Economic burden of hospital malnutrition and the cost–benefit of supplemental parenteral nutrition in critically ill patients in Latin America

Abstract

Aim: Disease-related malnutrition (DRM) is a prevalent condition that significantly increases the risk of adverse outcomes in hospitalized patients, particularly those with critical illness. Limited data is available on the economic burden of DRM and the cost–benefit of nutrition therapy in high-risk populations in Latin America. The aims of the present study were to estimate the economic burden of DRM and evaluate the cost–benefit of supplemental parenteral nutrition (SPN) in critically ill patients who fail to receive adequate nutrient intake from enteral nutrition (EN) in Latin America.

Methods: Country-specific cost and prevalence data from eight Latin American countries and clinical data from studies evaluating outcomes in patients with DRM were used to estimate the costs associated with DRM in public hospitals. A deterministic decision model based on clinical outcomes from a randomized controlled study and country-specific cost data were developed to examine the cost–benefit of administering SPN to critically ill adults who fail to reach ≥60% of the calculated energy target with EN.

Results: The estimated annual economic burden of DRM in public hospitals in Latin America is $10.19 billion (range, $8.44 billion–$11.72 billion). Critically ill patients account for a disproportionate share of the costs, with a 6.5-fold higher average cost per patient compared with those in the ward ($5488.35 vs. $839.76). Model-derived estimates for clinical outcomes and resource utilization showed that administration of SPN to critically ill patients who fail to receive the targeted energy delivery with EN would result in an annual cost reduction of $10.2 million compared with continued administration of EN alone.

Limitations: The cost calculation was limited to the average daily cost of stay and antibiotic use. The costs associated with other common complications of DRM, such as prolonged duration of mechanical ventilation or more frequent readmission, are unknown.

Conclusions: DRM imposes a substantial economic burden on Latin American countries, with critically ill patients accounting for a disproportionate share of costs. Cost–benefit analysis suggests that both improved clinical outcomes and significant cost savings can be achieved through the adoption of SPN as a therapeutic strategy in critically ill patients who fail to receive adequate nutrient intake from EN.     

DETERMINANTS OF FOREIGN DIRECT INVESTMENT – A TALE OF NINE THEORETICAL MODELS

Abstract.  This paper presents a review of nine theoretical models of foreign direct investment (FDI). Discussed are early studies of determinants of FDI (1) as well as determinants of FDI based on the neoclassical trade theory (2), ownership advantages (3), aggregate variables (4), the ownership, location and internalization advantage framework (5), horizontal and vertical FDI models (6), the knowledge-capital model (7), diversified FDI and risk diversification models (8) and policy variables (9). From each of the nine theories, the relevant determinants of FDI are derived. Empirical studies indicate the importance of these determinants in the real world. The paper shows that there is not one single theory of FDI, but a variety of theoretical models attempting to explain FDI and the location decision of multinational firms. Therefore, any analysis of determinants of FDI should not be based on a single theoretical model. Instead, FDI should be explained more broadly by a combination of factors from a variety of theoretical models such as ownership advantages or agglomeration economics, market size and characteristics, cost factors, transport costs, protection, risk factors and policy variables.     

THE 2007–2008 U.S. RECESSION: WHAT DID THE REAL‐TIME GOOGLE TRENDS DATA TELL THE UNITED STATES?

In the extant literature of business cycle predictions, the signals for business cycle turning points are generally issued with a lag of at least 5 months. In this paper, we make use of a novel and timely indicator—the Google search volume data—to help to improve the timeliness of business cycle turning point identification. We identify multiple query terms to capture the real‐time public concern on the aggregate economy, the credit market, and the labor market condition. We incorporate the query indices in a Markov‐switching framework and successfully “nowcast” the peak date within a month that the turning occurred. (JEL E37, G17)     

How to Attract an Audience at a Conference: Paper,Person or Place?

