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Socio-economic differences in receiving care by the over-80s in Germany and England: intensity of care needs as a moderator
No full textThe growing number of people aged 80 or older living in the community has raised concerns about meeting their care needs and about socio-economic inequalities in their care use. The study examines socio-economic status (SES) patterns in informal and formal care use, as well as unmet care needs, of people aged 80 or older living in the community in Germany and England. We propose that SES patterns in care use change with the intensity of care needs. The analyses use data from the Survey of Quality of Life and Well-Being of the Very Old in North Rhine-Westphalia and the English Longitudinal Study of Ageing. Despite the differences in the long-term care systems (LTCSs) and cultural norms around filial obligations, we find a consistent pattern of association between socio-economic status (SES) and care use for older people with only few care needs in both countries. In this group, people with a higher SES have the highest likelihood of experiencing unmet care needs. For older people with many care needs, we find country-specific SES patterns that we link to cultural differences and the design of the LTCSs. In Germany, SES is negatively associated with using informal care and positively with using formal care. In England, care use shows little SES variation for older people with many care needs. The findings underscore the importance of considering the intensity of care needs when assessing inequalities in care access
The effect of NFT visual quality on consumer evaluations of luxury goods in the metaverse
No full textLuxury brands creating non-fungible tokens (NFTs) often face technical constraints that compromise visual aesthetics, potentially conflicting with their high-end image. This study investigates how the visual quality of NFTs and the presence of price information influence consumer perceptions of luxury goods in the metaverse across three experimental studies. Study 1 compared consumer evaluations across three conditions: good-quality NFT, poor-quality NFT, and no NFT. The findings revealed that poor NFT visual quality negatively influenced evaluations of the original product, with perceived authenticity identified as the key underlying mechanism. Study 2 examined whether this negative effect could be mitigated by the presence of price information. The results showed that a poor-quality NFT accompanied by price information resulted in more favorable evaluations of the original bag, regardless of style similarity. Study 3 replicated these findings using a three-condition design (low-price NFT, high-price NFT, and no NFT), demonstrating that the mitigating role of price information. Together, these findings contribute to the emerging digital fashion literature by highlighting the importance of visual quality and price transparency in NFT-based luxury marketing strategies within the metaverse
Trends in time to withdrawal and full approval of accelerated approval cancer drug indications (1992–2024)
No full textThe US Food and Drug Administration (FDA) accelerated approval program facilitates earlier access to therapies for serious illnesses based on surrogate endpoints reasonably likely to predict clinical benefit. To minimize risk, sponsors are required to conduct post marketing studies to confirm the benefit. Over the past decade, concerns have emerged about the pace and quality of post marketing evidence generation. We analyzed regulatory outcomes of oncology indications granted accelerated approval between 1992 and 2024, using publicly available FDA data. Median time to conversion to regular approval decreased from 4.3 to 2.3 years and time to withdrawal decreased from 9.5 to 3.2 years between the 1992–2013 and 2014–2024 periods (both
FRAME: Framework for Real‐World Evidence Assessment to Mitigate Evidence uncertainties for efficacy/effectiveness – an evaluation of regulatory and health technology assessment decision making
No full textReal‐World Evidence (RWE) is increasingly used in submissions to regulatory agencies and health technology assessment bodies (HTAbs) to support the efficacy and effectiveness of new medicines and indications. However, there is limited information on the RWE characteristics that impact its role in approval and reimbursement decisions. To investigate these characteristics, we developed FRAME: a Framework for Real‐world evidence Assessment to Mitigate Evidence uncertainties for efficacy/effectiveness. We compiled a list of medicinal product indications where RWE supported the efficacy of interventional trials or assessed effectiveness in observational settings. FRAME was applied to a prioritized subset of these submissions to authorities from North America, Europe, and Australia. For each product indication, we extracted information on characteristics describing the submission, clinical context, strength of evidence, and process factors from publicly available assessment reports. Of the 87 identified medicinal product indications, 15 were prioritized, covering 68 submissions and 76 RWE studies across 11 authorities in scope. Four main results emerged: (i) low granularity within assessment reports on the analyzed variables, limiting the learnings from analyzing them; (ii) variability in how RWE was assessed within and across regulatory agencies and HTAbs; (iii) a positive association between the proportion of positive comments from authorities on RWE studies and their impact on decision making. Particularly, a large effect size was consistently noted when RWE was considered primary evidence; and (iv) limited use of advanced RWE study designs. These findings support five recommendations to enhance shared learning on RWE, clarify its evidentiary value, and generate evidence to better support authorities' decision making
Historical differences in female-owned manufacturing establishments: the United States, 1850–1880
