The economic burden of tuberous sclerosis complex in UK patients with renal manifestations: a retrospective cohort study in the clinical practice research datalink (CPRD)

Background: Tuberous sclerosis complex (TSC) is a multi-system genetic disorder in which renal manifestations occur in ～50% of children and 80% of adults. Since these often present alongside other manifestations, renal TSC is likely to incur significant costs. This study aims to quantify healthcare resource use (HCRU) and costs for renal TSC patients in the UK.

Methods: TSC patients in the Clinical Practice Research Datalink (CPRD) linked to Hospital Episodes Statistics were identified from January 1987–June 2013. Clinical data were extracted over the entire history and costs were reported over the most recent 3-year period. HCRU was compared with a matched comparator cohort. Incremental costs were reported and the key cost drivers by primary manifestation category were identified by regression modeling.

Results: A total of 79 renal TSC patients were identified with manifestations including chronic kidney disease stage 3–5 (with prevalence increasing with age) and renal angiomyolipoma. Renal TSC patients consistently reported greater HCRU than the comparator. Inpatient hospitalizations were more frequent for renal TSC patients (3.2 vs 1.6), but length of stay was comparable; however, 70.9% of renal TSC patients recorded no kidney-related procedures ever and averaged <1 test per year in the 3-year period. Average costs for renal TSC patients were nearly 3-fold greater than the comparator (£15,162 vs £5672). Costs increased with additional manifestation categories (£3600: only renal; £27,531: renal with ≥4 additional manifestation categories [25% of patients]). Additional nervous system and dermatology/psychiatric manifestations significantly (p?Conclusions: Renal TSC patients have greater HCRU than the general CPRD population, likely to result from progression of renal disease and additional manifestations; however, surveillance for disease progression appears to be deficient. Inadequate monitoring may contribute to a lack of co-ordinated care and increased healthcare-associated costs. Efforts should be made to follow the TSC guidelines to effectively monitor and treat patients.     

Incentives and teacher effort

Few would contest that teachers are a very important determinant of how much students learn in school, and how to improve teacher performance has been the focus of lively policy debate in both rich and poor countries. This paper examines how teacher incentives, both pecuniary and non‐pecuniary, correlate with teacher effort. Using school survey data from Lao PDR, we estimate measures of teacher effort, including the number of hours that teachers spend preparing for classes and teacher provision of private tutoring outside of class hours, which are not the typical measures used in previous research. Estimation results fit well under the standard labour supply framework and indicate that greater teacher effort is associated with non‐pecuniary incentives such as more teacher autonomy over teaching materials and monitoring as measured by the existence of an active parent – teacher association and the ability of school principals to dismiss teachers. Methodologically, this paper provides a detailed derivation of a simultaneous OLS‐probit model with school random effects that can jointly estimate teacher work hours and tutoring provision.     

Do Education and Income Really Explain Inequalities in Health? Applying a Twin Design

We apply a twin design to examine the relationship between health and education and income. The estimated associations between health and education and income, controlling for unobserved endowments, at the twin‐pair level, are lower than estimates obtained via ordinary least‐squares (OLS) on the same sample. Thus, OLS‐based effects of education and income are biased, exaggerating the contribution of education and income to health inequality. The main part of health inequality is explained by within‐twin‐pair fixed effects, incorporating family background and genetic inheritance. It appears that education and income policies have less to offer for reducing health inequality than is usually assumed.     

Perception of marital roles in purchase decision processes: A cross-cultural study

Following the approach of the classic 1974 marital-role influence study of Davis and Rigaux, the present study focuses on differences in decision making (i.e., joint, husband dominated, wife dominated) across 24 product categories as a function of two key factors. These factors are stage of the decision process (i.e., problem recognition, information search, and the final decision) and culture (People’s Republic of China and the United States). The Jacobson Marital-Role Egalitarianism Scale is included to further assess individual differences in husband and wife traditionality-modernism. The major findings are that emphasis on joint, husband-dominated, and wife-dominated decisions vary by stage and by stage-culture interaction. Practical implications are presented with suggestions for future research. He graduated from the University of Georgia in 1985 with a Ph.D. in marketing. His research interests include global strategic market planning and cross-cultural research issues and methodologies. He has published in such journals asJournal of Advertising Research, Industrial Marketing Management, Journal of the Academy of Marketing Science, Columbia Journal of World Business, International Marketing Review, Journal of Business Strategy, andJournal of Consumer Marketing. He graduated with honors in 1986 from the University of Mississippi with a Ph.D. in marketing. His research interests include cross-cultural consumer behavior and emotional responses to advertising stimuli. He has published in such journals asJournal of Advertising, Journal of Advertising Research, Journal of Public Policy and Marketing, Psychology and Marketing, Journal of Health Care Marketing, andInternational Marketing Review. He graduated from the University of Mississippi in 1986 with a Ph.D. in marketing. His research interests focus on cross-cultural consumer behavior. He has published in such journals asJournal of Advertising, Journal of Business Ethics, Journal of Health Care Marketing, Psychology and Marketing, and theInternational Journal of Purchasing and Materials Management.     

