Healthcare resource utilization by patients with treatment-refractory myasthenia gravis in England

Aims: To examine healthcare resource utilization associated with refractory myasthenia gravis (MG) in England.

Materials and methods: This was a retrospective cohort study of linked data from the Clinical Practice Research Datalink and the Hospital Episode Statistics database collected between 1997 and 2016. Included patients were ≥18?years of age at the index MG diagnosis. Patients with refractory MG were identified using an algorithm based on treatments received. Healthcare resource utilization since the index date was compared between refractory and non-refractory cohorts.

Results: The study included 1149 patients with MG, of whom 66 (5.7%) were refractory. Sex and age at diagnosis did not significantly differ between the refractory and non-refractory cohorts. Rates of healthcare resource utilization per person-year were significantly higher (p?p?Limitations: The algorithm for identifying refractory patients did not include clinical criteria. Also, treatments administered in hospitals or by specialists were not available in the databases.

Conclusions: Patients in England with refractory MG more often visit healthcare providers, are hospitalized and visit an emergency room than patients with non-refractory MG.     

房建工程地基基础施工关键技术探究

地基处理技术是近年来我国房屋建筑工程施工中一种较常见的施工处理技术,多见于房屋建筑工程中的软土地基施工环节。通过以往的房屋建筑经验,如果直接在软土地基上进行建筑施工,地基区域软土很容易会影响房屋建筑工程的稳定性,所以,在针对这一部分软土区域的施工环节,需要针对拟施工的地基软土区域进行处理,提升其软土的稳定性。到目前,地基处理技术已经在我国房屋建筑工程施工中广泛应用,这一技术应用过程中存在的不足也逐渐凸显,如何针对这一技术的不足予以完善,以此提升地基处理技术对房屋建筑质量的积极影响,成为了现阶段房屋建筑地基基础施工质量提升的重要环节之一。     

Cost comparison of continued anticoagulation with rivaroxaban versus placebo based on the 1-year EINSTEIN-Extension trial efficacy and safety results

Aims: The EINSTEIN-Extension trial (EINSTEIN-EXT) found that continued treatment with rivaroxaban for an additional 6 or 12 months (vs placebo) after 6–12 months of initial anticoagulation significantly reduced the risk of recurrent venous thromboembolism (VTE) with a small non-significant increased risk of major bleeding (none fatal or in critical site). This study aimed to compare total healthcare cost between rivaroxaban and placebo, based on the EINSTEIN-EXT event rates.

Methods: Total healthcare cost was calculated as the sum of treatment and clinical event costs from a US managed care perspective. Treatment duration and event rates were obtained from the EINSTEIN-EXT study. Adjustment on treatment duration was made by assuming a 10% non-adherence rate. Drug costs were based on wholesale acquisition costs. Cost estimates for clinical events (i.e. recurrent deep vein thrombosis [DVT], recurrent pulmonary embolism, major bleeding, clinically relevant non-major bleeding) were determined from the literature. Results were examined over a ±20% range of each cost component and over 95% confidence intervals (CIs) of event rate differences in deterministic (one-way) and probabilistic sensitivity analyses (PSA).

Results: Total healthcare cost was $1,454 lower for rivaroxaban-treated (vs placebo-treated) patients in the base-case, with a lower clinical event cost fully offsetting drug cost. The cost savings of recurrent DVT alone (–$3,102) was greater than drug cost ($2,723). Total healthcare cost remained lower for rivaroxaban in the majority (73%) of PSA (cost difference [95% CI]?=?–$1,454 [–$2,396, $1,231]).

Limitations: This study was conducted over the 1-year observation period of the EINSTEIN-EXT trial, which limited “real-world” applicability and examination of long-term economic impact. Assumptions on drug and clinical event costs were US-based and, thus, not applicable to other healthcare systems.

Conclusions: Total healthcare costs were estimated to be lower for patients continuing rivaroxaban therapy compared to those receiving placebo in VTE patients who had completed 6–12 months of VTE treatment.     

Higher Intensity,Higher Profit? Empirical Evidence from Dairy Farming in New Zealand

Over the last two decades there have been significant and well‐documented changes in the nature and structure of New Zealand dairy production. One particular feature has been a marked shift in the ‘input intensity’ of dairy farming systems through increased use of supplementary feed. These changes have generated debate about the impact of dairy farm intensity on the performance of farm businesses and the competitiveness of the New Zealand dairy sector. Using a novel econometric approach, we assess statistically the impact of three types of dairy farming systems on milk production and financial performance, using farm business data provided by DairyBase^®. Our empirical results show that higher input systems perform significantly better physically than lower input systems, but not financially. The disaggregated analysis suggests that the average treatment effects differ by region and performance quantiles.     

