The Welfare Consequences of Hospital Mergers

In the 1990s the US hospital industry consolidated. This paper estimates the impact of the wave of hospital mergers on welfare focusing on the impact on consumer surplus for the under-65 population. For the purposes of quantifying the price impact of consolidations, hospitals are modeled as an input to the production of health insurance for the under-65 population. The estimates indicate that the aggregate magnitude of the impact of hospital mergers is modest but not trivial. In 2001, average HMO premiums are estimated to be 3.2% higher than they would have been absent any hospital merger activity during the 1990s. In 2003, we estimate that because of hospital mergers private insurance rolls declined by approximately .3 percentage points or approximately 695,000 lives with the vast majority of those who lost private insurance joining the ranks of the uninsured. Our estimates imply that hospital mergers resulted in a cumulative consumer surplus loss of over $42.2 billion between 1990 and 2001. It is estimated that all but a modest$95.4 million of the loss in consumer surplus is transferred from consumers to providers

Carbon Free Boston: Buildings Technical Report

Part of a series of reports that includes: Carbon Free Boston: Summary Report; Carbon Free Boston: Social Equity Report; Carbon Free Boston: Technical Summary; Carbon Free Boston: Transportation Technical Report; Carbon Free Boston: Waste Technical Report; Carbon Free Boston: Energy Technical Report; Carbon Free Boston: Offsets Technical Report; Available at http://sites.bu.edu/cfb/OVERVIEW: Boston is known for its historic iconic buildings, from the Paul Revere House in the North End, to City Hall in Government Center, to the Old South Meeting House in Downtown Crossing, to the African Meeting House on Beacon Hill, to 200 Clarendon (the Hancock Tower) in Back Bay, to Abbotsford in Roxbury. In total, there are over 86,000 buildings that comprise more than 647 million square feet of area. Most of these buildings will still be in use in 2050. Floorspace (square footage) is almost evenly split between residential and non-residential uses, but residential buildings account for nearly 80,000 (93 percent) of the 86,000 buildings. Boston’s buildings are used for a diverse range of activities that include homes, offices, hospitals, factories, laboratories, schools, public service, retail, hotels, restaurants, and convention space. Building type strongly influences energy use; for example, restaurants, hospitals, and laboratories have high energy demands compared to other commercial uses. Boston’s building stock is characterized by thousands of turn-of-the-20th century homes and a postWorld War II building boom that expanded both residential buildings and commercial space. Boston is in the midst of another boom in building construction that is transforming neighborhoods across the city. [TRUNCATED]Published versio

The process of resort second home development demand quantification : exploration of methodologies and case study application

Thesis (S.M. in Real Estate Development)--Massachusetts Institute of Technology, Program in Real Estate Development in Conjunction with the Center for Real Estate, 2011.This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.Pages 93 and 94 blank. Cataloged from student-submitted PDF version of thesis.Includes bibliographical references (p. 90-92).Prevalent methodologies utilized by resort second home development professionals to quantify demand for future projects are identified and critiqued. The strengths of each model are synthesized in order to formulate an original, composite methodology for demand quantification with industry-wide applicability. This "best practices" synthesized model is then applied to a real world case study and back tested in an effort to gauge its accuracy. After analysis of its performance, modifications are made and an innovative method for forecasting absorption is added to its framework. The resulting product of this effort is the creation of the Comprehensive Resort Second Home Demand Forecasting Model.by Christopher J. Wholey.S.M.in Real Estate Developmen

A study on the bending of laminated glass under blast loading

Background: The bending behaviour of laminated glass plays an important role in determining its overall response to blast loading. It is costly and difficult to characterise the bending behaviour by carrying out full-scale blast tests, therefore an alternative method is required. Objective: The objective of this study is to understand the response of laminated glass under high-rate bending in the laboratory at rates representative of blast loading. Methods: In this paper a novel testing method is presented in which laminated glass strips of 700 mm long by 60 mm wide are tested up to speeds of 10 m/s in the laboratory. The laminated glass is accelerated to speeds comparable to blast loading and then brought to rest at its edges to mimic impulsive blast loading conditions. Different interlayer thickness, impact speeds, and boundary conditions were explored. Additionally, modelling methods were used to study the flexural rigidity of post-cracked laminated glass. Results: From the experiments it was found that the interlayer thickness plays a key role in determining whether the dominant failure mechanism is de-bonding of interlayer from the glass or interlayer tearing. In addition, it was found that by allowing the frame to bend under loading, the laminated glass can carry greater loads without failure. Finally, an iterative method was used to quantify the flexural rigidity of post-cracked laminated glass depending on the speed of travel. This is a novel finding as it is usually assumed that laminated glass behaves like a membrane in the post-cracked phase of the response. Conclusion: In modelling and design of laminated glass structures under blast loading, post-crack flexural rigidity must be taken into account. Additionally, having novel frame designs to add further load bearing capacity to the framing members, plays a key role in reducing the load intensity on the laminated glass structure

Putting theory oriented evaluation into practice

Evaluations of gaming simulations and business games as teaching devices are typically end-state driven. This emphasis fails to detect how the simulation being evaluated does or does not bring about its desired consequences. This paper advances the use of a logic model approach which possesses a holistic perspective that aims at including all elements associated with the situation created by a game. The use of the logic model approach is illustrated as applied to Simgame, a board game created for secondary school level business education in six European Union countries

Successful interdisciplinary management of the misdeployment of two self-expanding stents into the internal carotid artery: a case report

