Essays on public finance and health economics

This dissertation examines several questions in public finance, including health care, workers' compensation program, and tax rebates. The first chapter, entitled, "Financial Incentives and Physicians’ Behavior: Evidence from Texas Workers’ Compensation Medical Claims", examines whether financial incentives influence the quantity and composition of medical care provided by physicians. I study this question by leveraging an administrative change in the maximum allowed reimbursement rates for surgical services performed in a hospital setting for Texas Workers' Compensation medical claims. I document evidence of strong substitution in the location of care, indicating that many surgical services can be provided in either a hospital or office setting. I find that the 2% increase in surgical services provided in a hospital setting in response to this reform is fully offset by reduced utilization in an office setting. I also find that nonsurgical services performed in a hospital increased in response to the reform, suggesting surgical and nonsurgical services are complements with respect to physician financial incentives. More generally, my results suggest that the location of care is responsive to financial incentives, and an optimal payment policy should account for substitution along this margin. The second chapter, entitled "Cash-on-Hand and Demand for Credit", examines the effect of tax rebates on demand for small dollar credit loans. Subprime consumers often use small dollar credit to meet short-term financial needs over pay cycles. However, relatively little is known about the income sensitivity of demand for credit in this market. This chapter provides a causal estimate of the effect of tax rebates on the demand for small dollar credit, using shocks from the Earned Income Tax Credit (EITC) benefits and a unique proprietary loan-level dataset. The results show that a $100 increase in EITC benefits leads to a 8.3% in the number of loan applications and a 6.6% reduction in the number of borrowers. This could translate into sizable reductions in loan volume and savings in financial charges. The estimates are robust to various specifications checks. The results further indicate that EITC recipients are liquidity constrained. More broadly, the results suggest that public programs with income benefits could help recipients with consumption smoothing in the presence of credit market frictions. The third chapter, entitled "Take-up of Workers' Compensation Insurance in Texas", is coauthored with Marika Cabral and Michael Dworsky. This chapter examines how employers choose to provide benefits for their workers. Workers' compensation program is a large government program which provides monetary and medical benefits to injured workers. Texas is currently the only state that allows voluntary participation. Using difference-in-differences variation in regulated manual premium, this paper empirically analyzes employers' take-up of workers' compensation insurance coverage. We find that 10% increase in regulated premium reduces the number of covered firms by 2%, with similar effect on covered payroll.Economic

Evolution of Iron Kα_{\alpha} Line Emission in the Black Hole Candidate GX 339-4

GX 339-4 was regularly monitored with RXTE during a period (in 1999) when its X-ray flux decreased significantly (from 4.2$\times 10^{-10}$ erg cm$^{-2} s^{-1}$ to 7.6$\times 10^{-12}$ erg cm$^{-2}$s$^{-1}$ in the 3--20 keV band), as the source settled into the ``off state''. Our spectral analysis revealed the presence of a prominent iron K$_{\alpha}$ line in the observed spectrum of the source for all observations. The line shows an interesting evolution: it is centered at $\sim$6.4 keV when the measured flux is above 5$\times 10^{-11}$ erg cm$^{-2} s^{-1}$, but is shifted to $\sim$6.7 keV at lower fluxes. The equivalent width of the line appears to increase significantly toward lower fluxes, although it is likely to be sensitive to calibration uncertainties. While the fluorescent emission of neutral or mildly ionized iron atoms in the accretion disk can perhaps account for the 6.4 keV line, as is often invoked for black hole candidates, it seems difficult to understand the 6.7 keV line with this mechanism, because the disk should be less ionized at lower fluxes (unless its density changes drastically). On the other hand, the 6.7 keV line might be due to recombination cascade of hydrogen or helium like iron ions in an optically thin, highly ionized plasma. We discuss the results in the context of proposed accretion models.Comment: 18 pages, 2 figures, accepted for publication in the ApJ in v552n2p May 10, 2001 issu

LHC Searches for Non-Chiral Weakly Charged Multiplets

Because the TeV-scale to be probed at the Large Hadron Collider should shed light on the naturalness, hierarchy, and dark matter problems, most searches to date have focused on new physics signatures motivated by possible solutions to these puzzles. In this paper, we consider some candidates for new states that although not well-motivated from this standpoint are obvious possibilities that current search strategies would miss. In particular we consider vector representations of fermions in multiplets of $SU(2)_L$ with a lightest neutral state. Standard search strategies would fail to find such particles because of the expected small one-loop-level splitting between charged and neutral states.Comment: 16 pages, 9 figure