Psychometric validation of anti-clot treatment scale and treatment satisfaction questionnaire for medication version II in Japanese patients with atrial fibrillation

Aims: The Anti-Clot Treatment Scale (ACTS) and Treatment Satisfaction Questionnaire for Medication version II (TSQM-II) are validated treatment satisfaction patient-reported outcome (PRO) instruments. The ACTS includes two domains: Burdens and Benefits; the TSQM-II includes four: Effectiveness, Side Effects, Convenience, and Global Satisfaction. Japanese-language versions of the ACTS and TSQM-II have been developed and linguistically validated. This study aimed to assess their psychometric properties in Japanese patients with atrial fibrillation (AF).

Materials and methods: ACTS and TSQM-II data from 534 patients with AF were collected in a Japanese post-marketing surveillance study of a direct oral-anticoagulant, rivaroxaban. Four key psychometric properties, in line with best practice guidelines from the US Food and Drug Administration, were examined using traditional psychometric methods: acceptability, scaling assumptions, reliability (i.e. internal consistency reliability, test-retest reliability), and construct validity (i.e. convergent validity and known groups).

Results: ACTS Burdens and Benefits and TSQM-II Effectiveness, Convenience, and Global Satisfaction scales were found to be acceptable (e.g. item-level missing data at baseline <4%), with all scales having good internal consistency (Cronbach’s alpha > 0.80). test-retest reproducibility intraclass correlation coefficients for the ACTS Burdens and Benefits were 0.59 and 0.65, respectively, and between 0.54–0.61 for the TSQM-II scales. Known-groups validity for the ACTS and TSQM-II was supported by differences in scale scores by positive and negative impact (p?<?0.05). Correlations between the ACTS and TSQM-II (convergent validity) were lower than expected (range r?=?0.09–0.48), but in line with the original ACTS development study.

Limitations: Evaluation of test-retest reproducibility was limited by assessment period, which was longer (3 months) than recommended guidelines (usually up to 2 weeks).

Conclusions: Overall, Japanese versions of ACTS and TSQM-II scales satisfied internal consistency reliability and traditional validity criteria. Our study supports the ACTS and TSQM-II as appropriate PRO instruments to measure satisfaction with anticoagulant treatment in Japanese patients with AF.

Trial registration: NCT01598051, clinicaltrials.gov; registered April 20, 2012.     

建筑施工中的地基施工处理技术分析

在近几年的发展中,建筑工程在我国的发展越来越完善,人们在建筑上的需求逐渐增高,不仅注重建筑的质量,在美观上也要更加有创新性。以此,为加强对建筑工程的实施,地基施工处理技术是建筑的重要组成部分,在提升建筑工程发展时,地基施工处理技术起着至关重要的作用,这直接影响着整个工程的发展。     

On the treatment of persons with disabilities in organizations: A review and research agenda

Human resource practitioners play a crucial role in promoting equitable treatment of persons with disabilities, and practitioner's decisions should be guided by solid evidence‐based research. We offer a systematic review of the empirical research on the treatment of persons with disabilities in organizations, using Stone and Colella's seminal theoretical model of the factors influencing the treatment of persons with disabilities in work organizations, to ask: What does the available research reveal about workplace treatment of persons with disabilities, and what remains understudied? Our review of 88 empirical studies from management, rehabilitation, psychology, and sociology research highlights seven gaps and limitations in extant research: (a) implicit definitions of workplace treatment; (b) neglect of national context variation; (c) missing differentiation between disability populations; (d) overreliance on available data sets; (e) predominance of single‐source, cross‐sectional data; (f) neglect of individual differences and identities in the presence of disability; and (g) lack of specificity on underlying stigma processes. To support the development of more inclusive workplaces, we recommend increased research collaborations between human resource researchers and practitioners on the study of specific disabilities and contexts, and efforts to define and expand notions of treatment to capture more nuanced outcomes.     

新会计准则下政府补助会计税务处理及其对研发加计扣除的影响

新会计准则完善了旧会计准则的不足,且对会计税务处理以及财务人员提出了更高要求。为了使企业在之后的发展过程中能更好地处理税务工作,分析新会计准则给企业经营带来的影响十分必要。基于此,文章分析了政府补助的内涵,以此为依据分析与之相关的会计核算和税务处理工作,并以当前的企业案例为依据,总结新会计准则下政府补助的会计税务处理对企业研发加计扣除产生的影响,进而为企业持续长远发展提供有参考价值的建议。     

自动岩土工程勘察与地基处理问题及解决对策

在建筑工程项目建设过程中,岩土工程勘察为地基设计提供了基础支持,能够为建筑物基础设计、地基处理、施工提供工程地质资料和技术参数。但是,很多建筑企业不注重岩土工程勘察工作,导致实际勘察工作中出现了一系列问题,相关部门需要深入分析这些问题,针对岩土工程勘察和地基处理问题制定相应的解决方法,论文主要分析了岩土工程勘察与地基处理问题及解决对策。