The American Middle Class, Income Inequality, and the Strength of Our Economy

Analyzes 1979-2007 income growth by income group and how the state of the middle class and level of income inequality affect factors shaping the economy, such as human capital, demand for goods and services, entrepreneurship, and inclusive institutions

The long and short of it: Global liberalization, poverty and inequality

Global deregulation of current and capital account is often touted as successful means to reduce poverty and inequality. On the face of it, though, the evidence does not support this claim. Rising intra-country inequality is widespread, income inequality between countries grows, the absolute number of people living in poverty increases, and poverty rate reductions are geographically isolated. Critics of global deregulation have charged that more deregulated trade flows result in a worse income distribution and unregulated capital flows in more macro economic instabilities that are especially harmful to the poor. Using data from the World Bank, the IMF and the UN, we test the impact of increased deregulation on the incomes of the poor. Our results indicate that global deregulation of trade and capital markets does hurt the poor. We find that the income share of the poor is generally lower in deregulated and in macro economically less stable environments, which are more prone to occur after capital account liberalization. The evidence also suggests that trade flows in more regulated environments may be good for growth and, by extension, for the poor in the long-run. --

Why China Grew: Understanding the Financial Structure of Late Development

This dissertation explores how economic institutions governing finance and investment have con- tributed to growth in reform-era China. Economic and political reforms greatly transformed China\u27s prior centrally-planned economy. Although reforms incorporated elements of market institutions and private enterprise, China\u27s state institutions exercising extensive authority over a wide range of eco- nomic affairs critically and fundamentally played a central role in transforming this economy from one of the world\u27s poorest to the world\u27s second largest in the span of one generation. I explain the emergence of a unique configuration of institutions supportive of industrial policy implemented by largely autonomous local government officials. In combination with state-directed bank credit, this local government industrial policy finance have played a significant and positive role in development of exports in China. Foreign direct investment, too, was positively and significantly associated with export development, though on a more geographically-limited basis. Though private entrepreneurs are often seen as dynamic engines of growth in China\u27s reform-era economy, I show that the vast majority of entrepreneurs are low-skilled, low-productivity, and exhibit non-positive rates of capital accumulation. Most entrepreneurs would experience higher earnings were they not segmented into self-employment occupations by adverse socioeconomic conditions. Rather than engines of growth, China\u27s entrepreneurs resemble more the vast numbers of informal sector self-employment prevalent in many developing countries

The long and short of it: Global liberalization, poverty and inequality

Global deregulation of current and capital account is often touted as successful means to reduce poverty and inequality. On the face of it, though, the evidence does not support this claim. Rising intra-country inequality is widespread, income inequality between countries grows, the absolute number of people living in poverty increases, and poverty rate reductions are geographically isolated. Critics of global deregulation have charged that more deregulated trade flows result in a worse income distribution and unregulated capital flows in more macro economic instabilities that are especially harmful to the poor. Using data from the World Bank, the IMF and the UN, we test the impact of increased deregulation on the incomes of the poor. Our results indicate that global deregulation of trade and capital markets does hurt the poor. We find that the income share of the poor is generally lower in deregulated and in macro economically less stable environments, which are more prone to occur after capital account liberalization. The evidence also suggests that trade flows in more regulated environments may be good for growth and, by extension, for the poor in the long-run

Development and application of an antibiotic spectrum index for benchmarking antibiotic selection patterns across hospitals

Standard metrics for antimicrobial use consider volume but not spectrum of antimicrobial prescribing. We developed an antibiotic spectrum index (ASI) to classify commonly used antibiotics based on activity against important pathogens. The application of this index to hospital antibiotic use reveals how this tool enhances current antimicrobial stewardship metrics.Infect Control Hosp Epidemiol 2017;38:993–997</jats:p

Variability in antifungal and antiviral use in hospitalized children

We analyzed antifungal and antiviral prescribing among high-risk children across freestanding children’s hospitals. Antifungal and antiviral days of therapy varied across hospitals. Benchmarking antifungal and antiviral use and developing antimicrobial stewardship strategies to optimize use of these high cost agents is needed.Infect Control Hosp Epidemiol2017;38:743–746</jats:p