Field-effect transistors assembled from functionalized carbon nanotubes

We have fabricated field effect transistors from carbon nanotubes using a novel selective placement scheme. We use carbon nanotubes that are covalently bound to molecules containing hydroxamic acid functionality. The functionalized nanotubes bind strongly to basic metal oxide surfaces, but not to silicon dioxide. Upon annealing, the functionalization is removed, restoring the electronic properties of the nanotubes. The devices we have fabricated show excellent electrical characteristics.Comment: 5 pages, 6 figure

Combinations of β-lactam or aminoglycoside antibiotics with plectasin are synergistic against methicillin-sensitive and methicillin-resistant Staphylococcus aureus.

Bacterial infections remain the leading killer worldwide which is worsened by the continuous emergence of antibiotic resistance. In particular, methicillin-sensitive (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) are prevalent and the latter can be difficult to treat. The traditional strategy of novel therapeutic drug development inevitably leads to emergence of resistant strains, rendering the new drugs ineffective. Therefore, rejuvenating the therapeutic potentials of existing antibiotics offers an attractive novel strategy. Plectasin, a defensin antimicrobial peptide, potentiates the activities of other antibiotics such as β-lactams, aminoglycosides and glycopeptides against MSSA and MRSA. We performed in vitro and in vivo investigations to test against genetically diverse clinical isolates of MSSA (n = 101) and MRSA (n = 115). Minimum inhibitory concentrations (MIC) were determined by the broth microdilution method. The effects of combining plectasin with β-lactams, aminoglycosides and glycopeptides were examined using the chequerboard method and time kill curves. A murine neutropenic thigh model and a murine peritoneal infection model were used to test the effect of combination in vivo. Determined by factional inhibitory concentration index (FICI), plectasin in combination with aminoglycosides (gentamicin, neomycin or amikacin) displayed synergistic effects in 76-78% of MSSA and MRSA. A similar synergistic response was observed when plectasin was combined with β-lactams (penicillin, amoxicillin or flucloxacillin) in 87-89% of MSSA and MRSA. Interestingly, no such interaction was observed when plectasin was paired with vancomycin. Time kill analysis also demonstrated significant synergistic activities when plectasin was combined with amoxicillin, gentamicin or neomycin. In the murine models, plectasin at doses as low as 8 mg/kg augmented the activities of amoxicillin and gentamicin in successful treatment of MSSA and MRSA infections. We demonstrated that plectasin strongly rejuvenates the therapeutic potencies of existing antibiotics in vitro and in vivo. This is a novel strategy that can have major clinical implications in our fight against bacterial infections

Pt-decorated nanoporous gold for glucose electrooxidation in neutral and alkaline solutions

Exploiting electrocatalysts with high activity for glucose oxidation is of central importance for practical applications such as glucose fuel cell. Pt-decorated nanoporous gold (NPG-Pt), created by depositing a thin layer of Pt on NPG surface, was proposed as an active electrode for glucose electrooxidation in neutral and alkaline solutions. The structure and surface properties of NPG-Pt were characterized by scanning electron microscopy (SEM), transmission electron microscopy (TEM), X-ray powder diffraction (XRD), and cyclic voltammetry (CV). The electrocatalytic activity toward glucose oxidation in neutral and alkaline solutions was evaluated, which was found to depend strongly on the surface structure of NPG-Pt. A direct glucose fuel cell (DGFC) was performed based on the novel membrane electrode materials. With a low precious metal load of less than 0.3 mg cm-2 Au and 60 μg cm-2 Pt in anode and commercial Pt/C in cathode, the performance of DGFC in alkaline is much better than that in neutral condition

Cytochrome P450 2E1 polymorphism and nasopharyngeal carcinoma development in Thailand: a correlative study

