Patterns of care and burden of chronic idiopathic thrombocytopenic purpura in Brazil

Aims: Although several therapeutic options are available for chronic immune thrombocytopenic purpura (cITP), little is known about the treatment of cITP in Brazil.

Materials and methods: A multi-center, retrospective chart review, observational study was designed to describe the treatment patterns, clinical burden, resources use, and associated costs for adult patients diagnosed with cITP and treated in public and private institutions in Brazil. Patient charts were screened in reverse chronological order based on their last visit post January 1, 2012. (All costs were calculated using 1.00 USD?=?3.9571 BRL, from February 2016.)

Results: Of 340 patient charts screened, 50 patients were eligible for inclusion in the study. Single-drug therapy (prednisone, dexamethasone, or dapsone) was the most commonly used treatment, followed by combination therapies (azathioprine?+?prednisone, azathioprine?+?prednisone?+?danazol, and prednisone?+?dapsone). Splenectomy was performed in 22% of patients after at least first-line treatment. Platelet count and number of bleeding episodes at diagnosis were 31,561.1/mm³ (SD?=?±26,396.1) and 40 episodes, respectively; in first-line, 92,631.1/mm³ (SD?=?±79,955.3) and 19 episodes, respectively; in second-line, 96,950.0/mm³ (SD?=?±76,476.4) and 17 episodes, respectively. Private system patients had a higher median cost compared to public system patients (USD 17.49/month, range?=?0–2,020.77 vs USD 9.51/month, range?=?0–192.64, respectively).

Limitations: This study does not allow conclusions for causal explanations due to the cohort study design, and treatment patterns represent only the practices of physicians who have agreed to participate in the study.

Conclusions: The data indicate that available therapeutic strategies for second- and third-line therapies appear to be limited.     

Length of stay and economic consequences with rivaroxaban vs enoxaparin/vitamin K antagonist in patients with DVT and PE: findings from the North American EINSTEIN clinical trial program

Objective:

Venous thromboembolism (VTE) (deep vein thrombosis [DVT] and pulmonary embolism [(PE]) represents a substantial economic burden to the healthcare system. Using data from the randomized EINSTEIN DVT and PE trials, this North American sub-group analysis investigated the potential of rivaroxaban to reduce the length of initial hospitalization in patients with acute symptomatic DVT or PE.

Methods:

A post-hoc analysis of hospitalization and length-of-stay (LOS) data was conducted in the North American sub-set of patients from the randomized, open-label EINSTEIN trial program. Patients received either rivaroxaban (15?mg twice daily for 3 weeks followed by 20?mg once daily; n?=?405) or dose-adjusted subcutaneous enoxaparin overlapping with (guideline-recommended ‘bridging’ therapy) and followed by a vitamin K antagonist (VKA) (international normalized ratio?=?2.0–3.0; n?=?401). The open-label study design allowed for the comparison of LOS between treatment arms under conditions reflecting normal clinical practice. LOS was evaluated using investigator records of dates of admission and discharge. Analyses were carried out in the intention-to-treat population using parametric tests. Costs were applied to the LOS based on weighted mean cost per day for DVT and PE diagnoses obtained from the Healthcare Cost and Utilization Project dataset.

Results:

Of 382 patients hospitalized, 321 (84%), had acute symptomatic PE; few DVT patients required hospitalization. Similar rates of VTE patients were hospitalized in the rivaroxaban and enoxaparin/VKA treatment groups, 189/405 (47%) and 193/401 (48%), respectively. In hospitalized VTE patients, rivaroxaban treatment produced a 1.6-day mean reduction in LOS (median?=?1 day) compared with enoxaparin/VKA (mean?=?4.5 vs 6.1; median?=?3 vs 4), translating to total costs that were $3419 lower in rivaroxaban-treated patients.

Conclusion:

In hospitalized North American patients with VTE, treatment with rivaroxaban produced a statistically significant reduction in LOS. When treating DVT and PE patients, clinicians should consider newer anti-coagulants with less complex treatment regimens.     

ESTIMATION OF VALUE AT RISK AND RUIN PROBABILITY FOR DIFFUSION PROCESSES WITH JUMPS

In this paper we give upper bounds for both the Value at Risk   VaR _α,  0 < α < 1  , and for ruin probabilities associated with the supremum of a process driven by a Brownian motion and a compound Poisson process. We obtain lower bounds for the same Value at Risk, and for different cases we discuss the behavior of the bounds for small α. We prove our bounds are "asymptotically" optimal, as α tends to zero. The ruin probabilities obtained are related to other bounds found in recent literature.     

