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Prospective payment systems reimburse hospitals based on diagnosis-specific flat fees, which are generally based on average costs. While this encourages cost-consciousness on the part of hospitals, it introduces undesirable incentives for patient transfers. Hospitals might feel encouraged to transfer patients if the expected treatment costs exceed the diagnosis-related flat fee. A transfer fee would discourage such behavior and, therefore, could be welfare enhancing. In 2003, New Zealand introduced a fee to cover situations of patient transfers between hospitals. We investigate the effects of this fee by analyzing 4,020,796 healthcare events from 2000 to 2007 and find a significant reduction in overall transfers after the policy change. Looking at transfer types, we observe a relative reduction in transfers to non-specialist hospitals but a relative increase in transfers to specialist facilities. It suggests that the policy change created a focusing effect that encourages public health care providers to transfer patients only when necessary to specialized providers and retain those patients they can treat. We also find no evidence that the transfer fee harmed the quality of care, measured by mortality, readmission and length of stay. The broader policy recommendation of this research is the introduction or reassessment of transfer payments to improve funding efficiency.

Cytokines released during chronic inflammatory diseases induce pro-inflammatory properties in polymorphonuclear neutrophils (PMNs). Here, we describe the development of a subgroup of human PMNs expressing CCR5, termed CCR5

We present a general framework for thermodynamic limits and its applications to a variety of models. In particular we will identify criteria such that the limits are uniform in a parameter. All results are illustrated with the example of eigenvalue counting functions converging to the integrated density of states. In this case, the convergence is uniform in the energy.

We prove a Lifshitz tail bound on the integrated density of states of random breather Schr\"odinger operators. The potential is composed of translated single site potentials. The single site potential is an indicator function of set $tA$ where $t$ is from the unit interval and $A$ is a measurable set contained in the unit cell. The challenges of this model are: Since $A$ is not assumed to be star-shaped the dependence of the potential on the parameter $t$ is not monotone. It is also non-linear and not differentiable., Comment: accepted in Comptes rendus - Math\'ematique

We develop a Glivenko–Cantelli theory for monotone, almost additive functions of i.i.d. sequences of random variables indexed by Z d . Under certain conditions on the random sequence, short range correlations are allowed as well. We have an explicit error estimate, consisting of a probabilistic and a geometric part. We apply the results to yield uniform convergence for several quantities arising naturally in statistical physics.

Existing models in the parimutuel betting literature typically explain betting data by either assuming a single, representative bettor with certain risk preferences or by assuming that a number of risk neutral bettors compete strategically within a game theoretic framework. We construct a theoretical framework of parimutuel markets in which we model both strategic interaction and individual bettor risk preferences, distinguishing between sophisticated insiders and recreational outsiders. We solve this model analytically for the optimal insider betting amount in a static symmetric Nash equilibrium. A new data set of 126 million individual horse race bets in New Zealand from 2006 to 2014 allows us to calibrate the model. We find that insiders (those betting $100 or more) outperform outsiders by 7.5% in terms of realized returns. The best fit of the model to the data is obtained when insiders are assumed to be risk neutral and to have an information advantage of 0.08 in probability terms. This findin...

We refine a result of Matei and Meyer on stable sampling and stable interpolation for simple model sets. Our setting is model sets in locally compact abelian groups and Fourier analysis of unbounded complex Radon measures as developed by Argabright and de Lamadrid. This leads to a refined version of the underlying model set duality between sampling and interpolation. For rather general model sets, our methods also yield an elementary proof of stable sampling and stable interpolation sufficiently far away from the critical density, which is based on the Poisson Summation Formula., Comment: 31 pages, 2 figures; v3: minor corrections and adjustments

One of the main concerns about capitation-based reimbursement systems is that tertiary institutions may be underfunded due to insufficient reimbursements of more complicated cases. We test this hypothesis with a data set from New Zealand that, in 2003, introduced a capitation system where public healthcare provider funding is primarily based on the characteristics of the regional population. Investigating the funding for all cases from 2003 to 2011, we find evidence that tertiary providers are at a disadvantage compared with secondary providers. The reasons are that tertiary providers not only attract the most complicated, but also the highest number of cases. Our findings suggest that accurate risk adjustment is crucial to the success of a capitation-based reimbursement system. Copyright © 2017 John Wiley & Sons, Ltd.

