Partial Compliance Research Articles

Emerging international indigenous rights norms and ‘over-compliance’ in New Zealand and Canada

The UN Declaration on the Rights of Indigenous Peoples now represents the minimum international standard on indigenous rights. A qualitative analysis of state responses to this emerging indigenous rights regime produces some curious results, including state compliance, non-compliance, under-compliance, partial compliance, and also a pattern of ‘over-compliance’ in indigenous rights. Over-compliance, a counter-intuitive behaviour in international relations, occurs when a state’s legal or policy behaviour exceeds its treaty or international normative commitments. New Zealand and Canada both demonstrate such a pattern of indigenous rights over-compliance. A comparative case study of these two over-compliant states demonstrates that over-compliance in indigenous rights occurs when several conditions develop and intersect to propel a state towards a state-centric model of reconciliation. The article argues that Canada and New Zealand are over-compliant in indigenous rights not because they are necessarily progressive in indigenous rights but because they are actually resisting the emerging indigenous rights discourse.

Shipboard trials of an ozone-based ballast water treatment system

Legislation introduced by the United Nations International Maritime Organization (IMO) has focused primarily on standards defining successful treatments designed to remove invasive species entrained in ballast water. An earlier shipboard study found that ozone introduced into salt water ballast resulted in the formation of bromine compounds, measured as total residual oxidants (TRO) that were toxic to both bacteria and plankton. However, the diffuser system employed to deliver ozone to the ballast water tanks resulted in patchiness in TRO distribution and toxicity to entrained organisms. In this follow-up study, the shipboard diffuser system was replaced by a single Venturi-type injection system designed to deliver a more homogeneous biocide distribution. Within-tank variability in TRO levels and associated toxicity to zooplankton, phytoplankton and marine bacteria was measured via a matrix of tubes deployed to sample different locations in treated and untreated (control) tanks. Three trials were conducted aboard the oil tanker S/T Prince William Sound in the Strait of Juan de Fuca off Port Angeles, Washington State, USA, between June and December 2007. Mortalities of plankton and bacteria and oxidant concentrations were recorded for treated and untreated ballast water up to 3days following treatment, and residual toxicity beyond this period was measured by bioassay of standard test organisms. Results indicated uniform compliance with current IMO standards, but only partial compliance with other existing and pending ballast water legislation.

Influence of job seniority, hand hygiene education, and patient-to-nurse ratio on hand disinfection compliance

Hand hygiene compliance was evaluated by direct observation in 2006 and 2007. In 2007, data on characteristics such as job seniority, hand hygiene education, and patient-to-nurse ratio during direct observations were collected. A hand hygiene promotional programme was performed between the two evaluations. Univariate and multivariate analysis identified factors associated with improved hand hygiene compliance. Between 2006 and 2007, from 761 hand hygiene opportunities, overall and partial compliance improved from 44.9% to 58% (P<0.001) and from 73.5% to 88.4% (P<0.001), respectively. In 2007, improvements in hand hygiene overall or partial compliance were seen when senior healthcare workers (HCWs) were present in the clinical area under investigation (P=0.04 or P=0.08, respectively). Partial hand hygiene compliance was significantly better in 2007 after a hand hygiene educational programme had been presented (P<0.015). Similar rates of compliance were observed whatever the patient-to-nurse ratio during the observation. Multivariate analysis identified job seniority as an independent predictor of hand hygiene compliance. Our results suggest that hand hygiene compliance is influenced by education on hand hygiene and that a senior HCW could act as a role model for other HCWs. These data should be considered when developing future hygiene interventions.

State Legislative Response to Direct Democracy and the Politics of Partial Compliance

Over the last quarter-century, direct democracy has played an increasingly important role in state politics and policy. While limited attitudinal data show high levels of legislative approval for direct democracy, the most prominent piece of behavioral scholarship concludes that California legislators often attempt to steal the initiative by displacing ballot measure content and preventing full implementation. Results from an original web survey indicate that Oregon lawmakers are cautiously supportive of the initiative process and identify the conditions under which they support changes to voter-ratified bills. Case study evidence shows how legislators use their power to amend successful initiatives to clarify and improve flawed measures. I argue that institutional rules governing the initiative amendment process in Oregon allow legislators to engage in partial compliance while preserving voters core ideas. By drawing on new data sources and analyzing both behavior and attitudes, the findings shed new light on when, how, and under what conditions state government actors interfere in the initiative process and offer an important correction to the literature on legislative response to direct democracy.

