"For good design, you pay now; for bad design, you pay later"--or do you?

Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Urban Studies and Planning, 2006.This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.Includes bibliographical references (leaves 117-118).What is the value of architectural design on office building income? This empirical study of 296 office building located in 11 Metropolitan Statistical Areas (MSA) hopes to quantitatively determine if a plain vanilla cereal box suburban office building commands more or less net operating income than an office building with a higher level of design. Previous empirical studies have found a strong influence of design on rents but were limited in geography, building characteristics and total number of observations. In an important study by Vandell and Lane (1990), they found that good architecture commanded a premium of over 20% in office rents. Also, their study showed that good design cost more to produce on average, but not necessarily in every case. Data was gathered from a portfolio of US office buildings and consisted of building metrics and property level 2000-2005 Net Operating Income (NOI). This base data set, MSA dummy variables and architectural attribute dummy variables (created by the authors) formed the backbone of the research. Multiple log linear regression analysis was conducted to identify the economic effects of good design.(cont.) In addition, a survey taken by 31 architects was used to capture subjective rankings on the all 296 office buildings to determine if there is a consensus as to what constitutes good design. It is hoped that these professionals, who are formally trained and are practicing in the field, are well-qualified to evaluate the design of each building. The survey results showed that the architects' responses are idiosyncratic and subjective. Not only did the individual participant's rankings show no significant relationship with one another, but also did not exhibit any relationship with actual building NOI. The empirical study found that the market paid a premium of 7.9% for buildings with non-center cores. Also, a significant 11.7-13.2% premium was paid for properties with non-rectangular and non-square shaped floor plans. Finally, buildings with 60% to 90% exterior windows commanded a substantial 10.7% premium. These results imply that better-designed buildings generate higher NOI either because the tenants are willing to pay a premium or because the operating costs of the building are less, or both.by Meena Murugappan and S. Michael O'Young, Jr.S.M

Innovative Partnership Between a Rural Mental Health Center and Community Pharmacy: Integration of a Mental Health Pharmacist

Purpose: The purpose of this article is to describe how an innovative partnership between a rural community mental health center, community independent pharmacy and College of Pharmacy and integration of a mental health pharmacist lead to identification of medication therapy problems (MTP’s) and interprofessional team partnerships with center mental health professionals. Methods: A contractual arrangement was initiated between Northern Pines Mental Health Center (NPMHC), GuidePoint Pharmacy Services GPS) and the University of Minnesota College of Pharmacy (UMN CoP) to place a PGY1 resident at NPMHC.  The resident was assigned to work closely with the Chief Medical Officer and provide initial comprehensive medication management (CMM) services to individuals who were enrolled in Assertive Community Treatment (ACT). A retrospective chart review was conducted to evaluate the impact of services provided. Patient inclusion criteria included ACT enrollees 18 years or older, a diagnosis of SPMI, taking at least one psychotropic medication, and participation in at least one resident-led CMM visit. Additional findings included the relationship between the pharmacist, the psychiatric physician, and other members of the ACT team. Descriptive statistics were used to document the findings. Findings: N = 30 met the inclusion criteria: 18 males and 12 females, age ranged from 24 - 69 with average of 44 years old. 110 MTPs were identified ranging from no MTPs to 10 MTPs per patient, with a mean of 4 MTPs/patient. There was an uneven distribution of MTPs between psychiatric and medical conditions, with a disproportionately high occurrence of “Needs Additional Drug Therapy” in medical conditions and “Adverse Drug Reaction” in psychiatric conditions. In addition, the services were valued by members on the ACT team. Conclusion: Rural residents with SPMI in intensive community treatment have complex medication needs that require the training and skills of a clinical pharmacist. Despite the inclusion of a medication list as part of the ACT fidelity standards MTPs may go unrecognized and unresolved without the services of a clinical pharmacist conducting CMM. The pharmacist and psychiatric physician formed a collaborative partnership to address medication issues. We conclude that there is a need for integrating clinical pharmacist services into rural mental health centers.   Article Type: Original Researc

High rifaximin out-of-pocket costs are associated with decreased treatment retention among patients with hepatic encephalopathy

Background and Aims:. Hepatic encephalopathy (HE) is associated with significant morbidity and mortality for those with cirrhosis. Despite the known benefits of rifaximin use for HE, treatment retention remains low. This study aimed to evaluate the impact of out-of-pocket (OOP) rifaximin cost on treatment retention among commercially insured patients in the United States. Methods:. Adult patients with cirrhosis and HE were identified from the IBM MarketScan claims database. Those who began rifaximin treatment between January 1, 2011, and December 1, 2021 were included. Regression models were used to analyze the relationship between patients’ 30-day OOP rifaximin cost and rifaximin retention (≥80% eligible days with rifaximin supply) at 180, 360, and 540 days. Models were controlled for patient demographic and clinical characteristics including age, sex, comorbid conditions, Charlson comorbidity index (CCI), and lactulose use. Results:. A total of 6839 adult patients were included. Most patients were between 55 and 64 years (57.1%), male (60.4%), and living in urban settings (84.6%). Treatment retention was low for all time periods; retention rates for rifaximin were 42%, 25%, and 16% at 180, 360, and 540 days, respectively. In multivariable analysis, 30-day OOP costs of ≥ $150 were associated with a decreased likelihood of rifaximin retention at 180, 360, and 540 days [relative risk (RR) = 0.67, RR = 0.62, and R = 0.60, respectively]. Younger age was associated with reduced treatment retention for all time periods. Metastatic cancer and depression were associated with reduced treatment retention at 180 days (RR = 0.70 and RR = 0.87, respectively). Conclusions:. Rates of rifaximin treatment retention are low despite the known benefits of rifaximin use for breakthrough HE. High 30-day OOP cost is associated with reduced rifaximin treatment retention

Investigating Health Care Utilization Among Low-Income Adults in Duluth, Minnesota (2014-04-14)

Research projectDMRI seminar seriesThe University of Minnesota Medical School Duluth and College of Pharmacy jointly support the HOPE Clinic, a student run free clinic with faculty supervision. The HOPE Clinic is located in the CHUM drop-in center in downtown Duluth.Duluth Medical Research Institute, Medical Schoo