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This study reviews the economic viability of the Rashtriya Swasthya Bima Yojana (RSBY), India's landmark health insurance program for below poverty line (BPL) populations in West Bengal state of India. It addresses the issue through in‐depth analysis of literature, national and state level data, and a number of key stakeholder interviews. The study argues that the market failure conditions of this insurance model will continue to perpetuate losses for not only the state, but also for insurance companies, unless they adjust on a continuous basis for profit by raising the premium rate. This will further deplete state budgets for health care affecting the viability of the scheme in the long run.

Objective To quantify the effect of Medicaid expansions on office‐based care among the newly eligible. Data Source 2008–2014 Medical Expenditure Panel Survey. Study Design The main sample is adults age 26–64 with incomes ≤138% of poverty who were not eligible for Medicaid prior to the Affordable Care Act. For this population, difference‐in‐differences linear probability models compare utilization between expansion and nonexpansion states and between 2008–2013 and 2014. Extraction Methods Medicaid eligibility is simulated using data on family relationships, state of residence, and income. Principal Findings Relative to comparable adults in nonexpansion states, newly eligible adults in expansion states were 9.1 percentage points more likely to have any office‐based primary care physician visit in 2014, a 21.4% increase from 2013 (p‐value = .004); 6.9 percentage points more likely to have a specialist visit, a 25.2% increase from 2013 (p‐value = .036); and 5.1 percentage points more likely to have a visit with a nurse practitioner, nurse, or physician assistant, a 34.5% increase from 2013 (p‐value = .016). Conclusions State Medicaid expansions in 2014 were associated with greater likelihoods of visits with a variety of office‐based providers. The estimated effects are larger among newly eligible compared with previous estimates on broader populations of low‐income adults.

Objective To explore organizations’ experiences providing family planning during the first year of an expanded primary care program in Texas. Data Sources Between November 2014 and February 2015, in‐depth interviews were conducted with program administrators at 30 organizations: 7 women's health organizations, 13 established primary care contractors (e.g., community health centers, public health departments), and 10 new primary care contractors. Study Design Interviews addressed organizational capacities to expand family planning and integrate services with primary care. Data Extraction Interview transcripts were analyzed using a theme‐based approach. Themes were compared across the three types of organizations. Principal Findings Established and new primary care contractors identified several challenges expanding family planning services, which were uncommon among women's health organizations. Clinicians often lacked training to provide intrauterine devices and contraceptive implants. Organizations often recruited existing clients into family planning services, rather than expanding their patient base, and new contractors found family planning difficult to integrate because of clients’ other health needs. Primary care contractors frequently described contraceptive provision protocols that were not evidence‐based. Conclusions Many primary care organizations in Texas initially lacked the capacity to provide evidence‐based family planning services that women's health organizations already provided.

The paper examines the value‐generating strategies used in some of New Zealand's primary activities in a rapidly changing trading context in which the countries of East Asia increasingly figure. These strategies range from scaling up volume, with a consequent conspicuous impact on rural landscapes, to innovative value‐enhancing relationships linking producers, processors and consumers in processes which value landscapes for the contribution they make to provenance stories. Our argument is that higher‐value strategies are necessarily more intensely collaborative and involve a pursuit of engaged relationships, especially between onshore producers and manufacturers and consumers at a distance. We term this collaborative form of strategising as ‘the relationships economy’. We illustrate our argument using two case studies, dairying and merino. While there are great differences in scale between them, and dairying focuses significantly on volume‐generating capacity, there are players in dairying who are adopting higher‐value relationships‐based approaches similar to those developed in the merino industry. The common thread connecting the case studies is that of intentional enactment, which echoes earlier periods in New Zealand's trading history when considerable work was undertaken by industry participants to create new markets for primary products.

The 2010 Affordable Care Act extended dependent coverage for adult children up to age 26 in the USA. Since then, considerable studies have assessed its various impacts among young adults. However, little is known about whether there is any change in health care use when young adults age out of dependent coverage. This study examines health care consumption changes among young adults prior to their aging out process. I used data from a large insurance claim database and studied health care utilization of young adults under parents' coverage during a 2‐year period in a difference‐in‐difference framework. I found that young adults had relative reductions in health services use, except ER visits, compared with individuals who stayed under parents' coverage. This pattern was the same for both male and females. Individuals with regular medical needs had greater relative reductions compared with those without regular medical needs. The relative reductions in health care use during the aging out process may have an important impact on young adults' health, especially for those with regular medical needs. More efforts could be made to help them maintain regular medical utilization during the transition.

Objective We examine whether drugs’ excluded versus recommended status on pharmacy benefit manager exclusion lists corresponds to evidence from cost‐effectiveness analyses, lack of evidence, or rebates. Data Sources To find cost‐effectiveness data for drugs on 2016 exclusion lists of CVS Caremark and Express Scripts, we searched the Tufts Cost‐Effectiveness Analysis Registry and the peer‐reviewed literature. Study Design For each excluded and recommended drug, we compared the mean cost‐per‐QALY, and we calculated the difference between the numbers of excluded and recommended drugs for which we could find no cost‐effectiveness evidence. Data Collection As keywords in our searches, we used the brand and generic drug name and “cost‐effectiveness” and “cost‐per‐quality‐adjusted life‐year.” Of 240 retrieved studies, 110 were selected for analysis. Principal Findings The mean cost‐per‐QALY for excluded drugs was higher ($51,611) than the cost‐per‐QALY for recommended drugs ($49,474), but not statistically significant. We could find no cost‐effectiveness evidence in the Registry or peer‐reviewed literature for 23 of the excluded drugs, and no evidence for 5 of the recommended drugs. Conclusions Cost‐effectiveness does not correlate with a drug's excluded or recommended status. Lack of cost‐effectiveness evidence favors a drug's excluded status.

