Gender disparities: a medical detoxification program

Significant gaps exist in health care regarding gender in the United States. Health status, social roles, culturally patterned behavior and access to health care can be influenced by gender. Women have been the primary users of health care and minority women usually have received poorer quality care than Non-Hispanic White (NHW) females. The objectives of this study were to identify gender, racial and ethnic disparities in access to substance abuse treatment in a Texas hospital. Secondary data collected on 1,309 subjects who underwent detoxification were studied. Gender, race/ethnicity, drug of abuse, relapse and financial classification were included in the analysis. Results indicate Hispanic females and Non-Hispanic Black (NHB) females were about 5 and 3.5 more likely than NHW females to use Medicaid services respectively (p < .05). NHW and NHB males were more likely to use Medicare than females (p < .05). NHB and Hispanic females were 5.8 and 2.1 times more likely to receive care for abuse of cocaine when compared to NHW females respectively (p < .05). Hispanic females were 2.3 times more likely to relapse than Non-Hispanic females, and uninsured NHB females were 7.1 times at a higher risk to abuse multiple drugs compare to NHW females (p < .05). Socio-economic factors, lower labor force participation rates, and less financial independence can explain females utilizing more often Medicaid regardless of their race/ethnicity. These results can be also explained by aggressive case management utilization, socio cultural barriers and/or discriminatory practices, both intentional and unintentional.     

The effects of integration agreements in Western Hemisphere trade, 1970–2014

The paper analyzes the effects of four regional integration agreements (Common Market of the South [MERCOSUR], Andean Community [ANCOM], Central American Common Market [CACM] and North America Free Trade Agreement [NAFTA]) on bilateral trade in 19 countries from the Western Hemisphere for the period 1970–2014. For this purpose we estimate different gravity models to control for trade creation and diversion, export diversification and intra-industry trade using OLS log-linearized gravity model and Poisson pseudo-maximum-likelihood panel data estimators that allow controlling for zero-value trade flows. We find trade creation for ANCOM, MERCOSUR and CACM and trade diversion for NAFTA and MERCOSUR countries. Export diversification negatively affects bilateral trade in all American agreements, while intra-industry trade has contributed to trade expansion in ANCOM and the opposite for NAFTA, MERCOSUR and CACM. Global supply chains may help us explain these results. Finally, we find anticipatory effects on trade several years before the signing of the agreements, but only NAFTA countries seem to be natural trading partners in the region while the rest of Latin American regional agreements have not resulted in a comprehensive, profound and consolidated common market.     

Hospital economic impact from hemostatic matrix usage in cardiac surgery

Objective:

Improved health outcomes can result in economic savings for hospitals and payers. While effectiveness of topical hemostatic agents in cardiac surgery has been demonstrated, evaluations of their economic benefit are limited. This study quantifies the cost consequences to hospitals, based on clinical outcomes, from using a flowable hemostatic matrix vs non-flowable topical hemostatic agents in cardiac surgery.

Research design and methods:

Applying clinical outcomes from a prospective randomized clinical trial, a cost consequence framework was utilized to model the economic impact of comparator groups. From that study, clinical outcomes were obtained and analyzed for a flowable hemostatic matrix (FLOSEAL, Baxter Healthcare Corporation) vs non-flowable topical hemostats (SURGICEL Nu-Knit, Ethicon–Johnson &; Johnson; GELFOAM, Pfizer). Costing analyses focused on the following outcomes: complications, blood transfusions, surgical revisions, and operating room (OR) time. Cardiac surgery costs were analyzed and expressed in 2012 US dollars based on available literature searches and US data. Comparator group variability in cost consequences (i.e., cost savings) was calculated based on annualized impact and scenario testing.

Results:

Results suggest that if a flowable hemostatic matrix (rather than a non-flowable hemostat) was utilized exclusively in 600 mixed cardiac surgeries annually, a hospital could improve patient outcomes by a reduction of 33 major complications, 76 minor complications, 54 surgical revisions, 194 transfusions, and 242?h of OR time. These outcomes correspond to a net annualized cost consequence savings of $5.38 million, with complication avoidance as the largest contributor.

Conclusions:

This cost consequence framework and supportive modeling was used to evaluate the hospital economic impact of outcomes resulting from the usage of various hemostatic agents. These analyses support that cost savings can be achieved from routine use of a flowable hemostatic matrix, rather than a non-flowable topical hemostat, in cardiac surgery.     

The Relationships of Empathy,Moral Identity and Cynicism with Consumers’ Ethical Beliefs: The Mediating Role of Moral Disengagement

This study examines the relationships of empathy, moral identity and cynicism with the following dimensions of consumer ethics: the passive dimension (passively benefiting at the expense of the seller), the active/legal dimension (benefiting from questionable but legal actions), the ‘no harm, no foul’ dimension (actions that do not harm anyone directly but are considered unethical by some) and the ‘doing-good’/recycling dimension (pro-social actions). A survey of six hundred Australian consumers revealed that both empathy and moral identity were related to negative beliefs regarding the passive and the active/legal dimensions of consumer ethics and were related to positive beliefs regarding the ‘doing-good’/recycling dimension. Cynicism was related to positive beliefs regarding the passive dimension of consumer ethics and was related to negative beliefs regarding the ‘doing-good’/recycling dimension. The role of moral disengagement in mediating these relationships was examined. Empathy and moral identity were only indirectly negatively related to the ‘no harm, no foul’ dimension of consumer ethics through moral disengagement, while cynicism was indirectly positively related to this dimension through moral disengagement. Theoretical and practical implications of these findings are discussed.     