No full textWe characterize female-owned manufacturing establishments using digitized manuscripts from the US Census of Manufactures (1850, 1860, 1870, 1880). Female-owned establishments were smaller than male-owned establishments and had lower capital-to-output ratios, which could reflect more constrained financial access and other distortions. Female-owned establishments employed more women and paid women higher wages, creating a potential cycle between increased female business ownership and increased female labor market participation. Female-owned establishments concentrated in subindustries like women's clothing and millinery, which is associated with some but not all of these differences. We also show how female owners differed from other women in the Population Census
An asset-level analysis of financial tail risks under extreme weather events
No full textExtreme weather events pose a risk to the economic and financial system. To understand the materiality of these risks, financial institutions are beginning to conduct climate stress testing exercises. This requires climate risk models to be integrated with financial risk models. In this paper, we introduce an open, modular, and reproducible framework for the assessment of asset-level physical risk and the translation of these risks into portfolio-level impacts. The proposed framework addresses key limitations of previous research by including multiple financial transmission channels, and the incorporation of spatial correlations between weather events for bottom-up, asset-level, estimation of portfolio-level tail risks. By incorporating direct capital damages, business disruptions, and insurance coverage, we provide an overview of the direct financial impact of extreme weather events. Through an application of the framework for the assessment of flood risk to a portfolio of power firms located in India, we show that these extensions have material impacts on the risk estimates. We further show how different assumptions related to spatial correlations can lead to large under- or overestimations of portfolio-level tail risks
A novel type of precautionary argument for situations of severe uncertainty in science and policy
No full textThis paper articulates and defends a novel type of precautionary argument for situations of severe uncertainty in science and policy, which I term precautionary slippery slope argument. The paper explicates the structure of precautionary slippery slope arguments, identifies the main factors that bear on the strength of these arguments, and illustrates how the proponents of such arguments can address several influential objections put forward against standard slippery slope arguments and other prominent forms of precautionary reasoning
New goals, more actors: rethinking the political economy of fiscal institutions
No full textThis chapter argues that traditional measures of fiscal success, like fiscal discipline and economic growth, should be complemented by new goals reflecting broader human purposes and policy objectives, such as advancing key development priorities, addressing inequalities, and tackling climate change. It also suggests that a broader set of actors, including civil society, fiscal councils, and Supreme Audit Institutions (SAIs) should play more significant roles in holding governments accountable for these long-term policy objectives. Some governments have already initiated reforms to incorporate these broader goals into fiscal policy, including through the adoption of tools like gender budgeting and climate risk assessments, but these efforts are still incipient. The chapter concludes by highlighting the need for rethinking budget processes and institutional designs to address cross-sectoral challenges and incentivize long-term planning, supported by more and better data on the long-term and distributional impacts of public policies
Understanding youth online experiences and mental health: development and validation of the digital activity and feelings inventory (DAFI)
No full textObjectives: We created the Digital Activity and Feelings Inventory (DAFI) to measure youth digital activities and the psychological reactions they evoke, established its psychometric properties and tested its validity in predicting mental health relative to screen time estimates. Methods: An initial pool of items was generated using the existing research on youth digital activity and mental health and further refined via consultations with experts and young people (online youth panel sessions, n = 14). The participants (n = 383, mean age = 19 years) completed the resulting DAFI alongside established measures of depression, anxiety, wellbeing, and screen time. The DAFI factor structure, reliability and predictive validity were tested. Results: Exploratory factor analyses identified five digital activity subscales: Risky Content, Risky Interactions, Social Comparison, Leisure Activities and Social Engagement and three psychological reactions subscales: Negative Self-Reactions, Negative Stress Reactions, and Positive Reactions. Internal consistency and test-retest reliability were high. Social Comparison and Negative Self-Reactions, but not screen time, independently predicted depression and anxiety symptoms. Positive Reactions, lack of Negative Self-Reactions, lower screen time and Social Engagement predicted wellbeing. Conclusion: The DAFI is a reliable measure of digital activities and associated psychological reactions and predicts youth mental health better than screen time
NHS talking therapies bring long-term economic returns to England
No full textMental health treatment improves workers’ employability and increases their earnings. Klaudia Rzepnicka, Emma Sharland, Marta Rossa, Ted Dolby, Ekaterina Oparina, Rob Saunders, Daniel Ayoubkhani and Vahé Nafilyan conducted the first nationally representative analysis of how psychological therapies in England affect people’ work outcomes. They found evidence of the benefit of public investments in talking therapies