Cost-effectiveness of Access to Critical Cerebral Emergency Support Services (ACCESS): a neuro-emergent telemedicine consultation program

Aims: Access to Critical Cerebral Emergency Support Services (ACCESS) was developed as a low-cost solution to providing neuro-emergent consultations to rural hospitals in New Mexico that do not offer comprehensive stroke care. ACCESS is a two-way audio-visual program linking remote emergency department physicians and their patients to stroke specialists. ACCESS also has an education component in which hospitals receive training from stroke specialists on the triage and treatment of patients. This study assessed the clinical and economic outcomes of the ACCESS program in providing services to rural New Mexico from a healthcare payer perspective.

Methods: A decision tree model was constructed using findings from the ACCESS program and existing literature, the likelihood that a patient will receive a tissue plasminogen activator (tPA), cost of care, and resulting quality adjusted life years (QALYs). Data from the ACCESS program includes emergency room patients in rural New Mexico from May 2015 to August 2016. Outcomes and costs have been estimated for patients who were taken to a hospital providing neurological telecare and patients who were not.

Results: The use of ACCESS decreased neuro-emergent stroke patient transfers from rural hospitals to urban settings from 85% to 5% (no tPA) and 90% to 23% (tPA), while stroke specialist reading of patient CT/MRI imaging within 3?h of onset of stroke symptoms increased from 2% to 22%. Results indicate that use of ACCESS has the potential to save $4,241 ($3,952–$4,438) per patient and increase QALYs by 0.20 (0.14–0.22). This increase in QALYs equates to ～73 more days of life at full health. The cost savings and QALYs are expected to increase when moving from a 90-day model to a lifetime model.

Conclusion: The analysis demonstrates potential savings and improved quality-of-life associated with the use of ACCESS for patients presenting to rural hospitals with acute ischemic stroke (AIS).     

A divisia system approach to modelling monetary aggregates

A complete system of Divisia partial adjustment asset equations based on the augmented-price expectations Baumol-Tobin inventory and transactions postulates is used to study the dynamic behaviour of monetary aggregates and their components in Australia during 1969.III to 1983.IV. The system provides a new and useful approach to modelling demand-for-money functions for effective monetary policy controls and targetting.     

Sources and Measurement of Agricultural Productivity and Efficiency in Canadian Provinces: Crops and Livestock

This paper measures and assesses the variation in total factor productivity (TFP) growth among Canadian provinces in crops and livestock production over the period 1940–2009. It also determines if agricultural productivity growth in Canada has recently slowed down as indicated by earlier studies. The paper uses the stochastic frontier approach that incorporates inefficiency to decompose TFP growth into technical change (TC), scale effect (SE), and technical efficiency change. The results indicate that productivity changes were mainly driven by TCs for crops, while the productivity changes in livestock was mainly driven by SEs and technical progress. Though change in technical efficiency is mainly positive (except for New Brunswick and Nova Scotia), its contribution to productivity growth was very little for the provinces. We also found that over the entire period, the productivity growth rates for the crop subsector are on average higher for the Prairie provinces than for the Eastern and Atlantic provinces. On the other hand, the productivity growth rates in the livestock subsector are on average higher in the Eastern and Atlantic provinces than in the Prairie region with the exception of Manitoba. Finally, we found that though there is some evidence of a recent decline in productivity growth for the crops subsector, there is no such evidence in the livestock subsector.     

Should Australia be concerned by Beijing’s trade threats: modelling the economic costs of a restriction on imports of Australian coal

A country’s economic dependence on its trade with various other countries is often expressed in terms of trade values and shares. A country’s vulnerability to economic coercion by the countries with which it trades is similarly expressed in such terms. Using the recent issues relating to Australia’s coal trade with China as an example, we propose a better framework for assessing vulnerability to coercive trade instruments. We argue that the capacity for a given export trade to fund real consumption is a superior indicator of economic vulnerability than the simple value of the underlying trade flow. Our framework takes account of trade diversion, foreign capital ownership, the terms of trade, resource mobility, and capital and production tax rates. Using this framework, we demonstrate that the damage from trade sanction is far less than might be expected from a simple focus on the value of the affected trade flow alone.     

Medical consumption over the life-cycle

We investigate the association between age and medical spending in the U.S. using data from the Medical Expenditure Panel Survey. We estimate a partially linear seminonparametric model and construct “pure” life-cycle profiles of health spending simultaneously controlling for time effects (i.e., institutional changes and business cycles effects) and cohort effects (i.e., generation specific conditions). We find that time and cohort effects together introduce a significant estimation bias into predictions of health expenditures per age group, especially for individuals older than 60 years. The estimation bias introduced by cohort effects increases monotonically with age while the bias due to time effects is not significant. The overall effect of Medicare on the cohort and time effects biases is negligible.     

The long-run relationship of gold and silver and the influence of bubbles and financial crises

This paper analyzes the long-run relationship between gold and silver prices. We closely follow Escribano and Granger (J Forecast 17:81–107, 1998) and extend their study. We use a longer sample period from 1970 to 2011 and study the role of bubbles and financial crises for the relationship between gold and silver prices. We find clear evidence for a co-integration relationship between gold and silver with gold prices driving the relationship. The analysis also indicates that the results are influenced by bubble-like episodes and financial crises.     

Does Peacetime Military Service Affect Crime?

Draft lottery data combined with Danish longitudinal administrative records show that military service can reduce criminal activity for youth offenders. For this group, property crime is reduced, and our results indicate that the effect is unlikely to be the result of incapacitation only. We find no effect of military service on violent crime, on educational attainment, or on employment and earnings, either in the short run or in the long run. These results suggest that military service does not upgrade productive human capital directly, but rather affects criminal activity through other channels (e.g., by changing attitudes to criminal activity).     

The nexus between firm-supply-chain relationships and the potential for tourism development: A case study approach

This exploratory study examines the importance of firm-supply chain relationships for tourism development. Based upon prior observations, two firms seeking to boost their tourism offerings and operating in a popular Vietnamese tourist destination were selected. Semi-structured face-to-face and online interviews were conducted and complemented by on-site visits, and firm information. Various salient dimensions emerged from the data analysis. The ‘performance catalyst’ and ‘detectable value adding’ dimensions underscore the supply chain's benefits, while the ‘discerning relations’ dimension highlights deeper relationships through mutual support, building trust, or demonstrating care. Conceptually, the study proposes a framework with associated theoretical and practical implications.     

Seatbelt and child restraint use among vehicle occupants in Ho Chi Minh City: an observational study in Vietnam

Abstract

This paper presents the trend of seatbelt use, disaggregated by vehicle occupants, in Ho Chi Minh City between 2016 and 2018. We conducted statistical analyses to identify the determinants of seatbelt use, including the effect of a new fine imposed against seatbelt law violation in the rear seats that became effective in January 2018. Seatbelt use was observed in at least half of all vehicle occupants, and drivers were more likely to use seatbelts than passengers. Only 4.4% of children younger than 5-years and 2.5% of 5 to12-year-olds used a child restraint system. Seatbelt use increased among all occupants after the imposed fine, especially among rear-seat passengers. Imposing new or increasing fixed penalties, with enforcement and public education, may increase seatbelt use to prevent road traffic injuries.     

Team innovation in retail services: the role of ambidextrous leadership and team learning

Service Business - Drawing upon the ambidextrous leadership theory for innovation, this study investigates the role of opening and closing leadership behaviors in both exploratory and exploitative...