Objective To build and test a model that predicts community discharge probabilities for Medicaid‐eligible nursing home (NH) residents who remain in the nursing home at 90 days after admission and, thus, would be candidates for the Money Follows the Person (MFP) program. Data Source The Minimum Data Set, Medicaid Management Information Systems, and Minnesota Vital Statistics file. Data Cohort of 33, 590 nursing home stays that qualified for Medicaid by the 90th day of their stay from 383 Minnesota nursing homes from July 2011 to June 2013. Study Design Mixed effects logistic regression model to predict community discharge. Principal Findings The scoring system had a high level of accuracy in predicting community discharge for both the fitting and validation cohorts. Subpopulations with severe mental illness or intellectual disability were well represented across the entire score range. Conclusions Findings are being applied in the Minnesota's MFP initiative (Moving Home Minnesota) to target Medicaid‐eligible NH residents for transitioning to the community. This approach could be applied to MFP in other states.

Objective To examine the effects of the penetration of dual‐eligible special needs plans (D‐SNPs) on health care spending. Data Sources/Study Setting Secondary state‐level panel data from Medicare‐Medicaid Linked Enrollee Analytic Data Source (MMLEADS) public use file and Special Needs Plan Comprehensive Reports, Area Health Resource Files, and Medicaid Managed Care Enrollment Report between 2007 and 2011. Study Design A difference‐in‐difference strategy that adjusts for dual‐eligibles’ demographic and socioeconomic characteristics, state health resources, beneficiaries’ health risk factors, Medicare/Medicaid enrollment, and state‐ and year‐fixed effects. Data Collection/Extraction Methods Data from MMLEADS were summarized from Centers for Medicare and Medicaid Services (CMS)'s Chronic Conditions Data Warehouse, which contains 100 percent of Medicare enrollment data, claims for beneficiaries who are enrolled in the fee‐for‐service (FFS) program, and Medicaid Analytic Extract files. The MMLEADS public use file also includes payment information for managed care. Data in Special Needs Plan Comprehensive Reports were from CMS's Health Plan Management System. Principal Findings Results indicate that D‐SNPs penetration was associated with reduced Medicare spending per dual‐eligible beneficiary. Specifically, a 1 percent increase in D‐SNPs penetration was associated with 0.2 percent reduction in Medicare spending per beneficiary. We found no association between D‐SNPs penetration and Medicaid or total spending. Conclusion Involving Medicaid services in D‐SNPs may be crucial to improve coordination between Medicare and Medicaid programs and control Medicaid spending among dual‐eligible beneficiaries. Starting from 2013, D‐SNPs were mandated to have contracts with state Medicaid agencies. This change may introduce new effects of D‐SNPs on health care spending. More research is needed to examine the impact of D‐SNPs on dual‐eligible spending.

This paper presents a copula‐based method for identifying and estimating the coefficient of a binary endogenous regressor in a Poisson regression. The method offers advantages over existing approaches. Most importantly, it relies upon standard maximum likelihood approaches, and it does not require numerical integration. Further, as part of its implementation, the method provides a convenient test for the presence of endogeneity. The empirical application investigates the effect of insurance status (a binary measure) on doctor visits (a count measure).

Literature examining WTO+ commitments in services trade agreements (STAs) has not considered the role of services regulation. We bridge this gap using a sample of 15 South/South‐East Asian countries, given the burgeoning trend of Asian economies towards services preferentialism and the largely WTO+ nature of their preferential services commitments. Our empirical findings suggest that Asian trading dyads with regulatory frameworks that are more similar and more trade restrictive tend to undertake higher levels of WTO+ commitments in their STAs. There is also evidence in our results, including by modes of supply, for WTO+ commitments in Asian STAs being driven by goods trade complementarities, alluding to supply chain dynamics in the region. Such results support the hypothesis that the heightened “servicification” of production generates a demand to lower services input costs arising from regulatory incidence and heterogeneity.

This article examines the “chicken‐egg” two‐way relationships between online consumer reviews and sales, and assesses the dual influencer and indicator roles of online consumer reviews in relation to purchase behavior. Considering the time factor, we adopt the methodology of Granger causality test and track 3,390 products on Amazon.com over a 2‐month period. The results reveal that a causality loop exists between online consumer review volume and sales. Specifically, our findings indicate that the volume of negative consumer reviews drive consumers' purchasing decisions, but the volume of positive consumers reviews only marginally affects purchasing decisions. Also, consumers generate more positive reviews than negative reviews after sales. Our results highlight the importance of negative consumer reviews; negative reviews not only lead to sales, but sales, in turn, lead to higher volume of negative reviews. The findings suggest an alternative strategy for practitioners to address negative online consumer reviews and highlight the awareness effect of online consumer review postings that can later convert into purchase behaviors.

This representative study of German search engine users (N = 1,000) focuses on the ability of users to distinguish between organic results and advertisements on Google results pages. We combine questions about Google's business with task‐based studies in which users were asked to distinguish between ads and organic results in screenshots of results pages. We find that only a small percentage of users can reliably distinguish between ads and organic results, and that user knowledge of Google's business model is very limited. We conclude that ads are insufficiently labelled as such, and that many users may click on ads assuming that they are selecting organic results.

Objective The objective of this literature review was to summarise current research regarding how consumers seek health‐related information from social media. Primarily, we hope to reveal characteristics of existing studies investigating the health topics that consumers have discussed in social media, ascertaining the roles social media have played in consumers’ information‐seeking processes and discussing the potential benefits and concerns of accessing consumer health information in social media. Methods The Web of Science Core Collection database was searched for existing literature on consumer health information seeking in social media. The search returned 214 articles, of which 21 met the eligibility criteria following review of full‐text documents. Conclusion Between 2011 and 2016, twenty‐one studies published explored various topics related to consumer information seeking in social media. These ranged from online discussions on specific diseases (e.g. diabetes) to public health concerns (e.g. pesticide residues). Consumers’ information needs vary depending on the health issues of interest. Benefits of health seeking on social media, in addition to filling a need for health information, include the social and emotional support health consumers gain from peer‐to‐peer interactions. These benefits, however, are tempered by concerns of information quality and authority and lead to decreased consumer engagement.

