DIMINISHING MARGINAL VALUE

The notion of diminishing marginal value has had a profound impact on the development of neoclassical theory. Early neoclassical scholars had considerable difficulty convincing contemporaries of the new paradigm's value until political economists, including Jevons and Walras, used the critical assumption of diminishing marginal value to link utility and demand. While diminishing marginal value remains a key component of modern economic intuition, there is surprisingly little empirical verification of its existence or level. This paper gathers field data across a myriad of subject pools--from undergraduate students to PTA members to sportscard enthusiasts--to examine several aspects of preferences in both price and exchange institutions. Examining behavior of nearly 900 subjects across several treatments, we find strong evidence of diminishing marginal value.Research Methods/ Statistical Methods,

A Test of Competing Explanations of Compensation Demanded

The disparity between willingness-to-pay and willingness-to-accept, also known as compensation demanded, is a robust experimental finding. Two types of explanations been proposed. The first invokes psychological effects, broadly categorized as reference dependence and loss aversion. The second explanation is that there are large substitution effects but that underlying behavior is neoclassically utility-theoretic. The key observation motivating the present study is that loss aversion implies concavity of willingness to accept, whereas the utility-theoretic explanation implies convexity. We report experiments in which subjects were endowed with 3 items and asked the minimum payments they required to be willing to relinquish 1, 2, or 3 of them. We examine whether the compensation demanded is convex, concave, neither, or both in the number of items being relinquished

Associations of Emergency Department Length of Stay With Publicly Reported Quality-of-care Measures.

OBJECTIVE: The Institute of Medicine identified emergency department (ED) crowding as a critical threat to patient safety. We assess the association between changes in publicly reported ED length of stay (LOS) and changes in quality-of-care measures in a national cohort of hospitals. METHODS: Longitudinal analysis of 2012 and 2013 data from the American Hospital Association (AHA) Survey, Center for Medicare and Medicaid Services (CMS) Cost Reports, and CMS Hospital Compare. We included hospitals reporting Hospital Compare timeliness measure of LOS for admitted patients. We used AHA and CMS data to incorporate hospital predictors of interest. We used the method of first differences to test for relationships in the change over time between timeliness measures and six hospital-level measures. RESULTS: The cohort consisted of 2,619 hospitals. Each additional hour of ED LOS was associated with a 0.7% decrease in proportion of patients giving a top satisfaction rating, a 0.7% decrease in proportion of patients who would definitely recommend the hospital, and a 6-minute increase in time to pain management for long bone fracture (p \u3c 0.01 for all). A 1-hour increase in ED LOS is associated with a 44% increase in the odds of having an increase in left without being seen (95% confidence interval = 25% to 68%). ED LOS was not associated with hospital readmissions (p = 0.14) or time to percutaneous coronary intervention (p = 0.14). CONCLUSION: In this longitudinal study of hospitals across the United States, improvements in ED timeliness measures are associated with improvements in the patient experience

Policies for the Treatment of Alcohol and Drug Use Disorders: A Research Agenda for 2010-2015

Provides an agenda for policy research on drug and alcohol addiction treatment, including integrating screening and short-term interventions into primary care and other settings, services in specialty treatment centers, and ongoing support services

The development of a position-sensitive CZT detector with orthogonal co-planar anode strips

We report on the simulation, construction, and performance of prototype CdZnTe imaging detectors with orthogonal coplanar anode strips. These detectors employ a novel electrode geometry with non-collecting anode strips in one dimension and collecting anode pixels, interconnected in rows, in the orthogonal direction. These detectors retain the spectroscopic and detection efficiency advantages of single carrier (electron) sensing devices as well as the principal advantage of conventional strip detectors with orthogonal anode and cathode strips, i.e. an N×N array of imaging pixels are with only 2N electronic channels. Charge signals induced on the various electrodes of a prototype detector with 8×8 unit cells (1×1×5 mm3)are compared to the simulations. Results of position and energy resolution measurements are presented and discussed

Analog processing of signals from a CZT strip detector with orthogonal coplanar anodes

We present the requirements, design, and performance of an analog circuit for processing the non-collecting anode strip signals from a cadmium zinc telluride (CZT) strip detector with orthogonal coplanar anodes. Detector signal simulations and measurements with a prototype are used to define the range of signal characteristics as a function of location of the gamma interaction in the detector. The signals from the non- collecting anode strip electrodes are used to define two of the three spatial coordinates including the depth of interaction, the z dimension. Analog signal processing options are discussed. A circuit to process the signals from the non- collecting anode strips and extract from them the depth of interaction is described. The circuit employs a time-over- threshold (TOT) measurement. The performance of the detector prototype with a preliminary version of this circuit is presented, and future development work is outlined

Rural-Urban Disparities in Emergency Department Intimate Partner Violence Resources

Objective: Little is known about availability of resources for managing intimate partner violence (IPV) at rural hospitals. We assessed differences in availability of resources for IPV screening and management between rural and urban emergency departments (EDs) in Oregon. Methods: We conducted a standardized telephone interview of Oregon ED directors and nurse managers on six IPV-related resources: official screening policies, standardized screening tools, public displays regarding IPV, on-site advocacy, intervention checklists and regular clinician education. We used chi-square analysis to test differences in reported resource availability between urban and rural EDs. Results: Of 57 Oregon EDs, 55 (96%) completed the survey. A smaller proportion of rural EDs, compared to urban EDs, reported official screening policies (74% vs. 100%, p=0.01), standardized screening instruments (21% vs. 55%, p=0.01), clinician education (38% vs. 70%, p=0.02) or on-site violence advocacy (44% vs. 95%, p<0.001). Twenty-seven percent of rural EDs had none or one of the studied resources, 50% had two or three, and 24% had four or more (vs. 0%, 35%, and 65% in urban EDs, p=0.003). Small, remote rural hospitals had fewer resources than larger, less remote rural hospitals or urban hospitals. Conclusion: Rural EDs have fewer resources for addressing IPV. Further work is needed to identify specific barriers to obtaining resources for IPV management that can be used in all hospital settings. [West J Emerg Med. 2011;12(2):178-183.

