The Need for Culturally-Based Palliative Care Programs for African American Patients at End-of-life

Patients facing life-threatening illness often experience unnecessary and preventable suffering including extreme and prolonged pain, psychological distress, as well as unsatisfactory communication with doctors, all of which result in enormous strain on patients and caregivers (Chochinov et al., 2009; Kamal et al., 2011; Morrison & Meier, 2011). It is common for needs in the physical, psychosocial and spiritual domains to be unmet (Zhukovsky, 2000). As a result, the last few weeks and months of life, and that of their loved ones, may be additionally burdened with physical, emotional and spiritual suffering. Palliative care programs, interdisciplinary care focused on relief of pain and other symptoms in support of best possible quality of life for patients with serious illness and their families, or consultations with palliative care experts where such team programs are not available, have been shown to reduce symptoms, alleviate suffering, improve doctor-patient communication and satisfaction with care, improve family satisfaction, and enhance the efficiency and effectiveness of hospital services (Bakitas et al., 2009a; Bakitas et al., 2009b; Casarett et al., 2008; Lagman, Rivera, Walsh, LeGrand, & Davis, 2007; Morrison & Meier, 2011; O’Hara et al., 2010), as well as to be associated with hospital cost savings (Morrison et al., 2008; Morrison et al., 2011; Penrod et al., 2010). Palliative care consultations for inpatients have successfully identified unrecognized symptoms and unmet problems (Abrahm, Callahan, Rossetti, & Pierre, 1996; Bailey et al., 2005; Bascom, 1997; Kuin et al., 2004; Manfredi et al., 2000), and have been associated with lower use of ICUs (Elsayem et al., 2006; Norton et al., 2007), lower likelihood of dying in ICU (Elsayem et al., 2006), lower costs of care (Penrod et al., 2006; Smith et al., 2003), and improvement in care processes, including medication prescribing and documenting patient goals for care(Bailey et al., 2005; Higginson et al., 2002; Higginson et al., 2003)

Opportunistic competition law enforcement

We analyse the interplay between investigation policies, deterrence and desistance in a model where a competition authority monitors multiple sectors and faces a budget constraint that prevents it from deterring cartels in all sectors simultaneously. Most studies of competition law enforcement treat competition authorities as all-knowing, unwavering and benevolent. They do not behave opportunistically, do not face asymmetric information and choose their actions to optimize social welfare. In this paper, we drop one of these assumptions, and study a competition authority that can not commit to a particular investigation strategy. As a consequence, a competition authority’s decisions to investigate will be driven by the (ex-post) desistance effect instead of the (ex ante) deterrence effect of an investigation policy. The resulting opportunistic behaviour may lead to a suboptimal investigation strategy. We find that, in the absence of commitment, developing a sector specific reward scheme based on the number of captured cartels can improve welfare.

Modelling health care expenditures; overview of the literature and evidence from a panel time series model

The first purpose of this paper is to give an up to date overview of the literature on health care expenditures. Secondly, this paper contributes to the existing literature by investigating the impact of several factors on health care expenditures in an empirical analysis using an error-correction model. Health care expenditures in industrial countries have been growing rapidly over the past forty years. This rapid growth jeopardizes the sustainability of public budgets and causes an increasing interest in the determinants of health care expenditures. Additional to the 'usual suspects' for rising health care expenditures, we pay attention to a somewhat neglected driving factor, which is the increase in the relative price of health care compared to other goods and services. We find that the increasing price of health care helps to explain the increase in real health care expenditures. However, the use of health care in volume terms is negatively affected by the increasing price. This effect seems to be stronger in periods of cost containment policy. Consistent with most recent findings in the literature, we find that income and ageing are important drivers of health care expenditures.

“This sympathizèd one day’s error”: Genre, Representation, and Subjectivity in The Comedy of Errors

This essay reexamines the mixtures of genres in The Comedy of Errors to argue that Shakespeare's play encourages reflection on genre as a mode of representation. In particular, the genres of romance and farce each offer specific approaches to subjectivity, which would have been especially meaningful to early modern urban playgoers grappling with the period's many cultural, economic, and social transitions. While The Comedy of Errors emphasizes romance in the frame and farce in the middle of the play, Shakespeare has the two genres overlap with, address, and incorporate each other, creating not only a generic rivalry but also striking instances of generic merger. These moments allow the audience to contemplate the nature of the world view presented in each genre and to determine its own position in the debate on subjectivity that emerges from the confrontation of the two. Romance and farce present identity as made up of the same components, but they judge these components in opposing ways. The same aspects of selfhood that point to an unchanging, essential core to the self in romance suggest the randomness of subjectivity in farce. Shakespeare's idealist version of romance overcomes the challenges posed by the secularism of farce by making materiality an integral part of collective harmony and individual subjectivity. All the same, the vast transformation that must take place to arrive at closure in the play suggests the broad differences between the two genres and their respective world views

Did the 2006 covenants reduce school dropout in the Netherlands?