In this paper, we show theoretically and empirically that the US quantitative easing (QE) policy results in lower exchange rate pass‐through into the destination prices of Chinese exporters. In addition, the more the exchange rate in the export destination appreciates than the Chinese yuan, the stronger this effect becomes. Our model combines various marginal effects of QE policy on the destinations of Chinese exporters and variable markups of export firms due to strategic complementarities. The model predicts that the impact of US QE policy on the pass‐through of Chinese exporters depends on its spillover on the exchange rate between China and the export destination of different firms. We provide strong support for the model predictions using Chinese firm‐product‐level data with information on export destinations. The baseline result and the heterogeneity we find in the response of exchange rate pass‐through of Chinese exporters to US QE policy remain robust to alternative measures of samples and controls.

This study investigates whether the European Union's funding of civil society organizations (CSOs) can foster equal access to existing channels of participation. This is analyzed by using data from 7,889 CSOs that are registered in the EU Transparency Register. Two criteria should be met for funding to combat inequalities among CSOs: the funding must support underrepresented interests, and it must increase their participation in the policy process. The results of a logistic regression analysis show that the Commission's funding scheme does support underrepresented interests but makes participation more unequal by also supporting already overrepresented groups. Furthermore, the analysis shows that the probability of a CSO having access to formal channels of participation significantly increases if it has received funding. The conclusion is that funding could be used more efficiently if the Commission were to consistently support underrepresented interests.

Despite its high political interest, the impact of removing user charges for health care in low‐income settings remains a debatable issue. We try to clear up this contentious issue by estimating the short‐term effects of a policy change that occurred in 2006 in Zambia, when 54 of 72 districts removed fees. We use a pooled synthetic control method in order to estimate the causal impact of the policy on health care use, the provider chosen, and out‐of‐pocket medical expenses. We find no evidence that user fee removal increased health care utilisation, even among the poorest group. However, we find that the policy is likely to have led to a substitution away from the private sector for those using care and that it virtually eliminated medical expenditures, thereby providing financial protection to service users. We estimate that the policy was equivalent to a transfer of US$3.2 per health visit for the 50% richest but of only US$1.1 for the 50% poorest.

Using quarterly data from 1995 until 2014, we investigate whether Euro Area (EA) membership influences the probability of a European Union Member State going through an episode of sudden stop or through an episode of bonanza, after controlling for a number of push and pull factors. Overall, our results do not support the claim that EA membership constituted a weakness during the recent financial crisis. On the contrary, we find that EA membership decreases the probability of a sudden stop, all else equal. We find no evidence that being part of the EA has a direct effect on the probability of bonanza. When allowing for interaction effects, our results suggest that EA membership might have mitigated the risk perception arising from higher government debt in the case of bonanzas.

Purpose This study examined the time from breast cancer diagnosis to initiation of treatment among Alaska Native (AN) women. We evaluated the impact of age, cancer stage, and rural/urban residence at diagnosis. Methods We evaluated characteristics of women recorded in the Alaska Native Tumor Registry who received a first diagnosis of breast cancer between 2009 and 2013. Median time from diagnosis to treatment was assessed. Associations of demographic and clinical characteristics with timely initiation of treatment were evaluated using logistic regression and Cox proportional hazards models. Results Two hundred seventy‐eight (278) AN women were diagnosed with invasive breast cancer in years 2009‐2013. Mean age at diagnosis was 56.8 years (SD = 13.0). The median time from diagnosis to initiation of treatment was 23 days (P < .05) with most (94.6%, n = 263) meeting the ≤60‐day guideline target. Time to treatment was not associated with rural/urban residence, age, or stage at cancer diagnosis. Conclusion These findings indicate that most AN women diagnosed with breast cancer within the AN Tribal Health System receive timely treatment after diagnosis.

Background Malaria is a major global health challenge. This study aims to clarify the manner in which contextual factors determine the use and maintenance of bed nets and the extent to which malaria prevention policy is responsive to them in Southern Benin. Methods Semi‐structured interviews and direct observations were undertaken with 30 pregnant women in the municipality of So‐Ava from June to August 2015. Key informants in the Ministry of Health and local community health workers were also interviewed regarding malaria prevention policy formation, and the monitoring and evaluation of bed net interventions, respectively. Data were analyzed through categorical content analysis and grouped into themes. Results The majority of pregnant women participants (80%) declared non‐adherence to instructions for hanging and maintaining insecticide‐treated nets (ITNs). The distributed bed nets were washed like clothes, which affected their bio‐efficacy, and were in poor condition (ie, torn or had holes). Multiple factors contributed to the poor condition of ITNs: Pregnant women's limited understanding of risk including their inability to connect the key environmental factors to personal risk, gendered responsibility for installing bed nets, and lack of public measures that would enable women to re‐treat or access new bed nets as needed. Poverty that determined structural aspects of housing such as the size and quality of homes and access to bed nets exacerbated the challenges. Conclusion Institutionalizing an iterative process of monitoring, review, and responsive adaptation throughout the entire policymaking cycle would better support malaria preventive policy implementation in Benin.

This study investigates the sourcing patterns of Japanese export‐platform foreign affiliates in Mexico, which mainly export to the United States and Canada. We propose a novel approach to estimate intermediate input elasticities of exports by sourcing country. We find that, on average, Japanese export‐platform foreign affiliates in Mexico source intermediate inputs from third countries, including the United States and Canada, rather than from Japan and Mexico, suggesting that Japanese export‐platform foreign affiliates in Mexico are mainly integrated into the vertical production networks back and forth between Mexico, the United States and Canada. In turn, Japanese foreign affiliates selling domestically in Mexico source intermediate inputs not only within the North American Free Trade Agreement countries but also from Japan. In addition, we find that export‐platform foreign affiliates in Mexico use more labour‐intensive production than do foreign affiliates selling domestically in Mexico. This suggests that saving labour costs is one of the motives for export‐platform foreign direct investment in Mexico.