Progress in the study of CdZnTe strip detectors

We report new performance measurements and computer simulations of a sub-millimeter pitch CdZnTe strip detector under study as a prototype imaging spectrometer for astronomical x-ray and gamma-ray observations. The prototype is 1.5 mm thick with 375 micron strip pitch in both the x and y dimensions. Previously reported work included demonstrations of half-pitch spatial resolution (approximately 190 microns) and good energy resolution and spectral uniformity. Strip detector efficiency measurements have also been presented. A model that includes the photon interaction, carrier transport and the electronics was developed that qualitatively reproduced the measurements. The new studies include measurements of the CdZnTe transport properties for this prototype in an effort to resolve quantitative discrepancies between the measurements and the simulations. Measurements of charge signals produced by laser pulses and (alpha) -rays are used to determine these transport properties. These are then used in the model to predict gamma-ray efficiencies that are compared with the data. The imaging performance of the detector is studied by scanned laser and gamma beam spot measurements. The results support the model\u27s prediction of nearly linear sharing of the charge for interactions occurring in the region between electrodes. The potential for strip detectors with spatial resolution much finer than the strip pitch is demonstrated. A new design scheme for strip detectors is shortly discussed

A novel mode of capping protein-regulation by Twinfilin

Cellular actin assembly is controlled at the barbed ends of actin filaments, where capping protein (CP) limits polymerization. Twinfilin is a conserved in vivo binding partner of CP, yet the significance of this interaction has remained a mystery. Here, we discover that the C-terminal tail of Twinfilin harbors a CP-interacting (CPI) motif, identifying it as a novel CPI-motif protein. Twinfilin and the CPI-motif protein CARMIL have overlapping binding sites on CP. Further, Twinfilin binds competitively with CARMIL to CP, protecting CP from barbed-end displacement by CARMIL. Twinfilin also accelerates dissociation of the CP inhibitor V-1, restoring CP to an active capping state. Knockdowns of Twinfilin and CP each cause similar defects in cell morphology, and elevated Twinfilin expression rescues defects caused by CARMIL hyperactivity. Together, these observations define Twinfilin as the first \u27pro-capping\u27 ligand of CP and lead us to propose important revisions to our understanding of the CP regulatory cycle

Management practices and the quality of care in cardiac units

Importance:- To improve the quality of health care, many researchers have suggested that health care institutions adopt management approaches that have been successful in the manufacturing and technology sectors. However, relatively little information exists about how these practices are disseminated in hospitals and whether they are associated with better performance. Objectives:- To describe the variation in management practices among a large sample of hospital cardiac care units; assess association of these practices with processes of care, readmissions, and mortality for patients with acute myocardial infarction (AMI); and suggest specific directions for the testing and dissemination of health care management approaches. Design:- We adapted an approach used to measure management and organizational practices in manufacturing to collect management data on cardiac units. We scored performance in 18 practices using the following 4 dimensions: standardizing care, tracking of key performance indicators, setting targets, and incentivizing employees. We used multivariate analyses to assess the relationship of management practices with process-of-care measures, 30-day risk-adjusted mortality, and 30-day readmissions for acute myocardial infarction (AMI). Setting:- Cardiac units in US hospitals. Participants_ Five hundred ninety-seven cardiac units, representing 51.5% of hospitals with interventional cardiac catheterization laboratories and at least 25 annual AMI discharges. Main Outcome Measures:- Process-of-care measures, 30-day risk-adjusted mortality, and 30-day readmissions for AMI. Results:- We found a wide distribution in management practices, with fewer than 20% of hospitals scoring a 4 or a 5 (best practice) on more than 9 measures. In multivariate analyses, management practices were significantly correlated with mortality (P = .01) and 6 of 6 process measures (P < .05). No statistically significant association was found between management and 30-day readmissions. Conclusions and Relevance:- The use of management practices adopted from manufacturing sectors is associated with higher process-of-care measures and lower 30-day AMI mortality. Given the wide differences in management practices across hospitals, dissemination of these practices may be beneficial in achieving high-quality outcomes. Interest in quality improvement in health care during the past 10 years has been associated with a handful of important successes.1- 3 However, improvements in the quality of care have been slower than many would have hoped for,4- 8 and quality is still highly variable across organizations.9 Although significant effort has been focused on the use of evidence-based medicine—clinical practices that lead to better care—an interest in organizational strategies and management practices that enable and incentivize high-quality health care is emerging.10- 15 One of the most active areas of interest is in the use of management practices with origins in manufacturing, including, for example, “Lean” methodologies developed at Toyota16 or the use of balanced scorecard approaches that originated in the technology sector.17 These management approaches can be characterized as a set of formalized tools, the use of which is intended to improve quality through multiple pathways, such as eliminating inefficient and variable practices; engaging providers in a collaborative, team-based approach; and structuring mechanisms for setting targets and tracking progress. However, the evidence on the potential effectiveness of these approaches in health care is relatively weak13,18 and consists primarily of single-site studies.19- 21 To address this gap in knowledge, we present a new framework and instrument for defining key management dimensions and for measuring them on a large scale in health care organizations. We describe the variation in management practices among a large sample of hospitals; assess its association with processes of care, readmissions, and mortality for patients with acute myocardial infarction (AMI); and suggest specific directions for the testing and dissemination of health care management approaches