Does certificate of need affect cardiac outcomes and costs?

Several U.S. states enforce Certificate of Need (CON) regulations, which limit the number of hospitals performing open heart surgery or coronary angioplasty. CON regulations were intended to restrain cost growth and improve quality of care. This study compares mortality rates and costs for cardiac care in states with and without CON. CON appears to raise hospital procedure volume and lower the average cost of care. However, CON is associated with little reduction in inpatient mortality, and it may lead hospitals to operate on more patients than they would otherwise. The claimed welfare benefits of CON regulations require careful reconsideration. Copyright Springer Science+Business Media, LLC 2006Regulation, Certificate of need, Outcomes assessment, Cardiac surgery, Costs, I110 Analysis of Health Care Markets, I180 Health: Government Policy, Regulation, Public Health,

Sensual, material, and technological understanding: exploring prehistoric soundscapes in south India

Recent years have witnessed an increased interest within archaeology in the non-visual senses, and particularly sound. To date, however, most studies have focused on the evidence for musical instruments and the acoustic properties of special structures and spaces, like monuments and caves. This study reports on further evidence for special musical activities at the prehistoric site of Sanganakallu-Kupgal in south India, but then also moves on to a discussion of the acoustic dimension of more mundane Neolithic technological and productive activities, like flint-knapping, axe-grinding, and crop production. It focuses on the evidence for links between such activities at Sanganakallu-Kupgal, based on shared material, gestural, and acoustic properties, and argues that the hammering of ringing rocks to make music was only one aspect of a wider Southern Neolithic cultural propensity to address technological and ritual requirements by applying stone against stone. The article attempts to bring to recent discussions of the senses an awareness of the materiality of sensory experience, which, despite recent interest in the body, remains marginalized in theoretical accounts