Speedier delivery: coastal shipping times and speeds during the Age of Sail †

There is a debate about whether coastal shipping experienced substantial productivity growth prior to the advent of steam power. To study changes over the long eighteenth century, this article uses thousands of coastal journey times culled from Board of Trade crew lists between 1835 and 1844 and coastal port books for the mid‐to‐late 1600s, along with a newly digitized coastal network. Comparisons between matched samples show that journey speeds, defined as miles sailed per day, were significantly higher in the crew lists compared to the port books, and that voyage cycle times, defined as days between starting two identical voyages, were substantially lower. The study also shows that voyage times in the east coast coal trade were substantially lower around 1840 than around 1700, but the difference was much smaller when peace years are compared. These new data imply that total factor productivity growth in the east coast coal trade was significant, especially if one accounts for gains from peace after 1815. The findings contribute to the larger literature studying the rate and sources of productivity growth during the industrial revolution.     

To challenge the world view or to flow with it? Teaching sustainable development in business schools

This paper explores the fundamental question of what ‘responsibility’ means to different sets of world views adopted implicitly by business students. The exploration adopts the stakeholder theory and three subsets of the Friedman mentality to explain how individuals may value sustainability initiatives. Subsequently, it explores whether it is better to flow with the dominant economic‐driven world view as prescribed by the business school or to challenge it in order to cultivate business students with sustainability‐driven values. The conclusion highlights implications for business and management education, as well as the role of entrepreneurship to promote sustainability values.     

Higher education and firms: on the interaction between research and regional policies

In the European Union, a series of competencies are shared between a central agency called the European Commission, and the governments of the Member States. This paper focuses on two of those policies: research and regional development. Here, we model and discuss how the level of commitment of a central authority toward poor regions affects the design of the best decision-making process. We explore cases of full centralization and full decentralization, and situations where the two levels of government are allowed to take decisions, either simultaneously or sequentially. In the latter case, we make a distinction between a situation where the central agency decides first as in most federations, and one in which it decides second, then being an agent of national governments. This setting is especially relevant for the European Union. We show, in particular, that when the degree of commitment of the center is high, assignment of redistributive competencies to both levels of power is a proxy for centralization. Additionally, the poorer region may find its best interest in an institutional design where the regions decide first.     

Exchange-rate forecasts with simultaneous nearest-neighbour methods: evidence from the EMS

In this paper we extend nearest-neighbour predictors to allow for information content in a wider set of simultaneous time series. We apply these simultaneous nearest-neighbour (SNN) predictors to nine EMS currencies, using daily data for the 1st January 1978–31st December 1994 period. When forecasting performance is measured by Theil's U statistic, the (nonlinear) SNN predictors perform marginally better than both a random walk and the traditional (linear) ARIMA predictors. Furthermore, the SNN predictors outperform the random walk and the ARIMA models when producing directional forecasts.When formally testing for forecast accuracy, in most of the cases the SNN predictor outperforms the random walk at the 1% significance level, while outperforming the ARIMA model in three of the nine cases. On the other hand, our results suggest that the probability of correctly predicting the sign of change is higher for the SNN predictions than the ARIMA case.     

Unfolding Social Hierarchies

Consider a large population of finitely-lived agents organized into n different hierarchical levels. Every period, all those placed at each level are randomly matched to play a given symmetric game. Based on the resulting outcome, a ρ-fraction of agents who (within their own level) attain the highest payoffs are promoted upwards. On the other hand, newcomers replacing those who die every period enter at the lowest level and choose irreversibly the strategy to be played for the rest of their life. This choice is made, with some noise, by imitating one of the strategies adopted at the highest level.  In this setup, the unique long-run behavior of the system is fully characterized for the whole class of 2×2 coordination games and two alternative variations of the model. The results crucially depend on the key “institutional” parameters ρ and n. In particular, it is shown that inefficient behavior prevails in the long run (even when risk-dominated) if promotion is only mildly selective—high ρ—and the social system is quite hierarchical—large n. In a stylized manner, these parameter conditions may be viewed as reflecting a sort of institutional deficiency that impairs economic performance. Journal of Economic Literature Classification Numbers: C70, C72, C73, D72.     

What hinders innovation performance of services and manufacturing firms in Mexico?

Barriers to innovation are heterogeneous, of financial and non-financial nature. The importance of barriers to innovation and their actual influence on innovation depend on firms’ characteristics such as sectoral affiliation, technological behavior and their response to perceived obstacles to innovation. Firms either continue to engage in innovation, or they avoid the activity altogether. This paper explored the nature and perceived importance of the obstacles to innovation that firms confront, in a developing-country context; we build on survey data about firms in Mexico. Our findings suggest that two kinds of policy interventions should help offset a firm’s perception of barriers to innovation. On the one hand, policies should enhance the innovation capacity of firms interested in innovation; on the other hand, policies need to tackle factors that reduce the interest of firms in innovation. Policies that boost demand for locally generated innovations would assist in achieving both these goals.