Patterns of care and burden of chronic idiopathic thrombocytopenic purpura in Brazil

Aims: Although several therapeutic options are available for chronic immune thrombocytopenic purpura (cITP), little is known about the treatment of cITP in Brazil.

Materials and methods: A multi-center, retrospective chart review, observational study was designed to describe the treatment patterns, clinical burden, resources use, and associated costs for adult patients diagnosed with cITP and treated in public and private institutions in Brazil. Patient charts were screened in reverse chronological order based on their last visit post January 1, 2012. (All costs were calculated using 1.00 USD?=?3.9571 BRL, from February 2016.)

Results: Of 340 patient charts screened, 50 patients were eligible for inclusion in the study. Single-drug therapy (prednisone, dexamethasone, or dapsone) was the most commonly used treatment, followed by combination therapies (azathioprine?+?prednisone, azathioprine?+?prednisone?+?danazol, and prednisone?+?dapsone). Splenectomy was performed in 22% of patients after at least first-line treatment. Platelet count and number of bleeding episodes at diagnosis were 31,561.1/mm³ (SD?=?±26,396.1) and 40 episodes, respectively; in first-line, 92,631.1/mm³ (SD?=?±79,955.3) and 19 episodes, respectively; in second-line, 96,950.0/mm³ (SD?=?±76,476.4) and 17 episodes, respectively. Private system patients had a higher median cost compared to public system patients (USD 17.49/month, range?=?0–2,020.77 vs USD 9.51/month, range?=?0–192.64, respectively).

Limitations: This study does not allow conclusions for causal explanations due to the cohort study design, and treatment patterns represent only the practices of physicians who have agreed to participate in the study.

Conclusions: The data indicate that available therapeutic strategies for second- and third-line therapies appear to be limited.     

Purification of Bayesian–Nash equilibria in large games with compact type and action spaces

We present a purification result for incomplete information games with a large but finite number of players that allows compact metric spaces for both actions and types. We then compare our framework and findings to the early purification theorems of Rashid (1983. Equilibrium points of non-atomic games: asymptotic results. Economics Letters 12, 7–10), Cartwright and Wooders (2002 On equilibrium in pure strategies in games with many players. University of Warwick Working Paper 686 (revised 2005)), Kalai (2004. Large robust games. Econometrica 72, 1631–1665) and Wooders, Cartwright and Selten (2006. Behavioral conformity in games with many players. Games and Economic Behavior 57, 347–360). Our proofs are elementary and rely on the Shapley–Folkman theorem.     

The relationship between technology adoption and strategy in business-to-business markets : The case of e-commerce

Firms have been traditionally advised to adopt information and communication technologies (ICT) to support the achievement of existing business objectives. However, entry into business-to-business e-commerce may require the concurrent adoption of new business strategies. This paper argues, therefore, that ICT analysis needs to be considered at the same time and at the same strategic level, as internal, competitor and market analysis. This is because the source of the competitive advantage brought by ICT has changed, to be largely obtained through increase in customers' perceived value. The literature presents a confused picture of the likely consequences to a firm of its adoption of e-commerce. This paper concludes that any such adoption must be evaluated in the environment of the individual firm. A multidimensional analytical framework, taking a combined informational and marketing perspective, is presented to assist with such evaluations.     

Ethnic Marketing Ethics

Culture plays an important role in defining ethics standards because dissimilar cultures socialize their people differently, according to what is acceptable behaviour. The potential significance of ethnic groups for marketing justifies inquiry into the moral judgments, standards, and rules of conduct exercised in marketing decisions and situations arising from decisions whether or not to focus on individual ethnic groups within an economy. Identifying and targeting ethnic groups for marketing purposes are tasks fraught with many ethical difficulties. In a multicultural society consisting of a dominant group and many diverse, minority groups defined by ethnicity, these problems can be expected to increase substantially. Consequently, marketers may include minority ethnic consumers in their mainstream marketing programs. In itself, this has ethical consequences. Alternatively, if marketers seek to target individual minority ethnic groups within the same economy a further set of ethical consequences needs to be considered. This paper reviews the concepts of ethnicity and ethnic groups and their relevance for marketing strategy within an economy where there is a dominant group and also significant minority ethnic groups. The ethical consequences for minority communities arising from the use of non-ethnic, mainstream marketing programs are examined. An alternative approach, ethnic marketing, is also examined and its ethical consequences in terms of other groups within the one country appraised. The ethical dilemma and tradeoffs facing marketers within advanced, culturally diverse countries are then considered.     

