it would seem there was no direct correlation between that and the angles of the hoof wall. Research suggests that optimal hoof angles for both front and back feet should be 50–55° [62]. In addition, minimal correlation between the dorsal aspect of the distal phalanx angle and deep digital flexor tendon injury has been found and the hoof wall angle was not the same as the distal phalanx angle [61], which could account for natural variation in hoof pastern axis.
The deviation of distal phalanx angle affects the orientation of the structures above it and subsequently the metacarpophalangeal joint; which in turn has the potential to cause soft tissue injuries [63, 64]. This is because the ground reaction forces are reduced delaying break-over to latter breaking phase [64] whereas the horse should have increased loading at this point [62, 65]. This has the potential to reduce the strain on the interosseous muscle but could also inhibit the elastic strain energy needed to create its passive force.
Kane et al. [63] identified 43 race horses with ruptured suspensory ligaments with lower heel and toe angles; for example the difference between the toe heel angle control group and those with suspensory apparatus failure was 1.3° less, a relatively small number in terms of angles but quite significant over the lifetime of a horse. In real terms this means that an increase in angle of 10° increases the chance of suspensory ligament failure by 6.75 times [63].
Shoeing has been used since domestication of the horse as a means to improve performance and help maintain hoof balance. The combination of farriery techniques like rolled toes, plus different types of shoe have a significant effect on the horse’s feet and their movement [34, 45, 66]. It could be assumed that the application of the shoe would only affect the gait pattern of the horse but an 11% vertical displacement of the trunk has been observed [66], which implies a physiological effect of the structures of the back over a lifetime of a horse. Different types of shoe also have varying effects on the horse [67]. The glue on heart bar increased strain of the suspensory ligament while the racing plate alone increased strain in the superficial digital flexor tendon, interestingly when packing was added to the racing plate the increased strain was seen in the suspensory ligament. Others demonstrated an increase force of 101 N between the unshod and the steel shod foot [45, 66]. However, when looking at this in greater detail it can be seen that there is a difference in kinetics between the two states. By comparison the shod foot remains medial throughout the entire stance phase putting greater strain on the medial aspect of the limb structures. This is due to the gripping nature of the steel shoe which effectively shortens the natural slip effect of the bare foot and increases musculoskeletal forces after impact, altering the dampening effect of the suspensory ligament and preventing hoof and frog expansion on impact [34]. The stride duration also increased with the application of a shoe from (mean) 694 to 706 ms as did the stride length from 2.78 to 2.82 m; with the stride protraction and retraction decreasing after the application of shoes. This was seen as the carpal joint extending later in the swing phase and the foot being behind the movement at impact [66]. The unshod foot lands medially to then shift laterally at mid stance to then move back again medially. The application of a metal shoe removed the hoofs natural cycle of wear from the equation, which proved to be beneficial for the horse when assessing the morphology of 100 feral Brumbies [68]. Increased substrate hardness and distance travelled reduced the likelihood of hoof wall flare, however a possible negative of this is the loading of the peripheral sole in locomotion as well as the expected loading of the hoof wall [68].
There are many influencing factors when taking into consideration the relationship between horse and rider; the riders ability to control their balance, the weight of the rider and the fit of the saddle, all of these factors can have an effect on the equilibrium and the physiology of the horse. The influence of rider weight on horse movement has also been investigated. Riders were classified as light, medium, heavy and very heavy; all of which were classified as experienced riders [69]. Horses were subjectively and objectively observed with inertial sensors to determine movement at the poll and pelvis, each horse was then assessed with each rider. All heavy and very heavy rider assessments were abandoned due to temporary lameness inducement, suggesting a biomechanical change with the introduction of a dynamic load. In a study that used a lead weight added to the saddle they found the addition of weight extended the spine [70]. Thoracolumbar width changes have also been observed in another study, differing by 7.3% from the lightest to heaviest riders [71]. Variables such as saddle fit were accounted for by Master Saddlers checking prior to the tests being ridden and on the days of the test being ridden. However oscillation of the saddle in trot was reported with all rider weight groups; very heavy 14.0%, heavy 50.0%, medium 76.9% and light 84.6%, although there was no depth of discussion as to the occurrence of this except to say not all saddles fitted perfectly. Saddle bounce also occurred with the very heavy rider on 4 out of 6 horses, although this was associated with the horse being crooked in canter. Having said that, in the objective gait analysis a pelvic minimal difference of 2.2 ± 4.8 (mean ± SD) was observed [72].
Influential factors also include rider height and leg length, as this affects the fit of the saddle for both horse and rider, plus the rider’s core strength for which it is assumed that an increase in core strength would reduce rider movement in the saddle. One of the stark conclusions drawn from this study was that lameness was observed in most of the horses when being ridden regardless of rider weight (that was not apparent in hand) and that the heavier riders consistently induced severe lameness [71, 72]. This research did not answer the question of rider weight ratio but it highlighted the importance of a well-fitting saddle and the role that it plays in maintaining normal gait patterns for that horse.