Institutional Change as an Interactive Process: The Case of the Modernization of the French Cancer Centers

A good deal of strategic choice has been given back to organizations, which have become actors of their (only partial) compliance with institutional demands that they in turn contribute to shaping. The reported case of the successful modernization of the French cancer centers and their reinstatement as the leaders in their field contributes to a better understanding of the role of leadership in institutional change because it demonstrates a positional approach to institutional leadership. Cancer centers' reformers were both central, because they were placed at the intersection of several potentially interdependent organizational fields or institutional spheres, and marginal to most but not all of them. This particular position of the change-entrepreneurs, with its relational constraints and also its resources, enabled them to initiate a successful drive for the transformation of the field of cancer care and also greatly explains the particular form it took. Our analysis underscores the interactive nature of institutional change, where the motor of change simultaneously structures and is structured by the process it is driving and where the initiators of reform have to create their proper and specific combination of old and new in order to build an innovative dynamic.

Economics of Avian Influenza Management and Control in a World with Competing Agendas

This article explores the economic and related institutional issues at macro and micro levels, in different production systems and in different countries that influence avian influenza (AI) management and control. It does this by examining three groups of stakeholders with different agendas and concerns. For the "international community," the overriding driver has been and still is concern for human safety. This is reflected in the high level of contributions to emergency response programs, a strong focus on pandemic prevention and preparedness, and the pressure put on countries to develop prevention and control plans. For the most influential countries and companies in the global poultry sector, those that control the largest commercial poultry populations, trade growth and stability are major concerns. Private investment in biosecurity, reorganization of supply chains, and an increasing interest in compartments are all indications of a perceived need to secure the boundaries. Poor poultry-keeping households must focus on dayto-day livelihoods and food security, whereas small-scale commercial producers are driven by small margins and short credit cycles. Although these people operate a little differently, they have in common a necessity to focus on the short term and a limited willingness and ability to invest in their flocks. There is also very little information that we can provide either of them on financially viable ways to upgrade their enterprises. Noncompliance or partial compliance with AI regulations often makes good economic sense. Different highly pathogenic AI management and control measures are economically viable in different circumstances. The article discusses the positive and less-positive impacts created by each stakeholder perspective and the conflicts and trade-offs that can arise, and suggests some approaches for reconciling differences and thus improving AI control.

