Length of stay and economic consequences with rivaroxaban vs enoxaparin/vitamin K antagonist in patients with DVT and PE: findings from the North American EINSTEIN clinical trial program

Objective:

Venous thromboembolism (VTE) (deep vein thrombosis [DVT] and pulmonary embolism [(PE]) represents a substantial economic burden to the healthcare system. Using data from the randomized EINSTEIN DVT and PE trials, this North American sub-group analysis investigated the potential of rivaroxaban to reduce the length of initial hospitalization in patients with acute symptomatic DVT or PE.

Methods:

A post-hoc analysis of hospitalization and length-of-stay (LOS) data was conducted in the North American sub-set of patients from the randomized, open-label EINSTEIN trial program. Patients received either rivaroxaban (15?mg twice daily for 3 weeks followed by 20?mg once daily; n?=?405) or dose-adjusted subcutaneous enoxaparin overlapping with (guideline-recommended ‘bridging’ therapy) and followed by a vitamin K antagonist (VKA) (international normalized ratio?=?2.0–3.0; n?=?401). The open-label study design allowed for the comparison of LOS between treatment arms under conditions reflecting normal clinical practice. LOS was evaluated using investigator records of dates of admission and discharge. Analyses were carried out in the intention-to-treat population using parametric tests. Costs were applied to the LOS based on weighted mean cost per day for DVT and PE diagnoses obtained from the Healthcare Cost and Utilization Project dataset.

Results:

Of 382 patients hospitalized, 321 (84%), had acute symptomatic PE; few DVT patients required hospitalization. Similar rates of VTE patients were hospitalized in the rivaroxaban and enoxaparin/VKA treatment groups, 189/405 (47%) and 193/401 (48%), respectively. In hospitalized VTE patients, rivaroxaban treatment produced a 1.6-day mean reduction in LOS (median?=?1 day) compared with enoxaparin/VKA (mean?=?4.5 vs 6.1; median?=?3 vs 4), translating to total costs that were $3419 lower in rivaroxaban-treated patients.

Conclusion:

In hospitalized North American patients with VTE, treatment with rivaroxaban produced a statistically significant reduction in LOS. When treating DVT and PE patients, clinicians should consider newer anti-coagulants with less complex treatment regimens.     

Mortality Among the Elderly in Sweden 1988–1997

By replacing the exponential growth in a Makeham function with a straight line at very high ages, graduated mortality rates gives an acceptable adherence to observed data.     

Customer Preferences for Frontline Employee Traits: Homophily and Heterophily Effects

Although previous research has underscored the significance of the personality traits of frontline employees (FLEs) in employee service behaviors, knowledge about customer preferences for FLE personality traits is lacking. This study responds to this gap in the literature, empirically assessing customers’ preferences for FLE personality traits. The main research objective is to investigate whether and how these preferences vary with the customer's own personality. The study proposes and tests a conceptual framework that reconciles two opposing theoretical perspectives—homophily and heterophily. The existing research in interpersonal psychology has only given limited support to the heterophily effect, whereas it has consistently evidenced the homophily effect. Moderator analyses indicate these effects are largely invariant across customer and service characteristics. Notwithstanding this, post hoc tests show that the level of preferred FLE traits is positively related to the level of customer traits. Equity theory helps explain these seemingly conflicting results.     

Mobility of public researchers, scientific knowledge transfer, and the firm's innovation process

The present study provides evidence on the mobility effects of researchers from the public R&D system with regard to firm's innovation process. This issue is particularly novel and important as these researchers contribute to the production and transfer of knowledge previously developed and accumulated in the public R&D system. The findings confirm that scientific knowledge which public researchers provide has a positive influence on both inputs and outputs of the firms' innovation process. The fact that firms have access to additional knowledge which is complementary to that they already hold represents a spur for exploiting and applying this new knowledge. The firms in this study continually increased their in-house R&D investments. As a result of these investments firms create new knowledge of a unique and valuable type. The study draws two important conclusions geared to providing a greater efficiency in human resource management and to improve the design of technology policies.     