BACKGROUND: Nasopharyngeal carcinoma (NPC) is a rare tumor in most parts of the world but occurs at relatively high frequency among people of Chinese descent. The cytochrome P450 2E1 enzyme (CYP2E1) is responsible for the metabolic activation of nitrosamines, and has been shown to be a susceptibility gene for NPC development in Taiwan [RR = 2.6; 95%CI = 1.2-5.7]. Since there has been only one report of this link, it was decided to investigate the susceptibility of CYP2E1 to NPC development in other populations. Therefore, the correlation between the RsaI polymorphism of this gene and NPC was studied in-patients including Thai and Chinese in Thailand. The present study comprised 217 cases diagnosed with NPC and 297 healthy controls. RESULTS: Similar to the result found in Taiwanese, a homozygous uncut genotype demonstrated a higher relative risk both when all cases were analyzed [RR = 2.19; 95%CI = 0.62-8.68] or individual racial groups, Thai [RR = 1.51; 95%CI = 0.08-90.06] or Chinese [RR = 1.99; 95%CI = 0.39-10.87]. The ethnicity-adjusted odds ratio is 2.39 with 95%CI, 0.72-7.89. CONCLUSIONS: Though our finding was not statistically significant due to the moderate sample size of the study, similarity to the study in Taiwan with only a slight loss in precision was demonstrated. The higher RR found for the same genotype in distinct populations confirmed that CYP2E1 is one of several NPC susceptibility genes and that the RsaI minus variant is one mutation that affects phenotype

Whole Genome Sequencing and Complete Genetic Analysis Reveals Novel Pathways to Glycopeptide Resistance in Staphylococcus aureus

The precise mechanisms leading to the emergence of low-level glycopeptide resistance in Staphylococcus aureus are poorly understood. In this study, we used whole genome deep sequencing to detect differences between two isogenic strains: a parental strain and a stable derivative selected stepwise for survival on 4 µg/ml teicoplanin, but which grows at higher drug concentrations (MIC 8 µg/ml). We uncovered only three single nucleotide changes in the selected strain. Nonsense mutations occurred in stp1, encoding a serine/threonine phosphatase, and in yjbH, encoding a post-transcriptional negative regulator of the redox/thiol stress sensor and global transcriptional regulator, Spx. A missense mutation (G45R) occurred in the histidine kinase sensor of cell wall stress, VraS. Using genetic methods, all single, pairwise combinations, and a fully reconstructed triple mutant were evaluated for their contribution to low-level glycopeptide resistance. We found a synergistic cooperation between dual phospho-signalling systems and a subtle contribution from YjbH, suggesting the activation of oxidative stress defences via Spx. To our knowledge, this is the first genetic demonstration of multiple sensor and stress pathways contributing simultaneously to glycopeptide resistance development. The multifactorial nature of glycopeptide resistance in this strain suggests a complex reprogramming of cell physiology to survive in the face of drug challenge

Regulation of ABCC6 trafficking and stability by a conserved C-terminal PDZ-like sequence

Mutations in the ABCC6 ABC-transporter are causative of pseudoxanthoma elasticum (PXE). The loss of functional ABCC6 protein in the basolateral membrane of the kidney and liver is putatively associated with altered secretion of a circulatory factor. As a result, systemic changes in elastic tissues are caused by progressive mineralization and degradation of elastic fibers. Premature arteriosclerosis, loss of skin and vascular tone, and a progressive loss of vision result from this ectopic mineralization. However, the identity of the circulatory factor and the specific role of ABCC6 in disease pathophysiology are not known. Though recessive loss-of-function alleles are associated with alterations in ABCC6 expression and function, the molecular pathologies associated with the majority of PXE-causing mutations are also not known. Sequence analysis of orthologous ABCC6 proteins indicates the C-terminal sequences are highly conserved and share high similarity to the PDZ sequences found in other ABCC subfamily members. Genetic testing of PXE patients suggests that at least one disease-causing mutation is located in a PDZ-like sequence at the extreme C-terminus of the ABCC6 protein. To evaluate the role of this C-terminal sequence in the biosynthesis and trafficking of ABCC6, a series of mutations were utilized to probe changes in ABCC6 biosynthesis, membrane stability and turnover. Removal of this PDZ-like sequence resulted in decreased steady-state ABCC6 levels, decreased cell surface expression and stability, and mislocalization of the ABCC6 protein in polarized cells. These data suggest that the conserved, PDZ-like sequence promotes the proper biosynthesis and trafficking of the ABCC6 protein. © 2014 Xue et al