Cost–consequence analysis of a hemostatic matrix alone or in combination for spine surgery patients

Background: A five-year retrospective database analysis comparing the use of Floseal¹ flowable topical hemostat alone (F) and in combination with gelatin/thrombin (F?+?G/T) to achieve hemostasis and control surgical bleeding showed higher resource utilization for F?+?G/T cases relative to F matched pairs during spinal surgery. Lower resource use in the F group was characterized by shorter hospital length of stay and surgical time as well as fewer blood transfusions and less hemostat agent used per surgery.

Objective: To evaluate the cost–consequence of using F compared to F?+?G/T in minor, major and severe spinal surgery from the US hospital perspective.

Methods: A cost–consequence model was developed using the US hospital perspective. Model inputs include clinical inputs from the literature, cost inputs (hemostatic matrices, blood product transfusion, hospital stay and operating room time) from the literature, and an analysis of annual spine surgery volume (minor, major and severe) using the 2012 National Inpatient Sample (NIS) database. Costs are reported in 2017?US dollars. One-way and probabilistic sensitivity analyses address sources of variability in the results.

Results: A medium-volume hospital (130 spine surgeries per year) using F versus F?+?G/T for spine surgeries is expected to require 85 less hours of surgical time, 58 fewer hospital days and 7 fewer blood transfusions in addition to hemostat volume savings (F: 1?mL, thrombin: 1994?mL). The cost savings associated with the hospital resources for a medium-volume hospital are expected to be $317,959 (surgical hours?=?$154,746, hospital days?=?$125,237, blood transfusions?=?$19,023, hemostatic agents?=?$18,953) or $2445 per spine surgery.

Conclusions: The use of F versus F?+?G/T could lead to annual cost savings for US hospitals performing a low to high volume of spinal surgeries per year.     

Market Structure And The Adoption Of Innovations: The Case Of The Spanish Banking Sector ‡

This paper is an empirical study of the determinants of adoption time for the teleprocess terminal by Spanish commercial and savings banks. The explanatory variables include the characteristics of the adopting firms, size, and in the case of the savings banks, the structure of the market and concentration. The results indicate that the speed of adoption is maximized at intermediate levels of size and market concentration, confirming one theoretical prediction of models of diffusion: namely, that adoption time is minimized at intermediate levels of market concentration.     

Spillovers and absorptive capacity in the decision to innovate of Spanish firms: the role of human capital

This paper investigates whether the existence of knowledge spillovers and the capacity of firms to assimilate them, which we relate with R&D intensity and some human resource management practices, are associated with the decision to innovate of Spanish firms. In order to do this, we employ data from the ‘Central de Balances’ database, which covers both manufacturing and services firms during the period 2003–2007, and use an estimator proposed by Wooldridge [2005. Simple solutions to the initial conditions problem in dynamic nonlinear panel data models with unobserved heterogeneity. Journal of Applied Econometrics 20, no. 1: 39–54] for dynamic random effects discrete choice models. The empirical exercise provides evidence on the positive link between spillovers and the innovative behaviour of companies, not just for the knowledge generated in the same industry, but also for that generated in the same region or by the public sector. Moreover, this link is stronger for those firms with a higher capacity to absorb those spillovers. This ability not only works through firms’ R&D capabilities, but also through factors such as the quality of the labour force, the share of temporary employment and the amount of resources spent in training. In addition to these factors, we find that innovation performance exhibits a high degree of inertia. Further, some other observed firm characteristics, such as size, sales growth, export behaviour, sector capital intensity or financial structure variables, are also found to be relevant determinants of the likelihood of innovation.     