Targeted Sanctions and Individual Human Rights

Since the beginning of the 1990s, the UN security council has experimented with, developed, and refined the instrument of targeted sanctions. Targeted sanctions were first introduced in 1992 to isolate and pressure the political leadership of Libya to turn over individuals suspected of involvement in the attacks on Pan Am and UTA. They were developed and refined with the financial targeting of the military leadership of the Raoul Cedras regime in 1994, following its overthrow of the democratically elected government in Haiti. The UN's move to targeted sanctions was complete following the full realization of the humanitarian crisis caused by the imposition of comprehensive sanctions against Iraq in the mid- to late 1990s (and the inability of the oil-for-food program to relieve adequately the human suffering involved). As a result of the debacle caused by the imposition of comprehensive sanctions against Iraq, UN sanctions today are targeted sanctions.Sanctions can be targeted in a number of different ways - against an individual, against a corporate entity (such as a firm or political party), against a sector of an economy (an arms embargo, aviation ban, or a ban on the trade in high-value commodities like diamonds, oil, or timber), or against a single region of a country (as in the Democratic Republic of the Congo). They can be used for a variety of different purposes, from the pursuit of individuals for legal prosecution to efforts to halt massive human rights violations, to enforce the terms of peace agreements, to counter the financing of terrorism, orto prevent or delay the proliferation of weapons of mass destruction.There are both theoretical and practical advantages to the use of targeted sanctions, particularly when they are compared with the bluntness and relatively indiscriminate nature of comprehensive sanctions. In contrast to comprehensive sanctions, targeted sanctions can be applied gradually, combined with positive incentives, and relaxed more readily in the case of partial compliance by the targets of sanctions. There is an all or nothing character to comprehensive sanctions, and any relaxation or adaptation is often interpreted as a weakening of political resolve among the sanctioning parties. If properly targeted and implemented, targeted sanctions do not penalize an entire population for actions taken by an unrepresentative (and often unelected) elite. They can relieve the sanctions instrument of some, but not necessarily all, of its negative humanitarian costs.With the unusually rapid development of the regime to counter the financing of terrorism after 2001, with its national legal harmonization, parallel reporting requirements, and institutionalization within financial institutions, the potential effectiveness of multilateral targeted sanctions measures has been significantly enhanced.1 As a result, assuming a consensus can be maintained among the permanent five members of the UN security council, the application of targeted financial sanctions is likely to be more common, and possibly more effective, in the future.Despite these and other advantages associated with targeted sanctions, there is one issue that has undermined the instrument - the way in which targeted sanctions can violate individual human rights. The UN is a profoundly state-centric institution, and the UN security council was accustomed to the idea of member states acting collectively to impose a sanction on another member state. With the move to targeted sanctions, however, the security council moved from imposing sanctions against states to imposing sanctions against individuals, groups, and corporate entities. Ironically, this move was undertaken in the name of protecting the human rights of a larger population.When targeted sanctions were first introduced in the early 1990s, the rights of those individuals targeted, typically sovereign heads of state and/ or their key political supporters, were not of primary concern. …

Denoising forced‐choice detection data

Observers in a two-alternative forced-choice (2AFC) detection task face the need to produce a response at random (a guess) on trials in which neither presentation appeared to display a stimulus. Observers could alternatively be instructed to use a 'guess' key on those trials, a key that would produce a random guess and would also record the resultant correct or wrong response as emanating from a computer-generated guess. A simulation study shows that 'denoising' 2AFC data with information regarding which responses are a result of guesses yields estimates of detection threshold and spread of the psychometric function that are far more precise than those obtained in the absence of this information, and parallel the precision of estimates obtained with yes-no tasks running for the same number of trials. Simulations also show that partial compliance with the instructions to use the 'guess' key reduces the quality of the estimates, which nevertheless continue to be more precise than those obtained from conventional 2AFC data if the observers are still moderately compliant. An empirical study testing the validity of simulation results showed that denoised 2AFC estimates of spread were clearly superior to conventional 2AFC estimates and similar to yes-no estimates, but variations in threshold across observers and across sessions hid the benefits of denoising for threshold estimation. The empirical study also proved the feasibility of using a 'guess' key in addition to the conventional response keys defined in 2AFC tasks.

Partial Compliance as Determined From Plasma Levels of Sertraline and Its Metabolite in Depressed Patients in Primary Care

Partial Compliance as Determined From Plasma Levels of Sertraline and Its Metabolite in Depressed Patients in Primary Care

The Invisible Hand in Legal Theory

Theorists have offered invisible-hand justifications for a range of legal institutions, including the separation of powers, free speech, the adversary system of litigation, criminal procedure, the common law, and property rights. These arguments are largely localized, with few comparisons across contexts and no general account of how invisible-hand justifications work. This essay has two aims. The first is to identify general conditions under which an invisible-hand justification will succeed. The second is to identify several theoretical dilemmas that arise from the structure of invisible-hand justifications and that cut across local contexts. These are the dilemma of norms, which arises because norms of truth-seeking, ethical action or altruism can both promote and undermine the workings of the invisible hand; the dilemma of second best, which arises because partial compliance with the conditions for an invisible-hand justification can produce the worst of all possible worlds; and the dilemma of verification, which arises where theorists claim that an invisible-hand process functions as a Hayekian discovery procedure -- a claim that is empirical but pragmatically unverifiable.

