US Practice Research Articles

The Dividend Policy of High-Tech Companies in the Digital Economy

The subject of the research is the improvement of the dividend policy of high-tech companies. The purpose of the work was to develop recommendations for improving the dividend policy to ensure the stable development of companies and increase their value based on comparison of the US and Russian practices. The performance indices of the company’s dividend policy are calculated. Recommendations on improving the dividend policy are given. It is concluded that US companies do not have a positive correlation between the market price of a share and the dividend per share, and the dividends payout ratio has a tendency to decreasing in comparison with the share buyback ratio, which is associated with a high level of return on equity. The borrowed capital costs US companies cheaper, so they actively pursue the buyback policy rather than paying cash dividends. Russian companies that have worse ROE indicators are recommended to reduce their equity by buying back their own shares and reduce the cash dividend payment base.

Revisiting ‘awareness contexts’ in the 21st century hospital: How fragmented and specialized care shape patients' Awareness of Dying

In 1965, Glaser and Strauss (1965) offered the concept of “awareness contexts” to explain what patients in hospitals do or don't know about their death trajectories. Awareness ranges from closed (where patients are completely unaware and family and providers protect “the secret”) to open (where all parties communicate openly and honestly). While closed awareness was the norm in 1960s, open awareness is now considered standard practice in US, a reflection of mounting evidence that patients, families, and providers benefit from clear and honest communication at end of life (Seale et al., 1997; Wright et al., 2008). Despite the known benefits of open awareness, many terminal patients remain unaware or confused about their prognoses (Chen et al., 2017). This paper asks why, in an era of open awareness, are patients and families uncertain about dying? To answer this question, we focus on an aspect of Glaser and Strauss's theory that remains relatively understudied by researchers, namely the role of institutional and organizational realities in shaping awareness contexts. Based on interviews with 43 family members of deceased patients who died at General Hospital in the Midwestern US, we argue that two related conditions in hospitals—the increased specialization of medical professionals and the fragmentation of patient care—serve as important context for the death awareness of patients and families.

Chronic comorbidities and cervical cancer screening and adherence among US-born and foreign-born women

Whereas chronic conditions and foreign-birth have an inverse relationship with cervical cancer screening, the combined effect of these factors on screening is unknown. This study examined the associations between chronic comorbidities and Pap screening recommendations and adherence, and whether these associations vary between foreign- and US-born women. In 2017, data from 2013 and 2015 National Health Interview Survey on women aged 21-65years (N = 20,080) were analyzed. Bivariate associations between chronic comorbidities (hypertension, diabetes, and obesity) and cervical cancer screening recommendation and adherence (screened in the last 3years) were examined using Chi-square analysis. Multivariate binary logistic regression was used to examine the association between foreign-born status and participant Pap test adherence, adjusting for physician Pap test recommendation and chronic comorbidities. Obesity, hypertension, and diabetes were positively associated with Pap screening recommendation. Hypertension and diabetes were negatively associated with screening adherence. Pap screening recommendation (60% vs. 57%, p < 0.05) and adherence (85% vs. 78%, p < 0.001) were higher among foreign-born than US-born women. After adjusting for chronic conditions, foreign-born women had significantly lower odds of receiving Pap tests compared with US-born women (OR 0.8, 95% CI 0.6-0.9). In stratified analysis, only obesity was associated with Pap testing among US-born and foreign-born women. Among foreign-born women, the association between obesity and Pap testing was attenuated after controlling for years lived in the US and citizenship. Public health intervention efforts must improve regular access to preventive care and encourage Pap screening among women diagnosed with chronic conditions. Future research should further identify additional factors driving the cervical cancer screening practices of both US- and foreign-born women with and without chronic conditions.

