Pre-entry Period Research Articles

A systematic review of family and social relationships: implications for sex trafficking recruitment and victimisation

Sex trafficking is a current, severe and intense global phenomenon. Many studies have made substantial efforts to map the routes and relations between countries of origin, transit, destination, and the methods of recruitment and retention. With a focus on the role of social relationships, for this article, we conducted a literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to provide further scientific evidence of the elements and processes that push victims – primarily women and girls – into sex trafficking. The findings show that family, intimate relationships, friendships and acquaintances play a critical role in the pre-entry period before sex trafficking. Among these, family violence, abandonment and abuse emerge as severe risk factors, as well as the role of fraudulent intimate relationships. We also include additional social and individual risk factors that, together with the role of family and social relationships, have impacts on potential victims, increasing the likelihood of sex trafficking.

Association of entry into hospice or palliative care consultation during acute care hospitalization with subsequent antibiotic utilization

ObjectiveWe aimed to estimate antibiotic use during the last 6 months of life for hospitalized patients under hospice or palliative care and identify potential targets (i.e. time points) for antibiotic stewardship during the end-of-life period. MethodsWe conducted a retrospective cohort study of nationwide Veterans Affairs (VA) patients who died between January 1, 2014 and December 31, 2019 and who had been hospitalized within 6 months prior to death. Data from the VA's integrated electronic medical record were collected, including demographics, comorbid conditions, and duration of inpatient antibiotics administered, along with outpatient antibiotics dispensed. A propensity score–matched cohort analysis was conducted to compare antibiotic use between hospitalized patients placed into palliative care or hospice matched to hospitalized patients not receiving palliative care or hospice. ResultsThere were 9808 and 40 796 propensity score–matched patient pairs in the hospice and palliative care groups, respectively. Within 14 days of placement or consultation, 41% (4040/9808) of hospice patients and 48% (19 735/40 796) of palliative care patients received at least one antibiotic, while 25% (2420/9808) matched nonhospice and 27% (10 991/40 796) matched nonpalliative care patients received antibiotics. Entry into hospice was independently associated with a 12% absolute increase in antibiotic prescribing, and entry into palliative care was associated with a 17% absolute increase during the 14 days post-entry vs. pre-entry period. DiscussionWe observed that patients receiving end-of-life care had high levels of antibiotic exposure across this VA population, particularly during admissions when they received hospice or palliative care consultation.

Knowledge and Practice of Farmers on Pesticide Pre-Harvest Interval and Pre-Entry Period and Personal Protective Equipment Use in Vegetable Growing Area of South Gondar, Ethiopia

This study aimed to assess the personal protective equipment use, understanding of farmers on pre-harvest interval, and pre-entry period for pesticides on different vegetables after pesticide application in south Gondar, Ethiopia. Sixty-three farmers were randomly selected and interviewed using a questionnaire. The majority of the farmers were not aware of the negative effects of pesticides on their health and the environment if not well handled. The farmers did not have awareness about the pesticide pre-harvest interval period and they did not read the instruction. Similarly, none of the respondents, followed the instruction of the manufacturer (reentry time specified on pesticide label) to reenter the sprayed field. Furthermore, farmers in the study area do have not enough awareness or they are careless regarding PPE use. Unavailability, inconvenience PPE wearing (e.g. mask affect breath properly), misperception about pesticide long term health effect and cost of personal protective equipment were raised as major causes for different farmers as factors behind their pesticide handling without personal protective equipment. It is recommended that If farmers can not to read the period of reentry on the pesticide container label, it is advised to wait at least 72 hours after the last application. Keywords: pesticide Pre-harvest interval period, re-entry time, personal protective equipment DOI: 10.7176/JBAH/11-23-02 Publication date: December 31 st 2021