An important consideration is also the discipline of the horse and the movements they are required to perfect. An example of this was elite dressage horses which are required to produce collection; “maintaining impulsion from behind to allow a lighter shoulder”, to carry out higher level movements thus distinguishing the important factor of higher proportion of bodyweight carried by the pelvic limb [73]. Although this was recognised there was no appreciation that the movement must originate in the sacroiliac joint. Furthermore the link between tarsal joint compressions was made but not associated to orthopaedic injury. However this point was contradicted by the description that the greatest movement of the SIJ to be on the transverse plane [2]. This allowed for a wider overall viewpoint comparing the likelihood of SID by disciplines; with dressage horses and show jumpers being more susceptible [2]. This suggested that SID is induced by the greater degree of collection required of each discipline and increased angles of the moment arms of the hindlimbs, in effect reducing stability of the joint.
Data analysis primarily segregates elite and non-elite horses in order to classify gross morphology [73], demonstrating the understanding that each discipline has a differing physiological impact. This is then subdivided to location or type of injury. Conversely, they did not make the distinction in forelimb and hindlimb suspensory ligament injuries, and although there were a significant number of classifications observed, it was not stated whether these were distinct individual injuries or if the horses had sustained more than one [73]. However Barstow and Dyson [1] went a step further and subdivided their cohort into sacroiliac pain only and sacroiliac pain with hindlimb lameness; thus starting to demonstrate a correlation between the two. In comparison, others recognised the presence of other abnormalities but mainly focussed on osseous changes [74]. Dyson [61] considered an alternative perspective of tarsal conformation predisposing horses to PSD and acknowledged biomechanics as a possible influencing factor but again with no correlation to SID.
The surface that horses work on have to be taken into consideration as they directly influence the impact on hoof loading (hoof sliding and the declarative longitudinal forces) and therefore the reaction of the limb structures [38]. Surfaces vary based on their composition, a ménage situation will have a hard under layer with surface applied to a specific depth, while some race tracks will run on turf. The most important element here is the cushion depth as this has the potential to absorb some of the concussion [75, 76]. Having said that, a softer surface encourages the toe to pivot causing a rotational force on the distal limb structures [38]. In a human based assessment it was found that peak forces reduced with an increase in compliant surfaces [76]. The compliance of track surfaces has also been examined, each type of surface had a distinct effect on the hoof velocity and swing phase, with the greatest deformation coming from the most compliant surface [75]. Even though it was noted that this surface caused significant increases in stance time and angle of hoof on landing, they did not draw any conclusions from this or discuss the soft tissue implications for the horse. However, it does imply that the suspensory ligament would have to sustain its force for a prolonged period and thus potentially fatigue if longer stance time occurred. This concept was looked at in greater detail with the use of a dynamometric shoe applied to three race horses which showed that turf surfaces had a greater ground reaction force (42.9 ± 3.8 g; mean ± SEM) compared to synthetic surfaces which reduced the ground reaction forces significantly (28.5 ± 2.9 g; mean ± SEM) [77]. This implies that there will be less impact on the soft tissue structures of the hindlimb and subsequently the sacroiliac joint.
In order to gain a full understanding of the relationship between hindlimb PSD and SID, the way in which the horse works, its discipline and level, plus the rider influence and ability must be considered [73, 78, 82]. Barstow and Dyson [1] used rider colloquialisms to aid quantification of lameness; this is very subjective even when well versed in this terminology [12]. This highlights the need to be objective and specific in pinpointing lameness. Similarly another study used anecdotal evidence to support their hypothesis of sports performance level and orthopaedic injury diagnosis, suggesting that this is frequently seen in practice but not yet documented [73]. Having said that, some studies [4, 5] have noted that some horses may suffer concurrent injuries of the sacroiliac joint or proximal suspensory (respectively) but did not draw conclusions from this regarding cause and effect or relationship.
As already stated, it is difficult, if not impossible to ascertain where the pain is coming from within the sacroiliac joint; one of the possibilities is the articular surface. As the horse ages there is an increased likelihood of cartilaginous deterioration irrespective of breed type or discipline. This deterioration and possible changes may be the result of long term laxity of the surrounding ligaments [83] which in itself could cause instability of the sacroiliac joint or degenerative suspensory desmitis which would alter the gait pattern of the horse permanently [84]. Another factor, of course, could be the ground reaction forces and the impact of hard work on hard ground for sustained periods.