The AGOA as stepping stone for USA–Africa free trade agreements

PurposeThe purpose of this paper is to show how the pattern of trade relations between the USA and African countries is gradually shifting toward reciprocity. It therefore demonstrates that the African Growth and Opportunity Act (AGOA) was conceived to be a building block toward future bilateral trade agreements.Design/methodology/approachThis paper adopts a historical approach to the USA’s policy toward Africa in general and in trade matters in particular. It critically reviews the chronology of US involvement in the continent.FindingsAlthough it was designed as a preferential trade arrangement, AGOA was intended to evolve into reciprocal trade agreements. This is what the USA started doing even prior to the entry into force of the AGOA, by entering into Trade and Investment Framework Agreements with individual countries or blocs. It also transpires that the deployment comes as a response to the European Union which is already engaged in the redefinition of its own trade relations with Africa since 2004.Originality/valueThe paper is important in many respects. Not only it is a study of the US practice as preference-granting country, but it is also interested in the typology of trade agreements concluded by the USA in other regions of the world. This is important to indicate and analyze the types of provisions African countries should be expected to face when the time of entering into reciprocal binding trade treaties arrives.

What makes a biostatistician?

Biostatisticians play an important role in medical research. They are co-responsible for an appropriate and efficient study design, they are involved in monitoring the study conduct, they plan and perform the data analysis, and they are involved in interpreting and publishing the results. However, how are the biostatisticians prepared for their tasks and responsibilities? Graduate programs in biostatistics are being offered, but some practicing biostatisticians completed their studies in a mathematical or epidemiological program, or obtained their degree in subject-specific fields (such as medicine or biology). Therefore, the expertise and the competencies can vary widely between the individual biostatisticians, also depending on the application field. In this article, focusing on European and US practices, we discuss the required professional expertise for the main areas of applications in the medical field as well as the necessary soft skill competencies of a biostatistician.

Chronic Hepatitis C: Post-Cure Elastography Score Improvement

Introduction: Elastography Scores are routinely obtained in the evaluation of chronic hepatitis C pts and help play a role in choosing proper DAA regimen. Follow up of Chronic Hepatitis C pts post-cure beyond 3 months is frequently undertaken, especially in pts with elevated elastography scores suggestive of significant fibrosis. Transient Elastography scores are known to be skewed by degree of ALT elevation. Alternative US elastography techniques such as Shear-Wave Elastography (SWE) with Supersonic Imagine Aixplorer device are not as widely utilized in US practice, but is used extensively elsewhere in the world. What affect cure of hepatitis C on elastography measurements one or more years post-cure and the clincial significance of a worsened or improved scores is not clear, as well as the role of additional co-factors that may drive liver fibrosis such as DM, HTN, obesity, smoking and excessive ETOH. Methods: Retrospective chart review of all Chronic Hepatitis C pts seen in our clinic over past 3 years in whom Hepatitis C virus was cured and fu for > 1 yr has occurred with both a pre-tx SWE score and subseqeunt post cure SWE score have been obtained. Clinical data examined included age, gender, BMI, presence of DM, HTN, smoking, and ETOH use. SWE was obtained uisng a XC6-L or SC6-L probe. Q box stability index minimum of 90% required for a vaild measuremen and 3 to 10 measurements obtained from right lobe liver. If right lobe SWE was unattainable, left lobe SWE was obtained. Univariate analysis of potential factors involved in SWE worsening or mprovement was with Fishers exact test. Results: 27 Hepatitis C pts met all inclusion criteria, 9 F:18 M. Genotype was 1a in 15, 1b in 5, 2 in 2 and 3 in five. BMI 29.8+6.8, HTN 15, DM 9, ETOH 7Smoking 11. Liver Bx was obtaiend in 16 pts, SWE scores ranged from 6.9 up to 66 with mean of 20.5 Post Hep C cure, SWE improved in 22 (81%), and worsened in 5 (19%). Improved SWE scores % change ranged from a low of 5.3% up to 85% with mean improvement of 32.6%. In the 5 pts in whom SWE score worsened, 2 had insignificant changes < 1% while the remaining worsened by 5.1%, 19.1% and 115%, respectively. No factor other than Hep C cure was found to play a role in SWE improvement. Conclusion: SWE scores improve in a majority (>80%) of Hepatitis C post prolonged cure with improvements ranging from 5.3% up to 85%. The exploration of factors that drive apparent progressive liver stiffness (scarring) is ongoing and will require larger study population analysis.

US Criminal Justice Policy and Practice in the Twenty‐First Century: Toward the End of Mass Incarceration?

