Cost–consequence analysis of a hemostatic matrix alone or in combination for spine surgery patients

Background: A five-year retrospective database analysis comparing the use of Floseal¹ flowable topical hemostat alone (F) and in combination with gelatin/thrombin (F?+?G/T) to achieve hemostasis and control surgical bleeding showed higher resource utilization for F?+?G/T cases relative to F matched pairs during spinal surgery. Lower resource use in the F group was characterized by shorter hospital length of stay and surgical time as well as fewer blood transfusions and less hemostat agent used per surgery.

Objective: To evaluate the cost–consequence of using F compared to F?+?G/T in minor, major and severe spinal surgery from the US hospital perspective.

Methods: A cost–consequence model was developed using the US hospital perspective. Model inputs include clinical inputs from the literature, cost inputs (hemostatic matrices, blood product transfusion, hospital stay and operating room time) from the literature, and an analysis of annual spine surgery volume (minor, major and severe) using the 2012 National Inpatient Sample (NIS) database. Costs are reported in 2017?US dollars. One-way and probabilistic sensitivity analyses address sources of variability in the results.

Results: A medium-volume hospital (130 spine surgeries per year) using F versus F?+?G/T for spine surgeries is expected to require 85 less hours of surgical time, 58 fewer hospital days and 7 fewer blood transfusions in addition to hemostat volume savings (F: 1?mL, thrombin: 1994?mL). The cost savings associated with the hospital resources for a medium-volume hospital are expected to be $317,959 (surgical hours?=?$154,746, hospital days?=?$125,237, blood transfusions?=?$19,023, hemostatic agents?=?$18,953) or $2445 per spine surgery.

Conclusions: The use of F versus F?+?G/T could lead to annual cost savings for US hospitals performing a low to high volume of spinal surgeries per year.     

What Do Wages Add to the Health‐Employment Nexus? Evidence from Older European Workers

The role of wages in the health‐employment nexus can be important for designing employment policies aimed at older workers with health limitations. We, therefore, estimate the direct effect of health on employment and hours worked and its indirect effect that is mediated through wages using individual‐level panel data from SHARE. The endogeneity of self‐reported health is controlled for by instrumenting it with severe health conditions in a correlated random effects model. For men, we find that the direct effects of health deterioration, as measured by a reduction in health from the 75th to the 50th percentile of the health distribution, are about a 20% point lower employment probability and about 171 fewer hours worked per year. The indirect health effects through wages work in the opposite directions as health positively affects wages and wages negatively affect employment and hours worked. The total effects of this health deterioration amount to a 12% point lower employment probability and 95 fewer hours worked per year. In particular our finding of a large direct health effect on employment suggests an instrumental role for policy aimed at accommodating workers with health limitations to keep them employed at older ages.     

Original Institutional Economics and Political Anthropology: Reflections on the Nature of Coercive Power and Vested Interests in the Works of Thorstein Veblen and Pierre Clastres

Our inquiry advances a comparison of the anthropological content of Thorstein Veblen’s evolutionary perspective with the foundations of the political anthropology drawn from selected works of Pierre Clastres. We seek to establish that what can be referred to as a clastrean reference can simultaneously offer new perspectives on institutionalism, while maintaining a radical and emancipatory understanding of Veblen’s writings. In this sense, we seek to reconsider and reevaluate the role of economic surplus drawn from Veblen’s anthropology, while also offering a general and critical perspective for understanding the emergence of coercive power within societies.     

Which projects are selected for an innovation subsidy? The Portuguese case

Portuguese Economic Journal - Several empirical studies have analyzed which firm characteristics influence government evaluators in the decision to select specific firms to participate in Research...     

Estimating the U.S. output gap with state‐level data

This paper develops a method to estimate the U.S. output gap by exploiting the cross‐sectional variation of state‐level output and unemployment rate data. The model assumes that there are common output and unemployment rate trend and cycle components, and that each state's output and unemployment rate are subject to idiosyncratic trend and cycle perturbations. I estimate the model with Bayesian methods using quarterly data from 2005:Q1 to 2018:Q2 for the 50 states and the District of Columbia. Results show that the U.S. output gap reached about negative 4.6% around the years of the Great Recession and was about 0.9% in 2018:Q2.     

Pedagogical and technological replanning: a successful case study on integration and transversal skills for engineering freshmen

Replanning is often used to optimize results of an activity in an ever changing world. To address the challenge of preparing future engineers for success, a special course was created for all engineering freshmen of the Faculty of Engineering of the University of Porto, in Portugal. Presented as a case study, this special course underwent a careful replanning as a result of several years of experience in teaching practice alongside with a theoretical deepening in pedagogical and technological issues, under the aegis of the action-research methodology. Within the context of the case study course, the mentioned replanning was also based on a theoretical approach that clearly identifies teaching–learning-assessment methodologies that promote regulation from those that foster emancipation, using a specific instrument: a taxonomy of educational processes. The replanning was designed to globally boost results regarding the educational aims of the course such as furthering freshmen’s integration into work environment and preparing them for success by fostering transversal skills (needed for study and work). Technology is seen as a mean of education enrichment as well as a productivity tool. The introduced innovations include fun-but-educational activities, several types of assessment over time and specific technological tools which were critical for the educational impact/achievement of this course. Success is demonstrated by encouraging feedback from the stakeholders, high students’ classifications and a steady reduction in retention. It is advocated that large portions of the reasoning behind the replanning can be extrapolated to other courses.     

Examining the predictive validity of SUS-TAS with maximum parsimony in developing island countries

The Sustainable Tourism Attitude Scale (SUS-TAS) has been used as a tool to gauge the sentiment of local residents toward sustainable tourism development. This scale has been validated in cross-cultural settings by several scholars. In a like manner, in order to validate this scale, data were collected in the Cape Verde islands (off the coast of Africa) and the results showed (1) a parsimonious version of the 21-item SUS-TAS that facilitates the process of data collection without compromising its robustness and psychometric properties, (2) a validated second-order factor model, confirming that the seven factors of SUS-TAS can be loaded in two broader dimensions named “perceived tourism impacts” and “expected tourism sustainability”, (3) a SUS-TAS second-order factor model with validity in predicting residents’ support for sustainable tourism development, (4) that SUS-TAS can be interpreted by seven individual factors and/or as a global factor as indicated by the hierarchical measurement model and predictive validity. Methodological and theoretical interpretations are discussed and future refinement and applications are also offered.