Risk of major amputation or death among patients with critical limb ischemia initially treated with endovascular intervention,surgical bypass,minor amputation,or conservative management

Aims: Patients with critical limb ischemia (CLI) have an increased risk of major amputation. The initial treatment approach for CLI may significantly impact the subsequent risk of major amputation or death. The objective of this study was to describe the initial treatment approaches of patients with CLI and the limb outcomes associated with each approach.

Methods: Data from MarketScan Commercial and Medicare Supplemental Databases from January 2006–December 2014 was utilized. Cohorts of CLI patients were defined as follows: (1) peripheral vascular intervention (PVI); (2) peripheral vascular surgery (PVS); (3) minor amputation without concomitant PVI or PVS (MinAMP); and (4) Patients without PVI, PVS, or MinAMP (conservative therapy). The odds of major amputation or inpatient death were estimated using the Cox proportional hazards model. For those patients requiring a major amputation, the incremental expenditures per member per month (PMPM) were estimated using a gamma log-link model.

Results: Conservative therapy was associated with significantly higher odds of major amputation or inpatient death compared to patients who underwent minor amputation (1.59-times), PVI (2.08-times), or PVS (2.12-times). Patients treated with an initial strategy of minor amputation also had higher odds of major amputation or inpatient death compared to PVS (1.31-times) or PVI (1.33-times). The estimated incremental expenditures PMPM for patients with a major amputation was $5,165.

Conclusions: Revascularization reduces the risk of a major amputation or inpatient death for patients with CLI when compared to conservative therapy. Major amputation is also associated with significantly higher healthcare expenditures.     

EVIDENCE ON THE EFFECT OF TAXES ON FIRMS' DECISIONS TO RETIRE DEBT EARLY

We examine the effect of marginal tax rates on the decision to retire debt early. Other factors that have been linked to the debt retirement decision are also investigated, including leverage adjustment and the value associated with the immediate recognition of a loss for tax purposes on early retirement. Results indicate that firms that retire debt early have lower marginal tax rates than firms that do not retire debt early. This finding is consistent with the proposition that firms are motivated to retire debt early by an incentive to reduce tax shields that cannot be used efficiently. Further, firms that retire debt early are more highly leveraged than firms that do not retire debt early. Evidence also suggests that some firms retire debt early at a loss to reduce currently taxable income.     

Faux Predation in Markets with Imperfect Information on Product Quality

When consumers and producers are asymmetrically informed about product quality, faux predation is shown to be a profitable method of inducing a rival firm to exit. A successful episode of faux predation persuades an efficient rival to exit without requiring the faux predator to price below cost and recoup losses with higher prices in the future. Cost-based rules for establishing presumptive evidence of predatory intent and behavior—such as the Areeda–Turner rule—will fail to detect faux predation since pricing below unit costs is not necessary. Faux predation can damage competition yet go undetected and undeterred under present antitrust law.     

A new perspective on entrepreneurial regions: linking cultural identity with latent and manifest entrepreneurship

What are the entrepreneurial places in the USA? Although seminal theorizing on the determinants of entrepreneurship gives culture a unique and important role, systematic empirical evidence linking the distinct cultural identity of regions to their local entrepreneurial spirit and vitality is still scarce. This study offers a first, systematic overview on the nexus between regional cultural identity and latent and manifest entrepreneurship across the USA. To directly assess regional cultural identity, we apply the American Nations and Patchwork Community Types approaches and explore in which way these distinct spatially based cultural regions are reflected by significant differences in entrepreneurial activity and underlying biologically based propensities. We combine annual entrepreneurship rates at the county level with personality data collected in a large-scale, Internet-based study of 3,457,270 US residents. The findings suggest that entrepreneurship culture reflects the dynamic interplay between the region’s cultural identity and its latent and manifest entrepreneurship.     

Kickstarting growth in bus patronage: Targeting support at the margins

This paper presents an assessment of the performance of the Kickstart and Bus Route Development Grant schemes in England and Scotland which aimed to move marginal or new bus services towards commercial operation. Three key aspects are addressed, namely: the bidding and implementation process; performance against objectives and the future potential of the approach. The evidence suggests that this form of transformational support appears to offer a better return than subsidy that supports the status quo or indeed patronage based support.     

Same-Sex Couples in Advertisements: An Investigation of the Role of Implicit Attitudes on Cognitive Processing and Evaluation

This research examined how implicit attitudes are associated with cognitive processing and self-reported evaluation of advertisements featuring same-sex couples. Hypotheses were posited using the theoretical framework of social identity theory (Tajfel and Turner 1986) and perspectives on implicit attitudes. In Study 1, participants watched and evaluated 10 television advertisements while physiological measures of cognitive and affective processing were collected. Ads varied such that half used same-sex couples as protagonists while the other half used other-sex couples. Participants demonstrated less positive responses to ads featuring same-sex couples. Physiological and self-reported responses were associated with implicit attitudes toward homosexuality Negative implicit attitudes toward homosexuality were associated with more negative affect, less attention, less positivity, and less liking for ads featuring same-sex couples. Two subsequent studies replicated these findings in nonstudent samples, indicating that participants preferred ads with other-sex couples (Study 2) and that implicit attitudes were associated with this response (Study 3). This research suggests that implicit attitudes affect processing and evaluation of ads featuring same-sex couples in ways unaccounted for by explicitly measured attitudes. Results are discussed in terms of advancing theory, furthering understanding of the dynamic processing of ads featuring in-group and out-group members, and practical implications.     

Traditional farm expansion versus joint venture remote partnerships

Traditionally, farms expand by buying out a neighbour. But might remote partnerships be a better way of expanding a farm business given projected climate change and price volatility? This question is addressed using farm business financial modelling. Representative farms at 27 locations in Western Australia are constructed to enable comparison of the value of buying out a neighbour versus expansion using geographically distant joint venture (JV) partners. The farm models consider economies of size, bulk purchase price discounts, the variability and correlation of returns associated with farm expansion, and impacts of climate change. Random selection of a remote partner generates little improvement in wealth; on average only 2.3 and 1.6 per cent, respectively, under current and projected future climate across all locations. However, there is large variation in wealth appreciation opportunities for each location and between locations. Preferred partnerships are a function of each farm's characteristics. Locations highly preferred as JV partners under current climate are similarly preferred partners under projected future climate. The main sources of additional wealth come from economies of size advantages, risk‐spreading benefits of combining geographically separated farms and bulk discounts. Farmers seeking business expansion will often benefit greatly from careful selection of a remote partner.