Although the wisdom of mass incarceration is now widely questioned, incarceration rates have fallen far less than what would be predicted on the basis of crime trends. Informed by institutional studies of path dependence, sociolegal scholarship on legal discretion, and research suggesting that “late mass incarceration” is characterized by a moderated response to nonviolent crime but even stronger penalties for violent offenses, this article analyzes recent sentencing‐related reforms and case processing outcomes. Although the legislative findings reveal widespread willingness to moderate penalties for nonviolent crimes, the results also reveal a notably heightened system response to both violent and nonviolent crimes at the level of case processing. These findings help explain why the decline in incarceration rates has been notably smaller than the drop in crime rates and are consistent with the literature on path dependence, which emphasizes that massive institutional developments enhance the capacity and motivation of institutional actors to preserve jobs, resources, and authorities. The findings also underscore the importance of analyzing on‐the‐ground case processing outcomes as well as formal law when assessing the state and fate of complex institutional developments such as mass incarceration.

Radiation Dose and Fractionation for Limited-stage Small-cell Lung Cancer: Survey of US Radiation Oncologists on Practice Patterns

BackgroundThoracic radiotherapy (TRT) with concurrent chemotherapy is standard for limited-stage small-cell lung cancer (LS-SCLC). However, the optimal dosing and fractionation remain unclear. The National Comprehensive Cancer Network guidelines have recommended either 45 Gy delivered twice daily (BID) or 60 to 70 Gy delivered once daily (QD). However, the current practice patterns among US radiation oncologists are unknown. Materials and MethodsWe surveyed US radiation oncologists using an institutional review board-approved questionnaire. The questions covered demographic data, self-rated knowledge of key trials, and treatment recommendations. ResultsWe received 309 responses from radiation oncologists. Of the 309 radiation oncologists, 60% preferred TRT QD and 76% acknowledged QD to be more common in their practice. The respondents in academic settings were more likely to endorse BID treatment by both preference (P = .001) and actual practice (P = .009). The concordance between preferring QD and administering QD in practice was 100%. In contrast, 40% of respondents who preferred BID actually administered QD more often. Also, 15% of physicians would be unwilling to switch from QD to BID and 3% would be unwilling to switch from BID to QD, even on patient request. Most respondents (88%) recommended a dose of 45 Gy for BID treatment. For QD treatment, the division was greater, with 54% recommending 60 Gy, 30% recommending 63 to 66 Gy, and 10% recommending 70 Gy. ConclusionSubstantial variation exists in how US radiation oncologists approach TRT dosing and fractionation for LS-SCLC. Three quarters of our respondents reported administering TRT QD most often. The most common doses were 60 Gy QD and 45 Gy BID. The results of the present survey have provided the most up-to-date information on US practice patterns for LS-SCLC.

Assessing use of patient-focused pharmacotherapy in glycemic management through the Diabetes Collaborative Registry (DCR)

BackgroundAlthough practice guidelines stress individualization of glucose management in patients with type 2 diabetes (T2D), the extent to which providers take patient factors into account when selecting medications is not well known. MethodsDiabetes Collaborative Registry (DCR) is an outpatient diabetes registry including primary care, cardiology, and endocrinology practices. T2D medications were grouped as those which may be suboptimal for key patient subgroups, and we examined patient factors associated with use of these agents using hierarchical, multivariable Poisson models. ResultsIn DCR, 157,551 patients from 374 US practices were prescribed a glucose-lowering medication. Patients with morbid obesity were more likely treated with medications prone to cause weight gain (relative rate [RR] 1.09, 95% CI 1.07–1.11). Older patients were more likely to be treated with medications with increased risk of hypoglycemia (RR 1.04 per 5 years, 95% CI 1.04–1.05). Patients with CKD 4/5 were less likely to be treated with agents with known risk in patients with advanced CKD (RR 0.74, 95% CI 0.71–0.77). Patients with coronary artery disease were no more or less likely to be treated with medications with potential cardiovascular safety issues (RR 0.99, 95% CI 0.96–1.01). ConclusionsWe observed some targeted use of glucose-lowering therapies in certain subgroups but also identified potential opportunities for better personalization of treatment. Data sources such as the DCR can highlight potential areas for improving targeted approaches to pharmacologic therapy in order to optimize selection of patients most likely to benefit (and least likely to be harmed) from treatments.