Challenges for land system science

While considerable progress has been made in understanding land use change, land system science continues to face a number of grand challenges. This paper discusses these challenges with a focus on empirical land system studies, land system modelling and the analysis of future visions of land system change. Contemporary landscapes are contingent outcomes of past and present patterns, processes and decisions. Thus, empirical analysis of past and present land-use change has an important role in providing insights into the socio-economic and ecological processes that shape land use transitions. This is especially important with respect to gradual versus rapid land system dynamics and in understanding changes in land use intensity. Combining the strengths of empirical analysis with multi-scale modelling will lead to new insights into the processes driving land system change. New modelling methods that combine complex systems thinking at a local level with macro-level economic analysis of the land system would reconcile the multi-scale dynamics currently encapsulated in bottom-up and top-down modelling approaches. Developments in land use futures analysis could focus on integrating explorative scenarios that reflect possible outcomes with normative visions that identify desired outcomes. Such an approach would benefit from the broad and in-depth involvement of stakeholders in order to link scientific findings to political and societal decision-making culminating in a set of key choices and consequences. Land system models have an important role in supporting future land use policy, but model outputs require scientific interpretation rather than being presented as predictions. The future of land system science is strongly dependent on the research community's capacity to bring together the elements of research discussed in the paper, via empirical data collection and analysis of observed processes, computer simulation across scale levels and futures analysis of alternative, normative visions through stakeholder engagement.     

Towards a Smart Tourism Business Ecosystem based on Industrial Heritage: research perspectives from the mining region of Rio Tinto,Spain

The implications of the study provide suggestions for future improvements relating to the development of industrial tourism destinations. The possibility of ‘re-using’ the old industrial and mining heritage could favour the development of an economic opportunity to the recession that affected most industrial regions after the 1960s. This paper is focused on the field of industrial heritage tourism management (IHTM) to deepen the knowledge about its business ecosystem. The IHTM is chosen because a number of evidences highlight the interconnections that exist between this field and the business ecosystem concept. To explore these interconnections, the purpose of this article is to define a frame of analysis based also on the emergent initiative of smart tourism and to set up a theoretical framework not only used to the case study of the region of Rio Tinto mine in Spain, but also used as a policy instrument to suggest propositions for recommending new paths for future studies.     

MEDICARE AND INEQUALITIES IN HEALTH OUTCOMES: THE CASE OF BREAST CANCER

This article evaluates whether expanding Medicare to cover those between ages 55 and 64 will improve the health status of these near-elderly individuals. We compare the experiences of near-elderly and elderly women with breast cancer and pay special attention to those demographic groups traditionally thought to be disadvantaged. Using unique individual-level data from the National Cancer Institute, we find that expanding Medicare does not improve the probability that a black woman will have her cancer diagnosed early. However, if she does happen to be diagnosed early, a discretE-time hazard model of survival finds that the price effects of insurance will improve her odds of survival.     

Non-cooperative bargaining in apex games and the kernel

This paper studies non-cooperative bargaining with random proposers in apex games. Two different protocols are considered: the egalitarian protocol, which selects each player to be the proposer with equal probability, and the proportional protocol, which selects each player with a probability proportional to his number of votes. Expected equilibrium payoffs coincide with the kernel for the grand coalition regardless of the protocol. The equilibrium is in mixed strategies and the indifference conditions can be reinterpreted in the language of the kernel.     

The Impact of Innovation on Employment in Services: Evidence from Italy

This article investigates the employment impact of innovation in services, using the data gathered through the 1993-95 Italian innovation survey. The empirical evidence shows that the impact of innovation on employment varies greatly across industries and according to the level of qualification of the labour force. Among small firms and in less than a half of the service sectors considered, the employment impact of innovation is positive, particularly in industries that have a strong scientific and technological base. A negative impact of innovation on employment is, on the contrary, found among large firms, capital-intensive industries and in all financial-related sectors (banking, insurance and other financial services). In these industries the labour-saving effect of innovation seems to be linked to the widespread use of Information and Communication Technologies (ICTs) which displace the least qualified employees. In the case of Italy, an overall negative impact of innovation on employment is found. It is argued that this result is affected by the Italian economy's specialisation in the most traditional service industries.