Comparative evaluation of the efficiency of a series of commercial antioxidants studied by kinetic modeling in a liquid phase and during the melt processing of different polyethylenes

AbstractAn antioxidant response in condensed polymeric environments is often ambiguous and may vary strongly depending on the nature of the polymer and the conditions of polymer storage, processing, and use. The impact of polymeric environments during melt processing on the intrinsic efficiency of a set of commercial antioxidants was studied. The antioxidative activity of primary antioxidants Lowinox CPL, Lowinox 22IB46, Naugard 445, hydroxylamine Genox EP, and secondary phosphite Weston TNPP were determined by using two versions of the model reaction of cumene initiated (2,2′‐azobisisobutyronitrile, AIBN, and cumyl hydroperoxide, ROOH) oxidation. The melt stabilizing efficiency of the antioxidants was also studied during multipass extrusion testing in HDPE (Phillipstype), metallocene LLDPE, and (Ziegler‐Natta) LLDPE. The kinetic measurements showed that each of the three functional hydroxyl groups of Lowinox CPL is consumed in the model reaction (version 1) with the same high inhibition rate constant (k7), whereas the two functional groups of Lowinox 22IB46 have different activity stipulated by hydrogen bonding between the hydroxyls. All the primary stabilizers involved afforded transformation products with additional antioxidative activity. For phenolic Lowinox CPL and amine Naugard 445, these products exhibited lower inhibition rate constants than that of the main functionality, but for Lowinox 22IB46, the discrepancy was not observed. Genox EP revealed three inhibition centers with different rate constants which, however, have low values of the inhibition coefficients (f). This effect is presumably due to the versatility of the inhibition pathways for the antioxidant and its intermediates, including the path of active interception of cumylalkyl (R•) radicals. The secondary stabilizer Weston TNPP, tested by means of the second version of the model system, along with the expected decomposition of hydroperoxide appeared to be an effective radical scavenger. Kinetic parameters of the antioxidizing activity of the stabilizers – inhibition rate constants, coefficients of the oxidation chain termination, and total antioxidative activity {A = ∑[k7(i) (fn[InH])(i)]} — were determined for each functional group and for the whole antioxidant molecule. The phenolic stabilizers manifested powerful antioxidative activity. Their strongest functional groups have very high inhibition rate constant values: (log k7) = 5.4 ± 0.15 (Lowinox 22IB46) and 5.2 ± 0.1 M−1s−1 (Lowinox CPL). In terms of the total inhibiting activity in the liquid system the antioxidants can be ordered as: Lowinox CPL &gt; Lowinox 22IB46 &gt; Naugard 445 &gt; Genox EP &gt; Weston TNPP. The effect of stabilizers during multipass extrusion experiments was assessed via melt flow rate and yellowness index measurements conducted as a function of the number of passes. Phenolic antioxidants and Genox EP significantly improved the melt stability of the polyethylenes in terms of melt viscosity retention and in partial compliance with the data from kinetic modeling measurements. According to the melt stabilizing efficiency data, the antioxidants can be arranged as: Lowinox 22IB46 &gt; Lowinox CPL &gt; Genox EP &gt; Naugard 445 &gt; Weston TNPP. The Lowinox 22IB46 with relatively lower molecular weight exhibited the best results among the primary stabilizers because of the unrestricted molecular dynamics in the viscous‐flow state of the polymer. Yellowness index measurements made after multiple extruder passes indicated that Weston TNPP effectively decreased the color development caused by the phenolic antioxidants. Genox EP displayed high efficiency as an antioxidant and melt‐processing stabilizer and additionally provided good color protection. Generally, we received a good correlation between the activity of the antioxidants in the model system and their melt stabilization performance in HDPE, metallocene LLDPE, and LLDPE. The model reaction of cumene‐initiated oxidation has demonstrated excellent applicability as an effective tool for preliminary quantitative assessment of antioxidant radical‐scavenging efficiency. J. VINYL ADDIT. TECHNOL., 2010. © 2009 Society of Plastics Engineers

Fake, partial and imposed compliance: the limits of the EU's normative power in the Western Balkans