Risk of chemotherapy-induced febrile neutropenia with same-day versus next-day pegfilgrastim prophylaxis among patients aged ≥65 years: a retrospective evaluation using Medicare claims

Background: Two recent evaluations reported that risk of febrile neutropenia (FN) may be higher when pegfilgrastim prophylaxis (PP) is administered on same day as chemotherapy rather than per recommendation (1–3 days following chemotherapy). Such evidence is based largely on the experience of younger privately insured adults and may not be generalizable to older patients in US clinical practice.Methods: A retrospective cohort design and data from Medicare Claims Research Identifiable Files (January 2008–September 2015) were employed. Patients were aged ≥65 years, had breast cancer or non-Hodgkin’s lymphoma, received chemotherapy with intermediate/high risk for FN, and received PP in ≥1 cycle; cycles with PP were stratified based on administration day (same-day [“Day 0”] vs. 1–3 days following chemotherapy [“Days 1–3”]) and were pooled for analyses. Adjusted odds ratios (ORs) for FN during the cycle were estimated for patients who received PP on Day 0 versus Days 1–3.Results: Study population included 65,003 patients who received PP in 261,184 cycles; in 5% of cycles, patients received PP on Day 0. Incidence proportion for FN in cycle 1 was 11.4% for Day 0 versus 8.4% for Days 1–3; adjusted OR was 1.4 (p < .001). Incidence proportion for FN when considering all cycles was 7.7% for Day 0 and 6.0% for Days 1–3; adjusted OR was 1.3 (p < .001). Adjusted ORs when considering all cycles and only inpatient FN episodes (1.3, p < .001) and the narrow definition for FN (1.5, p < .001) were similar.Conclusions: Among Medicare patients receiving chemotherapy and PP in US clinical practice, PP was administered before the recommended timing in 5% of cycles and FN incidence was significantly higher in these cycles. Along with prior research, study findings support recently updated US practice guidelines indicating that PP should be administered the day after chemotherapy.

Sustainability reporting practices in US and UK: an empirical comparison

PurposeThis paper aims to investigate and compare the sustainability reporting practices of companies in the two most successful Western economies, the USA and the UK, as per Global reporting initiative framework.Design/methodology/approachContent analysis has been applied on a sample of 136 companies listed on the Stock Exchanges of the USA and the UK (USA – NASDAQ 100, 100 companies and Amex major market index, 20 companies; UK – FTSE 100, 100 companies). It uses descriptive statistics and independent sample t-test to identify significant comparisons.FindingsThe findings of the study suggest that the level of sustainability reporting is almost similar in the USA and the UK. It is somewhat low in both the countries. Overall mean disclosure score is 39.1 per cent in case of the USA followed by UK with 34.5 per cent. The result of independent sample t-test shows that these differences are not significant.Practical implicationsSustenance is not a grave issue in both the USA and the UK. Thus, sustainability reporting is a voluntary practice in both these countries. Even then these countries are fostering in the field of sustenance and sensitizing the developing nations towards its need and relevance. The present study would provide developing countries a base and understanding of need based rules for moving on the path of sustenance.Originality/valueThe USA and the UK are the two most successful Western economies. However, not even a single study was found while reviewing the literature that studied and compared the sustainability reporting practices of these two leading developed countries.

TRUMP’S FOREIGN POLICY: PLANS AND REALITIES

The article considers the changes in US foreign trade policy at the beginning of the Trump’s presidency. Exporting is a critical component for the long-term growth and the U.S. economy overall, and supporting millions of jobs in US. Though D. Trump campaigned for president as a protectionist, there was no such steps the first year of his presidency. But his second year in the White House began with announcing new tariffs on solar panels, washing machines, then on steel, aluminium. As concerning steel products, the United States being the world’s largest steel importer have persistent trade deficit.The US trade law allows the president to limit imports in case if domestic industries are threatened, against unfair foreign trade practices for a period of time, but such measures were not frequent in US practice. Meanwhile new protectionist measures are debated. Trump’s policy is being opposed not only by trade partners of the US, but in the US as well, by those who argue that protectionist measures will complicate international relationships.

Who owns a scientist’s mind?

Changes in US law and practice during the 20th century gradually gave businesses more rights to their researchers’ ideas, but controlling knowledge is no easy task.

