Physicians’ use of medical technology: an analysis of the introduction and subsequent failure of drug-eluting stents

Using data on cardiac patients in Florida hospitals from 2003 to 2007, we analyse the adoption and deadoption of a major new medical technology, drug-eluting stents (DESs). The Food and Drug Administration approved DESs in April 2003 and physicians rapidly adopted the new technology. In March 2006, a presentation was made at the American Cardiology Conference which showed that patients receiving DES in real-world settings suffered higher rates of mortality and myocardial infarction than those receiving stents without drugs. We examine the utilization of DES from April 2003 to the end of 2007. Using a hospital fixed-effects model, we find that board-certified and top-trained physicians were initially quicker to adopt DES. Over time, this effect dissipated and top-trained physicians were less likely to use DES by the time new clinical trials indicated they could be problematic. After the news, board-certified and top-ranked physicians were less likely to change their behaviour. Physicians’ own experience also contributes to the use of technology and the effects are stronger for non-board-certified physicians. We conclude that even within hospitals, physician training and experience play an important role in explaining differences in rates of technology use.     

Unleashing proactive low-carbon strategies through behavioral factors in biodiversity-intensive sustainable supply chains: Mixed methodology

The aim of this research is to understand the complex and relatively understudied relationship between human and behavioral factors and low-carbon management practices from the perspective of the resource-based view (RBV). Research application is in the “biodiversity sector” and consists of a survey and multiple-case study in Brazil, the richest country globally in terms of biodiversity but a country that also faces challenges in protecting biodiversity. The research problem considers the relationship between human critical success factors and the adoption of low-carbon management practices. Quantitative analysis through structural equation modeling shows the three branches of hypothesis to be accepted—the first with a higher coefficient than the second and the second with a higher coefficient than the third. It was observed that human factors influence low-carbon product management practices the most, followed by process practices and finally logistics practices. Qualitative multiple-case study research shows that companies are at different stages of maturity in relation to low-carbon management organizational practices, ranging from the highest stage to the lowest. It was found that the intensity of the presence of human critical success factors was higher where organizations had greater adoption of low-carbon management practices.     

Evolution of state clusters related with technological capability in Mexico: Application of a multivariate statistical analysis of cluster

The objective of this work is to analyze how the technological capability is distributed between the Mexican states and to examine their evolution. To this end, an empirical study was developed using the cluster multivariate statistical analysis technique, based on the set of indicators proposed by Cepal (2007), and gathering the data from various public sources in the country during years 2006 and 2012. This was done to study the evolution of said conglomerates, trying to see which states have been able to move to a conglomerate located in more advanced positions and which have retreated within said period. The results show the existence of 7 groups of states characterized by different levels of technological capability. Furthermore, 3 entities that evolved into a more advanced conglomerate – regarding absorption and innovation capability, as well as infrastructure technological capability – are also detected.     

Why the Doctor Will NOT See You Now: The Ethics of Enforcing Covenants Not to Compete in Physician Employment Contracts

When a physician employment relationship terminates, the physician–patient relationship may also be terminated by enforcement of a covenant not to compete, which typically forces the physician to leave the geographic area for a period of time. This gives rise to several ethical dilemmas. The public interest is compromised when enforcement of these covenants contributes to the shortage of physicians in the community, and individual patients are harmed when their physicians are no longer available. The authors undertook a unique study to explore physician perspectives concerning the ethics of banning a physician from practice and the impact of the ban on both the physician and the physician’s patients. The results identified harmful effects that have not been raised in prior scholarly articles or reported court opinions. After reviewing the legal background of covenants not to compete, this paper presents the results of that study and concludes that resorting to the legal system for enforcement of covenants not to compete is not always the ethical course of action.     