It is recognised that lameness of the hindlimb creates compensatory movements within the lumbosacral region [74, 85]. Signs of subtle discomfort or pain are not so easily detected. A reduction in equine motivation to work or refusing jumps or bolting with their rider can be seen [4]. However, use of inertial measurement units can make the process of assessing asymmetry objective. The assessment of 60 horses used for polo showed 36 horses (60%) demonstrated an asymmetrical movement in the head, pelvic or both [86]. Statistical analysis linear regression revealed none of these measures had a slope greater in difference than zero. This tells us two things; that inertial measures are able to quantify small asymmetries in the horse but the value of this in a lameness evaluation must be left with the veterinary professionals to interpret. In reality this technology is not commonly used in practice and the standardised approach is to use diagnostic nerve blocks to determine the area of pain. However, this is not straight forward as they need to be used in conjunction with clinical examination and imaging modalities. In fact Pilsworth and Dyson [87] described clinically sound horses receiving a palmer nerve block to have a change in gait. This was echoed by Denoix and co-authors [88] when describing the pitfalls of sacroiliac nerve blocks, in that potential error could cause a false positive. In contrast others focussed on the biomechanics of the entire vertebral column [11, 82] but limited the discussion of the limbs to kinematics. This was echoed following assessment of the dynamic asymmetry of polo ponies, which again reverberated the question of correlation and cause [89].
The need to be more specific was demonstrated by Murray et al. [73] in their results making reference to thoracolumbar and pelvis but not specifically the SIJ. Goff and co-authors [90] advanced this to identify degenerative changes of the SIJ causing poor performance. However there is no correlation to unilateral or bilateral distal limb lameness. To emphasise the need to be unambiguous Murray et al. [73] used a large sample size (1069 horses), which potentially could be representative of the equine population. However, as the study was conducted at a referral hospital it would not represent primary veterinarians seeing acute injuries or stages of disease; emphasising the need for a retrospective study of primary veterinary practices.
In a study by Barstow and Dyson [1] 296 horses were assessed for SIJ pain, of which 203 (80%) showed hindlimb lameness with 181 specifically identified with proximal suspensory desmitis (89% [94% bilateral, 6% unilateral]). Although this represents relatively small numbers by comparison to sports performance studies [73] its findings are significant and showed a direct correlation. Furthermore, the work up of the horses was carried out by the same veterinarian reducing the likelihood of subjectivity in gait analysis.
In a similar study the prevalence of orthopaedic injuries was examined, classifying the horse by injury alone [91]. Having said that, discipline was acknowledged but no relationship established; although the kinematics of the show jumper’s pelvic limb were noted. A limitation of this study was that the information was extracted from yard records rather than from veterinarian’s records. Furthermore the initial assessments were made by several veterinarians potentially providing greater diversity in objectivity of lameness detection. In contrast, a unique perspective examining the likelihood of heritable degenerative suspensory ligament desmitis in the Peruvian Paso was published [92]. Dyson [61] demonstrated an understanding of this but also questioned conformation as a predisposing factor.
All of this begs the question as to how a horse with sacroiliac dysfunction and hindlimb PSD can be identified? Generalised pain detection using facial expressions has been used for many years with infants. Langford et al. [93] took this principle and adapted it to form the mouse grimace scale for those used in biomedical research, this was hailed as a great success as a pain indicator. Miller et al. [94] developed this further to include pain behaviours. The assessment of pain has always been subjective and relative to the experience of the practitioner, formalising a grimace scale for horses [95] has made this an objective process for the equine veterinarian. There are general indicators of pain as seen in the horse grimace scale whereby an assessment of the horses facial postures are calculated on an ethogram to determine general level of pain. For example, a horse with tension above the eye alone may not be indicative of pain, but coupled with ears stiffly backwards and prominent chewing muscles, it may indicate a level of pain [95]. The facial grimace scale alone has been identified as limiting an ethogram for equine pain behaviours both ridden and in hand has been developed [60]. Importantly this study ensured its efficacy by refining its use with a “within observer repeatability study” to confirm this as a suitable tool for quantifying pain behaviours. This concept was taken a step forward in order to develop a scale for the ridden horse, for example the horse moving on three tracks in trot or canter could be an indicator of sacroiliac pain [69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96]. Some other indicators are a direct reflexion of the location of pain such as bucking going into canter demonstrating pain in the sacroiliac region; however, a horse at the very start of its education may resist the rider and buck out of frustration. Having said that, persistent displays of these behaviours are a direct indicator of pain [69]. There are many more subtle signs including asymmetry of the tuber coxae and the tuber ischii that can be visually assessed by the practitioner, asymmetrical muscle mass of the superficial gluteal and holding the tail to one side can also be seen as pain indicators [97]. Saddle slip has also been identified as an indicator of hindlimb lameness with a direct correlation between bilateral and unilateral lameness (p = 0.344 and p = 0.286 respectively) [98]. This advancement could improve criteria in determining the subtle variations in lameness between sacroiliac dysfunction and hindlimb PSD.
Research in the last 10 years has focussed on poor performance and diagnostic techniques, back pain and biomechanics or suspensory ligament disease. The correlation of information to demonstrate that lameness may be from one or more sites in the horse is limited. This indicates the necessity for further studies to determine whether there are correlations between hindlimb proximal suspensory desmopathy and sacroiliac disease. Understanding whether correlations are present between the two disorders could have an impact on evaluation and diagnosis, treatment and recovery, prognostics and welfare.
Albert A. Rizvanov (
The authors declare no conflicts of interest.
IntechOpen publishes different types of publications
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