Measurement of fractional exhaled nitric oxide in real-world clinical practice alters asthma treatment decisions

BackgroundAssessment of asthma using clinical measures alone often fails to detect underlying airway inflammation. Fractional exhaled nitric oxide (FeNO) is a recognized biomarker of type 2 airway inflammation in asthma. Measurement of FeNO is instrumental in the assessment and management of patients with corticosteroid-sensitive asthma. ObjectiveTo determine the impact of measuring FeNO on asthma management in real-world clinical practices. MethodsClinicians from 337 US practices performed a clinical assessment and recorded treatment plans before and after measuring FeNO in 7,901 patients with asthma. Airway inflammation was classified as low, intermediate, or high according to the clinician's usual procedures, including clinical examination, spirometry, and symptoms. Clinicians recorded asthma medication plans, indicating medications to be initiated, continued, or stopped. FeNO measurement was performed, followed by documentation of any change(s) in the treatment plans based on the FeNO value (eg, initiating new medications or changing the dose of or discontinuing existing medications). ResultsClinical assessment was concordant with FeNO measurement in only 56% of cases, matching FeNO more frequently in patients with low inflammation (64%) vs high inflammation (34%). After FeNO measurement, clinicians modified their treatment plan in 31% and altered prescriptions for inhaled corticosteroids in 90% of cases. Inhaled corticosteroids were initiated or their dose increased in 66% of patients with high inflammation but discontinued or their dose decreased in only 9% of patients with low inflammation. ConclusionMeasurement of FeNO enabled clinicians to assess underlying airway inflammation, leading to a significant revision of their treatment plans compared with real-world clinical assessment of asthma alone.

Assessing U.S. Targeted Killings Under An International Human Rights Law Framework

The US practice of targeted killings provokes difficult questions concerning the appropriate legal framework and the standards that govern such strikes. This article will argue that, in certain cases, it is necessary to examine the legality of targeted killings under international human rights law (IHRL). An explicit IHRL justification for targeted killings is important and, at present, often ignored by the US. IHRL requires any use of lethal force to be proportionate to the legitimate aim of safeguarding life and a necessary measure with no other reasonable means available to address the threat. It is possible, following a survey of human rights decision-makers, that targeted killings in exceptional circumstances are justifiable under IHRL. It is also incumbent on the US to pass domestic legislation that provides a legal basis for strikes disconnected to September 11, and also the provision of administrative and judicial review in order to provide a post-hoc check on targeted killing decisions.

State terrorism: orientalism and the drone programme

ABSTRACTThis article builds on the recent and growing scholarship on the negative effects of the drone programme. Current literature has shown that the drone programme terrorises the civilian population that it keeps under surveillance. Furthermore, it has articulated the drone programme’s violence as biopolitical and its surveillance as a necropolitical technology of distinction. It is argued in this article that the Orientalist attitudes and logic necessary for drone targeting form the basis for the biopolitical and necropolitical component of the drone programme. This article explores the Orientalism that suffuses the US drone programme in order to juxtapose it with governmental discourses that characterise the drone programme and its surveillance as neutral and humane – demonstrating the gap between government discourses of modernity and the actual drone programme. The necropolitical logic of distinction used for targeting leads to the assimilation of those under the drone’s gaze to a population that can be put to death, leading the drone programme to operate indiscriminately. The biopolitical logic is visible in the US practices, which I argue constitutes terrorism with the corroboration of civilian testimonies.

Development of a Regional Lidar-Derived Above-Ground Biomass Model with Bayesian Model Averaging for Use in Ponderosa Pine and Mixed Conifer Forests in Arizona and New Mexico, USA

Historical forest management practices in the southwestern US have left forests prone to high-severity, stand-replacement fires. Reducing the cost of forest-fire management and reintroducing fire to the landscape without negative impact depends on detailed knowledge of stand composition, in particular, above-ground biomass (AGB). Lidar-based modeling techniques provide opportunities to increase ability of managers to monitor AGB and other forest metrics at reduced cost. We developed a regional lidar-based statistical model to estimate AGB for Ponderosa pine and mixed conifer forest systems of the southwestern USA, using previously collected field data. Model selection was performed using Bayesian model averaging (BMA) to reduce researcher bias, fully explore the model space, and avoid overfitting. The selected model includes measures of canopy height, canopy density, and height distribution. The model selected with BMA explains 71% of the variability in field-estimates of AGB, and the RMSE of the two independent validation data sets are 23.25 and 32.82 Mg/ha. The regional model is structured in accordance with previously described local models, and performs equivalently to these smaller scale models. We have demonstrated the effectiveness of lidar for developing cost-effective, robust regional AGB models for monitoring and planning adaptively at the landscape scale.