This article examines the EU's external power through the prism of perceptions by non-EU countries of the aims of EU's foreign policy, as shown in the Western Balkans. It argues that the EU's policy in the Western Balkans lacks a strong normative justification, which affects the degree of compliance with the EU's demands in areas related to state sovereignty. The perceived lack of legitimacy opens up political space for domestic actors to contest the positions taken by the EU on normative grounds. The Western Balkan countries have responded by giving preference to internal sources of legitimacy and asserting domestic reasons for fake compliance, partial compliance or non-compliance with the EU's conditions, with the latter provoking imposed compliance. The article links the enlargement literature with the study of EU foreign policy by offering a new approach to analysing the normative and strategic dimensions of the EU's external power.

Infection control knowledge and practices related to HIV among Nigerian dentists

Many diseases including HIV/AIDS can be transmitted in the dental setting when effective infection control procedures are ignored. The aim of this study, therefore, was to evaluate the infection control knowledge and practices of Nigerian dentists in the era of HIV/AIDS. Information on knowledge of transmission of HIV, occupational vulnerability, infection control practices, and opinion on adequacy of infection control facilities were gathered from dentists through a self-administered questionnaire. Knowledge was assessed on a total score of 20 questions. Only 3.6% of the dentists had poor knowledge. Younger males and dentists working in teaching hospitals had significantly better knowledge than their counterparts. While 40.8% believed HIV could be transmitted through saliva, only 43.2% knew it could be transmitted through the conjunctiva. Most (93.2%) wore gloves routinely and the most common barrier to glove use was non-availability. Most (79.2%) used autoclaves for sterilization; however, chemical disinfectants and boiling were also used. The majority (72.4%) believed the facilities for infection control in their centres were inadequate. Close to half of the respondents (47.6%; n = 118) rated the occupational risk of becoming infected with HIV as high. The results of this study have shown that while the level of knowledge of the dentists was generally acceptable, there were still some misconceptions on the transmission and occupational vulnerability of HIV. It also indicates only partial compliance with recommended infection control procedures among Nigerian dentists as a result of inadequate supplies.

Partial Adherence to Antipsychotic Medication Impacts the Course of Illness in Patients With Schizophrenia

Although many clinicians acknowledge the occurrence of adherence problems with medication regimens among patients with schizophrenia, the problem shows no sign of improving. This may be because, in thinking about the issue, clinicians have tended to focus on patients who openly refuse or repeatedly discontinue treatment. While this description applies to only a minority of patients, in our experience, full adherence is rare; most patients are only partially adherent at best. This article examines the issue of adherence behavior in schizophrenia, focusing on the impact of partial adherence on treatment outcomes, particularly early in the course of illness. We also review potential strategies for managing the problem. Original research and review articles published in English from 1980 to 2008 were identified using the PubMed database, with the search terms schizophrenia or psychosis combined with compliance, noncompliance, partial compliance, adherence, nonadherence, or partial adherence. Articles were selected by the authors on the basis of the hypotheses and/or data described. Failure to adhere to medication as prescribed can have a major impact on the course of illness and treatment outcomes in patients with schizophrenia. Even relatively short gaps in medication coverage increase the risk of relapse. Problems with adherence are common early in the course of illness, when the consequences of relapse can be particularly devastating. Clinicians in primary care and psychiatric settings need to be vigilant for signs of adherence problems among their patients and to act when necessary to prevent or alleviate the consequences of inadequate medication cover. Relapse prevention strategies, particularly for patients with early psychosis, should include ensuring that medication lapses are minimized or eliminated.