<p>Abstract</p> <p>Introduction</p> <p>With the widespread use of carotid artery stenting, previously unknown technical mistakes of this treatment modality are now being encountered. There are multiple strategies for the treatment of in-stent restenosis. With regard to surgical management, endarterectomy and patch plasty are favored. To the best of our knowledge, this report is the first description of a complete stent removal by the eversion technique.</p> <p>Case presentation</p> <p>We report the case of a 63-year-old Caucasian man with misdeployment of two stents into his stenotic proximal internal carotid artery, resulting in a high-grade mechanical obstruction of the internal carotid artery lumen. With the contralateral internal carotid artery already occluded and associated stenoses of both proximal and distal vertebral arteries, an interdisciplinary therapeutic concept was applied. Bilateral balloon angioplasty and stenting of the proximal and distal stenotic vertebral arteries were carried out to provide sufficient posterior collateral blood flow, followed by successful surgical stentectomy and carotid endarterectomy using the eversion technique. Duplex scanning and neurological assessments were normal over a 12-month follow-up period.</p> <p>Conclusions</p> <p>Interdisciplinary treatment is a recommended option to protect patients from further impairment. Further evaluation in larger studies is highly recommended.</p

A systematic review of sport-based life skills programs for young people: The quality of design and evaluation methods

Over the past two decades, researchers have reported positive life skills outcomes for young people participating in sport-based lifeskills programs. However, to date, there has been a lack of consideration in the literature regarding the quality of the programs designed and the evaluation methods adopted. Therefore, we conducted a systematic review of the life skills literature to: (a) assess the quality of sport-based life skills program design and evaluation methods; and (b) identify characteristics relating to the quality of sport-based life skills programs where authors had evidenced life skills development and transfer. Using the PRISMA guidelines, we searched six databases for relevant research papers and applied inclusion and exclusion criteria to the papers returned, of which 15 papers met the criteria. We conducted two quality assessment exercises (design and evaluation methods) and found three moderate high quality life skills programs, 11 moderate quality programs, and one low quality program. We present the characteristics (regarding quality) of intervention designs and methods, conclude with recommendations for designing quality sport-based life skills programs, and provide guidelines for researchers to evaluate sport-based life skills programs. Lay summary: Through engaging in sport-based life skills programs, young people can develop transferable skills. However, the quality of these life skills programs is unclear. We assess the quality of the design and evaluation methods of sport-based life skills programs, present the characteristics of moderate-high and moderate quality programs, and offer recommendations for future research and practice

Carotid Artery Stenting Using a Novel Self-Expanding Braided Nickel–Titanium Stent: Feasibility and Safety Porcine Trial

We studied the deliverability and safety of a braided, self-expanding, closed-cell nickel–titanium (NiTi) stent (E-volution, Jotec GmbH, Hechingen, Germany) especially designed for the endovascular treatment of carotid artery bifurcation stenosis with special regard to in-stent stenosis and thrombosis compared with a laser-cut reference nitinol stent in a porcine model of percutaneous vascular interventions. We aimed to assess histopathologic response in minipig carotid and subclavian arteries. Eight minipigs received a total of 42 stents: 14 reference stents and 28 E-volution stents. Eleven of the E-volution stents were additionally coated with heparin. Control angiography was obtained immediately before and after vascular intervention as well as 4 weeks after the procedure. Primary endpoints were 28 days of angiographic analyses as well as histomorphometric analysis, including injury score, inflammation score, luminal diameter, vessel diameter, maximal neointimal thickness, and area of in-stent stenosis. Secondary end points were procedural success, 28-day mortality, and stent thrombosis. All stents could be delivered successfully without procedural complications, morbidity, or mortality during our observation time. As confirmed by histology, no in-stent thrombosis was observed. Compared with common carotid arteries, subclavian arteries are significantly more vulnerable to developing in-stent stenosis caused by neointima proliferation (p < 0.05). Compared with the use of 1 single stent/artery, serial application of two stents leads to a more excessive but not significantly different neointimal proliferation (p > 0.05). The E-volution stent, especially when heparin coated, is in line with the comparison to the laser-cut reference stent displaying similar results of angiographic, histologic, and histomorphometric analyses (p > 0.05). Compared with the reference laser-cut stent, the self-expanding nitinol stent (E-volution) with its advanced braiding technology is feasible and safe. In our opinion, the high radial resistive force and the advanced braided design with tight stent-strut interstices may be beneficial in terms of plaque stabilization. Further studies are necessary and warranted

Bronchial artery embolization for management of massive cryptogenic hemoptysis: a case series

<p>Abstract</p> <p>Introduction</p> <p>Hemoptysis constitutes a common and urgent medical problem. Swift and effective management is of crucial importance, especially in severe, life-threatening cases. In cases of idiopathic hemoptysis, in which no underlying pulmonary pathology can be identified, treatment is challenging. We report our experience with bronchial artery embolization in the treatment of massive idiopathic hemoptysis.</p> <p>Cases presentation</p> <p>We report three consecutive cases of acute severe idiopathic hemoptysis. Our patients (two men aged 51 and 56 years and one woman aged 46 years), were of Caucasian ethnicity. We discuss the results and management of the patients, and review the literature. All three patients were treated safely and successfully with transcatheter embolization of the bronchial arteries using tris-acryl gelatin microspheres. Hemoptysis was controlled. All cases were followed up for 12 months, and there was no recurrence of bleeding.</p> <p>Conclusion</p> <p>Bronchial artery embolization is an effective tool for the evaluation and treatment of massive idiopathic hemoptysis.</p