Time spent on erythropoietin stimulating agents administration in hemodialysis centers in Panama: a time and motion study

Objectives: There is a lack of data in Panama on the potential differences in total healthcare professional (HCP) time between routine administrations of short-acting erythropoietin simulating agents (ESAs) (i.e. epoetin alfa) and continuous erythropoietin receptor activator (CERA) (i.e. methoxy polyethylene glycol–epoetin beta). This study aimed to quantify the HCP time associated with a single administration of epoetin alfa and CERA for the treatment of anemic patients with chronic kidney disease (CKD) on hemodialysis.

Methods: This was a multi-center, cross-sectional study, using a time-and-motion methodology. Costs related to HCP time and consumables usage associated with administration of epoetin alfa and CERA were estimated.

Results: Based on 60 administrations of either CERA or epoetin alfa, the estimated savings in mean total active HCP time were 2.34 (95% confidence interval?=?1.87–2.81) min (–30%) per administration. When extrapolating to a full year’s treatment with intravenous ESA, it would require a total of 20.3 (95% CI?=?19.90–20.71) h of HCP time for epoetin alfa vs 1.1 (95% CI?=?1.01–1.19) h for CERA per patient per year. Estimated savings in active HCP time per patient per year were 19.20 (95% CI?=?19.20–19.21) h (–95%). This, in turn, translates into staff cost efficiency that favors Mircera with an estimated annual saving of $78.24 (95% CI?=?78.24–78.28) (–95%) per patient.

Conclusions: Data from a real-world setting showed that the adoption of CERA could potentially lead to a reduction in active HCP time.

• Highlights

• Few comparative data have explored the costs and potential savings of using long-acting erythropoietin–stimulating agents (ESA) instead of short-acting ESAs to treat anemia in CKD patients on hemodialysis.

• This time-and-motion study shows that use of CERA reduces total healthcare professional time and could represent a save for an institution in a real-world setting in Panama.

     

The family gap in wages: What wombmates reveal

We shed new light on the effects of having children on hourly wages by exploiting access to data on the entire population of employed same-sex twins in Denmark. Our second contribution is the use of administrative data on absenteeism; the amount of hours off due to holidays and sickness. Our results suggest that childbearing reduces female hourly wages but the principal explanation is in fact mothers’ higher levels of absence. We find a positive wage premium for fathers.     

Partnering relationships in construction: A literature review

There is no unified view as to what partnering relationships are in the construction industry. The purpose of this paper is to examine the literature in order to identify the main assumptions about partnering relationships in construction research and practice. The literature is compared to the Construction Industry Institute’s (CII, 1991) frequently cited definition of partnering as a long-term commitment between two or more parties in which shared understanding and trust develop for the benefits of improving construction. The literature review reveals a tendency to focus on project partnering in dyads between clients and contractors and there is also an emphasis on formal tools to develop these relationships, even if social aspects and relationship dynamics are recognised. The paper discusses these findings and suggests that, in order to increase the understanding of the substance and function of partnering relationships, it could be useful to incorporate knowledge from theoretical perspectives that are more in line with the CII definition. Two perspectives that seem particularly interesting in this respect are Supply Chain Management (SCM) and the Industrial Network Approach (INA), both of which focus on long-term relationships between actors beyond the dyad. INA also emphasises the informal aspects of relationship development. Incorporating these dimensions of partnering relationships requires processual and longitudinal studies, which are relatively rare in the contemporary partnering literature.     

Spacing identity: Unfolding social and spatial-material entanglements of identity performance

In this paper, we analyze how architectural design, and the spatial and material changes this involves, contributes to the continuous shaping of identities in an organization. Based upon a case study of organizational and architectural change in a municipal administration at a time of major public sector reforms, we examine how design interventions were used to (re)form work and professional relationships. The paper examines how engagements with spatial arrangements and material artifacts affected people’s sense of both occupational and organizational identity. Taking a relational approach to sociomateriality, the paper contributes to the further theorizing of space in organization studies by proposing the concept of spacing identity to capture the fluidity of identity performance.     

A small country's high-tech dilemma: the challenge facing new technology-based firms in Norway

Judging from their profit trends, new technology-based firms have not been very successful in Norway. After ten or more years of activity, fewer than half a dozen has accumulated profits over £1 million. Those that risked large initial investments in order to standardize an innovative new technology enjoyed the greatest amount of success. Most firms were able to develop a prototype, but many had great difficulties gearing up for production. Insufficient financing and know-how were the main problems. Firms have had more problems with production than with marketing, but very few seem prepared for the costs and challenges of an international marketing effort. Most lacked a clear marketing strategy or business plan. Financing was often a problem: there was little private investment, and equity capital was often scarce with a mean debt to equity ratio of less than 30%. Most firms received some sort of public funding, usually in support of product development, but so far it has had little impact on profit trends. A multi-national follow-up study with access to a larger data base would provide many more insights.     

Minimax optimality of CUSUM for an autoregressive model

Different change point models for AR(1) processes are reviewed. For some models, the change is in the distribution conditional on earlier observations. For others, the change is in the unconditional distribution. Some models include an observation before the first possible change time – others not. Earlier and new CUSUM type methods are given, and minimax optimality is examined. For the conditional model with an observation before the possible change, there are sharp results of optimality in the literature. The unconditional model with possible change at (or before) the first observation is of interest for applications. We examined this case and derived new variants of four earlier suggestions. By numerical methods and Monte Carlo simulations, it was demonstrated that the new variants dominate the original ones. However, none of the methods is uniformly minimax optimal.     

Impact of Immigration on Inhabitants' Educational Investments

We examine whether immigration into the labour market of the building and construction (BaC) industry affects enrolment in vocational programmes that teach the skills required in this industry. Results suggest that a higher supply of immigrant labour is associated with lower enrolment into programmes teaching BaC skills. The strength of this relationship increases according to the grades that the students achieved in lower secondary school. This finding indicates that the negative effect of immigration on educational recruitment is mainly caused by students who turn away from these programmes, rather than a reduction in apprenticeship positions offered by employers.