An alternative interpretation of the discontinuity in earnings distributions

We show that the asymmetric effects of income taxes and special items for profit and loss firms contribute to a discontinuity at zero in the distribution of earnings. Income taxes draw profit observations towards zero while negative special items pull loss observations away from zero. These earnings components are thus expected to contribute to a discontinuity even in the absence of discretion. We show our results are not an artifact of deflation and that other common components of earnings do not have similar effects on the earnings distribution around zero.

Supply structure: The pendulum in action

Using an in-depth longitudinal case study based on an “historical retrospective”, this article focuses on how some factors (“drivers”) set into motion the pendulum of change in supply structures, a research theme neglected in the supply field. It examines, over a 20-year period, the changes made to the supply structure of a well-known organization. The data comes mainly from: (a) semi-structured interviews with 21 managers and professionals within eight operating units, and (b) documentary analyses of the archives. This article shows how to map structural changes of the supply function, while explaining the nature and the causes of these changes. Understanding the pendulum movement from one supply structure to another can be very valuable, as well for academics as for managers.     

Property rights imperfections and asset allocation: Co-ownership in Bulgaria

This paper analyzes how imperfections of property rights affect households’ allocation of assets using micro-survey data from Bulgaria. Co-ownership of assets is widespread in many countries due to inheritance. Central and Eastern Europe offers an interesting natural experiment to assess the effects of this type of property rights imperfection because of the asset restitution process in the 1990s. In Bulgaria, where co-ownership is very prominent and land is strongly fragmented, the land reform and inheritance legislation allows identifying the impact of co-ownership by taking advantage of a discontinuity created by a minimum plot size law. We find that land in co-ownership is more likely to be used by less efficient farm organizations or to be left abandoned, and that it is related to significant welfare losses. The paper hence provides evidence of sub-optimal land allocation following a privatization that established formal but imperfect property rights.     

An investigation of issues relating to where energy should enter the production function

This paper examines the impact of imposing different separability assumptions in the specifications of the standard hierarchical KLEM production function in a computable general equilibrium (CGE) model. The appropriate means of introducing energy to production functions has been a source of debate for a number of years. However, while modellers often subject results to parametric sensitivy analysis regarding the values associated with elasticities of substitution between inputs, it is rarely the case that the structure of the production function is subjected to testing. However, the chosen structure reflects the modeller's view about elasticity between different inputs and will have implications for model results wherever there are changes in relative prices. We illustrate our argument by introducing a simple demand shock to a CGE model of the Scottish economy (targeted at the energy supply sector) under different assumptions regarding the structure of the KLEM production function and separability assumptions therein.     

Engaging patients and families in ehealth

National Health IT Week, which ran from September 11-16, 2011, served as a time to highlight the importance of efficient information systems that protect the privacy and security of personal health information while improving the delivery of health care in the United States. During the week, the health IT community came together to raise national awareness regarding the consistent breakthroughs and hard work industry professionals, providers, and consumers have put forward to ensure they are moving toward the common goal of advancing the future of health care through private and secure health IT. Two events during the week (the Consumer Health IT Summit and the launch of the HealthlT.gov web site) brought home a theme increasingly seen as important to improving our health care system--patients participation in their care. Nurses will need to work with patients so they understand the importance of their participation as a partner in their care, instead of playing a passive role. One way we can do that is to encourage our patients to actively use technology to manage their own health care and to share information with their health care providers.     

The CNO/CFO partnership: navigating the changing landscape

With increasing pressure to cut costs, both real and immediate, and those forecasted and anticipated, the partnership and collaboration between nursing and finance will continue to take on new challenges. This partnership has historically been strained and does not always come easy due to differences in focus, different priorities, and inadequate communication, listening, and hearing. That needs to change and a strong CNO-CFO partnership is needed. Nursing leaders need to understand and appreciate the financial constraints and balance them with expected outcomes, and financial leaders need to understand and appreciate the core clinical business and what gaps in care mean to the financial viability of the organization and to patient outcomes. One health system developed a platform for change and is dedicated to the hard work involved in continuously working on those partnerships so when it comes to patient quality, safety, and financial performance, nursing and finance leaders are well positioned for future health care challenges.     

The nursing informatics workforce: who are they and what do they do?

Nursing informatics has evolved into an integral part of health care delivery and a differentiating factor in the selection, implementation, and evaluation of health IT that supports safe, high-quality, patient-centric care. New nursing informatics workforce data reveal changing dynamics in clinical experience, job responsibilities, applications, barriers to success, information, and compensation and benefits. In addition to the more traditional informatics nurse role, a new position has begun to emerge in the health care C-suite with the introduction of the chief nursing informatics officer (CNIO). The CNIO is the senior informatics nurse guiding the implementation and optimization of HIT systems for an organization. With their fused clinical and informatics background, informatics nurses and CNIOs are uniquely positioned to help with "meaningful use" initiatives which are so important to changing the face of health care in the United States.     