In this paper we study spectral properties of self-adjoint operators on a large class of geometries given via sofic groups. We prove that the associated integrated densities of states can be approximated via finite volume analogues. This is investigated in the deterministic as well as in the random setting. In both cases we cover a wide range of operators including in particular unbounded ones. The large generality of our setting allows to treat applications from long-range percolation and the Anderson model. Our results apply to operators on Z^d, amenable groups, residually finite groups and therefore in particular to operators on trees. All convergence results are established without any ergodic theorem at hand., Comment: 37 pages, 8 figures

Context: We describe the clinical investigation of the first generation aldosterone synthase inhibitor, LCI699, in patients with essential, uncontrolled, resistant, or secondary hypertension. LCI699 competitively reduced blood pressure at lower doses yet counterintuitive effects were observed at higher doses. Objective and method: An extensive endocrine biomarker analysis was performed to better understand the pharmacological mechanism of the drug. Results: The interference of LCI699 in the renin–angiotensin–aldosterone system occurred with limited target selectivity, as a dose-dependent compensatory stimulation of the hypothalamic-pituitary-adrenal feedback axis was discovered. Thus, LCI699 affected two endocrine feedback loops that converged at a single point, inhibiting the 11β-hydroxylase reaction in the adrenal gland, leading to supraphysiological levels of 11-deoxycortiscosterone. The accumulation of this potent mineralocorticoid may explain the blunted blood pressure response to LCI699. Conclusion: Future aldosterone synthase inhibitors may improve their target selectivity by sparing the 11β-hydroxylase reaction and preferentially inhibiting one of the two other enzymatic reactions mediated by aldosterone synthase.

The literature estimating the take-out rate (price) elasticity of horse race wagering has consistently found values far above one. The persistence of these apparently inefficiently high prices can be attributed to institutional factors of the US market where federal taxes are imposed on the total amount wagered, and not on the bookmakers’ revenue. By investigating all horse races in New Zealand from August 1993 to April 2009, our article is the first one to consider price setting for wagering in an unregulated market where taxes for a monopolistic betting agency are based on revenues. In such a setting, one would expect elasticities close to one, but in all econometric specifications, we find values well below one. We identify two reasons why higher prices could nevertheless reduce profits: cross price elasticities are negative and, due to the specific features of parimutuel betting, international competitors may only be attracted when take-out rates are above a critical threshold.

We consider random fields indexed by finite subsets of an amenable discrete group, taking values in the Banach-space of bounded right-continuous functions. The field is assumed to be equivariant, local, coordinate-wise monotone, and almost additive, with finite range dependence. Using the theory of quasi-tilings we prove an uniform ergodic theorem, more precisely, that averages along a Foelner sequence converge uniformly to a limiting function. Moreover we give explicit error estimates for the approximation in the sup norm., Comment: 28 pages, 1 figure, accepted in Annales of Applied Probability

Summary Background Serelaxin, recombinant human relaxin-2, is a vasoactive peptide hormone with many biological and haemodynamic effects. In a pilot study, serelaxin was safe and well tolerated with positive clinical outcome signals in patients with acute heart failure. The RELAX-AHF trial tested the hypothesis that serelaxin-treated patients would have greater dyspnoea relief compared with patients treated with standard care and placebo. Methods RELAX-AHF was an international, double-blind, placebo-controlled trial, enrolling patients admitted to hospital for acute heart failure who were randomly assigned (1:1) via a central randomisation scheme blocked by study centre to standard care plus 48-h intravenous infusions of placebo or serelaxin (30 μg/kg per day) within 16 h from presentation. All patients had dyspnoea, congestion on chest radiograph, increased brain natriuretic peptide (BNP) or N-terminal prohormone of BNP, mild-to-moderate renal insufficiency, and systolic blood pressure greater than 125 mm Hg. Patients, personnel administering study drug, and those undertaking study-related assessments were masked to treatment assignment. The primary endpoints evaluating dyspnoea improvement were change from baseline in the visual analogue scale area under the curve (VAS AUC) to day 5 and the proportion of patients with moderate or marked dyspnoea improvement measured by Likert scale during the first 24 h, both analysed by intention to treat. This trial is registered at ClinicalTrials.gov, NCT00520806. Findings 1161 patients were randomly assigned to serelaxin (n=581) or placebo (n=580). Serelaxin improved the VAS AUC primary dyspnoea endpoint (448 mm × h, 95% CI 120–775; p=0·007) compared with placebo, but had no significant effect on the other primary endpoint (Likert scale; placebo, 150 patients [26%]; serelaxin, 156 [27%]; p=0·70). No significant effects were recorded for the secondary endpoints of cardiovascular death or readmission to hospital for heart failure or renal failure (placebo, 75 events [60-day Kaplan-Meier estimate, 13·0%]; serelaxin, 76 events [13·2%]; hazard ratio [HR] 1·02 [0·74–1·41], p=0·89] or days alive out of the hospital up to day 60 (placebo, 47·7 [SD 12·1] days; serelaxin, 48·3 [11·6]; p=0·37). Serelaxin treatment was associated with significant reductions of other prespecified additional endpoints, including fewer deaths at day 180 (placebo, 65 deaths; serelaxin, 42; HR 0·63, 95% CI 0·42–0·93; p=0·019). Interpretation Treatment of acute heart failure with serelaxin was associated with dyspnoea relief and improvement in other clinical outcomes, but had no effect on readmission to hospital. Serelaxin treatment was well tolerated and safe, supported by the reduced 180-day mortality. Funding Corthera, a Novartis affiliate company.