Conditional conservatism and cost of capital

We empirically test the association between conditional conservatism and cost of equity capital. Conditional conservatism imposes stronger verification requirements for the recognition of economic gains than economic losses, resulting in earnings that reflect losses faster than gains. This asymmetric reporting of gains and losses is predicted to lower firm cost of equity capital by increasing bad news reporting precision, thereby reducing information uncertainty (Guay and Verrecchia 2007) and the volatility of future stock prices (Suijs 2008). Using standard asset-pricing tests, we find a significant negative relation between conditional conservatism and excess average stock returns over the period 1975–2003. This evidence is corroborated by further tests on the association between conditional conservatism and measures of implied cost of capital derived from analysts’ forecasts.     

Packard Electric/Delphi and the birth of the autopart cluster: the case of Chihuahua,Mexico

The purpose of this article is to describe, from a dual perspective, the birth and evolution of the technological cluster located in Chihuahua, Mexico. It reconstructs Packard Electric–Delphi’s evolutionary path as a dominant company, alongside the technological trajectory of the wiring harness. I build a taxonomy whose purpose is to distinguish different moments in the harness history. This approach to the harness demands systemic distinctions of a dynamic, quantitative and qualitative nature. The formation of the electrical/electronics cluster of automotive parts located in Chihuahua can be understood in the context of Packard Electric’s integration/disintegration dynamics. This regional and international reconstruction process reflects: (1) the accumulation of technological and organizational capabilities inside a firm; (2) technological competition within the sector; (3) the fact that each company follows particular technological learning ‘paths’ as well as a unique regional technological cluster formation (technological path); and (4) that the integration/disintegration dynamics of firms are difficult and unstable processes, dependent on the difference between internal and external transactional costs. L’article décrit lémergence et le développement du district technologique de Chihuahua (Mexique) à travers une approche évolutionniste qui s’attache à reconstituer une double trajectoire: celle d’une firme; Packard Electric–Delphi (PE), et celle d’une technologie, le câblage. Les différentes étapes de la technologie du câblage sont appréhendées en mettant l’accent sur la dynamique systémique de nature quantitative et qualitative. La formation du district technologique du câblage électrique/électronique de Chihuahua est mise en perspective avec la stratégie d’internationalisation et de localisation de la firme multinationale. Cette dynamique est le résultat d’un processus de développement des ressources technologiques et organisationnelles de la firme, du jeu de la concurrence technologique au sein de l’industrie du câblage et de l’articulation entre la trajectoire d’apprentissage technologique de la firme et celle associée à la formation du district technologique. La dynamique d’intégration et de d’externalisation de la firme apparaît ainsi de nature instable, dépendant des différences entre les coûts de transaction interne et externe.     

A tight sufficient condition for Radner-Stiglitz nonconcavity in the value of information

This paper deals with the existence of a nonconcavity in the value of information, as was first explained by Radner and Stiglitz [A nonconcavity in the value of information, in: M. Boyer, R.E. Kihlstrom (Eds.), Bayesian Models in Economic Theory, Elsevier Science Publishers, Amsterdam, 1984, pp. 33-52 (Chapter 3)]. After defining infinitesimal information distance variationIIDV, we find that IIDV=0 is sufficient for a zero marginal value of information at the null. This is a condition only on the information structure and in particular is independent of the decision maker's preferences. This condition is tight: when IIDV>0, there exists a payoff function for which the marginal value of information at the null is positive under general assumptions.     

Rudolf Kjellén and modern Swedish geopolitics

This article explores the possibility of developing a more progressive sense of place which recognises the mutual interdependence and interconnection of South America, the Falklands (Malvinas) and the South Atlantic rather than perpetuating exclusive identities and sovereignty. Since the 1982 South Atlantic conflict, there have been considerable improvements in Anglo‐Argentine relations resulting in a decade‐long period of South Atlantic co‐operation and the 14 July 1999 Joint Statement. The difficulties of generating a progressive sense of place in regions where conflict, distrust and bitterness endure remain powerful forces. These endeavours will require all parties to develop a more plural sense of culture, geographical identity and place. The recent public recognition of shared loss by former President Carlos Menem and HRH the Prince of Wales is interpreted as a promising development in the long‐term process of co‐operation and forgiveness. Finally, this investigation considers how political geographers can contribute to these acts of reconciliation and recognition.