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.     

Understanding the trend to mobile-only internet connections:A decomposition analysis

A growing portion of internet users rely solely on mobile devices such as smartphones for their online access. The percentage of “mobile-only” households increased from 9% in 2011 to 20% in 2015, more than doubling in only four years. As this shift continues, it leads to the question of what factors are driving the rise in mobile-only adoption. Using nationally representative data, this study uses logistic regressions and a decomposition technique to understand the trend. The decomposition reveals that a significant portion (65%) of the growth was due to an increase in the download speeds of mobile networks. An increased acceptance of mobile-only access by households aged 55 and older was also partly responsible. Understanding (and developing a response to) the trend towards mobile-only adoption will be important as organizations and governments continue to work to close the digital divide.     

Firm age and performance

Amid increasing interest in firm age and its effects on firm performance, this special issue offers an exhaustive review of the literature and a novel collection of evidence on the effects of firm age on performance, including a special focus of interest on innovation performance, financial performance, exports, survival and growth. This editorial positions the theme in the extant literature, and provides key definitions and challenges ahead in the field of evolutionary economics. It introduces the collection of articles composing the special issue. The papers offer a diversity of country contexts, as well as analytical approaches and methods. They include an exhaustive review of the literature on age and firms’ performance, and present original empirical studies focusing on the effects of age on firms’ economic outcomes on the one hand, and on innovation outcomes on the other hand. While most of the papers use econometric analysis, the level of analysis ranges from firm to individual.     

Risk aversion,prudence and temperance: An experiment in gain and loss

We characterize the individual's attitude towards risk, prudence and temperance in the gain and loss domains. We analyze the links between the three features of preferences for a given domain and between domains for each feature of preferences. Consequently, the reflection effect, the mixed risk aversion and the risk apportionment, are key concepts of our study. We also display some determinants for risk aversion, prudence and temperance in each domain. To do this, we conducted a lab experiment with students eliciting risk aversion, prudence and temperance in the two domains, and collected information about each subject's characteristics.     

The different roles of product originality and usefulness in generating word-of-mouth

This paper explores how the dimensions of new products, specifically, the originality and usefulness of the products, influence word-of-mouth (WOM). In four studies, using lab and field setups, we find that originality and usefulness have different effects on WOM. We show that consumers spread more WOM about original products, but the valence of what they say depends on the usefulness of the product. Therefore, originality enhances the effect of usefulness such that consumers spread relatively more and more positively valenced WOM about original and useful products compared to less original but equally useful products. Conversely, consumers spread more and more negatively valenced WOM about original products that are not useful compared to less original products with the same level of low usefulness. The results indicate that product originality should be managed carefully when developing and positioning new products. Although originality increases buzz, it might lead to negatively valenced WOM when the usefulness of the product is perceived to be low.     

Management Roles and Sustainability Information. Exploring Corporate Practice

Little empirical research has been conducted on perceptions of the types of sustainability information dealt with by different managers in internal company processes. In this study the roles of different managers are distinguished based on contingency theory and using the categorisation in the sustainability balanced scorecard concept. Expected sustainability information types are identified for these roles and hypotheses are derived and tested about perceptions of the types of sustainability information in different management roles. Interviews identified 116 roles involved with sustainability information in a set of leading German and UK sustainability reporting companies. Results from analysing sustainability information types contingent upon different management roles contribute to the understanding of sustainability accounting systems and practices and how companies can best support different management roles with appropriate sustainability information.     

Within‐Subject Intra‐ and Inter‐Method Consistency of Two Experimental Risk Attitude Elicitation Methods

We compare the consistency of choices in two methods used to elicit risk preferences on an aggregate as well as on an individual level. We ask subjects to choose twice from a list of nine decisions between two lotteries, as introduced by Holt and Laury 2002, 2005 ) alternating with nine decisions using the budget approach introduced by Andreoni and Harbaugh ( 2009 ). We find that, while on an aggregate (subject pool) level the results are consistent, on an individual (within‐subject) level, behaviour is far from consistent. Within each method as well as across methods we observe low (simple and rank) correlations.     

Disruptive Innovation in the Nordic Countries＇ Healthcare Systems

The Nordic healtheare model is recognized to be one of the most innovative in the world. Here billions of USD are annually invested in developing new treatments, drugs, robots etc. to diagnose and cure diseases. Nevertheless, this study establishes that there is a fundamental shortcoming in the system that supports healthcare innovation： It is strongly biased towards micro-level innovation projects focusing on new products, alternative processes, and new financial solutions. The problem with this approach to support new projects is that the results are created as inventions within the system thus lacking holistic perspectives. This has consequently contributed with increasing costs that are out of proportion with existing budgets. Therefore this study seeks to analyze the current understanding of the Nordic healthcare system from a business model perspective. Here other aspects of the healthcare system are explored to determine if they could be redesigned to promote new types of innovation projects. The purpose of undertaking this task is to challenge the established patterns of the current healthcare innovation support practices. Here the vertical innovation process （VIP） framework, which is a systematic radical innovation model that seeks macro-level outcomes based on standalone inventions （see more below）, is applied to analyze the current state-of-the-art in Nordic healthcare innovation projects. The results determine that very little attention is given to rethink and redesign the healthcare system at a macro-level, and it is discussed that stand-alone inventions ought to be rethought into the entire healthcare system to create a larger impact. Finally, it is argued that existing performance measures are inappropriate to foster projects that innovate the existing system： New measuring points should be developed to promote macro-level projects and to avoid the current rapid increase of costs in the Nordic healthcare system.     

Estimating the Enduring Effects of Fertiliser Subsidies on Commercial Fertiliser Demand and Maize Production: Panel Data Evidence from Malawi

Most studies of input subsidy programmes confine their analyses to measuring programme effects over a one‐year period. This article estimates the potential longer‐run or enduring effects of fertiliser subsidy programmes on smallholder farm households' demand for commercial fertiliser and maize production over time. We use four waves of panel data on 462 farm households in Malawi for whom fertiliser use can be tracked for eight consecutive seasons between 2003/2004 and 2010/2011. Panel estimation methods are used to control for potential endogeneity of subsidised fertiliser acquisition. Results indicate that farmers acquiring subsidised fertiliser in three consecutive prior years are found to purchase slightly more commercial fertiliser in the next year. This suggests a small amount of crowding in of commercial fertiliser from the receipt of subsidised fertiliser in prior years. In addition, acquiring subsidised fertiliser in a given year has a modest positive impact on increasing maize output in that same year. However, acquiring subsidised fertiliser in multiple prior years generates no statistically significant effect on maize output in the current year. These findings indicate that potential enduring effects of the Malawi fertiliser subsidy programme on maize production are limited. Additional interventions that increase soil fertility can make using inorganic fertiliser more profitable and sustainable for smallholders in sub‐Saharan Africa and thereby increase the cost‐effectiveness of input subsidy programmes.