Current state of antimicrobial stewardship in children’s hospital emergency departments

BACKGROUND Antimicrobial stewardship programs (ASPs) effectively optimize antibiotic use for inpatients; however, the extent of emergency department (ED) involvement in ASPs has not been described. OBJECTIVE To determine current ED involvement in children's hospital ASPs and to assess beliefs and preferred methods of implementation for ED-based ASPs. METHODS A cross-sectional survey of 37 children's hospitals participating in the Sharing Antimicrobial Resistance Practices collaboration was conducted. Surveys were distributed to ASP leaders and ED medical directors at each institution. Items assessed included beliefs regarding ED antibiotic prescribing, ED prescribing resources, ASP methods used in the ED such as clinical decision support and clinical care guidelines, ED participation in ASP activities, and preferred methods for ED-based ASP implementation. RESULTS A total of 36 ASP leaders (97.3%) and 32 ED directors (86.5%) responded; the overall response rate was 91.9%. Most ASP leaders (97.8%) and ED directors (93.7%) agreed that creation of ED-based ASPs was necessary. ED resources for antibiotic prescribing were obtained via the Internet or electronic health records (EHRs) for 29 hospitals (81.3%). The main ASP activities for the ED included production of antibiograms (77.8%) and creation of clinical care guidelines for pneumonia (83.3%). The ED was represented on 3 hospital ASP committees (8.3%). No hospital ASPs actively monitored outpatient ED prescribing. Most ASP leaders (77.8%) and ED directors (81.3%) preferred implementation of ED-based ASPs using clinical decision support integrated into the EHR. CONCLUSIONS Although ED involvement in ASPs is limited, both ASP and ED leaders believe that ED-based ASPs are necessary. Many children's hospitals have the capability to implement ED-based ASPs via the preferred method: EHR clinical decision support. Infect Control Hosp Epidemiol 2017;38:469-475

Changes in outpatient antibiotic prescribing for acute respiratory illnesses, 2011 to 2018.

OBJECTIVES: To describe acute respiratory illnesses (ARI) visits and antibiotic prescriptions in 2011 and 2018 across outpatient settings to evaluate progress in reducing unnecessary antibiotic prescribing for ARIs. DESIGN: Cross-sectional study. SETTING AND PATIENTS: Outpatient medical and pharmacy claims captured in the IBM MarketScan commercial database, a national convenience sample of privately insured individuals aged &lt;65 years. METHODS: We calculated the annual number of ARI visits and visits with oral antibiotic prescriptions per 1,000 enrollees overall and by age category, sex, and setting in 2011 and 2018. We compared these and calculated prevalence rate ratios (PRRs). We adapted existing tiered-diagnosis methodology for International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. RESULTS: In our study population, there were 829 ARI visits per 1,000 enrollees in 2011 compared with 760 ARI visits per 1,000 enrollees in 2018. In 2011, 39.3% of ARI visits were associated with ≥1 oral antibiotic prescription versus 36.2% in 2018. In 2018 compared with 2011, overall ARI visits decreased 8% (PRR, 0.92; 99.99% confidence interval [CI], 0.92-0.92), whereas visits with antibiotic prescriptions decreased 16% (PRR, 0.84; 99.99% CI, 0.84-0.85). Visits for antibiotic-inappropriate ARIs decreased by 9% (PRR, 0.91; 99.99% CI, 0.91-0.92), and visits with antibiotic prescriptions for these conditions decreased by 32% (PRR, 0.68; 99.99% CI, 0.67-0.68) from 2011 to 2018. CONCLUSIONS: Both the rate of antibiotic prescriptions per 1,000 enrollees and the percentage of visits with antibiotic prescriptions decreased modestly from 2011 to 2018 in our study population. These decreases were greatest for antibiotic-inappropriate ARIs; however, additional reductions in inappropriate antibiotic prescribing are needed