A review of biopsychosocial strategies to prevent and overcome early-recognized poor adherence in growth hormone therapy of children

Abstract

Background:

Adherence to growth hormone (GH) therapy among children is variable and remains a problem, possibly affecting growth outcomes and future health, and having economic consequences.

Objective:

To provide a review of the issues related to poor adherence to GH therapy in children and describe integrative strategies that may improve adherence.

Results:

Poor adherence may be caused by various factors, affecting both the children and their families. The key reasons for adherence difficulties are psychological/emotional problems, social/everyday problems and technical handling issues of the drug delivery device. Correspondingly a broad range of strategies to address adherence to GH therapy often revolve around counseling and education, not just for the patient but also for the family giving care.

Limitations:

This review is intended as a general survey of strategies which could help, in clinical practice, to overcome poor adherence to growth hormone therapy in children; it summarizes the representative literature but it does not aim to be a rigorous database literature search in every aspect.

Conclusions:

If poor adherence is recognized early on during treatment, appropriate steps may be taken to identify barriers that are amenable to change for encouraging the child to adhere to the treatment regimen. A preventative approach may also be considered; for example, doctors could address adherence issues early and train families of children treated with GH to recognize the resources as well as the barriers to adherence. The broad range of different causes for poor adherence demands a great variety of interventions, making it important to individualize optimal treatment behavior. Additionally, economic studies are required to quantify the cost of poor adherence to GH therapy and to show the financial benefits of good adherence.     

The projected costs and benefits of water diversion from and to the Sultan Marshes (Turkey)

The Sultan Marshes in the Develi Basin, Anatolia, one of twelve internationally important wetlands of Turkey, have been severely affected by the construction of an irrigation project in 1988. Intensive use of surface and ground water in irrigation has caused more than a 1 m decline in water levels and has affected the wetlands' ecological characteristics. Previous studies indicate that Sultan Marshes will need more water to restore viable ecological conditions. In this study, we analyze how economic benefits from agriculture and wetlands would be affected if moderate amounts of water were diverted from agriculture back to wetlands in the Develi Basin. By estimating total and marginal costs and benefits associated with water diversions, we determined the optimum or economically-efficient amount of water diversion. When only direct-use values of the wetland (animal grazing, plant harvesting, and ecotourism) were included in the analysis, the optimum amount of water diversion to the wetlands was found to be 5.2 million m³ year^− 1 (165 L sec^− 1), which compares to about 62 million m³ year^− 1 (1,957 L sec^− 1) used in irrigation. When wastewater treatment benefits (an indirect-use value) were added, the optimum amount rose to 7 million m³ year^− 1. Overall, the analysis showed that water diversion from agriculture to the Sultan Marshes is economically preferable.     

Why Marx Neither Has Nor Needs a Commodity Theory of Money

This paper argues, contrary to the standard interpretation, that money in Marx's theory is tied neither to bullion nor to any commodity basis. It is rather the sole social form of value autonomous from use-value. This is demonstrated by reference to Marx's account of the social functions of money, and by showing that to subsume 'money' under 'commodity' commits a category mistake within Marx's system. My argument is conceptual rather than historical. It seeks to locate, not to deny, the role of 'gold' in Marx's monetary theory. It has relevance to contemporary debates about the need for some new 'gold-standard' to sustain the international monetary system.     

Recycling and extending product-life: an evolutionary modelling

This paper presents a model-based analysis of firms’ economic incentives to extend product life and market recyclable products. We address this problem by developing an evolutionary simulation model to describe the behavior of business firms as interacting with consumers and recyclers. Market structure, business firms’ R&D strategies and consumers’ preferences are found to have an important influence here. The simulation results show that improvement in recycling is necessary but not sufficient to solve the issue of increase in waste. Recycling will need to be backed up with an extension in product-life to face such an unwanted increase. Adopting such a strategy could be positive for firms and for the environment because it could lead to high economic performance, both in terms of profits and market share, and to high environmental performance, both in terms of product recyclability and product lifetime. Our results suggest introducing regulation policies aimed at encouraging firms to invest in developing green products, i.e. those which are easily recyclable and which have a long lifetime, and getting consumers to buy them. It would also seem crucial to lend support to innovation outlay for such firms and to favor their seeking to improve product performance.

