Comparing post-operative resource consumption following transcatheter aortic valve implantation (TAVI) and conventional aortic valve replacement in the UK

Objective:

To define the in-hospital and 6-month post-discharge resource use, following Transcatheter Aortic Valve Implantation (TAVI) and conventional Aortic Valve Replacement (AVR) surgery within a single UK hospital.

Methods:

A local service evaluation of patients undergoing TAVI or AVR between January 2011 and May 2012 captured data until 6-months post-procedure, collected from hospital records and via a General Practitioner questionnaire. The main end-points were mortality, time in ITU/HDU, hospital length of stay (LoS), discharge destination, re-admission, and post-discharge primary/secondary care resource use. Sub-group analyses were performed for AVR patients aged ≥80 (AVR?≥?80) and with EuroSCORE of ≥10 (AVR ES?≥?10) to allow more direct comparison with ‘TAVI type’ patients.

Results:

Results are given as means (standard deviation) for TAVI (n?=?51), AVR (n?=?188), AVR?≥?80 (n?=?48), and AVR ES?≥?10 (n?=?47), respectively, unless otherwise stated. Age in years was 83.0 (8.1), 71.2 (13.1), 84.1 (2.7), 79.4 (7.1); EuroSCORE was 24.7 (11.9), 8.1 (6.4), 12.0 (6.0), and 16.5 (6.6); post-operative LoS (days) was 11.5 (11.2), 10.9 (10.8), 14.3 (16.7), and 15.2 (17.7). For discharged patients, 0%, 7%, 13%, and 9% had unplanned cardiac-related re-admissions within 30-days of discharge. Time to first readmission was 74.6 (34.0), 35.0 (34.2), 20.8 (9.7), and 22.6 (14.3) days.

Limitations:

This was a single-center retrospective evaluation, not prospectively powered to confirm differences in outcomes.

Conclusions:

Despite TAVI being performed in an older, higher risk population, LoS was similar to AVR. Most strikingly there were no cardiac-related re-admissions within 30-days for TAVI and time to first re-admission was significantly longer. This evaluation suggests that TAVI is clinically appropriate and provides economic advantages in both the hospital and post-discharge setting in this high risk group. Many patients undergoing TAVI are considered unfit for surgery and, hence, TAVI offers a treatment that delivers similar results to traditional AVR without the high risk associated with surgery.     

农村集体经济组织长期生存与制度变迁原因探讨——兼论人民公社的建立、失败与乡镇企业的改制

农村集体经济组织因其本身的重要意义而吸引着众多学者对其进行研究.研究农村集体经济组织变迁的目的不仅在于辨明集体经济组织的运行、变迁机理,更重要的是在此基础上预测其发展趋势.无论是改革开放前的人民公社,还是其后的乡镇企业,社区关联性都是其本质属性,即行为主体交往方式具有非匿名性、重复性、关联性等特点.理解经济组织不能仅仅关注组织内部,还要结合组织存在的制度环境,只有以此来解释农村集体经济组织的变迁过程,才能真正把握其本质及发展方向.     

证券领域行政执法与刑事司法的衔接问题研究

在我国,证券领域行政执法与刑事司法的衔接并不畅顺,大部分符合刑事追诉标准的案件仅被处以行政处罚,造成违法成本的低廉。其原因是多方面的,包括刑事与行政证明标准的差异,证据转换的困难,专业知识上的阻隔,以及监督的缺位等。建议通过推定方式转移公诉机关指控特殊类型证券犯罪的部分举证责任,减轻公诉机关的举证负担;根据不同证据的特点,完善行刑衔接证据转换规则;加强证券监管机构与公安机关、检察机关的沟通协调,建立信息共享及工作交流机制;增强规范执行力,确立有效的案件移送监督制度。     

The Link Between Corporate Social and Financial Performance: Evidence from the Banking Industry

The purpose of this investigation is to extend earlier research on the relationship between corporate social and financial performance. The unique contribution of the study is the empirical analysis of a sample of companies from the banking industry and the use of Community Reinvestment Act ratings as a social performance measure. The empirical analysis solidly supports the hypothesis that the link between social and financial performance is positive.     