Lessons learned from implementation of a demonstration program to reduce the burden of anemia and hookworm in women in Yen Bai Province, Viet Nam

BackgroundIron deficiency, anemia and hookworm disease are important public health problems for women of reproductive age living in developing countries and affect the health of newborns and infants. Iron supplementation and deworming treatment are effective in addressing these problems in both pregnant and non-pregnant women. Daily iron supplementation and deworming after the first trimester is recommended for pregnant women although these programs usually do not operate efficiently or effectively. Weekly iron-folic acid supplementation and regular deworming for non-pregnant women may be a viable approach for improving iron status and preventing anemia during the reproductive years. Addressing these diseases at a population level before women become pregnant could significantly improve women's health before and during pregnancy, as well as their infants' growth and development.Methods and ResultsThis paper describes the major processes undertaken in a demonstration intervention of preventive weekly iron-folic acid supplementation with regular deworming for all 52,000 women aged 15–45 years in two districts of Yen Bai province, in northern Viet Nam. The intervention strategy included extensive consultation with community leaders and village, commune, district and provincial health staff, and training for village health workers. Distribution of the drugs was integrated with the existing health service infrastructure and the village health workers were the direct point of contact with women. Iron-folic acid tablets and deworming treatment were provided free of charge from May 2006. An independent Vietnamese NGO was commissioned to evaluate compliance and identify potential problems. The program resulted in effective distribution of iron-folic acid tablets and deworming treatment to all villages in the target districts, with full or partial compliance of 85%.ConclusionTraining for health staff, the strong commitment of all partners and the use of appropriate educational materials led to broad support for weekly iron-folic acid supplementation and high participation in the regular deworming days. In March 2008 the program was expanded to all districts in the province, a target population of approximately 250,000 WRA, and management was handed over to provincial authorities.

Public Schools Versus Private Schools: Causal Inference With Partial Compliance

An approach to handle partial compliance behavior using principal stratification is presented and applied to a subset of the longitudinal data from the New York City School Choice Scholarship Program, a randomized experiment designed to assess the effects of private schools versus public schools on academic achievement. The initial analysis suggests an interesting relationship between compliance with the offer and academic achievement, including a possible “beneficial rejected offer” effect and a possible “adjustment hardship” effect. These results seem to favor public schools in the sense they suggest that the collection of students who would attend private school when offered the scholarship but attend public school without the offer had a lower average posttest score if they attended private school than if they attended public school. This case study illustrates the strengths of principal stratification: the explicit examination of specific assumptions and directly interpretable results with possible policy implications.

A Ten-Year Analysis of Venous Thromboembolism on the Surgical Service: The Effect of Practice Guidelines for Prophylaxis

Conclusion: High compliance with the American College of Chest Physicians (ACCP) Guidelines for Prophylaxis for Venous Thromboembolism has not resulted in a decrease in symptomatic venous thromboembolism (VTE) in surgical patients. Summary: The ACCP has published its Guidelines for Prophylaxis for Venous Thromboembolism about every 3 years since 1995, with the most recent version published in August 2008. There is currently intense interest in proving compliance with these guidelines to reduce the incidence of VTE in hospitalized patients. The effect on surgical patients of compliance or noncompliance with prophylaxis guidelines for VTE on morbidity and mortality is not known. In this series the authors sought to determine whether a decrease occurred in symptomatic VTE on their general surgical, vascular surgical, and trauma services since initial publication of the VTE prophylaxis guidelines. Care of patients with symptomatic VTE was analyzed for compliance or noncompliance with the guidelines, and reasons for noncompliance. The effect of VTE on short-term morbidity and mortality was also analyzed. The study used records of patients with symptomatic VTE on the general surgical, vascular surgical, and trauma surgical services at the University of Vermont for a 10-year period since publication of the 1995 ACCP guidelines. Morbidity of each episode of VTE was weighted based on likelihood of short-term mortality and long-term morbidity. There were 37,615 patients on the combined surgical services during the 10-year period of analysis, and a symptomatic VTE developed in 172 (0.46%). The incidence gradually increased during the years of the study. Partial or complete compliance with the guidelines was achieved in 84% of the patients. Of the VTEs that occurred, 37% were considered to be preventable, whereas 63% were judged nonpreventable based on full compliance with the guidelines or partial compliance associated with a documented contraindication to prophylaxis. Comment: The authors report one of the highest rates of compliance with ACCP guidelines for prophylaxis of VTE. Despite this, their rate of symptomatic VTE has increased during the 10-year period of the study. A number of factors may play a role in this increased incidence of symptomatic VTE. These include more aggressive pursuit of the diagnosis of pulmonary embolism or deep venous thrombosis and an increase in the comorbidity burden of patients undergoing surgical treatment. There is also the possibility that the prophylactic measures suggested by the guidelines are insufficient to prevent VTE in some high-risk patients.

