Comparative evaluation of treatment patterns and healthcare utilization of newly-diagnosed rheumatoid arthritis patients by anti-cyclic citrullinated peptide antibody status

Background: Anti-cyclic citrullinated peptide (CCP) antibody positivity is an established diagnostic factor for severe disease activity and joint damage and a prognostic factor for aggressive disease in rheumatoid arthritis (RA).

Objective: To compare RA-related treatment, healthcare utilization, and joint erosion between anti-CCP-positive and anti-CCP-negative RA patients.

Methods: Newly-diagnosed RA patients were identified from the Henry Ford Health System database between January 1, 2009 and December 31, 2014; the date of the first RA diagnosis within the study period was the index date. Baseline anti-CCP test was used to categorize patients as anti-CCP-positive or anti-CCP-negative, and outcomes were evaluated in the 6 months post-index.

Results: There were 217 anti-CCP-positive and 191 anti-CCP-negative RA patients included in the study. A higher proportion of anti-CCP-positive patients were initiated on RA treatment than anti-CCP-negative patients (70.5% vs 23.0%; p?<?.0001). More anti-CCP-positive patients received methotrexate (73.2% vs 56.8%; p?=?.0374), while more anti-CCP-negative patients received hydroxychloroquine (31.8% vs 13.1%; p?=?.0037) in first-line therapy. A higher proportion of anti-CCP-negative patients were tested for rheumatoid factor (RF) and erythrocyte sedimentation rate (ESR). Of those tested, there were more positive test results in the anti-CCP-positive cohort compared to the anti-CCP-negative cohort (RF: 84.4% vs 18.2%, p?<?.0001; C-reactive protein [CRP]: 69.7% vs 48.3%, p?=?.0008; and ESR: 89.5% vs 53.9%, p?<?.0001). Outpatient utilization predominated, with more anti-CCP-positive patients having any outpatient physician office visit (96.3% vs 77.5%, p?<?.0001) and a higher mean number of visits (5.3 vs 2.5, p?<?.0001) than anti-CCP-negative patients. Among anti-CCP-positive (n?=?113) and anti-CCP-negative (n?=?58) patients with imaging results, more anti-CCP-positive patients had joint erosion compared to anti-CCP-negative patients (18.6% vs 8.6%; p?=?.0858); however, statistical significance was not reached.

Conclusion: RA patients with positive anti-CCP antibodies had higher degrees of inflammation and disease activity as indicated by laboratory results, which likely contributed to their higher rates of healthcare utilization, joint erosion, and proportions of RA treatment.     

The industrial implications of an optimal reflationary mix for the British economy

This paper derives an optimal reflationary mix for the next decade and comments on the industrial implications of this policy. The discussion is based on simulations of the multisectoral dynamic model of the UK economy developed by members of the Cambridge Growth Project. The results suggest that the concentration on macroeconomic policy alone may be misguided and that instruments which attack the roots of Britain's industrial problems should receive more attention. The paper also demonstrates that the optimal control procedure is a reliable tool for steering an economy towards a desired target trajectory and that this is feasible for very large econometric models.     

Visitor perceptions of the role of tour guides in natural areas

This paper explores the potential of tour guides to contribute to the protection of natural areas by educating their customers through interpretation and modeling environmentally appropriate behaviors. Applying Cohen's (1985) model of the guides' role, modified by Weiler and Davis (1993) Weiler, B. and Davis, D. 1993. An exploratory investigation into the roles of the nature-based tour leader. Tourism Management, 14(2): 91–98. [Crossref] , [Google Scholar], as a framework, it examines the potential role that kayak tour guides can play in shaping the experience of visitors to one marine area, the Pacific Rim National Park. It uses two approaches to explore the perceptions of clients about the role of kayak guides using: (1) a pre- and post-trip questionnaire and (2) participant observation. Results indicate that five of the six roles were rated high in importance, but one role, the communication role, was not as important. Comparing performance with importance attached to each role revealed congruence with five roles, but lower levels of performance in relation to importance with the role of “motivator of responsible behavior”. Variability within all of the importance and performance measures suggest that for some individuals, performance did not match importance, highlighting the need to consider market segmentation in future studies. These findings are discussed within the ecotourism paradigm, and their implications for protected area management and for visitor behavior modification are considered.     

Leisure and work ethics and locus of control

Abstract

Equivocal findings regarding the relationship between attitudes toward leisure and the extent to which people feel in control of their own fate led to the consideration of possible mediating influences. The current study was an attempt to examine the relationship between locus of control and the affective domain of leisure attitude, or leisure “ethic,” while controlling for the influence of work ethic. The possibility of differences between males and females and students and nonstudents led to four separate subgroup analyses. Results indicated that of the four groups, only female students showed a substantial relationship between locus of control and leisure ethic. In this group, leisure ethic was associated with an external locus of control, the tendency to regard the control of life's circumstances as lying outside oneself. In none of the groups was the influence of work ethic great enough to make an appreciable difference in the relationship between locus of control and leisure ethic. The group differences were discussed in terms of sex‐role orientations and career aspirations.     

Retention of latent segments in regression-based marketing models

Product design and marketing mix decisions for segmented markets depend crucially on the correct specification of marketing models used as input to these decisions. With real-world data, the true number of segments in a market is unknown. Current evidence from simulation studies suggests that the accuracy of commonly used criteria for determining the number of segments in a market depends on the usage context, including the type of distribution being used to describe the data, the model specification, and the characteristics of the market. This study investigates via simulation the performance of seven segment retention criteria used with finite mixture regression models for normal data. This is one of the most important analysis contexts in marketing research since regression models are used, for example, in conjoint analysis and market response analysis, yet no previous study in either the marketing or statistics literatures explores the segment retention problem for mixture regression models. The study shows that one criterion, Akaike's Information Criterion (AIC) with a per-parameter penalty factor of 3 (AIC3), is clearly the best criterion to use across a wide variety of model specifications and data configurations, having the highest success rate and producing very low parameter bias. Currently, this criterion is rarely, if ever, used in the marketing literature.     

The theory of pluralism in corporate governance: A conceputal framework and empirical test

The concept of pluralism in corporate governance is stated as an emergent theory. Grounded in the concept of enhancing the input of various stakeholders and lessening the control of managers in corporate governance, the theory is the foundation of proposed legal changes in corporate governance and the board of directors. While more pluralistic control has been conceptually linked to improved social performance of the firm, this proposition is not supported in an empirical investigation.Rick Molz' main area of research is in strategic response to public policy initiatives. He has had articles published inColumbia Journal of World Business, Management International Review, The Journal of Business Research, Long Range Planning, The Journal of Business Strategy, andThe Journal of Business Ethics, as well as chapters and cases in several edited volumes.     

“搜索”淘金潮

“众里寻他千百度，蓦然回首，那人却在灯火阑珊处。“中国排名第一的搜索引擎公司——百度公司的名字取自辛弃疾的千古名篇《青玉案&#183;元夕》。从千年前的寻爱之旅到21世纪的搜索成功之路，百度仅仅走了不到5年的时间。     

Pushing back the frontiers: management control and work intensification under JIT/TQM factory regimes

Drawing on primary and secondary sources the authors argue that the JIT/TQM manufacturing system intensifies work as a result of increased surveillance and monitoring of workers' activities, heightened responsibility and accountability, the harnessing of peer pressure within 'teams' and via 'customers', and the fostering of 'involvement' in waste elimination and the continuous improvement of the production process.