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.     

Understanding the economic determinants of the severity of operational losses: A regularized generalized Pareto regression approach

We investigate a novel database of 10,217 extreme operational losses from the Italian bank UniCredit. Our goal is to shed light on the dependence between the severity distribution of these losses and a set of macroeconomic, financial, and firm‐specific factors. To do so, we use generalized Pareto regression techniques, where both the scale and shape parameters are assumed to be functions of these explanatory variables. We perform the selection of the relevant covariates with a state‐of‐the‐art penalized‐likelihood estimation procedure relying on L₁‐penalty terms. A simulation study indicates that this approach efficiently selects covariates of interest and tackles spurious regression issues encountered when dealing with integrated time series. Lastly, we illustrate the impact of different economic scenarios on the requested capital for operational risk. Our results have important implications in terms of risk management and regulatory policy.     

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 decision game: a serious game approach to understanding environmental risk management decisions

Abstract

Here we describe the implementation of an experimental research tool called the Decision Game that we used to collect data on household flood risk management decisions. Participants using this tool play an interactive game that involves making household decisions about place of residence and a variety of household expenditures, including spending on flood insurance and private flood risk mitigation. Participants also answer survey questions before and after playing the game; the pre-game survey collected demographic information, and the post-game survey collected information about participant experiences with flooding and flood mitigation. Online and face-to-face participants showed similar engagement with the experiment, and most participants appeared to have made deliberate and considered decisions about risk mitigation. Online study participants had similar responses to those who participated in person, although face-to-face participants seemed slightly more likely to mitigate against risk. Overall, participants in this research were younger, more educated and more likely to rent a home than the average Canadian. Serious games may be useful for augmenting existing data gathering strategies used in understanding environmental decision making, particularly for rare catastrophic events for which stated preference surveys may be less informative. Serious games allow for sharing a mixture of information with study participants, including maps, video clips, text and even immersive 3D experiences, and can be administered online to increase participation levels. Future research will consider longer duration online experiments and more immersive interaction frameworks.     

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.     

Small businesses as a research subject: Some reflections on knowledge of small businesses and its effects on economic theory

Most economists agree in their view of small and medium-sized enterprises, or small businesses (SMEs), as a marginal scientific subject. They may go so far as to ignore them, either because they think these economic units do not lend themselves to conventional economic studies — studies which, for instance, take into account the sacred cow theory of economies of scale — or because they see them as being not really different from big businesses.However, at least a few economists have recognized, first, the many characteristics differentiating SMEs from big firms, and second, their increasing importance in terms of numbers and job creation within economies. Among these few, Schumpeter was one of the first to show the importance of entrepreneurs and SMEs as the main variable of change in an economy. Simon and Lucas also explained the difference between small and big firms through the differing abilities required by managers to run them. Penrose looked at the question from another point of view by highlighting the interstices taken up by SMEs to fulfil needs that cannot be fulfilled by bigger units. Critics of the theory of economies of scale showed that such economies may be offset by a number of diseconomies, thus justifying the efficiency of many SMEs. More recently, Mills and Schumann suggested that SMEs compensate for their lack of economies of scale by their production flexibility, particularly in today's turbulent economy.The limits of traditional economic theory are clearly demonstrated by the fact that it does not take account of all these theories, concepts and ideas. It thus neglects a number of important economic phenomena, including the persistence and current expansion of SMEs. Consideration of such phenomena may lead to the development of a new economic theory based on the concepts of instability and contingency, together with the behaviour of entrepreneurs and small firms, thus tending to contradict, in particular, the concept of equilibrium in conventional economic theory.A first version of this paper has been presented as invited speaker at the symposium of TETRA Group at Lyon, France, 30–31 May 1990. I thank the colleagues Fritz Rieger, Frances Solé Parrellada, Jacques Filion and the two referees for their very interesting suggestions on a preliminary second version.