Introduction Administration is vital for health care. Its importance may increase as health care systems become more complex, but academic attention has remained minimal. We investigated trends in administrative expenditure across OECD countries, cross‐country spending differences, spending differences between health care system typologies, and differences in the scale and scope of administrative functions across typologies. Methods We used OECD data, which include health system governance and financing‐related administrative activities by regulators, governance bodies, and insurers (macrolevel), but exclude administrative expenditure by health care providers (mesolevel and microlevel). Results We find that governance and financing‐related administrative spending at the macrolevel has remained stable over the last decade at slightly over 3% of total health spending. Cross‐country differences range from 1.3% of health spending in Iceland to 8.3% in the United States. Voluntary private health insurance bears much higher administrative costs than compulsory schemes in all countries. Among compulsory schemes, multiple payers exhibit significantly higher administrative spending than single payers. Among single‐payer schemes, those where entitlements are based on residency have significantly lower administrative spending than those with single social health insurance, albeit with a small difference. Discussion These differences can partially be explained because multi‐payer and voluntary private health insurance schemes require additional administrative functions and enjoy less economies of scale. Studies in hospitals and primary care indicate similar differences in administrative costs across health system typologies at the mesolevel and microlevel of health care delivery, which warrants more research on total administrative costs at all the levels of health systems.

Background Few studies explore stroke survivor views and motivations towards stem cell therapy (SCT). This qualitative study explores the views and motivations of both stroke survivors and their partners/carers towards a proposed 2‐arm Phase III Randomised Controlled Trial (RCT) comparing intracerebral insertion of stem cells with placebo neurosurgery in stroke survivors with disability. Objective To explore views and motivations towards a proposed 2‐arm stem cell trial and identify factors that may impede and enhance participation. Design This study adopts a naturalistic design to explore the complexity of this field, employing a participatory action‐research approach comprising a specialized Conversation (World) Café form of focus group. Data were collected via 5 Conversation Cafés with stroke survivors (age 40‐75) and partners/carers between June and October 2016. Of 66 participants, 53 (31 male, 22 female) were stroke survivors and 13 (6 female, 7 male) were partners/carers. Qualitative data were analysed using a thematic approach. Discussion and Conclusion Stroke survivor views and motivations reflect anticipation of the personal and future benefits of regenerative medicine. Partners/carers sought to balance the value of stroke survivor hope with carrying the weight of hope as carer, a conflict burden adding to known caregiver burden. All participants expressed the need for during and post‐trial psychological support. This study provides a rare opportunity to explore the prospective views and motivations of stroke survivors and their partners/carers towards a proposed Phase III 2‐arm RCT. This adds weight to qualitative evidence exploring capacity, consent, decision making, perceptions of treatment risk and supports required for clinical trial participation.

This work extends the masspersonal communication model (MPCM; O'Sullivan & Carr, 2017) by introducing anticipated interaction as a way to understand variations within the masspersonal continuum. Drawing from Thompson's mediated communication framework (1995), we argue that anticipated interaction paves the way for establishing a communicative relationship between interactants. In social media, this relationship is rooted in a sender's expectations for audience response and the imagined responsive audience. Using experience sampling, we show that anticipated interaction varies across social media. Further, we outline the relational and situational factors associated with expecting response and the specificity of imagined responsive audience. These variations and their sources characterize masspersonal communication as a socially and technologically situated practice shaped by multiple intersecting influences.

This research focuses on the identification of social roles and an investigation of their influence in online context. Relying on a systemic approach for role conceptualization, we investigate member's activity, shared content and position in the network within a consumer to consumer social media‐based community (SMC) around a product. This investigation led to the identification of ten core roles, based on three key elements: object of interest (product, practice, and community), main contribution type (sharing information and seeking information), individual orientation (factual, emotional). We propose an explanation about how these roles, through their positioning, participate in the community dynamics and how they contribute to the creation and diffusion of cookery as a social practice, shaping the periphery around this practice.

Political information sharing in social media offers citizens opportunities to engage with news and express their political views, but how do different patterns of online political information exposure, including both incidental and selective exposure, affect sharing? Using two‐wave panel survey data collected in the United States, we examine the relationship between incidental and selective exposure and their consequent links to political information sharing, across different levels of strength of political party affiliation. Our results demonstrate that incidental exposure to counter‐attitudinal information drives stronger partisans to more actively seek out like‐minded political content, which subsequently encourages political information sharing on social media. The results highlight the need to consider both types of political information exposure when modeling citizens' political behavior online.

Purpose To examine the relationship between area population density and community pharmacy‐based Alzheimer's Disease (AD)‐related services: pharmacists’ medication knowledge and counseling, immunizations, and in‐stock cognitive enhancers in 3 predominantly rural regions of the United States. Methods A standardized interview was administered by telephone to a 100% sample of community pharmacies in 3 areas: Northern California/Southern Oregon (n = 206), North and South Dakota (n = 278), and West Virginia (n = 420). Key study outcomes included: pharmacists’ medication knowledge, availability of immunization services, and cognitive enhancers in stock. Respondents were classified by population density (persons/mi2) by pharmacy location to evaluate the relationship between rurality and AD‐related pharmacy services. Chi‐squared and logistic regression analyses were performed using Stata 10.1. Findings Pharmacies in more rural areas (50.1‐100.0, 25.1‐50.0, and ≤25.0 persons/mi2) were about 50% less likely to offer immunizations (95% CI: 0.32‐0.91; 0.32‐0.76; 0.28‐0.80, respectively) compared to the least rural areas (>100.0 persons/mi2). Compared to the least rural areas, pharmacists in the most rural areas (≤25.0 persons/mi2) were less likely to name ≥2 gastrointestinal adverse effects of donepezil (OR = 0.50, 95% CI: 0.31‐0.82) or have memantine XR 28 mg (OR = 0.61, 95% CI: 0.41‐0.89) and other surveyed medications (OR = 0.57, 95% CI: 0.39‐0.82) in stock. Conclusions We found disparities in AD‐related services in community pharmacies located in more rural counties, wherein individuals with AD and their caregivers may face barriers to obtaining quality pharmaceutical care. There is a need to strengthen pharmacists’ knowledge and improve pharmacy services to reduce disparities.