We analyze the drivers of audience size and the number of questions asked in parallel sessions at the annual conference of the German Economics Association. We find that the location of the presentation is at least as important for the number of academics attending a talk as the combined effect of the person presenting and the paper presented. Being a presenter in a late morning session on the second day of a conference, close to the place where coffee is served, significantly increases the size of the audience. When it comes to asking questions, location becomes less important, but smaller rooms lead to more questions being asked. Younger researchers and very senior researchers attract more questions and comments. There are also interesting gender effects. Women attend research sessions more diligently than men, but seem to ask fewer questions than men. Men are less likely to attend presentations on health, education, welfare and development economics than women. Our findings suggest that strategic scheduling of sessions could ensure better participation at conferences. Moreover, different behaviors of men and women at conferences might also contribute to the lack of women in senior scientist positions.     

Cournot equilibrium without apology: Existence and the Cournot inverse demand function

In a multi-commodity framework with absence of wealth effects, we prove the existence of equilibrium for Cournot oligopoly, and that the concept is completely non-ambiguous. We also obtain a uniquely defined endogenous inverse demand function, depending only on the competitive sector.     

Capital regulation, bank competition, and financial stability

We analyze capital requirements if banks compete for loans and deposits. Banks and firms are subject to a risk-shifting problem. The ambiguous effect of competition on banks’ risk-taking translates into an ambiguous effect of capital requirements on financial stability.     

The motivations,institutions and organization of university-industry collaborations in the Netherlands

This study builds on the economics and organization literatures to explore whether and how institutions and organizational structure complement or substitute each other to create specific spaces of alignment where specific individual actors’ motivations co-exist. Focusing on university-industry collaborations, the study examines whether and how different axes of alignment of university and industry motivations are integrated in projects with specific technological objectives and organizational structures, benefitting from the presence of specific institutions designed to facilitate collaboration. Empirically, the study relies on in-depth data on 30 university-industry collaborations in the Netherlands, and provides preliminary evidence that the technological objective and organizational structure of collaboration are malleable variables allowing the integration of both partners’ objectives and expectations. Different institutional incentives for university-industry collaboration favor specific axes of alignment of motivations and certain types of collaborative projects’ design. Hence, our exploratory results suggest that specific organizational and technological structures tend to prevail in the presence of specific institutions.     

Formal and informal external linkages and firms�� innovative strategies. A cross-country comparison

Firms increasingly rely upon external actors for their innovation process. Interaction with these actors may occur formally (i.e. through a collaboration agreement) or informally (i.e. external actors acts as sources of information). We analyze the reasons why firms consider it to be important to develop formal and informal external linkages in the innovation process by looking at the role played by firms’ innovative strategies and by taking into account the possibility that a complementarity or substitutive relationship might exist between formal and informal linkages. Data are from the Third Community Innovation Survey (CIS 3), where we have access to firm level micro-data from Sweden, Norway, the Netherlands and the UK.     

An application of co-word analysis and bibliometric maps for detecting the most highlighting themes in the consumer behaviour research from a longitudinal perspective

This article presents an application of a bibliometric and visual study of the research carried out on a social science subfield, concretely the consumer behaviour research (CBR), from a longitudinal perspective (period 1966–2008). The study combines performance analysis and science mapping for detecting and visualizing conceptual subdomains. Quantitative and qualitative measures are used in order to identify the most prominent themes. Quantitative data are used to put together very related concepts (themes or clusters of topics), while qualitative indicators (as those based on citations) are used to measure the quality and/or impact of the detected themes. The study also uses bibliometric maps to show in a visual way the associations between the main concepts treated by the CBR community. The maps provide insight into the structure of the CBR, visualize the division of the field into several subfields, and indicate the relationships between these subfields. Co-word analysis is the bibliometric technique used to identify the main themes. All this allows us to quantify and visualize the thematic evolution of the CBR. It also helps to both experts and novices to understand the current state of the art of the CBR and to predict where future research could lead.     

Responding to Digital Transformation by External Corporate Venturing: An Enterprising Family Identity and Communication Patterns Perspective

Digital transformation increasingly requires activities located outside firm boundaries, for example via alliances with start‐up companies. Despite this, German Mittelstand firms, primarily owned and managed by enterprising families and seen as role models of innovation, appear reluctant to place strategic emphasis on venturing outside the firm’s boundaries when it comes to digital transformation. Drawing on the concepts of identity and communication patterns, we theorize on the mechanisms behind this behaviour. Applying structural equation modelling to a sample of 254 members of the next generation in enterprising families from Germany, we find that family communication patterns impact the strategic priority for or against external corporate venturing via identity‐related considerations.