Mortality Among the Elderly in Sweden 1988–1997

By replacing the exponential growth in a Makeham function with a straight line at very high ages, graduated mortality rates gives an acceptable adherence to observed data.     

Mobility of public researchers, scientific knowledge transfer, and the firm's innovation process

The present study provides evidence on the mobility effects of researchers from the public R&D system with regard to firm's innovation process. This issue is particularly novel and important as these researchers contribute to the production and transfer of knowledge previously developed and accumulated in the public R&D system. The findings confirm that scientific knowledge which public researchers provide has a positive influence on both inputs and outputs of the firms' innovation process. The fact that firms have access to additional knowledge which is complementary to that they already hold represents a spur for exploiting and applying this new knowledge. The firms in this study continually increased their in-house R&D investments. As a result of these investments firms create new knowledge of a unique and valuable type. The study draws two important conclusions geared to providing a greater efficiency in human resource management and to improve the design of technology policies.     

Effects of Collaborative Communication on NPD Collaboration Results: Two Routes of Influence

Although NPD collaboration with external partners has become the next generation in NPD practice, the discussion concerning how to organize collaboration so as to obtain better results is far from over. Since communication is the most important element in successful interfirm exchange, this study focuses on the impact of collaborative communication and its facets—frequency, formality, reciprocal feedback, and rationality—on NPD collaboration results. In order to explain how collaborative communication can best be managed to enhance NPD collaboration results, this research combines the relational and resource‐based views, proposing the existence of two routes of influence: the direct resource‐based route and the indirect relational route mediated by trust. Using a sample of 207 NPD collaboration projects of innovative firms, empirical findings indicate that reciprocal feedback–rationality and frequency play an important role in product quality and adherence to budget and schedule, respectively, even without trust. Moreover, the trust between partners substantially reinforces the positive influence of reciprocal feedback–rationality on NPD collaboration results and makes the effect of formality significant. Therefore, the two alternative routes are confirmed as important paths to new product success, which provides relevant managerial implications.     

Towards a Smart Tourism Business Ecosystem based on Industrial Heritage: research perspectives from the mining region of Rio Tinto,Spain

The implications of the study provide suggestions for future improvements relating to the development of industrial tourism destinations. The possibility of ‘re-using’ the old industrial and mining heritage could favour the development of an economic opportunity to the recession that affected most industrial regions after the 1960s. This paper is focused on the field of industrial heritage tourism management (IHTM) to deepen the knowledge about its business ecosystem. The IHTM is chosen because a number of evidences highlight the interconnections that exist between this field and the business ecosystem concept. To explore these interconnections, the purpose of this article is to define a frame of analysis based also on the emergent initiative of smart tourism and to set up a theoretical framework not only used to the case study of the region of Rio Tinto mine in Spain, but also used as a policy instrument to suggest propositions for recommending new paths for future studies.     

Non-cooperative bargaining in apex games and the kernel

This paper studies non-cooperative bargaining with random proposers in apex games. Two different protocols are considered: the egalitarian protocol, which selects each player to be the proposer with equal probability, and the proportional protocol, which selects each player with a probability proportional to his number of votes. Expected equilibrium payoffs coincide with the kernel for the grand coalition regardless of the protocol. The equilibrium is in mixed strategies and the indifference conditions can be reinterpreted in the language of the kernel.     

The Impact of Innovation on Employment in Services: Evidence from Italy

This article investigates the employment impact of innovation in services, using the data gathered through the 1993-95 Italian innovation survey. The empirical evidence shows that the impact of innovation on employment varies greatly across industries and according to the level of qualification of the labour force. Among small firms and in less than a half of the service sectors considered, the employment impact of innovation is positive, particularly in industries that have a strong scientific and technological base. A negative impact of innovation on employment is, on the contrary, found among large firms, capital-intensive industries and in all financial-related sectors (banking, insurance and other financial services). In these industries the labour-saving effect of innovation seems to be linked to the widespread use of Information and Communication Technologies (ICTs) which displace the least qualified employees. In the case of Italy, an overall negative impact of innovation on employment is found. It is argued that this result is affected by the Italian economy's specialisation in the most traditional service industries.