The unanimity rule and religious fractionalisation in the Polish-Lithuanian Republic

This paper analyses the role of the unanimity rule—known as liberum veto—in medieval Poland. We argue that the primary effect of the liberum veto was that it secured religious freedom and established domestic peace in an otherwise deeply divided and fractionalised country. What is more, this institution succeeded in doing so during an era which was characterised by violent religious conflicts and rise of absolutist monarchies throughout the European continent. Even after 1652, when the liberum veto seemed to have practically paralysed the decision-making of Polish-Lithuanian parliament, there were still reasons—related to religious issues—why its use could have been preferable to less inclusive voting rules. It can be argued, however, that the use of unanimity was not warranted in questions related to defence, especially in situations of national emergency, although it is questionable to which extent the sole presence of the liberum veto was susceptible to bring about the demise of the Polish-Lithuanian Republic.

Influence of decision styles on use of decision models

This article discusses how the “decision style” of an administrator influences the adoption and use of particular decision models. Several “interactive” and “analytical” decision models often used to guide decision making are described and critiqued to point out their virtues and deficiencies. Propositions are suggested that contend that “systematic,” “judicial”, “speculative”, and “intuitive” styles have clear-cut preferences for a particular decision model. This model seems to be used, even when another would be more suitable. Effective decision makers are postulated to adapt their styles, or at least to see the benefits of different styles. Mixed-mode models are proposed that seem to simulate the behavior of successful decision makers.     

Sustainable Development and a Dwindling Carbon Space

Curbing global warming by setting long term maxima for temperature rise or concentrations of greenhouse gases defines spaces within which further emissions of these gases are to remain (referred to here as ‘carbon spaces’). This paper addresses questions related to how to share between countries the carbon space and/or efforts to stay within it, in the perspective of sustainable development; different allocation mechanisms are reviewed, responding to criteria such as ‘responsibility’ for climate change, ‘capability’ to engage in abating it, and ‘potential’ or future contribution. The carbon space remaining at any time will depend on effective mitigation up till that time, and will condense if more stringent maxima are to be set; per capita this space becomes smaller with rising population. Sharing the carbon space in a fair way requires “convergence” of currently widely unequal per capita emissions. If the world is to stay within the carbon space consistent with <2° warming, then developed economies—the wealthiest sources of greenhouse gases should quickly and deeply engage in mitigation. Also, substantial mitigation is to take place in developing countries and that this will require substantial support to developing countries (financially, technologically). Changing development paths can make a major contribution to climate change mitigation; this requires changes in investment, production and consumption patterns. Green New Deals as proposed in the context of a widened response to the current economic crisis could become a first phase of a fundamental transition towards a decarbonised global economy worldwide. Concerns to do with equity as well as sustainability must be incorporated and integrated into coherent transitory strategies.     

How to promote R&D-based growth? Public education expenditure on scientists and engineers versus R&D subsidies

This paper compares the positive and normative implications of two alternative measures to promote R&D-based growth: R&D subsidies to firms and publicly provided education targeted to the development of science and engineering (S&E) skills. The model accounts for the specificity of S&E skills, where individuals with heterogeneous ability choose their type of education. Although intertemporal knowledge spillovers are the only R&D externality, the analysis suggests that R&D subsidies may be detrimental to both productivity growth and welfare. Moreover, they raise earnings inequality. In contrast to R&D subsidies, publicly provided education targeted to S&E skills are found to be unambiguously growth-promoting and neutral with respect to the earnings distribution.     

Charitable Donations: Evidence of Demand for Environmental Protection?

Using data from the 2001 Giving and Volunteering in the United States survey, I examine household charitable donations to environmental organizations. Household income has a positive impact on environmental giving. While the tax price affects overall charitable contributions, it does not affect environmental giving. More education, being female, homeownership, and voting are also associated with a greater likelihood of contributing to the environment. African-Americans and Latinos are less likely to contribute to the environment, although conditional on giving, Latinos give more. Retired persons and households with children are less likely to contribute to the environment. Larger households give less to the environment. Households from the Northeast are the most likely to make environmental contributions while households from the South are the least likely.

