DO GENERAL, COMMUNITY HOSPITALS COMPETE BY SPECIALIZING IN HIGH VOLUME, HIGH REVENUE-GENERATING SERVICE LINES?

To determine if general, community hospitals show evidence of specializing in the nation\u27s six highest volume, highest revenue-generating service lines, 2003-2007 data of hospitals throughout Florida, Virginia, and Nevada were analyzed using backward deletion, stepwise regression. Service lines selected for study were cardiac surgery, cardiology, invasive cardiology, orthopedics, labor and delivery, and pulmonary services. Results do show evidence of specialization, but characteristics of hospitals vary by service line. Findings suggest that the general, community hospital, traditionally a full-service provider, may be undergoing transformation including specialization. The study demonstrates the usefulness of studying specialization at the service line level

The endogeneity of the natural rate of growth in Latin America

This study estimates the natural rate of growth à la León-Ledesma and Thirlwall for a panel of eleven Latin American countries from 2000 to 2023 using the seemingly unrelated regressions (SUR) estimator. Likewise, in the model, we incorporate a dummy variable in boom periods to determine whether endogeneity is present due to variations in the current rate of growth. Our results show that the behavior of the natural rate has a direct relationship with changes in the current rate; that is, it increases in boom periods and decreases during recessions, confirming the presence of endogeneity. In this sense, it is advisable to continue exploring the nature of the sensitivity of the natural growth rate to the economic situation. By providing recent evidence for Latin American countries with different degrees of economic development, our results allow us to conclude that the hypothesis of full employment on the supply side is not sufficient to explain the economic dynamics, so the inclusion of demand variables is necessary.La endogeneidad de la tasa natural de crecimiento en América Latina Este estudio estima la tasa natural de crecimiento à la León-Ledesma y Thirlwall para un panel de once países de América Latina en el periodo 2000-2023 mediante el estimador de regresiones aparentemente no relacionadas (SUR por sus siglas en inglés). Asimismo, en el modelo incorporamos una variable ficticia en los periodos de auge para determinar si la endogeneidad se debe a las variaciones de la tasa de crecimiento actual.  Nuestros resultados muestran que el comportamiento de la tasa natural tiene una relación directa con los cambios de la tasa actual, es decir, aumenta en períodos de auge y disminuye durante las recesiones, ratificado la presencia de endogeneidad. En este sentido, conviene seguir explorando la naturaleza de la sensibilidad de la tasa de crecimiento natural a la coyuntura económica. Al aportar evidencia reciente para países de América Latina con distintos grados de desarrollo económico, nuestros resultados permiten concluir que la hipótesis de pleno empleo por el lado de la oferta no es suficiente para explicar la dinámica económica, por lo que es necesaria la inclusión de variables de demanda

Public Deficits in USMCA Economies During the COVID-19 Economic Crisis

This paper aims to evaluate the fiscal policy implemented by the USMCA economies to deal with the COVID-19 economic crisis. We estimate the economic capacity (potential output) and the Cyclical Primary Balance as a percentage of GDP (CPB) of each of the scrutinized economies. Then we obtain the Cyclical Adjusted Primary Balance as a percentage of GDP (CAPB) as the difference between the Primary Balance (PB) and the CPB. Unlike previous CPB estimations, we obtain the potential output reference as the Economic Capacity methodology (Shaikh and Moudud, 2004), which overcome some alternative methodologies problems. According to our empirical analysis, an asymmetric fiscal policy stands across USMCA economies. Canada and the United States are using a countercyclical fiscal policy, while Mexico uses a procyclical one. Mexico should abandon its current fiscal policy, implement an alternative to support households and firms during crisis periods, and execute a progressive fiscal reform. Our paper's limitation is that we use PB and not its components to estimate the CPB; however, we use a more extended time series, contributing to obtaining more robust results.Déficits públicos de los países del T-MEC durante la crisis económica por COVID-19Nuestro objetivo es evaluar la política fiscal implementada por las economías del T-MEC para enfrentar la crisis del COVID-19. Estimamos la capacidad económica (producto potencial) y el Balance Primario Cíclico como porcentaje del PIB (CPB) de estas economías. Obtenemos el Balance Primario Ajustado por el Ciclo como porcentaje del PIB (CAPB) como la diferencia entre el Balance Primario (PB) y el CPB. A diferencia de estimaciones previas del CPB, el producto potencial se obtiene mediante la metodología de la Capacidad Económica (Shaikh y Moudud, 2004), que resuelve problemas asociados con metodologías alternativas. Nuestro análisis empírico muestra que existe una asimetría: en Canadá y Estados Unidos la política fiscal es anticíclica y en México es procíclica. México debería abandonar su política fiscal actual; implementar una alternativa de apoyo a los hogares y empresas durante los períodos de crisis y ejecutar una reforma fiscal progresiva. Una limitación de nuestro artículo es que usamos PB y no sus componentes para estimar el CPB; sin embargo, utilizamos series de tiempo más largas, lo que contribuye a obtener resultados más robustos