Surgeon Participation in Early Accountable Care Organizations.

We aimed to characterize the landscape of surgeon participation in early accountable care organizations (ACOs) and to identify specialty-, organization-, and market-specific factors associated with ACO participation. Despite rapid deployment of alternative payment models (APMs), little is known about the prevalence of surgeon participation, and key drivers behind surgeon participation in APMs. Using data from SK&A, a research firm, we evaluated the near universe of US practices to characterize ACO participation among 125,425 US surgeons in 2015. We fit multivariable logistic regression models to characterize key drivers of ACO participation, and more specifically, the interaction between ACO affiliation and organizational structure. Of 125,425 US surgeons, 27,956 (22.3%) participated in at least 1 ACO program in 2015. We observed heterogeneity in participation by subspecialty, with trauma and transplant reporting the highest rate of ACO enrollment (36% for both) and plastic surgeons reporting the lowest (12.9%) followed by ophthalmology (16.0%) and hand (18.6%). Surgeons in group practices and integrated systems were more likely to participate relative to those practicing independently (aOR 1.57, 95% CI 1.50, 1.64; aOR 4.87, 95% CI 4.68, 5.07, respectively). We observed a statistically significant interaction (P <0.001) between surgical specialty and practice organization. Model-derived predicted probabilities revealed that, within each specialty, surgeons in integrated health systems had the highest predicted probabilities of ACO and those practicing independently generally had the lowest. We observed considerable variation in ACO enrollment among US surgeons, mediated at least in part by differences in practice organization. These data underscore the need for development of frameworks to characterize the strategic advantages and disadvantages associated with APM participation.

CONTEMPORARY INCIDENCE OF RECURRENT CARDIOVASCULAR EVENTS 1 TO 3 YEARS AFTER MYOCARDIAL INFARCTION: LONGITUDINAL US ANALYSIS FROM NCDR REGISTRIES LINKED WITH ALL-PAYER CLAIMS DATABASE

Long-term risks of myocardial infarction (MI) survivors in contemporary US practice remains severely under recognized. Using a unique linkage of national cardiovascular registries and claims, we examined the longitudinal risks and the impact of a patient's comorbidity burden on risk. Patients were

Retrospective review of Arctic Front Advance Cryoballoon Ablation: a multicenter examination of second-generation cryoballoon (RADICOOL trial).

Pulmonary vein isolation (PVI) via catheter ablation is an approved therapy for patients with drug-refractory and symptomatic atrial fibrillation (AF). Furthermore, cryoballoon is now considered to be as effective as focal radiofrequency catheter ablation. This study examines the second-generation cryoballoon performance in a US multicenter review of real-world practices. By retrospective chart collections, the long-term efficacy and safety of the cryoballoon procedure were assessed in 15 US centers. All patients had a history of drug-refractory symptomatic paroxysmal AF and were treated with a cryoballoon PVI strategy at the index ablation. Four hundred fifty-two patients were evaluated, and acute PVI was achieved in 99% of patients by cryoballoon catheter ablation. In 0.88% of patients (4/452), an additional focal ablation catheter was used to achieve acute PVI during the ablation procedure. Average procedure time was 128 (range 82 to 260)min, using an average of 17 (range 1 to 19)min of fluoroscopy. The most frequent adverse event was transient phrenic nerve injury (1.5%; 7/452 patients) which all resolved by the end of the procedure with no diaphragmatic dysfunction at discharge. There were no strokes, transient ischemic attacks, cardiac tamponade, atrioesophageal fistulas, or deaths during the study. At the 12-month efficacy endpoint, single-procedure success of freedom from atrial arrhythmia was 87% (393/452 patients). This real-world examination of the US practice demonstrates that second-generation cryoballoon ablation by PVI strategy is safe and effective among patients with paroxysmal AF.