Public Expenditure And Property Cycle: The Case In Shanghai

China's economic growth heavily relies on fixed asset investment. Previous studies have demonstrated that GDP growth plays a key role in assessing Chinese local officials' performance and enhancing their chances of political promotion. Thus, local officials have a strong motivation to boost the economy, which also impacts the property market. Based on this notion, the empirical results of this study indicate that public expenditure fluctuations and residential property price movements in Shanghai were positively co-integrated from 1992 to 2009, suggesting that increased public expenditure has reshaped Shanghai's property cycle to have longer booms and shorter busts. The findings also shed light on the nature of property cycles in other large- and medium-sized Chinese cities and developing countries with rampant economic growth, low real interest rates and an increasing urban population

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

Economic performance of industrial development on collective land in the urbanization process in China: Empirical evidence from Shenzhen

The study investigates the economic performance of industrial development in the Chinese urbanization process under two different property rights arrangements. Industrial development contributes significantly to China's economic growth in the urbanization process. As one of the most fundamental institutional arrangements, the urban-rural dual land system is important in urbanization and industrial development in China. Two types of land system including state and collective ownership coexist in the current land administration system. According to the law, the state owns the urban land, whereas the village collective owns the rural land. State requisition is the only channel to convert rural land to urban land. Village collectives are not allowed to transfer their land for urban use. Therefore, the property rights on collective land are incomplete in the urbanization process. Do incomplete property rights cause unsatisfactory economic performance of industrial development on collective land? Based on community-level data from two districts with an area of 1557km2 in Shenzhen in 2006, a regression analysis shows that incomplete property rights have caused significant land use inefficiency in industrial development in terms of lower land rental value and lower industrial value added per unit of land. The findings suggest that monthly rental prices of industrial plants on collective land were approximately 57% less than those on state land in 2006. The industrial value produced on collective land was RMB 6.624 billion less than on state land per km2. © 2013 Elsevier Ltd.Link_to_subscribed_fulltex

Public expenditure and property cycle: The case in shanghai

China's economic growth heavily relies on fixed asset investment. previous studies have demonstrated that gdp growth plays a key role in assessing chinese local officials' performance and enhancing their chances of political promotion. thus, local officials have a strong motivation to boost the economy, which also impacts the property market. based on this notion, the empirical results of this study indicate that public expenditure fluctuations and residential property price movements in shanghai were positively co-integrated from 1992 to 2009, suggesting that increased public expenditure has reshaped shanghai's property cycle to have longer booms and shorter busts. the findings also shed light on the nature of property cycles in other large- and medium-sized chinese cities and developing countries with rampant economic growth, low real interest rates and an increasing urban population. © Penerbit Universiti Sains Malaysia, 2012.Link_to_subscribed_fulltex

How transaction costs affect real estate developers entering into the building energy efficiency (BEE) market?

Buildings consume a major proportion of the electricity power in most cities, thus promoting building energy efficiency (BEE) will directly contribute to low carbon cities. Some studies suggest that the additional investment on BEE should be well paid off by higher selling prices or more savings in term of life cycle costing. Real estate developers are profit driven and working in a competitive environment. However, it appears that real estate developers are skeptical in entering the BEE market, which requires alternate theories to explain their behaviors. In this study, we attempt incorporating transaction cost economics (TCE) and game theoretical frameworks into the analysis. It suggests that the anticipated transaction costs entailed in the provision of BEE products due to such factors as bounded rationality, opportunism and contractual hazards, combined with the asymmetrical information in the BEE market have curtailed the developers' interests. This study also leads to suggesting some policy recommendations to induce the developers entering into the BEE market by reducing the transaction costs. © 2011 Elsevier Ltd.Link_to_subscribed_fulltex