La Curva de Phillips desde una perspectiva Clásica

En este artículo planteamos que la relación entre los salarios y el desempleo codificada en la Curva de Phillips original (CP) (Phillips, 1958) puede estudiarse mejor desde la perspectiva analítica postulada por la economía política clásica que en los términos expresados en la hipótesis NAIRU (Friedman, 1968, 1977). Nuestra hipótesis radica en que es posible postular una versión clásica de la CP en la que la tasa de crecimiento de la productividad afecta positivamente al salario real. Para contrastar la hipótesis realizamos un análisis econométrico con datos de Alemania, España, Estados Unidos y Francia. Los resultados empíricos sugieren que es posible encontrar una correlación como la que postulamos

Spillovers entre los principales Mercados Accionarios de Latinoamérica, Estados Unidos y el Mercado Petrolero

Spillovers between major stock markets in Latin America, the United States and the Oil MarketWe analyze the spillovers in both yields and volatilities between the international oil price and the main stock markets in Latin America and the United States. To this end, we use the methodology proposed by Diebold and Yilmaz (2009, 2012), which consists of constructing spillover indices (SI) for yields and volatilities. The results show that the index for yields has larger effects compared to the one obtained for volatilities and that there is a weak interdependence between the stock market yields analyzed and those of the oil market. A disadvantage of this procedure is that the returns of the stock indexes on which this methodology is applied are aggregate indicators representative of the behavior of the main stocks in their markets, so that a possible extension, or recommendation, would be to apply the methodology with a higher level of disaggregation, such as the returns of some sectorial stock indexes or the returns of some stocks listed in the markets analyzed.Se analizan los spillovers (desbordamientos) tanto en los rendimientos como en las volatilidades entre el precio internacional del petróleo y los principales mercados bursátiles de América Latina y Estados Unidos. Para tal fin empleamos la metodología propuesta por Diebold y Yilmaz (2009, 2012) que consiste en construir índices de spillovers (IS) para los rendimientos y las volatilidades. Los resultados muestran que el índice de los rendimientos tiene mayores efectos en comparación con el obtenido para las volatilidades y que existe una interdependencia débil entre los rendimientos de los mercados bursátiles analizados y los del mercado petrolero. Una desventaja de este procedimiento es que los rendimientos de los índices accionarios sobre los cuales se aplica esta metodología constituyen indicadores agregados representativos del comportamiento de las principales acciones de sus mercados por lo que una posible extensión, o recomendación, consistiría en aplicar la metodología con un mayor nivel de desagregación como pueden ser los rendimientos de algunos índices accionarios sectoriales o incluso a algunas acciones que cotizan en los mercados analizados

Swine Influenza Virus Antibodies in Humans, Western Europe, 2009

Serologic studies for swine influenza viruses (SIVs) in humans with occupational exposure to swine have been reported from the Americas but not from Europe. We compared levels of neutralizing antibodies against 3 influenza viruses—pandemic (H1N1) 2009, an avian-like enzootic subtype H1N1 SIV, and a 2007–08 seasonal subtype H1N1—in 211 persons with swine contact and 224 matched controls in Luxembourg. Persons whose profession involved contact with swine had more neutralizing antibodies against SIV and pandemic (H1N1) 2009 virus than did the controls. Controls also had antibodies against these viruses although exposure to them was unlikely. Antibodies against SIV and pandemic (H1N1) 2009 virus correlated with each other but not with seasonal subtype H1N1 virus. Sequential exposure to variants of seasonal influenza (H1N1) viruses may have increased chances for serologic cross-reactivity with antigenically distinct viruses. Further studies are needed to determine the extent to which serologic responses correlate with infection

Replacement of Sublineages of Avian Influenza (H5N1) by Reassortments, Sub-Saharan Africa

The 3 sublineages initially introduced into Nigeria in 2006 were gradually replaced by different reassortants

Infectious complications and graft outcome following treatment of acute antibody-mediated rejection after kidney transplantation: A nationwide cohort study.