Estimation of consistent multi-country FEERs

Most studies on equilibrium exchange rates focus on a limited number of G7 countries. But in a situation of world imbalances, emerging countries can no longer be excluded. The study of all equilibrium exchange rates is delicate. First, the trade model has to be balanced at the aggregate level. This paper suggests a method to achieve world balance both in volume and in value. Second, the N − 1 bilateral exchange rates cannot ensure that the N areas will reach their macroeconomic equilibrium simultaneously. This paper examines the existing solutions to solve the N − 1 problem and proposes an alternative which minimizes the distance to the current-account targets. Finally, in order to compare the relevance of the different methodologies, FEERs are calculated for 19 industrialized and developing countries. The results, which are taking into account the modification on output gap assessment induced by the 2008–2009 crisis, lead for the year 2010 to a USD closed to its equilibrium, a RMB undervalued by around 35% in real effective terms and to a EUR/USD parity equals to 1.47.     

Property rights and information flows: a simulation approach

With the growth of the information economy, the proportion of knowledge-intensive goods to total goods is constantly increasing. Lessig (The future of ideas: the fate of the commons in a connected world. Vintage, New York 2001) has argued that IPRs have now become too favourable to existing producers and that their ‘winner-take-all’ characteristics are constraining the creators of tomorrow. In this paper we look at how variations in IPRs regimes might affect the creation and social cost of new knowledge in economic systems. Drawing on a conceptual framework, the Information Space or I-Space to explore how the uncontrollable diffusibility of knowledge relates to its degree of structure, we deploy an agent-based modelling approach to explore the issue of IPRs. We take the ability to control the diffusibility of knowledge as a proxy measure for an ability to establish property rights in such knowledge. Second, we take the rate of obsolescence of knowledge as a proxy measure for the degree of turbulence induced by different regimes of technical change. Then we simulate the quantity and cost to society of new knowledge under different property right regimes.

Valuing ecosystem goods and services: a new approach using a surrogate market and the combination of a multiple criteria analysis and a Delphi panel to assign weights to the attributes

A new approach to valuing ecosystem goods and services (EGS) is described which incorporates components of the economic theory of value, the theory of valuation (USappraisal), a multi-model multiple criteria analysis (MCA) of ecosystem attributes, and a Delphi panel of experts to assign weights to the attributes. The total value of ecosystem goods and services in the various tenure categories in the Wet Tropics World Heritage Area (WTWHA) in Australia was found to be in the range AUD$188 to $211 million year⁻¹, or AUD$210 to 236 ha⁻¹ year⁻¹ across tenures, as at 30 June 2002. Application of the weightings assigned by the Delphi panelists and assessment of the ecological integrity of the various tenure categories resulted in values being derived for individual ecosystem services in the World Heritage Area. Biodiversity and refugia were the two attributes ranked most highly at AUD$18.6 to $20.9 million year⁻¹ and AUD$16.6 to $18.2 million year⁻¹, respectively.     

Separation of powers and the erosion of the ‘right to property’ in India

There has been a substantial erosion of the ‘right to property’ with respect to state takings in India, reflected in a progression of amendments to the Indian Constitution. Among other things, these amendments signify a violation of the doctrine of separation of powers. To study the implications of this on governance in relation to state takings, this paper juxtaposes a narration of events that describe the progressive erosion of the ‘right to property’ against a heuristic analytical structure that seeks to capture the costs of violating the doctrine of separation of powers. This analysis is then utilized to point to the social costs that characterize the state acquisitions (takings) regime in India.

Figures of mockery. The cultural disqualification of physiocracy (1760–1790)

Abstract

By studying seriously a literature generally dismissed by the historians of economics – satires, tales, theatrical works, pamphlets, poems, and songs that mock with humour the physiocrats, their fellow-travellers, and their doctrines – this paper reveals what was made of them and their ideas, who did this, and the underlying whys and wherefores. Three major forms of critiques are considered. The first, that of a Church (the Encyclopédistes) fighting a rising heresy (the physiocrats), concludes that the fanaticism of the latter is incompatible with the virtues of tolerance that must characterise the true philosophes. In the second form, the Encyclopédistes and the Économistes are assimilated. Both led to the destruction of the old taxonomy of society and even to death, to famine and to a chaos of transgression. The third form concerns the dubious parallel between the y-king of ancient China and the Tableau économique. These three types of cultural writings capture and explain something new – physiocratic political economy – thanks to well-known mental constructs. It stages characters and facts in order to give meaning to events the causes of which are difficult to explain. It is, beyond all the irony and mockery, an attempt to understand and to defuse new fears resulting from this incredible endeavour to change reality.     