贫困农村农民培训模式的创新——以广西农村社区学习中心为例

实施农民教育和培训工程是现阶段提高农民素质、减少和消除贫困的重要措施。广西是＂贫困农村社区发展项目＂（PRCDP）的试点省之一,以该项目的教育分项目中的社区学习中心子项目为例,在了解传统农民培训模式的局限性的基础上,通过对比分析传统培训模式和社区学习中心培训模式在组织管理、决策方式、培训方式和培训内容等方面的异同,总结社区学习中心培训模式的创新价值     

Market-based grazing land transfers and customary institutions in the management of rangelands: Two case studies on the Qinghai-Tibetan Plateau

Beginning in the early 1990’s, grazing lands once held in common were contracted to individual households in the rangeland regions of China. The resulting fragmentation of rangelands has led to ecological and social problems. As China seeks to address intractable poverty and rangeland degradation, attention has turned to rental, or transfer, of contracted grazing land as a market-based approach to re-aggregating grazing land into larger units that support economies of scale. However, given that many pastoral regions still maintain community customary institutions, what the relationship between market mechanisms and local customary institutions should be in rangeland management needs further analysis. This paper applies comparative case studies of two types of relationships between market mechanisms and customary institutions: (1) market mechanisms that replace customary institutions in the case of Axi village, and (2) market mechanisms that are embedded within customary institutions in Xiareer village. This allows contrast of the impacts of differing approaches on livelihoods, livestock production, and wealth differentiation among pastoral households. We found that there is a higher level of livestock mortality, lower livestock productivity, and higher livestock production cost in Axi Village compared to Xiareer Village. In addition, household asset levels are higher and there is less income differentiation in Xiareer Village. It is concluded that embedding market mechanisms within customary institutions has had notable benefits for the herders of Xiareer Village, because it is a better fit to the coupled pastoral social-ecological system. Based on these findings, we argue that in pastoral communities where the rangeland transfer system for contracted grazing land has not yet been implemented, it is critical to reconsider China’s current policy approach to pay greater attention to the innovative management systems being developed in local regions. Instead of considering market-based approaches as oppositional to traditional institutions, options that derive from the interaction of market-based and customary institutions should be considered.     

Making the ‘rules of the game’: Constituting territory and authority in Nicaragua's indigenous communities

Indigenous communities, particularly in Latin America, are increasingly winning recognition of rights to lands and forests that they have managed or used historically under customary institutions. If property refers to ‘the rules of the game’, this article uses the constitution of indigenous communal territories in Nicaragua to examine the process of ‘making the rules’. Specifically, the recognition of rights by central governments leads to political contestations over both territory and authority as communities and indigenous political leaders vie for different configurations of both lands and new territorial authorities. That is, the process of constituting large collective territories is intimately related to the constitution of authority, as it involves not only the negotiation of physical boundaries but also the recognition of an existing authority structure – or the creation of a new entity – to represent the beneficiaries. In Nicaragua's North Atlantic Autonomous Region, then, the decision over ‘which configuration of territory’ is ultimately a political negotiation over which ‘authority’ will have the right to control and enforce access to which rights and benefits from land and natural resources.     

Optimal taxation and growth with public goods and costly enforcement

This paper studies optimal direct and indirect taxation in an endogenous growth framework with a productive public good and costly tax collection. Optimal (growth-maximizing) tax rules are derived under exogenous collection costs. The optimal direct–indirect tax ratio is shown to be negatively related to the administrative costs of collecting these taxes, as documented in cross-country data. This result also holds under endogenous collection costs (with these costs inversely related to administrative spending on tax enforcement), but for these to generate significant effects on tax collection requires implausibly high degrees of efficiency in spending, or the allocation of a large fraction of resources to tax enforcement. Depending on how it is financed, the latter policy may entail adverse effects on growth. Improving ‘tax culture’ and the sense of civic duty through greater budgetary transparency may be a more effective policy to improve tax collection and promote economic growth.     

Residents’ support for red tourism in China: The moderating effect of central government

This study proposes and tests a model that incorporates two competing theories of political trust, institutional trust and cultural trust, to examine community support for “red tourism” development. Using data gathered from residents living in close proximity to Jinggangshan Scenic Area in China, this study examines the influence of authoritarian values, particularly as they relate to level of residents’ power, their level of trust in government, and their effects on support for “red tourism.” Findings suggest that trust in central government moderates the relationship between trust in local government and support. Future studies should utilize the institutional trust framework to assess residents’ trust in the local government and the cultural trust framework to assess trust in the central government.