Exports, Productivity and Factor Intensity: Evidence for Brazilian Firms

Based on the theory of heterogeneous firms, participation in the international market leads to changes in performance and efficiency gains at the firm level. This article uses microdata at the level of firms of the Brazilian manufacturing industry (2007-2014) to investigate the impacts of exporting on the productivity trajectory and intensity of factors. The empirical strategy, via Differences in Differences, explores the fact that firms enter at different moments into the external market, generating a variation in the period and in the intensity of the permanence. The results evidence learning effects and the use of comparative advantages so that firms that start exporting have an immediate productivity growth of around 5% and an instantaneous decrease in capital intensity (2.3%) in relation to the pre-entry period compared to non-exporting firms in the comparison group. The permanence on the activity intensifies the effects, so that, after four periods, the growth (reduction) in productivity (intensity of capital) is, approximately, 12% (15%). Among the sources of heterogeneities investigated, the magnitude of effects varies in dimensions such as size, technological intensity and pre-entry levels of productivity and capital intensity.

Medicare Spending after 3 Years of the Medicare Shared Savings Program

BackgroundHealth care providers who participate as an accountable care organization (ACO) in the voluntary Medicare Shared Savings Program (MSSP) have incentives to lower spending for Medicare patients while achieving high performance on a set of quality measures. Little is known about the extent to which early savings achieved by ACOs in the program have grown and been replicated by ACOs that entered the program in later years. ACOs that are physician groups have stronger incentives to lower spending than hospital-integrated ACOs.MethodsUsing fee-for-service Medicare claims from 2009 through 2015, we performed difference-in-differences analyses to compare changes in Medicare spending for patients in ACOs before and after entry into the MSSP with concurrent changes in spending for local patients served by providers not participating in the MSSP (control group). We estimated differential changes (i.e., the between-group difference in the change from the pre-entry period) separately for hospital-integrated ACOs and physician-group ACOs that entered the MSSP in 2012, 2013, or 2014.ResultsMSSP participation was associated with differential spending reductions in physician-group ACOs. These reductions grew with longer participation in the program and were significantly greater than the reductions in hospital-integrated ACOs. By 2015, the mean differential change in per-patient Medicare spending was −$474 (−4.9% of the pre-entry mean, P<0.001) for physician-group ACOs that entered in 2012, −$342 (−3.5% of the pre-entry mean, P<0.001) for those that entered in 2013, and −$156 (−1.6% of the pre-entry mean, P=0.009) for those that entered in 2014. The corresponding differential changes for hospital-integrated ACOs were −$169 (P=0.005), −$18 (P=0.78), and $88 (P=0.14), which were significantly lower than for physician-group ACOs (P<0.001). Spending reductions in physician-group ACOs constituted a net savings to Medicare of $256.4 million in 2015, whereas spending reductions in hospital-integrated ACOs were offset by bonus payments.ConclusionsAfter 3 years of the MSSP, participation in shared-savings contracts by physician groups was associated with savings for Medicare that grew over the study period, whereas hospital-integrated ACOs did not produce savings (on average) during the same period. (Funded by the National Institute on Aging.)

Competition in Swedish passenger railway: Entry in an open access market and its effect on prices

The Swedish market for passenger railway services has been open to competition since the year 2010. Although minor entries have been made since this date, the incumbent SJ only faced substantial competition on the tracks when MTR entered the Stockholm-Gothenburg line in March 2015. Using unique Swedish ticket price data from operators' websites, this paper investigates what effects this entry has had on market prices.The results show that the incumbent's prices decreased by 12.6 percent on average between March 2015 and June 2016. The price level of the competitor is well below the average price that was offered in the pre-entry period. Further, the largest price reduction, in percentage terms, was found on tickets booked 13 days before departure date. Finally, the observed price decrease in the paper is most likely at a short-run equilibrium, or an ongoing process, implying that prices might adjust further in the long-run.