The link between attractiveness of “Extrabrand” attributes and the adoption of innovations

While innovators may rush to purchase many new products, most consumers are more conservative and do not want to buy into fads but purchase only those new products that are viable. How do the majority of consumers make judgments about whether they will adopt an innovation? This article examines the evaluative aspects of adoption as a means for better understanding consumer adoption and the market factors that may influence the success of an innovation. This research introduces a conceptual model that shows how consumers’ evaluation of product category attractiveness affects the adoption decision for really new products. These consumer evaluations are based on the attributes of the product category (“extrabrand” attributes) rather than brand attributes. Results from a test of the model indicate that consumers do use extrabrand attributes to assess the attractiveness of innovative new products.     

A dyadic study of interpersonal information search

Although interpersonal word-of-mouth communication, by definition, takes place between two people, rarely has the phenomenon of word of mouth been studied using both members of the dyad. Building on the literature, this article offers a model of active interpersonal information search that is tested by using a method in which information seeker and source perceptions were obtained. Source characteristics were important determinants of interpersonal influence, but seeker characteristics also played an important role. Interestingly, it proved useful to distinguish between demographic and attitudinal homophily of seeker and source as the former was inversely and the latter directly related to interpersonal influence. Mary C. Gilly is an associate professor in the Graduate School of Management and associate dean of Graduate Studies at the University of California, Irvine. Her Ph.D. is in marketing from the University of Houston. Her research interests include the unintended effects of marketing actions, such as the effects of advertising on employees. She also has interests in services marketing, such as customer service, including consumer complaint handling, and cross-cultural service encounters. Her work has been published in theJournal of Marketing, theJournal of Consumer Research, theJournal of Business Research, and other academic journals. John L. Graham is a professor in the Graduate School of Management at the University of California, Irvine. His Ph.D. is in marketing from the University of California, Berkeley. His primary research interests regard international marketing, international business negotiations, and structural equations modeling. His work has been published in theJournal of Marketing, theJournal of Consumer Research, Marketing Science, theJournal of International Business Studies, Management Science, and other academic journals. Mary Finley Wolfinbarger is an associate professor at California State University, Long Beach and is doing research on the topics of internal marketing and gift giving. She teaches Marketing Principles and Marketing Research. She received her Ph.D. in marketing from the University of California, Irvine. Her work has appeared in theJournal of Marketing and other academic journals. Laura J. Yale came to Fort Lewis College in 1991. She holds degrees in Hotel, Restaurant, and Travel Administration from the University of Massachusetts, Amherst, and received her Ph.D. from the University of California, Irvine. She teaches a variety of courses in Marketing and Travel and Tourism Administration, including Marketing Research, International Marketing and Services. Her industry experience and most of her research interest are in the services sector, particularly the tourism industry. She is on sabbatical leave this academic year, writing an introductory textbook on the tourism industry. She will return to teaching in September 1998.     

Forecasting interest rates with shifting endpoints

We consider forecasting the term structure of interest rates with the assumption that factors driving the yield curve are stationary around a slowly time‐varying mean or ‘shifting endpoint’. The shifting endpoints are captured using either (i) time series methods (exponential smoothing) or (ii) long‐range survey forecasts of either interest rates or inflation and output growth, or (iii) exponentially smoothed realizations of these macro variables. Allowing for shifting endpoints in yield curve factors provides substantial and significant gains in out‐of‐sample predictive accuracy, relative to stationary and random walk benchmarks. Forecast improvements are largest for long‐maturity interest rates and for long‐horizon forecasts. Copyright © 2013 John Wiley & Sons, Ltd.     

Distributional assumptions and a test of the dual labor market hypothesis

Recent application of the switching regression model to allocate workers into the primary and secondary labor markets is considered to be the best solution to the classification problem of the empirical testing of the dual labor market theory. In such models, normality of the error terms is assumed. This paper adopts the switching regression model to test the dual labor market theory by assuming different distributions of the error terms. The test results strongly support the dual labor market theory regardless of the assumption one makes about the error terms. However, the results indicate that different distribution can lead to different percentage distributions of workers in the two segments. In particular, the normal distribution generates more workers in the primary segment than the non-normal distributions. Therefore, care must be taken not to generalize the type of industries or occupations that fall under the primary and secondary segments. First version received: October 2000/Final version received: March 2002 RID="*" ID="*"  I would like to thank Kevin Lang, Robert Marshall, and two anonymous referees for their helpful comments. I am grateful for comments received from the session participants of the Western Economic Association International Conference, San Francisco, CA, June 28–July 2, 1996, and the Midwest Economic Association Conference, Kansas City, 1997. I thank George Bonney, the Chief Statistician of Fox Chase Cancer Center, Philadelphia for his comments. Any remaining errors are my responsibility. I gratefully acknowledge financial support from Penn State Research and Development Grant, 1995.