PRO-SOCIAL CONSUMER AND FIRM BEHAVIOR IN IMPERFECTLY COMPETITIVE REGIONAL AGRICULTURAL MARKETS

In this dissertation, I combine field research, econometric methods, and economic theory to analyze a market in which both firms’ and consumers’ choices are motivated by social preferences. This work contributes to the fields of behavioral economics, industrial organization, and local food systems economics. The dissertation expands the growing literature on social preferences to incorporate firms’ choices that are motivated by utility maximizing objectives in an environment that allows endogenous equilibrium prices and quantities. Firms with social preferences operate in a competitive environment in which they may face downstream market power. In particular, the research focuses on intermediated Farm to School markets for local food in which producers’ marketing decisions may be influenced by both market structure and the pro-social motivations embedded in local food markets

Different Tubers for Different Consumers: Heterogeneity in Human Values and Willingness to Pay for Social Outcomes of Potato Credence Attributes

This paper investigates heterogeneity in consumers’ human values and willingness to pay (WTP) for social outcomes of credence process attributes that might have some positive social impact on purchases of early potatoes in Italy and Germany. Consumers’ identification with cross‐cultural human values is measured according to the Schwartz’ Portrait Values Questionnaire; the distribution of preferences for product attributes that claim a positive social impact among respondents with different human values is modeled using mixed logit analysis. Parallel survey studies were conducted in each country with the intention of comparing the impact of human values using the Schwartz Values framework on willingness to pay for early potatoes with several credence process attributes that may signal a positive social outcome as a result of purchase (price, country of origin, carbon footprint certification, ethical certification, and method of production). This paper aims to help clarify the role, if any, that pro‐social consumer values have in influencing the willingness to pay for specific food credence process attributes that claim to have a social impact. To the best of our knowledge this is one of the first paper to focus on the role human values have in influencing the willingness to pay for specific extrinsic food attributes

Preventative tele-health supported services for early stage chronic obstructive pulmonary disease: a protocol for a pragmatic randomized controlled trial pilot

Background Chronic Obstructive Pulmonary Disease (COPD) is a prevalent debilitating long term condition. It is the second most common cause of emergency admission to hospital in the UK and remains one of the most costly conditions to treat through acute care. Tele-health monitoring offers potential to reduce the rates of re-hospitalisation and emergency department visits and improve quality of life for people with COPD. However, the current evidence base to support technology adoption and implementation is limited and the resource implications for implementing tele-health in practice can be very high. This trial will employ tele-health monitoring in a preventative capacity for patients diagnosed with early stage COPD following discharge from hospital to determine whether it reduces their need for additional health service support or hospital admission and improves their quality of life. Methods/Design We describe a pilot study for a two arm, one site randomized controlled trial (RCT) to determine the effect of tele-health monitoring on self-management, quality of life and patient satisfaction. Sixty patients who have been discharged from one acute trust with a primary diagnosis of COPD and who have agreed to receive community clinical support following discharge from acute care will be randomly assigned to one of two groups: (a) Tele-health supported Community COPD Service; or (b) Usual Care. The tele-health supported service involves the patient receiving two home visits with a specialist COPD clinician (nurse or physiotherapist) then participating in daily tele-monitoring over an eight week period. Usual care consists of six home visits to the patient by specialist COPD clinicians again over eight successive weeks. Health status and quality of life data for all participants will be measured at baseline, on discharge from the service and at six months post discharge from the service. Discussion The tele-health service under study is a complex service delivered through a collaboration between local authority and health care partners. The implementation of this service demanded significant changes to established working patterns and has been a challenging process requiring considerable planning - a challenge that many providers are likely to face in the future. Trial registration Current Controlled Trials ISRCTN6885601

First test results from a high-resolution CdZnTe pixel detector with VLSI readout

We are developing a CdZnTe pixel detector with a custom low- noise analog VLSI readout for use in the High-Energy Focusing Telescope balloon experiment, as well as for future space astronomy applications. The goal of the program is to achieve good energy resolution (< 1 keV FWHM at 60 keV) and low threshold in a sensor with approximately 500 micrometers pixels. We have fabricated several prototype detector assemblies with 2 mm thick, 680 by 650 micrometers pitch CdZnTe pixel sensors indium bump bonded a VLSI readout chip developed at Caltech. Each readout circuit in the 8 X 8 prototype is matched to the detector pixel size, and contains a preamplifier, shaping amplifiers, and a peak stretcher/discriminator. In the first 8 X 8 prototype, we have demonstrated the low-noise preamplifier by routing the output signals off-chip for shaping and pulse-height analysis. Pulse height spectra obtained using a ^(241)Am source, collimated to illuminate a single pixel, show excellent energy resolution of 1.1 keV FWHM for the 60 keV line at room temperature. Line profiles are approximately Gaussian and dominated by electronic noise, however a small low energy tail is evident for the 60 keV line. We obtained slightly improved resolution of 0.9 keV FWHM at 60 keV by cooling the detector to 5 degree(s)C, near the expected balloon- flight operating temperature. Pulse height spectra obtained with the collimated source positioned between pixels show the effect of signal sharing for events occurring near the boundary. We are able to model the observed spectra using a Monte-Carlo simulation that includes the effects of photon interaction, charge transport and diffusion, pixel and collimator geometry, and electronic noise. By using the model to simulate the detector response to uncollimated radiation (including the effect of finite trigger threshold for reconstruction of the total energy of multi-pixel events), we find the energy resolution to be degraded by only 10% for full-face illumination, compared to the collimated case. The small value of the degradation is due directly to the low readout noise and amplifier threshold