A growing literature highlights complexity of policy implementation and governance in global health and argues that the processes and outcomes of policies could be improved by explicitly taking this complexity into account. Yet there is a paucity of studies exploring how this can be achieved in everyday practice. This study documents the strategies, tactics, and challenges of boundary‐spanning actors working in 4 Sub‐Saharan Africa countries who supported the implementation of multisectoral nutrition as part of the African Nutrition Security Partnership in Burkina Faso, Mali, Ethiopia, and Uganda. Three action researchers were posted to these countries during the final 2 years of the project to help the government and its partners implement multisectoral nutrition and document the lessons. Prospective data were collected through participant observation, end‐line semistructured interviews, and document analysis. All 4 countries made significant progress despite a wide range of challenges at the individual, organizational, and system levels. The boundary‐spanning actors and their collaborators deployed a wide range of strategies but faced significant challenges in playing these unconventional roles. The study concludes that, under the right conditions, intentional boundary spanning can be a feasible and acceptable practice within a multisectoral, complex adaptive system in low‐ and middle‐income countries.

A trend of the shortening duration of pregnancies carried to term has been observed in several countries and represents a growing public health concern. This paper describes the trend in the Czech Republic and shows its relation to the changing demographic structure of mothers and the organisation of maternity care. Data from the birth register are used and supplemented with information about the capacity of maternity care (number of beds at maternity clinics, number of obstetricians and midwives). Logistic regression is used to estimate the odds of 37 to 39 vs 40+ completed weeks of gestation. The results show that the average gestational age at term decreased by 2.1 days between 2000 and 2013. The odds of 37 to 39 weeks of gestational duration increased, mainly due to the reduction in the number of beds at maternity clinics (adjusted odds ratio of 1.51). The effects of the number of health care staff members were weaker. The number of midwives positively influenced gestational duration, while the number of obstetricians had a negative effect. Maternal demographic structure cannot explain the trend. A likely explanation is the increased use of planned early term caesarean sections.

Background Social network processes impact on the genesis and management of mental health problems. There is currently less understanding of the way people negotiate networked relationships in times of crisis compared to how they manage at other times. Objective This paper explores the patterns and nature of personal network involvement at times of crises and how these may differ from day‐to‐day networks of recovery and maintenance. Method Semi‐structured interviews with 25 participants with a diagnosis of long‐term mental health (MH) problems drawn from recovery settings in the south of England. Interviews centred on personal network mapping of members and resources providing support. The mapping interviews explored the work of network members and changes in times of crisis. Interviews were recorded, transcribed and analysed using a framework analysis. Results Three key themes were identified: the fluidity of network relationality between crisis and recovery; isolation as a means of crises management; leaning towards peer support. Personal network input retreated at times of crisis often as result of “ejection” from the network by participants who used self‐isolation as a personal management strategy in an attempt to deal with crises. Peer support is considered useful during a crisis, whilst the role of services was viewed with some ambiguity. Conclusions Social networks membership, and type and depth of involvement, is subject to change between times of crisis and everyday support. This has implications for managing mental health in terms of engaging with network support differently in times of crises versus recovery and everyday living.

This article starts with discussing principles for a globally just system of refugee protection to which states contribute either by admitting refugees for resettlement or by supporting refugee integration in other states. Such a system requires relatively strong assurances of compliance by the states involved, which are absent in the international arena. In the European Union, however, the Member States form a predetermined set with prior commitments and supranational institutions that facilitate effective burden sharing. The article traces the failure of the EU's relocation scheme to meet this expectation to misconceptions how to determine fair shares, to incomplete prior harmonization of normative standards, and to contradictions between the Dublin Regulation's principle of assigning responsibility to first countries of entry, on the one hand, and the Schengen principle of open internal borders, on the other hand.

This article analyzes how Member States have used the opportunities and avoided the constraints of the EU's multilevel governance architecture to return unwanted migrants. Drawing on sociological approaches to the EU and a broad understanding of return policies, we investigate the ways in which the northern Member States, notably Germany and Austria, have increasingly relied upon the EU's operational and financial resources to achieve their goal of pursuing a bold return policy. A key ‘usage’ of Europe has been the pooling of political and financial power to externalize and informalize its return policy. At the same time, the northern Member States' deliberate – yet widely under‐researched – ‘non‐use’ of Europe, such as using and maximizing national leeway, has been an equally important strategy to reduce migratory pressure and achieve higher return rates.

The Trans‐Pacific Partnership (TPP) trade agreement, if were it to be successfully implemented, would be one of the largest regional agreements ever seen. It is the only exemplar to date of a “mega‐regional” FTA for which negotiations have been successfully concluded, and a landmark in evolving approaches to Asia–Pacific integration. As such, quantitative assessments of its potential effects are of considerable interest. One of the most widely used techniques for evaluating the economic impact of regional trading agreements is numerical simulation with computable general equilibrium, or CGE, models. There have now been a large number of papers written that use CGE methods to analyse the potential economic impact of the TPP agreement under varying theoretical and policy assumptions. In this paper we provide a synthesis of the key results that have emerged from the literature, and introduce some new simulation results of our own to anchor the discussion.

In April 2005, Lucio Gutiérrez was removed from office in the context of a fast‐growing economy. With no economic hardship to fuel social outrage, the failure of Gutiérrez illustrates how political and institutional factors can be the most important forces determining presidential survival. In this article, we qualitatively analyse the path toward confrontation between Gutiérrez and the congressional opposition which led to his political demise. We find that Ecuador's weak democratic tradition working through more proximate causes – radicalism, normative preference for democratic institutions and a negative institutional equilibrium – coupled with other institutional and political variables accelerated Lucio Gutiérrez's fall from power.

Objectives To investigate the association between hospital safety culture and 30‐day risk‐adjusted mortality for Medicare patients with acute myocardial infarction (AMI) in a large, diverse hospital cohort. Subjects The final analytic cohort consisted of 19,357 Medicare AMI discharges (MedPAR data) linked to 257 AHRQ Hospital Survey on Patient Safety Culture surveys from 171 hospitals between 2008 and 2013. Study Design Observational, cross‐sectional study using hierarchical logistic models to estimate the association between hospital safety scores and 30‐day risk‐adjusted patient mortality. Odds ratios of 30‐day, all‐cause mortality, adjusting for patient covariates, hospital characteristics (size and teaching status), and several different types of safety culture scores (composite, average, and overall) were determined. Principal Findings No significant association was found between any measure of hospital safety culture and adjusted AMI mortality. Conclusions In a large cross‐sectional study from a diverse hospital cohort, AHRQ safety culture scores were not associated with AMI mortality. Our study adds to a growing body of investigations that have failed to conclusively demonstrate a safety culture–outcome association in health care, at least with widely used national survey instruments.