Objectives The aim of this study was to assess the effects of serelaxin on short-term changes in markers of organ damage and congestion and relate them to 180-day mortality in patients with acute heart failure. Background Hospitalization for acute heart failure is associated with high post-discharge mortality, and this may be related to organ damage. Methods The Pre-RELAX-AHF (Relaxin in Acute Heart Failure) phase II study and RELAX-AHF phase III study were international, multicenter, double-blind, placebo-controlled trials in which patients hospitalized for acute heart failure were randomized within 16 h to intravenous placebo or serelaxin. Each patient was followed daily to day 5 or discharge and at days 5, 14, and 60 after enrollment. Vital status was assessed through 180 days. In RELAX-AHF, laboratory evaluations were performed daily to day 5 and at day 14. Plasma levels of biomarkers were measured at baseline and days 2, 5, and 14. All-cause mortality was assessed as a safety endpoint in both studies. Results Serelaxin reduced 180-day mortality, with similar effects in the phase II and phase III studies (combined studies: N = 1,395; hazard ratio: 0.62; 95% confidence interval: 0.43 to 0.88; p = 0.0076). In RELAX-AHF, changes in markers of cardiac (high-sensitivity cardiac troponin T), renal (creatinine and cystatin-C), and hepatic (aspartate transaminase and alanine transaminase) damage and of decongestion (N-terminal pro–brain natriuretic peptide) at day 2 and worsening heart failure during admission were associated with 180-day mortality. Serelaxin administration improved these markers, consistent with the prevention of organ damage and faster decongestion. Conclusions Early administration of serelaxin was associated with a reduction of 180-day mortality, and this occurred with fewer signs of organ damage and more rapid relief of congestion during the first days after admission.

Aldosterone inhibition with mineralcorticoid receptor antagonists (MRAs) is an effective treatment for resistant hypertension. Aldosterone synthase inhibitors (ASIs) are currently being investigated as a new therapeutic strategy to reduce aldosterone secretion from the adrenal gland. In this study, the efficacy and safety of the first-generation ASI LCI699 (0.25 mg twice daily, 1 mg 4 once daily, and 0.5 mg/1 mg twice daily) was compared with placebo and eplerenone (50 mg twice daily), in patients with resistant hypertension. Placebo-adjusted decreases in systolic blood pressure (BP) with LCI699 ranged from 2.6 mm Hg to 4.3 mm Hg at week 8; changes in diastolic BP ranged from +0.3 mm Hg to -1.2 mm Hg. However, reductions were smaller than observed with eplerenone 50 mg twice daily (9.9 mm Hg and 2.9 mm Hg for systolic and diastolic BP, respectively) and not statistically significant vs placebo. LCI699 suppressed plasma aldosterone levels in a dose-related manner with corresponding dose-dependent increases in plasma renin activity and plasma 11-deoxycorticosterone. LCI699 and eplerenone were well tolerated. These data demonstrate that aldosterone synthesis inhibition with LCI699 lowers BP modestly in patients with resistant hypertension. Aldosterone synthesis inhibition might offer an attractive adjunct to aldosterone receptor blockade, although the potential of a combination MRA/ASI has not yet been tested.

This paper investigates the international transmission of fiscal shocks between two closely-linked, open economies. We estimate impulse response functions using a semi-structural vector auto regressive (VAR) model and quarterly data from Australia and New Zealand for the period 1973:3–2008:4. We compare our empirical results with impulse response functions from a calibrated two-country international real business cycle model with habit formation and adjustment costs to investment. We show that a positive shock to Australian government consumption leads to an increase in Australian output initially and then to a decline in the medium term, while the New Zealand output is negatively affected both in the short and medium term. This result is in line with the recent literature that reports beggar-thy-neighbour effect of positive government spending shocks.