Comparison of two methods for measuring compliance with IFRS mandatory disclosure requirements

PurposeThe purpose of this research is to highlight the differences, and implications of any differences, between two approaches to measuring compliance with International Financial Reporting Standards (IFRS) mandatory disclosure requirements: the commonly used “dichotomous” approach; and the alternative, but rarely used, partial compliance unweighted approach. The former gives equal weight to the individual items required to be disclosed by all standards. The latter assumes that each standard is of equal importance and consequently gives equal weight to each standard.Design/methodology/approachThe paper employs both methods on a sample of companies. We then compare the results deriving from the application of the two methods and statistically test their differences.FindingsIt is found that the two methods produce significantly different overall and relative (i.e. ranking order) compliance scores.Practical implicationsThis paper should alert researchers to the implications of using either method. Additionally, it highlights the need for academics and/or practitioners to be cautious when interpreting the findings of prior studies on compliance with IFRS mandatory disclosure requirements. Since the two methods produce significantly different compliance scores, findings regarding the variables associated with compliance may differ, depending on the disclosure index method followed. The paper suggests that simultaneous application of both methods would result in more robust findings in future research.Originality/valueThis is the first study to compare the results produced by applying both methods and statistically test their differences. The research methods explored are in particular relevant for policy‐oriented, international accounting research.

A 10-year analysis of venous thromboembolism on the surgical service: The effect of practice guidelines for prophylaxis

There is a national effort to decrease the incidence of venous thromboembolism (VTE) in surgical patients by encouraging compliance with established guidelines for prophylaxis. Reported compliance with these guidelines has been poor. The outcome of noncompliance in terms of morbidity and mortality in surgical patients is unknown. We sought to determine if there has been a decrease in the incidence of symptomatic VTE since implementation of the guidelines and whether there has been compliance with the guidelines in individual patients; we also analyzed the outcome of a cohort with VTE. We reviewed the records of all patients with symptomatic VTE on 3 surgery services over the 10-year period since initial publication of the guidelines. We determined in each patient whether there was compliance with the guidelines. We weighted the morbidity of each episode of VTE based on the likelihood of short-term mortality and long-term morbidity to determine the disease burden. Of 37,615 patients, 172 developed a VTE (0.46%), and the incidence increased gradually over the years of the study. There was partial or complete compliance with the guidelines in 84% of the patients, but 37% of the VTEs were considered to be preventable. The disease burden was greatest in the higher-risk patients-there were 20 deaths (6%), 4 of which were caused by a pulmonary embolus. Despite one of the highest published rates of compliance with the guidelines for prophylaxis, the rate of symptomatic VTE is increasing.

Incorporating adherence into health economic modelling of osteoporosis

Osteoporosis medications are seldom taken according to the recommendations of health-care providers. A theoretical model was constructed to investigate the variables of drug adherence that affect the cost-effectiveness of drugs, using osteoporosis treatment as a model. Important variables were the magnitude of drug effect, drug price, and fracture-related costs. Adherence to anti-fracture medication is far from optimal and poses a challenge in osteoporosis management. The objectives of this study were to develop a model that could address adherence and identify the important drivers of cost-effectiveness. An individual state transition model was constructed to compare two theoretical medications, one of which conferred optimal adherence and was 50% more costly. Adherence was divided into persistence and compliance. Partial compliance was assumed to be associated with a 20% loss of anti-fracture effect. Non-persistent patients had an offset time as long as their time on medication, to a maximum of 5 years. The potentially important drivers of cost-effectiveness include reduced drug effectiveness due to poor compliance, offset time, fracture risk, anti-fracture drug effect, and drug price. Optimal adherence was associated with fewer osteoporotic fractures, and the impact was more evident among those with prior fractures. However, the health benefits of adherence were often partially offset by increased intervention costs associated with the improved drug-taking behaviour. High adherence is likely to be associated with added value for health-care systems, but should be used with care as a central health economic argument.