On the existence of pure-strategy equilibria in large games

Over the years, several formalizations and existence results for games with a continuum of players have been given. These include those of Schmeidler [D. Schmeidler, Equilibrium points of nonatomic games, J. Stat. Phys. 4 (1973) 295-300], Rashid [S. Rashid, Equilibrium points of non-atomic games: Asymptotic results, Econ. Letters 12 (1983) 7-10], Mas-Colell [A. Mas-Colell, On a theorem by Schmeidler, J. Math. Econ. 13 (1984) 201-206], Khan and Sun [M. Khan, Y. Sun, Non-cooperative games on hyperfinite Loeb spaces, J. Math. Econ. 31 (1999) 455-492] and Podczeck [K. Podczeck, On purification of measure-valued maps, Econ. Theory 38 (2009) 399-418]. The level of generality of each of these existence results is typically regarded as a criterion to evaluate how appropriate is the corresponding formalization of large games.In contrast, we argue that such evaluation is pointless. In fact, we show that, in a precise sense, all the above existence results are equivalent. Thus, all of them are equally strong and therefore cannot rank the different formalizations of large games.     

A green Lewis development model

This paper develops an environmental extension of a Lewis dual economy model, in which the interaction between environmental quality and economic growth, in one of its several dimensions, is explicitly modeled to explore long-run effects of a pollution abatement rule in developing economies. The government requires the modern sector to dedicate a fraction of its output to pollution abatement, with such profitability-reducing fraction being endogenous to the level of environmental quality. Meanwhile, the level of environmental quality positively affects labor productivity, profits and, therefore, savings, which has a positive impact on capital accumulation. It is shown that this pollution abatement requirement, by affecting profitability in the modern sector both negatively and positively, makes for the emergence of an ecological development trap from which a developing dual economy, if left to the free play of its structural forces, never escapes. Fortunately, however, this economy can be released from such a trap not only through a standard Big Push, in the spirit of Rosenstein-Rodan, but also by means of what we call an Environmental Big Push.     

Amino acid formula as a new strategy for diagnosing cow’s milk allergy in infants: is it cost-effective?

Aims: To estimate the cost-effectiveness of a new strategy that uses an amino acid formula in the elimination diet of infants with suspected cow’s milk allergy (CMA).

Materials and methods: This pharmacoeconomic study was developed from the perspective of the Brazilian Public Healthcare System. The new strategy proposes using an amino acid formula in the diagnostic elimination diet of infants (≤24 months) with suspected CMA. The rationale is that infants who do not respond to the amino acid formula do not suffer from CMA. Patients with a positive oral challenge test receive a therapeutic elimination diet based on Brazilian Food Allergy Guidelines. This approach was compared to the current recommendations of the Brazilian Food Allergy Guidelines. A decision model was constructed using TreeAge Pro 2012 software. Model inputs were based on a literature review and the opinions of a panel of experts. A univariate sensitivity analysis of incremental cost-effectiveness ratios was performed.

Results: The mean cost per patient of the new amino acid formula strategy was R$3,341.57, while the cost of the current Brazilian guidelines strategy was R$3,641.08. The mean number of symptom-free days per patient, which was used as an indicator of effectiveness, was 900.6 and 875.7 days, respectively. The new strategy is, therefore, dominant. In the sensitivity analysis, the dominance was maintained with parameter variation.

Limitations: In the absence of information in the literature, some premises were defined by a panel of specialists.

Conclusions: The new strategy, which uses an amino acid formula in the elimination diagnostic diet followed by an oral food challenge, is a dominant pharmacoeconomic approach that has a lower cost and results in an increased number of symptom-free days.     

The experience of technological collaborations by MERCOSUR companies

This paper examines some of the experiences in information and knowledge sharing involving MERCOSUR firm. It finds that while technological collaborations by MERCOSUR firms are relatively few, located in low-tech sectors and taking place in an environment of little innovation, they are motivated by the need to 'fuse' their own knowledge with that of partner or to improve available information. Modes of governance vary accordingly, with equity or contractual forms being used for new developments and informal agreements for improvements. Govmments and business associations can be important facilitators of technological collaborations. The analysis of technological collaborations suggested that the better prepared a corporation entered an agreement the more successful it was likely to be. It also pointed out that where interactions were intense, well intended and transparent, included personnel exchanges, were properly assessed and involved receptive participants, learning progressed smoothly and partners were satisfied. Benefits of the collaborations included new patentable and non-patentable products new factories, as well as building trust between partners. Premature termination of some collaborations was the result of financia1 limitations unrelated to the success of the collaboration.