Economic evaluation of anti-epileptic drug therapies with specific focus on teratogenic outcomes

Abstract

Background:

Anti-epileptic drugs are known to be teratogenic, yet many women do need to continue the anti-epileptic drug use during pregnancy.

Objectives:

To perform an economic evaluation of the anti-epileptic drug choice in young women who potentially wish to become pregnant. In particular, to estimate the impact of teratogenicity on the costs per quality adjusted life year (QALY).

Methods:

A decision-tree model is used to calculate the costs per QALY, taking into account the malformation risk in offspring due to the exposure to carbamazepine, lamotrigine or valproic acid, based on the European birth cohort of 2007. Probabilistic sensitivity analyses were performed using Monte Carlo simulation.

Results:

Valproic acid is dominated by carbamazepine after rank ordering on costs. The incremental cost-effectiveness of lamotrigine vs carbamazepine was estimated at €175,534 per QALY. Although valproic acid was dominated by carbamazepine in terms of costs and related effects, it is clinically relevant to compare lamotrigine with valproic acid. In particular, treatment options are dependent on several individual and clinical characteristics and these agents are therefore not always considered as interchangeable for all specified populations. The incremental cost-effectiveness for lamotrigine vs valproic acid was estimated at €13,370 per QALY. With assuming a willingness to pay threshold of €50,000 per QALY, results from the probabilistic analysis resulted in an acceptance level for lamotrigine vs carbamazepine and lamotrigine vs valproic acid of 4% and 99%, respectively.

Conclusion:

Based on epidemiological data it is advised to whenever possible avoid valproic acid during pregnancy. Both carbamazepine and lamotrigine are estimated to be cost-effective treatment options vs valproic acid if focused on teratogenicity.     

Greeks and games: Forerunners of modern game theory

Modern game theory is connected with its ancient Greek originals in three respects.

Liberalisation and de-regulation of the public sector in the transition from plan to market

The above analysis allows several conclusions to be drawn:

Determinants of R&D in knowledge-intensive business services firms

Research and development (R&D) is a key factor enabling firms to gather information, create knowledge and innovate. Although often seen as the preserve of goods-producing sectors, knowledge-intensive business services (KIBS) in particular also engage in R&D. In this paper, we are interested in understanding the determinants of R&D in KIBS. We address this question by exploring factors connected to R&D in KIBS, with attention to whether it is connected with internal capabilities or to establishments' openness. We show that KIBS' R&D is associated with internal capabilities, and that recourse to external R&D is part of a strategy of openness that complements internal capacity. We also suggest that KIBS's own view of R&D is aligned with R&D in the goods-producing sector, leading establishments in non-technological KIBS sectors to under-report R&D.     

Imitation processes with small mutations

This note characterizes the impact of adding rare stochastic mutations to an “imitation dynamic,” meaning a process with the properties that absent strategies remain absent, and non-homogeneous states are transient. The resulting system will spend almost all of its time at the absorbing states of the no-mutation process. The work of Freidlin and Wentzell [Random Perturbations of Dynamical Systems, Springer, New York, 1984] and its extensions provide a general algorithm for calculating the limit distribution, but this algorithm can be complicated to apply. This note provides a simpler and more intuitive algorithm. Loosely speaking, in a process with K strategies, it is sufficient to find the invariant distribution of a K×K Markov matrix on the K homogeneous states, where the probability of a transit from “all play i” to “all play j” is the probability of a transition from the state “all agents but 1 play i, 1 plays j” to the state “all play j”.     

Vanity and the love of system in Theory of Moral Sentiments

Abstract

Some recent writing on Adam Smith's Theory of Moral Sentiments has emphasised the importance of vanity as one of the most important human motivations. This reading leads to a new version of Das Adam Smith Problem, but this is unwarranted. Such a reading tends to conceal the significance that Smith gave to the love of system, which motivates the actions of the philosopher, the man of state, and above all the entrepreneur. This paper shows, by contrast, that by using this conception we can relate Theory of Moral Sentiments to Wealth of Nations, and reject the idea that these works are based upon contradictory assumptions.