This article examines the role of non‐financial interest groups in EU financial regulatory decision‐making. While regulatory capture theories clearly helped identify the causes for the incrementality in spite of the major shock the 2008 crisis had caused, this article will consider a range of regulatory policy initiatives that do not neatly conform with this theory. I examine the extent to which non‐financial groups are able to have their preferences met in the making of three different consumer policies: the Mortgage Credit Directive (MCD), stricter regulations of retail investment products (PRIPs/KID) and the reform of EU level supervisory structures. By employing a process‐tracing approach based on qualitative interviews to analyze political responses to the 2008 financial crisis, the article demonstrates that newly mobilized groups could translate key advocacy goals into policy by deploying counter‐expertise and co‐operating with policy‐makers in some cases but not in others.

Due to its fast economic growth and lifestyle changes, China is experiencing a rapid epidemiological transition from communicable to noncommunicable diseases (NCDs). Mental disorder such as depression is an important yet often neglected NCD and is becoming a growing cause of disability, suicides, and disease burden. This paper provides the first nationally representative estimate of the medical cost attributable to depression and depressive symptoms among the adult population in China. On the basis of the 2012 China Family Panel Studies survey, our results indicate that these mental health conditions have significant impacts on the individual medical expenditure, and they jointly contribute to 14.7% of total personal expected medical spending in China, with depression and depressive symptoms accounting for 6.9% and 7.8%, respectively. Given that patients with mental illness face multiple psychological and institutional barriers in seeking appropriate treatment, the high depression‐induced medical costs may be primarily driven by the cost‐shifting effect from mental health care to general health care, as mental disorders often coexist with other NCDs such as diabetes and hypertension. As an implication, our study calls for an urgent reform of China's mental health and insurance systems to remove the policy‐induced obstacles for the access to mental health care resources.

The explosive growth of mobile apps makes it difficult for users to find their needed apps in a crowded market. An effective mechanism that provides high quality app recommendations becomes necessary. However, existing recommendation techniques tend to recommend similar items but fail to consider users’ functional requirements, making them not effective in the app domain. In this article, we propose a recommendation architecture that can generate app recommendations at the functionality level. We address the redundant recommendation problem in the app domain by highlighting users’ functional requirements, an element that has received scant attention from existing recommendation research. Another main feature of our work is extracting app functionalities from textural user reviews for recommendation. We also propose an effective approach for functionality extraction. Experiments conducted on a real‐world dataset show that our proposed AppRank method outperforms other commonly used recommendation methods. In particular, it doubles the recall value of the second best method under an extremely sparse setting, increases the overall ranking accuracy of the second best method by 14.27%, and retains a high diversity of 0.99.

For diversity and novelty evaluation in information retrieval, we expect that the novel documents are always ranked higher than the redundant ones and the relevant ones higher than the irrelevant ones. We also expect that the level of novelty and relevancy should be acknowledged. Accordingly, we expect that the evaluation algorithm would reward rankings that respect these expectations. Nevertheless, there are few research articles in the literature that study how to meet such expectations, even fewer in the field of biomedical information retrieval. In this article, we propose a new metric for novelty and relevancy evaluation in biomedical information retrieval based on an aspect‐level performance measure introduced by TREC Genomics Track with formal results to show that those expectations above can be respected under ideal conditions. The empirical evaluation indicates that the proposed metric, geNov, is greatly sensitive to the desired characteristics above, and the three parameters are highly tuneable for different evaluation preferences. By experimentally comparing with state‐of‐the‐art metrics for novelty and diversity, the proposed metric shows its advantages in recognizing the ranking quality in terms of novelty, redundancy, relevancy, and irrelevancy and in its discriminative power. Experiments reveal the proposed metric is faster to compute than state‐of‐the‐art metrics.

Aims The aim of the study is to verify the knowledge and practices of health professionals working in prenatal care (PNC) related with syphilis during pregnancy and to identify the main barriers to the implementation of protocols for the control of this disease. Methods A cross‐sectional study in Teresina, Brazil, from January to May 2015, was conducted with 366 physicians and nurses working in PNC, corresponding to 70% of eligible professionals. We evaluated 20 knowledge and practice criteria related to the diagnosis and treatment of syphilis during pregnancy with a 95% compliance standard. We performed descriptive analysis of the data and used χ2 statistical test to verify differences according to professional category. Results Only 2 criteria, “knowledge about mother to child transmission according to gestational age” and “counselling on infection,” reached 95% compliance. Knowledge of the epidemiological profile of congenital syphilis and the goal of elimination of congenital syphilis and knowledge about serological tests had scores below 50%, while practices related with posttest counselling, cure control, and treatment of partners reached 60%. We identified organisational barriers related to the late initiation of PNC, to the delayed return of syphilis test results, to the application of benzathine penicillin in primary care units and to the treatment of partners. Conclusions Strategies for early initiation of PNC, implementation of rapid tests for syphilis, ensuring treatment of pregnant women with penicillin, adequate partner treatment, and continued education of health professionals on clinical management and counselling in sexually transmitted diseases are necessary to eliminate congenital syphilis.