International Knowledge Flows: Evidence From Patent Citations

This paper explores the patterns of citations among patents taken out by inventors in the U.S., the U.K., Francc. Germany and Japan. We find (I) patents assigned to the same firm are more likely to cite each other, and come sooncr than other citations; (2) patents in the same patent class are approxinlatcly 100 titlles as likely to cite each other as ydtents froin different patent classes, but there is not a strong time pattern to this effect; (3) patents whose inventors reside in the same country are typically 30 to 80% more likely to cite each other than inventors from othcr countrics, and these citations come sooner; and (4) there are clear country-specific citation tendencies, e.g., Japanese citations typically come sooner than those of othcr countries.     

Self-Service Technology Versus Traditional Service: Examining Cognitive Factors In The Purchase Of The Airline Ticket

This article aims to identify the cognitive factors which influence the consumer attitudes toward the purchase of the airline ticket. We refer to the comparison between the beliefs regarding self-service and the alternative service or traditional service. This study is based on a sample of 739 Spanish undergraduates and their attitudes toward buying an airline ticket. This is the best selling product on the Internet in Spain. We compare the beliefs in two segments—online consumers and offline consumers—regarding each of the two systems for air ticket purchasing: Internet versus traditional travel agency. Hence, in online consumers, control and delivery speed are observed to be differentiating cognitive factors in the use of a self-service system. However, with offline consumers, delivery speed is indicated as a particularly significant cognitive factor in the use of the traditional service system.     

Persistence in Portuguese mutual fund performance

Recent evidence suggests that future performance is predictable from past performance, that is, funds with superior (inferior) performance in the past are likely to remain good (bad) performers in the future. This research addresses the persistence of mutual fund performance in a European regional market (the Portuguese equity fund market). Some of the problems in evaluating fund persistence are identified in the context of limited sample size and using the peer group median as a benchmark for contingency table analysis of performance persistence. The criteria for assessing performance persistence based on the contingency table methodology of repeated winners and losers are presented in terms of significance statistics, adjusted for small sample bias. The adjustments are accomplished through the Yates continuity correction and Fisher's exact p-value. The appropriateness of each criteria under different circumstances is also discussed. The analysis of the returns of all Portuguese domestic equity funds, since a representative number was established, shows some performance persistence (on a quarterly basis). The persistence, however, is reduced when the returns are controlled for the various dimensions of risk. Significant risk persistence has been documented. Furthermore, for more or less frequent intervals of measurement, the industry persistence is rejected, although individual funds exhibit superior/inferior performance.     

Social vulnerability indexes as planning tools: beyond the preparedness paradigm

This article draws from the experience of the ongoing drafting of the Regional Plan of the Centre Region of Portugal, and the empirical application of the Social Vulnerability Index proposed by Susan Cutter. It consists in the construction of an index of social vulnerability to natural and technological hazards and to social risks for all the municipalities of the region. Methodologically, it extends the vulnerability analysis to technological hazards and social risks, as a more encompassing view is necessary for the elaboration of prevention and civil protection policies. The results confirm the interactive nature of social vulnerability, and they also reflect the diffuse urbanisation and industrialisation patterns that characterise Portugal. The scattered nature of social facilities and security and health infrastructures pose specific challenges to planners concerning risk prevention and mitigation, and the elaboration of effective risk communication strategies adapted to specific hazards and risks in the studied municipalities. The article concludes with some reflections on the need to revise established paradigms of disaster analysis and emphasise the importance of pre‐event planning and the social cartography of vulnerable populations for effective prevention and security policies that take into account social inequalities and citizenship rights.     

Why don't Lenders renegotiate more home mortgages? Redefaults,self-cures and securitization

A leading explanation for the lack of widespread mortgage renegotiation is the existence of frictions in the mortgage securitization process. This paper finds similarly small renegotiation rates for securitized loans and loans held on banks' balance sheets that become seriously delinquent, in particular during the early part of the financial crisis. We argue that information issues endemic to home mortgages, where lenders negotiate with large numbers of borrowers, lead to barriers in renegotiation. Consistent with the theory, renegotiation rates are strongly negatively correlated with the degree of informational asymmetries between borrowers and lenders over the course of the crisis.