PurposeThe purpose of this paper is to examine the regulation of advertising by considering market‐driven firms (those seeking to keep within the boundaries set by social and industry norms) and market drivers (those seeking to stretch boundaries to gain a competitive advantage). Thought is also given to the costs of regulation and tolerance to the social purse, and the benefits gained by compliance and violation.Design/methodology/approachThe authors develop a conceptual argument for boundary stretching where market drivers are present in a marketplace dominated by market‐driven firms. The authors then apply a game theory model to examine the conditions, the firm responses, and Government responses. In doing so the authors investigate incentives for non‐compliant behavior in a self‐regulated market and show that a firm can achieve a market advantage by stretching advertising boundaries.FindingsResults suggest that when government takes a “wait‐and‐see” approach of partial tolerance, then the market driver can become the focal point for the market‐driven, and a shift will take place in the regulatory boundary. If the government is the boundary shifter then social engineers are taking advantage of artificial boundaries they know will not be enforced, with implications for campaigns such as drink‐driving, smoking, and domestic violence. Also, the market driver will gain a competitive advantage by entering a market‐driven marketplace through boundary shifts, even after incurring an initial penalty.Research limitations/implicationsThe research demonstrates a need for research into marketing regulation to consider firm types, violation types, and tolerance levels. The study contributes to our understanding of marketer activity with two implications; first the firm is shifting the boundaries and redefining the market focal point as themselves, rather than violating the boundaries and setting themselves outside the rules. Second, depending on the level of tolerance that government has with the regulation of advertising, there is a cost to both the social purse and to market‐driven firms associated with boundary shifters.Practical implicationsA market driver, looking for growth opportunities, should try to enter markets dominated by market‐driven firms, and which have self‐regulation, while market driven firms should either look for regulatory protection or act collectively to wield power over third parties – for example forcing media outlets not to carry market driver advertising.Originality/valueBy introducing the concept of boundary stretching and allowing for market drivers and market driven firms, the authors show the effects of regulation (or tolerance) in a realistic setting and allow for the real‐world dynamics of a marketplace where new ideas create new focal points for social acceptance. This study also provides a clear illustration of the usefulness of game theory in marketing studies.

Imperfect information regarding the true needs of recipients is a common problem for governmental or not-for-profit service providers. This can lead to potentially dangerous under-provision or wasteful over-provision of services. We provide a method for optimally improving a service provider’s information regarding true client need through costly information gathering. Our contribution is to allow providers to endogenously and optimally choose the intensity of information gathering. Providers do so by specifying the level of correlation between observed and true recipient need, subject to an arbitrary cost function over the specified correlation. We derive the conditions that characterize the choice of optimal correlation for providers with quadratic utility. Using a realistic exponential correlation cost function, we show that there exists a critical value of true client need variance below which it is never optimal to engage in information gathering. Further, for true client variance above this critical level the optimal correlation will always exceed 0.5. Our findings have a wide range of policy implications in areas such as health care, social wellfare and even counter-terroism.

Preoperative chemotherapy has been shown to improve outcome of patients with adenocarcinoma of the esophagogastric junction (AEG) and gastric cancer (GC), and histopathologic response has been identified as an independent prognostic parameter in these patients. A recent meta-analysis has identified patients with AEG as benefiting more from preoperative chemotherapy than patients with GC. The aim of this retrospective analysis was to prove these findings in an experienced single-center large patient cohort because there are currently no recruiting prospective clinical trials.In a single center, 551 patients underwent preoperative platin-based chemotherapy followed by oncologic surgery for locally advanced AEG and GC. Pretherapeutic clinical parameters were correlated with histopathologic response to preoperative chemotherapy.Histopathologic response (10% of residual tumor) was found in 130 patients (24%) and was significantly correlated with overall survival (P0.0001). Tumor localization at the esophagogastric junction (GE junction), lower baseline cT stage, and baseline cN0 stage were significantly associated with histopathologic response (P=0.034, P=0.015, and P=0.002, respectively). In subgroup analyses, the latter two predictive parameters were confirmed only for AEG (n=378) but not for other GC (n=173). AEG patients who were pretherapeutically staged as having cT3/4, cN0 disease (n=73) were identified as the subgroup with the highest rate of histopathologic response (48%).AEG is more likely to respond to preoperative chemotherapy than GC, a finding that might help identify patients who would benefit from preoperative chemotherapy.