Background Patient engagement in research (PEIR) is promoted to improve the relevance and quality of health research, but has little conceptualization derived from empirical data. Objective To address this issue, we sought to develop an empirically based conceptual framework for meaningful PEIR founded on a patient perspective. Methods We conducted a qualitative secondary analysis of in‐depth interviews with 18 patient research partners from a research centre‐affiliated patient advisory board. Data analysis involved three phases: identifying the themes, developing a framework and confirming the framework. We coded and organized the data, and abstracted, illustrated, described and explored the emergent themes using thematic analysis. Directed content analysis was conducted to derive concepts from 18 publications related to PEIR to supplement, confirm or refute, and extend the emergent conceptual framework. The framework was reviewed by four patient research partners on our research team. Results Participants’ experiences of working with researchers were generally positive. Eight themes emerged: procedural requirements, convenience, contributions, support, team interaction, research environment, feel valued and benefits. These themes were interconnected and formed a conceptual framework to explain the phenomenon of meaningful PEIR from a patient perspective. This framework, the PEIR Framework, was endorsed by the patient research partners on our team. Conclusions The PEIR Framework provides guidance on aspects of PEIR to address for meaningful PEIR. It could be particularly useful when patient‐researcher partnerships are led by researchers with little experience of engaging patients in research.

First embodied by the European Supervisory Authorities in 2010, agency governance in the financial sector has gained momentum with the creation of the Single Resolution Board (SRB) – an EU agency with considerable competencies in banking prudential policy. Within a short period, backed by the ‘ESMA‐Short Selling case’ judgment, agencies have progressed from supporting the European Commission with their quasi‐rule making, to a more prominent role in the decision‐making process, potentially influencing policy‐makers' agenda. By engaging in a qualitative analysis of legal documents, official texts and relevant scholarship, this research note examines the formal framework and practical aspects of SRB's governance, in order to substantiate whether its establishment presents a ‘qualitative increase’ in financial sector agencification. At the same time, the research note highlights problematic issues arising because of the limitations set by the Meroni doctrine arguing that the Board's wide powers ‘on paper’ may prove challenging to implement in practice.

Does corruption influence trust in national institutions in the same way as trust in international institutions? Did this influence change over the economic crisis 2008? Using data from the European Social Survey, we examined the association between corruption and trust in national and European parliaments before and after the start of the Great Recession 2008. We found that over the Crisis, the effect of corruption on trust in national parliament became more negative than it was before 2008. We also discovered a positive association between corruption and trust in the EU before the Crisis. That is, states with a higher level of national corruption seem to have more trust in international institutions, such as the EU. However, this relationship disappears after 2008. Our findings contribute to the debates on the impact of corruption on trust in national and international institutions, and on the consequences of the Great Recession.

Whereas most research focuses on non‐compliant implementation, we lack understanding of implementers' incentives and abilities to outperform national legislation. This study investigates a largely under‐researched question: to what extent practical implementation exceeds levels of legislative compliance with EU requirements? To explain this phenomenon, we focus on the responsiveness of implementing actors to external (participation in transnational networks) and domestic pressures (national societal attitudes) for compliance with EU requirements and the availability of additional expertise at the implementation stage (bottom‐up). Moreover, implementing actors are unlikely to respond in the same way to different types of national legislative problems (top‐down). The findings suggest that implementers often outperform the transposition of EU laws. Practical outperformance depends on the level of societal support for external policies and is a response to incomplete or ambiguous domestic formal rules.

Sociologists of science emphasize the crucial role of the day‐to‐day practices of scholars in defining academic disciplines and epistemological schools. Taking the case of EU Studies (EUS), this article examines the key practice of normative writing. I analyze the degree to which 70 highly‐cited journal articles of political science writing in EUS explicitly or implicitly suggest that European integration or its institutions or policies are bad or good, flourishing or declining. I use this discourse analysis, plus biographical data on the authors of texts, to explain a major temporal pattern. Degrees of normativity in EUS articles progressively declined from the 1970s until the millennium, but then subsequently recovered. Factors ‘external’ to scholarship, such as the progressive intensification of European integration and crises faced by the EU help explain this pattern. However they interacted in complex ways with ‘internal’ academic factors, such as generational replacement, ‘mainstreaming’ and rivalries between sub‐disciplinary and theoretical camps.

The paper investigates the spatial interdependence of US MNE investments in the MENA region. Given the variations in resource endowments, governance structures and degree of infrastructure availability in MENA countries, one would expect these variables to affect an MNE's choice of FDI location. We do find that domestic non‐spatial factors such as own country inflation and governance measured by bureaucratic quality as well as infrastructure affect a host country's inward FDI. We also found that only one measure of natural resource endowment; that is, oil and gas exports were instrumental in attracting FDI. This non‐spatial result is generally robust and invariant to the two methodologies employed in this study, that is the spatially autoregressive (SAR) model and the spatial Durbin model (SDM). We found that neighbouring countries’ infrastructure availability measured either by “electricity used” or “energy used” affected FDI inflows in a host country. However, this spatial impact was found only in the SDM model. The spatial effects of neighbouring countries’ economic and political conditions and resource endowments were, however, not observed on a host country's inward FDI. The insignificance of both the surrounding market potential and the spatially weighted FDI suggests a purely horizontal motive of MNE investments in the MENA region.

This paper examines the relationship between China's exports, export tax rebates and exchange rate policy. It offers an explanation for why China's exports continued to rise under RMB real appreciations during the Asian financial crisis. Based on a traditional export demand model, we test our hypothesis that the counteracting effects of China's export tax rebate policy have diminished the effectiveness of real exchange rates in facilitating the resolution of trade imbalances under the current pegged exchange rate regime. We find evidence that RMB real appreciations during the crisis negatively affected China's exports, but the negative effects were mitigated by the positive effects of export tax rebates. We also find evidence of a long‐run relationship between China's exports and the other explanatory variables. The empirical evidence suggests that under the pegged exchange rate regime with limited adjustments, real exchange rate movements alone cannot resolve China's external imbalances. The policy implication of this study is that China needs to redirect its decades‐long export‐oriented development strategy to one that emphasises domestic demand‐oriented development and to replace the current pegged exchange rate regime with a market‐oriented more flexible exchange rate regime.