Advertising Response to New Entry

Empirical studies on advertising outlays report that incumbent firms change their advertising strategies in response to a new entry. While some incumbents reduce their advertising expenditures, others increase them in comparison to the pre-entry period. Existing literature on strategic advertising in entry games is mostly focused on entry deterrence, meanwhile no theoretical foundation is found in this literature to explain what determines a change in the advertising strategies in the case of entry accommodation. The present work considers four types of advertising and builds a model that examines how accommodating incumbents decide on advertising. The paper also provides results on how advertising is related to the size of the entry. Particularly, informative advertising and advertising enhancing product differentiation allow greater entry, while complementary and business-stealing advertising result in fewer entries since they reduce residual demand for potential entrants. Depending on whether post-entry competition variables are strategic substitutes or strategic complements, incumbent firms may increase or reduce their advertising outlays in response to new entries.

Research Note—Are Store-Brand Buyers Store Loyal? An Empirical Investigation

This paper tests the notion of whether high preference for store brands leads to higher store loyalty. Our work differs from the earlier empirical evidence on this issue in how we define and measure the two key constructs: store-brand loyalty and store loyalty. To measure store-brand preference, we develop a multicategory brand choice to elicit the basic latent tendency for a household to buy store brands, while controlling for other factors such as price sensitivity. The household-specific measures on store-brand preference and price sensitivity (along with other control variables) are then used to assess household store loyalty in the context of entry by a Wal-Mart supercenter in the market. Results show that store-brand buying behavior is driven by households' underlying “value trait” over and beyond what is captured by price sensitivity alone. In addition, these value-oriented households, which show high preference for store brands in the pre-entry period, shift a significantly higher level of their expenditures to Wal-Mart. These results are in contradiction to the conventional wisdom that high store-brand patronage is associated with a higher level of store loyalty. However, this finding comes with the caveat that the entrant analyzed in the paper has a well-defined “value” positioning and might not hold if the new entrant does not dominate the incumbent in the value proposition. Implications for supermarket managers in a more general context are discussed.

Use of Bayesian Net Benefit Regression Model to Examine the Impact of Generic Drug Entry on the Cost Effectiveness of Selective Serotonin Reuptake Inhibitors in Elderly Depressed Patients

Since their invention in the late 1980s and early 1990s, selective serotonin reuptake inhibitors (SSRIs) have become the primary form of pharmaceutical treatment for depression. As the patents of several top-selling SSRIs have expired or are soon to be expired, the SSRI market is expected to witness an increasing share of generic SSRIs. We explored the impact of generic drug entry on the cost effectiveness of SSRIs. Using Medicare MarketScan claims data, we compared the cost effectiveness of sertraline, citalopram, escitalopram and fluoxetine with paroxetine in elderly depressed patients, before and after the entry of generic paroxetine. We followed users of SSRIs for 6 months, starting from the date of their first prescription of an SSRI. For each patient, we measured costs (C(i)) as total medical costs and quantified effectiveness (E(i)) as the avoidance of treatment failure, which was defined as having a break exceeding 45 days in the use of antidepressants. We then calculated individual net benefit as lambda x E(i)- C(i) and employed both net benefit and Bayesian net benefit regression models to examine the impact of generic paroxetine on the cost effectiveness of the other four SSRIs compared with paroxetine, while controlling for patients' sociodemographic characteristics, co-morbidities and patterns of medication switch. Deterministic analysis showed that paroxetine was dominated by most SSRIs prior to the availability of generic paroxetine, and that, after the entry of generic paroxetine, citalopram and escitalopram were dominated by paroxetine. Net benefit regression analysis found that, at a number of lambda values ($US1000, $US5000 and $US10,000), sertraline and escitalopram were more cost effective than paroxetine in the pre-generic-entry period but not in the post-entry period, although the difference in net benefit between the two SSRIs and paroxetine was not statistically significant in both periods. The Bayesian net benefit regression analysis reached similar conclusions. At lambda = $US5000, the probability that sertraline, citalopram, escitalopram or fluoxetine was more cost effective than paroxetine was 96.7%, 77.6%, 96.3% and 97.0%, respectively, in the pre-entry period in the pooled analysis. These probabilities reduced to 36.7%, 62.7%, 33.0% and 60.1%, respectively, in the post-entry period. The probabilities became 94.1%, 71.9%, 89.1% and 92.1% in analysis using the pre-entry data as a prior to update the post-entry data rather than using the pooled data. Using generic drug entry as an example, our study demonstrated the importance of including the economic life cycle of pharmaceuticals in cost-effectiveness analyses. Additionally, the proposed Bayesian framework not only preserves the advantages of the net benefit regression framework, but more importantly, it introduces the possibility of conducting probabilistic cost-effectiveness analyses with claims data.

