The dependence of precipitation and its footprint on atmospheric temperature in idealized extratropical cyclones

Flood hazard is a function of the magnitude and spatial pattern of precipitation accumulation. The sensitivity of precipitation to atmospheric temperature is investigated for idealized extratropical cyclones, enabling us to examine the footprint of extreme precipitation (surface area where accumulated precipitation exceeds high thresholds) and the accumulation in different-sized catchment areas. The mean precipitation increases with temperature, with the mean increase at 5.40%/∘C. The 99.9th percentile of accumulated precipitation increases at 12.7%/∘C for 1 h and 9.38%/∘C for 24 h, both greater than Clausius-Clapeyron scaling. The footprint of extreme precipitation grows considerably with temperature, with the relative increase generally greater for longer durations. The sensitivity of the footprint of extreme precipitation is generally super Clausius-Clapeyron. The surface area of all precipitation shrinks with increasing temperature. Greater relative changes in the number of catchment areas exceeding extreme total precipitation are found when the domain is divided into larger rather than smaller catchment areas. This indicates that fluvial flooding may increase faster than pluvial flooding from extratropical cyclones in a warming world. When the catchment areas are ranked in order of total precipitation, the 99.9th percentile is found to increase slightly above Clausius-Clapeyron expectations for all of the catchment sizes, from 9 km2 to 22,500 km2. This is surprising for larger catchment areas given the change in mean precipitation. We propose that this is due to spatially concentrated changes in extreme precipitation in the occluded fron

Managed Care, Technology Adoption, and Health Care: The Adoption of Neonatal Intensive Care

Managed care activity may alter the incentives associated with the acquisition and use of new medical technologies, with potentially important implications for health care costs, patient care, and outcomes. This paper discusses mechanisms by which managed care could influence the adoption of new technologies and empirically examines the relationship between HMO market share and the diffusion of neonatal intensive care, a collection of technologies for the care of high risk newborns. We find that managed care slowed the adoption of NICUs, primarily by slowing the adoption of mid-level NICUs rather than the most advanced high-level units. Slowing the adoption of mid-level units would likely have generated savings. Moreover, opposite the frequent supposition that slowing technology growth is uniformly harmful to patients, in this case reduced adoption of mid-level units could have benefitted patients, since health outcomes for seriously ill newborns are better in higher-level NICUs and reductions in the availability of mid-level units appear to increase the chance of receiving care in a high-level center.

Is There Monopsony in the Labor Market? Evidence from a Natural Experiment

Recent theoretical and empirical advances have renewed interest in monopsonistic models of the labor market. However, there is little direct empirical support for these models. We use an exogenous change in wages at Department of Veterans Affairs (VA) hospitals as a natural experiment to investigate the extent of monopsony in the nurse labor market. We estimate that labor supply to individual hospitals is quite inelastic, with short-run elasticity around 0.1. We also find that non-VA hospitals responded to the VA wage change by changing their own wages

Human Capital and Organizational Performance: Evidence from the Healthcare Sector

This paper contributes to the literature on the relationship between human capital and organizational performance. We use detailed longitudinal monthly data on nursing units in the Veterans Administration hospital system to identify how the human capital (general, hospital-specific and unit or team-specific) of the nursing team on the unit affects patients' outcomes. Since we use monthly, not annual, data, we are able to avoid the omitted variable bias and endogeneity bias that could result when annual data are used. Nurse staffing levels, general human capital, and unit-specific human capital have positive and significant effects on patient outcomes while the use of contract nurses, who have less specific capital than regular staff nurses, negatively impacts patient outcomes. Policies that would increase the specific human capital of the nursing staff are found to be cost-effective.

Trends in resources for neonatal intensive care at delivery hospitals for infants born younger than 30 weeks' gestation, 2009-2020

Importance: In an ideal regionalized system, all infants born very preterm would be delivered at a large tertiary hospital capable of providing all necessary care. Objective: To examine whether the distribution of extremely preterm births changed between 2009 and 2020 based on neonatal intensive care resources at the delivery hospital. Design, setting, and participants: This retrospective cohort study was conducted at 822 Vermont Oxford Network (VON) centers in the US between 2009 and 2020. Participants included infants born at 22 to 29 weeks' gestation, delivered at or transferred to centers participating in the VON. Data were analyzed from February to December 2022. Exposures: Hospital of birth at 22 to 29 weeks' gestation. Main outcomes and measures: Birthplace neonatal intensive care unit (NICU) level was classified as A, restriction on assisted ventilation or no surgery; B, major surgery; or C, cardiac surgery requiring bypass. Level B centers were further divided into low-volume (<50 inborn infants at 22 to 29 weeks' gestation per year) and high-volume (≥50 inborn infants at 22 to 29 weeks' gestation per year) centers. High-volume level B and level C centers were combined, resulting in 3 distinct NICU categories: level A, low-volume B, and high-volume B and C NICUs. The main outcome was the change in the percentage of births at hospitals with level A, low-volume B, and high-volume B or C NICUs overall and by US Census region. Results: A total of 357 181 infants (mean [SD] gestational age, 26.4 [2.1] weeks; 188 761 [52.9%] male) were included in the analysis. Across regions, the Pacific (20 239 births [38.3%]) had the lowest while the South Atlantic (48 348 births [62.7%]) had the highest percentage of births at a hospital with a high-volume B- or C-level NICU. Births at hospitals with A-level NICUs increased by 5.6% (95% CI, 4.3% to 7.0%), and births at low-volume B-level NICUs increased by 3.6% (95% CI, 2.1% to 5.0%), while births at hospitals with high-volume B- or C-level NICUs decreased by 9.2% (95% CI, -10.3% to -8.1%). By 2020, less than half of the births for infants at 22 to 29 weeks' gestation occurred at hospitals with high-volume B- or C-level NICUs. Most US Census regions followed the nationwide trends; for example, births at hospitals with high-volume B- or C-level NICUs decreased by 10.9% [95% CI, -14.0% to -7.8%) in the East North Central region and by 21.1% (95% CI, -24.0% to -18.2%) in the West South Central region. Conclusions and relevance: This retrospective cohort study identified concerning deregionalization trends in birthplace hospital level of care for infants born at 22 to 29 weeks' gestation. These findings should serve to encourage policy makers to identify and enforce strategies to ensure that infants at the highest risk of adverse outcomes are born at the hospitals where they have the best chances to attain optimal outcomes

The Effect of Body Mass on the 30-15 Intermittent Fitness Test in Rugby Union Players.

To A) evaluate the difference in performance of the 30-15 Intermittent Fitness Test (30-15IFT) across four squads in a professional rugby union club in the United Kingdom (UK), and B) consider body mass in the interpretation of the end velocity of the 30-15IFT (VIFT).One hundred and fourteen rugby union players completed the 30-15IFT mid- season.VIFT demonstrated small and possibly lower (ES = -0.33; 4/29/67) values in the Under 16s compared to the Under 21s, with further comparisons unclear. With body mass included as a covariate all differences were moderate to large, and very likely to almost certainly lower in the squads with lower body mass, with the exception of comparisons between Senior and Under 21 squads.The data demonstrate that there appears to be a ceiling to the VIFT attained in rugby union players which does not increase from Under 16s to Senior level. However, the associated increases in body mass with increased playing level suggest that the ability to perform high intensity running is increased with age, although not translated into greater VIFT due to the detrimental effect of body mass on change of direction. . Practitioners should be aware that VIFT is unlikely to improve, however it needs to be monitored during periods where increases in body mass are evident