Early school-leaving is considered to be one of the major problems in Dutch education. In order to reduce the number of dropouts in the school year 2006-2007 the Dutch government has offered a financial incentive scheme to 14 out of 39 regions. This scheme provides a reward of 2000 euro per school dropout less in 2006-07. The target of the scheme was a reduction of the total number of school dropouts by at least 10 percent in one year. This paper evaluates the effectiveness of this school dropout policy by comparing the change in school dropout in these 14 regions with the change in the remaining 25 regions before and after the introduction of the policy. We observe a modest decline in the probability of dropping out in the 14 covenants regions. However, the decline in the non-covenant regions was equally large. We therefore find no significant effect on the probability of dropping out in the post-covenant year. In both regions, the number of dropouts has fallen by 3 percent in the year after the covenants. This nationwide decline can be largely assigned to changes in the student populations among the pre- and post-covenant year. The covenants also gave a reward to regions for a successful reintegration of dropouts in order to reduce school dropout in that way. However, estimates for the effect on the re-enrolment of previous dropouts are statistically insignificant as well. We conclude that 2006 covenant policy has not been effective in reducing early school-leaving.

Minimal Overlap Rules for Bankruptcy

This paper introduces a new way of representing bankruptcy rules.These representations are used to show that the minimal overlap rule is a composition of the Ibn Ezra rule and the constrained equal losses rule.The residual minimal overlap rule is analysed as an alternative extension of the Ibn Ezra rule, by using a composition with the constrained equal awards rule.bankruptcy;representations;Ibn Ezra rule;minimum overlap rule;duality

Mass transfer characteristics in structured packing for CO2 emission reduction processes

Acid gas treating and CO2 capture from flue gas by absorption have gained wide importance over the past few decades. With the implementation of more stringent environmental regulations and the awareness of the greenhouse effect, the need for efficient removal of acid gases such as CO2 (carbon dioxide) has increased significantly. Therefore, additional effort for research in this field is inevitable. For flue gas processes the ratio of absorption solvent to gas throughput is very different compared to acid gas treating processes owing to the atmospheric pressures and the dilution effect of combustion air. Moreover, in flue gas applications pressure drop is a very important process parameter. Packing types are required that allow for low pressure drop in combination with high interfacial areas at low liquid loading per square meter. The determination of interfacial areas in gas-liquid contactors by means of the chemical method (Danckwerts, P. V. Gas-liquid reactions; McGraw-Hill: London, 1970) has been very frequently applied. Unfortunately, many of the model systems proposed in the literature are reversible and therefore this condition possibly is not met. Versteeg et al. (Versteeg, G. F.; Kuipers, J. A. M.; Beckum, F. P. H.; van Swaaij, W. P. M. Chem. Eng. Sci. 1989, 44, 2292) have demonstrated that for reversible reactions the conditions for the determination of the interfacial area by means of the chemical method are much more severe. In a study by Raynal et al. (Raynal, L.; Ballaguet, J. P.; Berrere-Tricca, C. Chem. Eng. Sci. 2004, 59, 5395), it has been shown that there is a dependency of the interfacial area on the packing height. Unfortunately, most model systems used, e.g., CO2-caustic soda (as used by Raynal et al.), are much more complex and consist of (a set of) reversible reaction(s). The natures of these systems make the conditions at which the interfacial area can be determined much more severe and put more limitations on the process conditions and experimental equipment than a priori can be expected. Therefore, an extended absorption model is required to determine the conditions at which the interfacial area can be measured without detailed knowledge of the values of the liquid-side mass transfer coefficient, k1, beforehand.

The effect of the supplementary grant on parental contribution in the Netherlands

Recently, there has been considerable debate about a reform of the Dutch system of student support, in which grants will be (partly) replaced by loans. The discussion focuses on the effects on student enrollment decisions. Surprisingly, no study has yet analysed the effect of receiving a grant on parental contribution. Parents may decrease their contribution when their child receives a grant, in which case subsidies meant for the students unintentionally end up with the parents. Understanding the corresponding parental behaviour will contribute to a more in-depth discussion on the financial aid system. This paper focuses on the effect of the supplementary grant on the parental contribution in the Netherlands. The supplementary grant is meant to support students from disadvantaged families. Parents from students with the supplementary grant have less disposable income, which probably implies a lower contribution. Our identification strategy separates this income effect from the effect due to the payments of the supplementary grant. The results suggest substantial substitution. Each additional euro spent on supplementary grant reduces the parental contribution with approximately 20-60 cents. A broad range of sensitivity analyses support our main estimation results. Nevertheless, some caution in interpreting the results is needed because of data limitations.

True Fire, Noble Flame: Friendship Poetry by Katharina Lescailje, Cornelia van der Veer, and Katherine Philips

This essay examines early modern friendship poetry by women writers from England and the Dutch Republic, including Katherine Philips, Cornelia van der Veer, Catharina Questiers, and Katharina Lescailje. It argues that women used this genre to comment on the shifting definitions of public and private and especially to how these shifts affected them as women

'Before she ends up in a brothel': Public Femininity and the First Actresses in England and the Low Countries

This essay explores the first appearance of actresses on the public stage in England and the Dutch Republic. It considers the cultural climate, the theaters, and the plays selected for these early performances, particularly from the perspective of public femininity. In both countries antitheatricalists denounced female acting as a form of prostitution and evidence of inner corruption. In England, theaters were commercial institutions with intimate spaces that capitalized on the staging of privacy as theatrical. By contrast, the Schouwburg, the only public playhouse in Amsterdam, was an institution with a more civic character, in which the actress could be treated as unequivocally a public figure. I explain these differences in the light of changing conceptions of public and private and suggest that the treatment of the actress shows a stronger public- private division in the Dutch Republic than in England