Acute antibody-mediated rejection (AMR) remains a challenge after kidney transplantation (KT). As there is no clear-cut treatment recommendation, accurate information on current therapeutic strategies in real-life practice is needed. KT recipients from the multicenter Swiss Transplant Cohort Study treated for acute AMR during the first post-transplant year were included retrospectively. We aimed at describing the anti-rejection protocols used routinely, as well as patient and graft outcomes, with focus on infectious complications. Overall, 65/1669 (3.9%) KT recipients were treated for 75 episodes of acute AMR. In addition to corticosteroid boluses, most common therapies included plasmapheresis (56.0%), intravenous immunoglobulins (IVIg) (38.7%), rituximab (25.3%), and antithymocyte globulin (22.7%). At least one infectious complication occurred within 6 months from AMR treatment in 63.6% of patients. Plasmapheresis increased the risk of overall (hazard ratio [HR]: 2.89; P-value = 0.002) and opportunistic infection (HR: 5.32; P-value = 0.033). IVIg exerted a protective effect for bacterial infection (HR: 0.29; P-value = 0.053). The recovery of renal function was complete at 3 months after AMR treatment in 67% of episodes. One-year death-censored graft survival was 90.9%. Four patients (6.2%) died during the first year (two due to severe infection). In this nationwide cohort we found significant heterogeneity in therapeutic approaches for acute AMR. Infectious complications were common, particularly among KT recipients receiving plasmapheresis

Cost minimization analysis of different growth hormone pen devices based on time-and-motion simulations

<p>Abstract</p> <p>Background</p> <p>Numerous pen devices are available to administer recombinant Human Growth Hormone (rhGH), and both patients and health plans have varying issues to consider when selecting a particular product and device for daily use. Therefore, the present study utilized multi-dimensional product analysis to assess potential time involvement, required weekly administration steps, and utilization costs relative to daily rhGH administration.</p> <p>Methods</p> <p>Study objectives were to conduct 1) Time-and-Motion (TM) simulations in a randomized block design that allowed time and steps comparisons related to rhGH preparation, administration and storage, and 2) a Cost Minimization Analysis (CMA) relative to opportunity and supply costs. Nurses naïve to rhGH administration and devices were recruited to evaluate four rhGH pen devices (2 in liquid form, 2 requiring reconstitution) via TM simulations. Five videotaped and timed trials for each product were evaluated based on: 1) Learning (initial use instructions), 2) Preparation (arrange device for use), 3) Administration (actual simulation manikin injection), and 4) Storage (maintain product viability between doses), in addition to assessment of steps required for weekly use. The CMA applied micro-costing techniques related to opportunity costs for caregivers (categorized as wages), non-drug medical supplies, and drug product costs.</p> <p>Results</p> <p>Norditropin^®NordiFlex and Norditropin^®NordiPen (NNF and NNP, Novo Nordisk, Inc., Bagsværd, Denmark) took less weekly Total Time (p < 0.05) to use than either of the comparator products, Genotropin^®Pen (GTP, Pfizer, Inc, New York, New York) or HumatroPen^®(HTP, Eli Lilly and Company, Indianapolis, Indiana). Time savings were directly related to differences in new package Preparation times (NNF (1.35 minutes), NNP (2.48 minutes) GTP (4.11 minutes), HTP (8.64 minutes), p < 0.05)). Administration and Storage times were not statistically different. NNF (15.8 minutes) and NNP (16.2 minutes) also took less time to Learn than HTP (24.0 minutes) and GTP (26.0 minutes), p < 0.05). The number of weekly required administration steps was also least with NNF and NNP. Opportunity cost savings were greater in devices that were easier to prepare for use; GTP represented an 11.8% drug product savings over NNF, NNP and HTP at time of study. Overall supply costs represented <1% of drug costs for all devices.</p> <p>Conclusions</p> <p>Time-and-motion simulation data used to support a micro-cost analysis demonstrated that the pen device with the greater time demand has highest net costs.</p