Price Wars Caused by Switching Costs

In many markets consumers have for example learning costs or transaction costs, of changing between functionally equivalent brands of a product, or of using any brand for the first time. We analyse a four-period complete-information model of a market with switching costs in which new entry occurs after the second period. The new entry results, in equilibrium, in a price war. That is, the new entrants' prices are higher in the post-entry period than in the entry period, and the incumbent's price falls in either the pre-entry period or the entry period and subsequently rises. We can interpret the incumbent's lowering its price in the pre-entry period as limit-pricing behaviour. We distinguish between two types of price war that can occur, and show how the type or mixture of types that arises depends on the size of switching costs.

Further lessons from the EC/IC bypass study

Further study of the data from the EC/IC Bypass Trial has been pursued for three specific goals. Firstly, the issue of possible distortion of the conclusions by virtue of noncompliance in the centers with the obligation of randomization has been examined very closely. The thrice-yearly neurosurgical reports from the participating neurosurgeons in the 52 centers which entered 1191 patients (86.5% of the total study), reported that 1249 patients received bypass surgery outside the trial. Of these, 925 were medically ineligible by our protocol requirement, 258 refused to be placed in a trial which required randomization, and a mere 66 were deviated from the trial by a deliberate decision of the participating neurologists or neurosurgeons. The ratio of randomized and eligible to non-randomized and operated is 1191 : 1294, very close to 1 : 1. By contrast in the coronary artery study (CASS) this ratio, favoring non-randomization, was 25 : 1. Our participants in these key centers exhibited a disciplined approach to their commitments to the trial and they failed to randomize willing and eligible subjects on the average of 1.3 times per center every five years.Secondly, a number of prognostic studies were carried out in the medically-treated groups to clarify the impact of certain important variables on the outcome. The differential outcome of the radiological subgroups of TIA and minor stroke patients were examined. In the medically-treated patients, fatal and non-fatal strokes occurred within 18 months in 20% of those with ICA occlusion and continuing symptoms after the diagnostic arteriogram, and in 18% of the patients with intracranial carotid stenosis. By contrast patients with ICA occlusion without new symptoms and the patients with middle cerebral artery stenosis and occlusion had fatal and non-fatal 18 months stroke rates of 14%. At 5 years the patients with ICA occlusion and new symptoms after arteriographic confirmation, and those with ICA intracranial stenosis patients had 35% rates of fatal and non-fatal stroke; the rates for those with ICA occlusion without new symptoms and for MCA stenosis both stand at 30% and for MCA occlusion at 20%.Patients who entered the trial with minor stroke had a minimally worse prognosis than those who entered with TIA. The occurrence of recent events (less than 30 days prerandomization) portend greater risk of stroke than later events (30-91 days). Frequency of TIA in the 3 months prior to entry made a substantial difference, with the worst outlook for those having 3 or more compared with those having 2 or less ischemic events in this time-period. Except for those patients entering with recent stroke and having 2 or less TIA's in the 3 months pre-entry period, the highest rate of stroke and fatal stroke was in the 12 weeks period after entry.Thirdly, further intensive search has been made for possible subgroups which might benefit in strokeprevention from bypass surgery. None have surfaced including those with recent or frequent ischemic events, and in those without evidence of good collateral supply in the presence of occluded or stenosed MCA or similar occlusive or stenotic lesions of the ICA. It should be re-emphasized that this was not atrial to validate or deny benefit in ischemic recovery. Such a trial has never been conducted.