Frequent-user patients: reducing costs while making appropriate discharges

Homeless patients who lack access to the health resources they need to maintain their health on their own pose a challenge for hospitals: Premature discharge of such patients can result in their being readmitted to the hospital in a short time, leading to higher costs for the hospital. Hospitals can address this problem by developing clear, effective homeless discharge policies and by developing ongoing relationships with appropriate medical respite care providers. A hospital also can benefit from spearheading an initiative to develop a medical respite program, enlisting the assistance of other community stakeholders.     

The new ecological paradigm and responses to climate change in China

The purpose of this study was to develop and evaluate a Chinese-Mandarin version of the revised new ecological paradigm (NEP-R) scale. In a sample of 515 Mandarin-speaking Chinese nationals, we first assessed the factor structure and internal consistency of the NEP-R and assessed its validity by examining associations with global warming risk perceptions and mitigation behavior. Respondents completed the NEP-R scale, together with measures of risk perception and mitigation behavior. Exploratory and confirmatory factor analyses indicated that a two-factor solution, reflecting ecocentric and anthropocentric worldviews, best fit the data. Multi-group path analysis revealed that respondents with stronger ecocentric and weaker anthropocentric worldviews perceived more risks associated with global warming. In turn, respondents who perceived more risks reported engaging in more global warming mitigation behaviors. But importantly, the path between risk perceptions and behavior was significantly stronger for highly educated respondents than for less educated respondents, suggesting that education may represent an important strategy for bridging the gap between perceived risks about global warming and action.     

A complete asymptotic series for the autocovariance function of a long memory process

An infinite-order asymptotic expansion is given for the autocovariance function of a general stationary long-memory process with memory parameter d∈(−1/2,1/2)$d\in (-1/2,1/2)$. The class of spectral densities considered includes as a special case the stationary and invertible ARFIMA(p,d,q$p,d,q$) model. The leading term of the expansion is of the order O(1/k^1−2d)$O(1/k^{1-2d})$, where k$k$ is the autocovariance order, consistent with the well known power law decay for such processes, and is shown to be accurate to an error of O(1/k^3−2d)$O(1/k^{3-2d})$. The derivation uses Erdélyi’s [Erdélyi, A., 1956. Asymptotic Expansions. Dover Publications, Inc, New York] expansion for Fourier-type integrals when there are critical points at the boundaries of the range of integration - here the frequencies {0,2π}$\{0,2\pi \}$. Numerical evaluations show that the expansion is accurate even for small k$k$ in cases where the autocovariance sequence decays monotonically, and in other cases for moderate to large k$k$. The approximations are easy to compute across a variety of parameter values and models.     

Regulator performance,regulatory environment and outcomes: An examination of insurance regulator career incentives on state insurance markets

In this paper we test whether the past or future labor market choices of insurance commissioners provide incentives for regulators in states with price regulation to either favor or oppose the industry by allowing prices that differ significantly from what would otherwise be the competitive market outcome. Using biographical data on insurance regulators, economic and state specific market structure and regulatory variables, and state premium and loss data on the personal automobile insurance market, we find no evidence consumers in prior approval states paid significantly different “unit prices” for insurance than consumers in states that allow competitive market forces to determine equilibrium prices during the time period 1985–2002. We do, however, find evidence regulators who obtained the position of insurance commissioner by popular election and those who seek higher elective office following their tenure as insurance commissioner allow higher overall “unit prices” relative to competitive market states. The “unit price” of insurance in regulated states is not statistically different from the competitive market outcome for regulators that make lateral moves back into state government and it is mildly higher for regulators who enter the insurance industry following their tenure. Finally, we find some evidence regulators who describe themselves as consumer advocates are successful reducing the price of insurance in favor of consumers in regulated markets. Overall the results are consistent with the existence of asymmetric information in the regulatory process that agents use to enhance their career aspirations.     

A Primer on Unit Root Testing

The immense literature and diversity of unit root tests can at times be confusing even to the specialist and presents a truly daunting prospect to the uninitiated. In consequence, much empirical work still makes use of the simplest testing procedures because it is unclear from the literature and from recent reviews which tests if any are superior. This paper presents a survey of unit root theory with an emphasis on testing principles and recent developments. The general framework adopted makes it possible to consider tests of stochastic trends against trend stationarity and trend breaks of a general type. The main tests are listed, and asymptotic distributions are given in a simple form that emphasizes commonalities in the theory. Some simulation results are reported, and an extensive list of references and all annotated bibliography are provided.     

The Obama effect

Many observers argued that Barack Obama’s candidacy in the U.S. presidential election of 2008 benefited from the financial crisis and recessionary economic conditions which voters blamed on the Republican administration. However, an empirical examination of stock price and public opinion data indicates that improvements in Obama’s electoral prospects led stock price declines and that gains by Obama were more likely to be followed by falling stock prices than by rising prices. This evidence suggests that the poor performance of the stock market in the days leading up to Obama’s victory was partly caused by, rather than causing, Obama’s success.

Destination image differences between visitors and non‐visitors: a case of New York city

This note discusses the influences of previous visits on tourists' destination images. The cognitive and affective images of New York City (NYC) appear to change in certain directions after visiting. The results also found that city images have a significant influence on tourists' visit intention. However, previous visits to NYC did not play any moderating effect between destination images and visiting intention. Copyright © 2010 John Wiley & Sons, Ltd.     

Bootstrapping I(1) data

A functional law is given for an I(1) sample data version of the continuous-path block bootstrap of Paparoditis and Politis (2001a). The results provide an alternative demonstration that continuous-path block bootstrap unit root tests are consistent under the null.     

A systematic review of cost-effectiveness modeling of pharmaceutical therapies in neuropathic pain: variation in practice,key challenges,and recommendations for the future

Objectives: Complexities in the neuropathic-pain care pathway make the condition difficult to manage and difficult to capture in cost-effectiveness models. The aim of this study is to understand, through a systematic review of previous cost-effectiveness studies, some of the key strengths and limitations in data and modeling practices in neuropathic pain. Thus, the aim is to guide future research and practice to improve resource allocation decisions and encourage continued investment to find novel and effective treatments for patients with neuropathic pain.

Methods: The search strategy was designed to identify peer-reviewed cost-effectiveness evaluations of non-surgical, pharmaceutical therapies for neuropathic pain published since January 2000, accessing five key databases. All identified publications were reviewed and screened according to pre-defined eligibility criteria. Data extraction was designed to reflect key data challenges and approaches to modeling in neuropathic pain and based on published guidelines.

Results: The search strategy identified 20 cost-effectiveness analyses meeting the inclusion criteria, of which 14 had original model structures. Cost-effectiveness modeling in neuropathic pain is established and increasing across multiple jurisdictions; however, amongst these studies, there is substantial variation in modeling approach, and there are common limitations. Capturing the effect of treatments upon health outcomes, particularly health-related quality-of-life, is challenging, and the health effects of multiple lines of ineffective treatment, common for patients with neuropathic pain, have not been consistently or robustly modeled.

Conclusions: To improve future economic modeling in neuropathic pain, further research is suggested into the effect of multiple lines of treatment and treatment failure upon patient outcomes and subsequent treatment effectiveness; the impact of treatment-emergent adverse events upon patient outcomes; and consistent and appropriate pain measures to inform models. The authors further encourage transparent reporting of inputs used to inform cost-effectiveness models, with robust, comprehensive and clear uncertainty analysis and, where feasible, open-source modeling is encouraged.