Optimizing transit maintenance and rehabilitation to support human development and sustainability: A case study of Costa Rica’s railroad network

Public transportation plays a critical role in improving human development and consequently the 17 Sustainable Development Goals (SDGs) set by United Nations. Convenient and efficient transit enable inhabitants to reach labor markets, access social support facilities as well as health and education services. This study develops a decision-making support framework for transit agencies to select optimum maintenance, rehabilitation, and upgrade alternatives to accomplish good levels of service and improve human development and sustainability indexes. A case study of Costa Rica’s great metropolitan area is used to illustrate the study with various budget scenarios. The results show that the proposed system can accomplish significant improvements on both level of service and human development. It is also confirmed that the explicit consideration of human development and sustainability made a significant difference as compared to the classical approach, which only considers the level of service (LOS). The proposed model could be used by other public transit systems.     

The burden associated with thrombocytopenia and platelet transfusions among patients with chronic liver disease

Abstract

Background: Thrombocytopenia (TCP), a common complication of chronic liver disease (CLD), can cause uncontrolled bleeding during procedures. As such, CLD patients with TCP and platelet counts <50,000/μL often receive prophylactic platelet transfusions before invasive procedures. However, platelet transfusions are associated with clinical complications, which may result in increased healthcare utilization and costs.

Objective: This retrospective database analysis describes the clinical and economic burden in CLD patients with TCP, CLD patients without TCP, and CLD patients with TCP who receive platelet transfusions.

Methods: Adult CLD patients with or without TCP were identified in the IBM MarketScan Commercial Claims and Medicare Supplemental data from 1 January 2012 to 31 December 2015. CLD patients with or without TCP were propensity-score matched (1:1) for the analysis of annual healthcare utilization and costs. Platelet transfusions among CLD patients with TCP were identified using procedure codes.

Results: Of the 601,626 patients with CLD, 8,292 (1.4%) patients with TCP were matched to patients without TCP. Among CLD patients with TCP, 981 (11.8%) patients received ≥1 platelet transfusions and met inclusion/exclusion criteria. Compared to patients without TCP, CLD patients with TCP had more complications, including higher prevalence of neutropenia (11.4% vs 2.9%) and bleeding events (21.4% vs 10.9%), greater resource utilization including greater average hospital admissions (1.2 vs 0.7, p?<?.01), greater average ER visits (2.1 vs 1.3, p?<?.01), higher average outpatient office visits (20.1 vs 18.4, p?<?.01), and higher average healthcare costs including total costs (p?<?.01), inpatient costs (p?<?.01), ER visit costs (p?<?.01), and outpatient office visit costs (p?<?.01). The mean annual total costs in CLD and TCP patients with platelet transfusions were $206,396.

Conclusions: CLD patients with TCP, and particularly those who received platelet transfusions, experienced significantly greater clinical and economic burden compared to CLD patients without TCP. Safer and more cost-effective treatments to increase platelets are necessary.     

What happens to CEO compensation following turnover and succession?

When boards hire CEOs, the board and successor CEO have an opportunity to redesign the predecessor's compensation contract. The CEO's relative bargaining power will influence the outcome of compensation negotiations. Analyzing 508 successions, we find that total compensation of successor CEOs increases by 69% over their predecessor, but the structure of successor compensation is heavily influenced by the predecessors’ contracts. When the board's bargaining power is large, successors have a greater proportion of pay-at-risk and smaller proportion of salary. When the CEO's bargaining power is large, there is a smaller proportion of pay-at-risk and relatively greater proportion of salary.     

CEO compensation structure following succession: Evidence of optimal incentives with career concerns

To motivate managers to pursue shareholder interests, boards may design management compensation packages to reward managers for good firm performance. However, Gibbons and Murphy (1992) note that when CEOs are far from retirement, they have career concerns. In these cases, Gibbons and Murphy argue that it may not be optimal for their current compensation to be too dependent on firm performance. Testing this proposition, we find that abnormal returns are negatively related to the percentage of performance-based pay of newly hired CEOs when companies announce CEO successions. Since these newly hired CEOs are likely some distance from retirement, we interpret these results as being consistent with Gibbons and Murphy; it may be better to allow newly hired CEOs to be paid in human capital increases from the managerial labor market than to have their current pay too closely related to performance.