Comparative effectiveness of standard endotracheal tubes vs. endotracheal tubes with continuous subglottic suctioning on ventilator-associated pneumonia rates

Ventilator-associated pneumonia (VAP) accounts for the majority of nosocomial pneumonias, which may increase intensive care and prolonged hospital stays. Endotracheal tubes allowing continuous subglottic suctioning may reduce VAP; however, they are more expensive than standard endotracheal tubes not allowing continuous suctioning. he objective of this study was to measure the comparative costs associated with continuous subglottic suctioning endotracheal tubes (CSS-ETT) versus standard endotracheal tubes (S-ETT) among intubated patients and whether cost differential is offset by the occurrence of VAP in patients receiving either type of intubation. A retrospective chart review was conducted for 154 intubated adult patients (77 = S-ETT; 77 = CSS-ETT). The S-ETT group had one case of VAP; the CSS-ETT group had none. The mean total hospital charges were higher for the S-ETT group ($103,600; CSS-ETT= $88,500) (p = 0.3). Although the average number of intubation days and ICU days were greater for the CSS-ETT group, there were no cases of VAP compared to the S-ETT group. ased upon the one S-ETT VAP case and the VAP attributable costs, it is cost effective to use the CSS-ETT.     

Economic modeling for the US of the cost-efficiency and associated expanded treatment access of conversion to biosimilar pegfilgrastim-bmez from reference pegfilgrastim

Abstract

Aims: For this economic analysis, we aimed to model: (1) the cost-efficiency of prophylaxis with biosimilar pegfilgrastim-bmez for chemotherapy-induced (febrile) neutropenia (CIN/FN) compared to reference pegfilgrastim, and (2) the expanded access to CIN/FN prophylaxis and anti-neoplastic treatment that could be achieved with biosimilar cost-savings on a budget-neutral basis.

Methods: In a hypothetical panel of 20,000 cancer patients receiving CIN/FN prophylaxis and using the average sales price (ASP) for the second quarter of 2019 for reference pegfilgrastim, we: conducted an ex ante simulation from the payer perspective of the cost-savings of 10–100% conversion from reference to biosimilar pegfilgrastim-bmez using drug price discounting ranging from 10–35%; estimated the budget-neutral expanded access to biosimilar pegfilgrastim-bmez enabled by these cost-savings; and estimated the budget-neutral expanded access to anti-neoplastic treatment with pembrolizumab. The simulations were replicated using fourth quarter 2019 wholesale acquisition cost (WAC) for reference pegfilgrastim and biosimilar pegfilgrastim-bmez in a post facto analysis.

Results: In ASP simulations, cost-savings of using pegfilgrastim-bmez over reference pegfilgrastim in a 20,000 patient panel range from $1.3?M (at 15% price discount) to $3?M (35%) at 10% conversion rate and from $6.4?M to $14.9?M, respectively, at 50% conversion. These savings could provide prophylaxis with pegfilgrastim-bmez to an additional 352 (15% discount) to 1,076 patients (35%) at 10% conversion or 1,764–5,384, respectively, at 50% conversion. Alternatively, savings could be reallocated for anti-neoplastic treatment with pembrolizumab to 3 (15% discount) to 9 (35%) patients at 10% conversion or 19–45, respectively, at 50% conversion. When utilizing WAC, cost-savings range from $4.6?M (10% conversion) to $23.1?M (50%) which could provide pegfilgrastim-bmez to an additional 1,174 (10% conversion) to 5,873 patients (50%).

Conclusions: Prophylaxis with biosimilar pegfilgrastim-bmez increases the value of cancer care by generating significant cost-savings that could be reallocated to provide expanded access to CIN/FN prevention and anti-neoplastic therapy on a budget-neutral basis.     

Chefs and suppliers: An exploratory look at supply chain issues in an upscale restaurant alliance

This paper examines some basic issues associated with supply chains in the context of acquiring local ingredients as part of producing a culinary tourism experience. Based on data collected from Executive Chefs at Relais & Châteaux restaurants through surveys and personal interviews, the authors document producer-to-chef relationships, why and how local ingredients are featured in menu listings, and how chefs communicate their use of local ingredients to their guests. The results also describe chefs’ beliefs about the use of local ingredients, as well as potential issues related to the use of suppliers and their perceptions of their guests’ expectations for their meals.