First test results from a high-resolution CdZnTe pixel detector with VLSI readout

We are developing a CdZnTe pixel detector with a custom low- noise analog VLSI readout for use in the High-Energy Focusing Telescope balloon experiment, as well as for future space astronomy applications. The goal of the program is to achieve good energy resolution (< 1 keV FWHM at 60 keV) and low threshold in a sensor with approximately 500 micrometers pixels. We have fabricated several prototype detector assemblies with 2 mm thick, 680 by 650 micrometers pitch CdZnTe pixel sensors indium bump bonded a VLSI readout chip developed at Caltech. Each readout circuit in the 8 X 8 prototype is matched to the detector pixel size, and contains a preamplifier, shaping amplifiers, and a peak stretcher/discriminator. In the first 8 X 8 prototype, we have demonstrated the low-noise preamplifier by routing the output signals off-chip for shaping and pulse-height analysis. Pulse height spectra obtained using a ^(241)Am source, collimated to illuminate a single pixel, show excellent energy resolution of 1.1 keV FWHM for the 60 keV line at room temperature. Line profiles are approximately Gaussian and dominated by electronic noise, however a small low energy tail is evident for the 60 keV line. We obtained slightly improved resolution of 0.9 keV FWHM at 60 keV by cooling the detector to 5 degree(s)C, near the expected balloon- flight operating temperature. Pulse height spectra obtained with the collimated source positioned between pixels show the effect of signal sharing for events occurring near the boundary. We are able to model the observed spectra using a Monte-Carlo simulation that includes the effects of photon interaction, charge transport and diffusion, pixel and collimator geometry, and electronic noise. By using the model to simulate the detector response to uncollimated radiation (including the effect of finite trigger threshold for reconstruction of the total energy of multi-pixel events), we find the energy resolution to be degraded by only 10% for full-face illumination, compared to the collimated case. The small value of the degradation is due directly to the low readout noise and amplifier threshold

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

A pilot randomised controlled trial of a Telehealth intervention in patients with chronic obstructive pulmonary disease: challenges of clinician-led data collection

Background The increasing prevalence and associated cost of treating chronic obstructive pulmonary disease (COPD) is unsustainable, and focus is needed on self-management and prevention of hospital admissions. Telehealth monitoring of patients’ vital signs allows clinicians to prioritise their workload and enables patients to take more responsibility for their health. This paper reports the results of a pilot randomised controlled trial (RCT) of Telehealth-supported care within a community-based COPD supported-discharge service. Methods A two-arm pragmatic pilot RCT was conducted comparing the standard service with a Telehealth-supported service and assessed the potential for progressing into a full RCT. The co-primary outcome measures were the proportion of COPD patients readmitted to hospital and changes in patients’ self-reported quality of life. The objectives were to assess the suitability of the methodology, produce a sample size calculation for a full RCT, and to give an indication of cost-effectiveness for both pathways. Results Sixty three participants were recruited (n = 31 Standard; n = 32 Telehealth); 15 participants were excluded from analysis due to inadequate data completion or withdrawal from the Telehealth arm. Recruitment was slow with significant gaps in data collection, due predominantly to an unanticipated 60% reduction of staff capacity within the clinical team. The sample size calculation was guided by estimates of clinically important effects and COPD readmission rates derived from the literature. Descriptive analyses showed that the standard service group had a lower proportion of patients with hospital readmissions and a greater increase in self-reported quality of life compared to the Telehealth-supported group. Telehealth was cost-effective only if hospital admissions data were excluded. Conclusions Slow recruitment rates and service reconfigurations prevented progression to a full RCT. Although there are advantages to conducting an RCT with data collection conducted by a frontline clinical team, in this case, challenges arose when resources within the team were reduced by external events. Gaps in data collection were resolved by recruiting a research nurse. This study reinforces previous findings regarding the difficulty of undertaking evaluation of complex interventions, and provides recommendations for the introduction and evaluation of complex interventions within clinical settings, such as prioritisation of research within the clinical remit

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

BACKGROUND: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. METHODS: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). FINDINGS: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29-146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0- 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25-1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39-1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65-1·60]; p=0·92). INTERPRETATION: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention. FUNDING: British Heart Foundation