Journal of Knowledge Management, Volume 21, Issue 5, Page 1013-1034, September 2017.
Purpose The aim of this paper is to frame the stakeholder-driven system mapping approach in the context of climate change, building on stakeholder knowledge of system boundaries, key elements and interactions within a system and to introduce a decision support tool for managing and visualising this knowledge into insightful system maps with policy implications. Design/methodology/approach This methodological framework is based on the concepts of market maps. The process of eliciting and visualising expert knowledge is facilitated by means of a reference implementation in MATLAB, which allows for designing technological innovation systems models in either a structured or a visual format. Findings System mapping can contribute to evaluating systems for climate change by capturing knowledge of expert groups with regard to the dynamic interrelations between climate policy strategies and other system components, which may promote or hinder the desired transition to low carbon societies. Research limitations/implications This study explores how system mapping addresses gaps in analytical tools and complements the systems of innovation framework. Knowledge elicitation, however, must be facilitated and build upon a structured framework such as technological innovation systems. Practical implications This approach can provide policymakers with significant insight into the strengths and weaknesses of current policy frameworks based on tacit knowledge embedded in stakeholders. Social implications The developed methodological framework aims to include societal groups in the climate policy-making process by acknowledging stakeholders’ role in developing transition pathways. The system map codifies stakeholder input in a structured and transparent manner. Originality/value This is the first study that clearly defines the system mapping approach in the frame of climate policy and introduces the first dedicated software option for researchers and decision makers to use for implementing this methodology.

Journal of Knowledge Management, Volume 21, Issue 5, Page 1035-1052, September 2017.
Purpose The purpose of this paper is to explore and characterize knowledge integration approaches for integrating external knowledge of suppliers into new product development projects. Design/methodology/approach This paper is based on a multiple, in-depth case study of six product development projects at three knowledge-intensive manufacturing firms. Findings Firms make purposeful choices to devise knowledge integration approaches when working in collaborative buyer – supplier projects. The knowledge characteristics of the supplier input guide the choice of either coupling knowledge sharing and combining across firms or decoupling knowledge sharing (across firms) and knowledge combining (within firms). Research limitations/implications This study relies on a limited number of case studies and considers only one supplier relationship in each project. Further studies could examine the challenge of knowledge integration in buyer – supplier relationships in different contexts, i.e. in relation to innovation complexity and uncertainty. Practical implications Managers need to make choices when designing knowledge integration approaches in collaborative product development projects. The use of coupled and decoupled approaches can help balance requirements in terms of joint problem-solving across firms, the efficiency of knowledge integration and the risks of knowledge leakage. Originality/value The conceptualization of knowledge integration as knowledge sharing and knowledge combining extends existing perspectives on knowledge integration as either a transfer of knowledge or as revealing the presence of pertinent knowledge without entirely transmitting it. The findings point to the complexity of knowledge integration as a process influenced by knowledge characteristics, perspectives on knowledge, openness of firm boundaries and elements of knowledge sharing and combining.

Journal of Knowledge Management, Volume 21, Issue 5, Page 1053-1076, September 2017.
Purpose Although mobile devices are ubiquitous among employees, their awareness and readiness to use mobile technologies for competence development is still not widespread and therefore requires further exploration. The purpose of this study is to propose a conceptual model based on the unified theory of acceptance and use of technology (UTAUT) to explain the determinants that affect employees’ intention to use mobile devices and software for knowledge transfer during the process of knowledge management. Design/methodology/approach A conceptual model based on the UTAUT with new variables concerning relative usability (RU) and user autonomy (UA) and new connections between the determinants was developed as a result of a subject matter literature review. A structural equation modelling approach was used to validate the model on the basis of data collected via a survey collected from 371 employees from 21 sectors, both public and private. Findings The UTAUT model extended by new variables like RU and UA explains employee acceptance of mobile technologies for knowledge transfer reasonably well. New proposed variables highlighted that the usability of technology compared to other solutions and user autonomy in the selection and the use of applications have the strongest impact on the employees’ intention to use mobile devices and software for knowledge transfer. Research limitations/implications This model explains the 55 per cent behavioral intention of employees to use mobile technologies for knowledge transfer. Even though it is quite high in terms of acceptance theories, some new variables should be explored. Furthermore, study does not verify whether m-learning acceptance for knowledge transfer is sector-specific. Practical implications Mobile technologies used for knowledge transfer by employees should allow for high UA through their ability to select solutions that they find convenient, use of preferred platforms, personalize applications and utilize devices and software in various environments. They should not be simplified and should have the same functionality and efficiency of use as alternative solutions like web and desktop applications, even if additional effort to learn them would be required. Mobile technologies that take into account UA and RU support the process of employees capturing, distributing and effectively using knowledge. Originality/value The elaborated model provides a valuable solution with practical implications for increasing mobile technologies acceptance for knowledge transfer. The study results contribute both to knowledge management and technology acceptance research fields by introducing two new determinants for the acceptance of technologies in knowledge transfer, such as UA and RU with several additional connections between existing UTAUT variables.

Journal of Knowledge Management, Volume 21, Issue 5, Page 1077-1097, September 2017.
Purpose This study aims to investigate how psychological motivations influence the knowledge-sharing intention of employees and how these effects are moderated by traditional Chinese culture. Design/methodology/approach A questionnaire survey was conducted in China to test the research model. The target samples comprised MBA students who have enough practical experience, as well as considerable academic experience. Findings The results suggest that anticipated reciprocal relationships, anticipated extrinsic rewards and sense of self-worth exert different effects on knowledge-sharing intention. In addition, traditional Chinese culture plays different roles in the relationships among these three psychological motivations and knowledge-sharing intention. Specifically, guanxi orientation positively moderates the effect of anticipated reciprocal relationships and negatively moderates the effect of sense of self-worth. Face gaining negatively moderates the effect of anticipated reciprocal relationships and positively moderates the effect of sense of self-worth. Face saving negatively moderates the effect of anticipated reciprocal relationships and sense of self-worth. Originality/value A few studies in extant knowledge management (KM) literature provided insights into how traditional Chinese culture could directly affect knowledge sharing. The authors depart from these studies by integrating these characteristic indigenous concepts (i.e. face and guanxi orientation) into this study. The authors offer an indigenous cultural view of how these indigenous concepts truly influence an individual’s psychological states and inclination in KM literature. Through this approach, the results confirm that these cultural factors do play an important role during the formation of knowledge-sharing intention and reveals several important research findings.