By using a unique data set from the Turkish cement industry, we analyze the impact of privatization on the market value of private …rms already in the market (rivals). Privati- zation has two eects: It increases the e¢ ciency of the privatized …rms, and this e¢ ciency eect is bad news for rivals. If an incumbent buys a state owned …rm, however, the number of …rms in the market is reduced by one, and rivals bene…t from this concentration eect measured by the change in the Her…ndahl Index (HHI). We show that privatization leads to overall positive abnormal returns for rivals because the concentration eect outweighs the e¢ ciency eect. Consistent with our simple theoretical model, this eect is reinforced when the initial HHI is high. Abnormal returns of rivals decrease if …rms are sold through block sales which con…rms the …ndings of previous studies that concentrated ownership increases e¢ ciency of the privatized …rm.

This paper investigates the impact of a 'free drug program' on the market equilibrium of drugs. We introduce a screening model of the hard drug market in which dealers use payment and punishment options to screen between high and low risk users. We show that, if a free drug program selects sufficiently many high-risk drug users, the pure-strategy separating market equilibrium ceases to exist and a symmetric mixed-strategy equilibrium results, in which drug users derive a higher expected utility. This encourages new drug users to enter the market. The novelty of the paper is the transmission mechanism for this effect, which is via the influence on market price.

This technical paper describes the techniques used to calculate future economic impacts, using two quite different situations: a technology park in a major urban area and the suspension of fees at a tertiary institution in a provincial town. A number of issues arose which required assumptions to be made. Notable among these were the lack of regionalized input–output tables and estimating the ‘leakage’ to economies outside the specified target area.

Minimum wages are usually assumed to be inefficient as they prevent the full exploitation of mutual gains from trade. Yet advocates of wage regulation policies have repeatedly claimed that this loss in market efficiency can be justified by the pursuit of ethical goals. Policy makers, it is argued, should not focus on efficiency alone. Rather, they should try to find an adequate balance between efficiency and equity targets. This idea is based on a two-worlds-paradigm that sees ethics and economics as two inherently conflicting ways of thinking. We, however, believe that this view of the relationship between ethics and economics is fundamentally flawed and blurs our understanding of how an ethically responsible regulation of the labour market should be conducted. In drawing on an economic-ethical approach that resolves the antinomy between efficiency and equity, we show that ethics and economics are, in fact, two sides of the same coin and that minimum wage legislation can only be ethically responsible, if it is at the same time economically efficient. In other words, we can have our cake and eat it too. On the basis of our approach, we develop two simple game theoretical models for different types of labour markets and derive policy implications from an economic-ethical viewpoint. We suggest that under the assumption of perfectly competitive labour markets a tax-funded wage subsidy is preferable over minimum wages, as it makes everyone better off. If, however, employers have monopsony power in the wage setting process, the minimum wage is justifiable under certain conditions.

Is the minimum wage ethically justifiable? In this chapter, we attempt to answer this question from an order-ethical perspective. To this end, we develop two simple game theoretical models for different types of labour markets and derive policy implications from an order-ethical viewpoint. Our investigation yields a twofold conclusion. Firstly, order ethicists should prefer a tax-funded wage subsidy over minimum wages if they assume that labour markets are perfectly competitive. Secondly, order ethics suggests that the minimum wage can be ethically justified if employers have monopsony power in the wage setting process. As it turns out, then, order ethics neither favours nor disfavours the minimum wage. Rather, it implies conditions under which this form of labour market regulation is justified and, hence, allows empirical science to play a great role in answering the ethical questions that arise in the context of the minimum wage debate. This illustrates one of order ethics’ strengths, viz. the fact that it tends to de-ideologize the debate about ethical issues.

We assess investment risks for European non-listed real estate funds byconsidering a set of macroeconomic and fund-specific factors and by takinginto account the real estate market phase. Using fund-level data, we applypanel regression techniques with random effects. Our results suggest thatno differences exist across sectors. However, we find that there is anoptimal fund size, as there is an optimal gearing level. The latter varies withrespect to investment style and market phase. Investment style, vehiclestructure and vintage also matter. Regarding macroeconomic risk factors,we find significant impacts for real GDP growth, interest rates, inflationcomponents, money supply and stock market returns. For comparisonpurposes, the same analysis is performed for listed and direct real estateinvestments. We find that the three kinds of real estate exposure reactbroadly in the same way to macroeconomic risk factors although coefficientssuggest that non-listed funds are more akin to direct real estate than tolisted real securities.