Misaligned Incentives and Mortgage Lending in Asia

This paper provides a conceptual basis for the price discovery potential for tradable market instruments and specifically the development of mortgage securitization in Asia and the potential dangers of such markets. Nonetheless we argue for the potential importance of securitization in Asia because of its possible role in increasing transparency of the financial sector of Asian economies. We put forth a model explaining how misaligned incentives can lead to bank generated real estate crashes and macroeconomic instability, with or without securitization under certain circumstances. We examine the banking sectors performance in Asia compared to securitized real estate returns, to provide evidence on the contribution of misaligned incentives in the past. We discuss how the addition of liquid MBS could help to inoculate markets from the shocks arising from bank-financed mortgage lending. We conclude with a brief discussion of current MBS markets in Asia.tradable market instruments, price discovery, mortgage securitization, dangers, Transparency, MBS markets

Access to primary care and visits to emergency departments in England: a cross-sectional, population-based study

Background The number of visits to hospital emergency departments (EDs) in England has increased by 20% since 2007-08, placing unsustainable pressure on the National Health Service (NHS). Some patients attend EDs because they are unable to access primary care services. This study examined the association between access to primary care and ED visits in England. Methods A cross-sectional, population-based analysis of patients registered with 7,856 general practices in England was conducted, for the time period April 2010 to March 2011. The outcome measure was the number of self-referred discharged ED visits by the registered population of a general practice. The predictor variables were measures of patient-reported access to general practice services; these were entered into a negative binomial regression model with variables to control for the characteristics of patient populations, supply of general practitioners and travel times to health services. Main Result and Conclusion General practices providing more timely access to primary care had fewer self-referred discharged ED visits per registered patient (for the most accessible quintile of practices, RR = 0.898; P<0.001). Policy makers should consider improving timely access to primary care when developing plans to reduce ED utilisation

Immunologic markers of progression to acquired immunodeficiency syndrome are time-dependent and illness-specific

Krämer A, Biggar RJ, Hampl H, et al. Immunologic markers of progression to acquired immunodeficiency syndrome are time-dependent and illness-specific. American Journal of Epidemiology. 1992;136(1):71-80.Since prevalent cohorts may be biased by the duration of human immunodeficiency virus (HIV) infection (onset bias), it is useful to assess the potential predictive value of markers in incident cohorts of HIV-positive subjects for whom the date of seroconversion is known or can reliably be estimated. Of 131 homosexual men with HIV-1 seroconversion from New York City and Washington, DC, who were evaluated annually beginning in 1982, 60 developed acquired immunodeficiency syndrome (AIDS) by the end of 1989. The prognostic significance of immunologic markers (proportion of CD4+ T-lymphocytes, neopterin, ß2-microglobulin, serum interferon, and anti-p24 antibody) and of a virologic marker (HIV p24 antigen) was determined using measurements made at defined time intervals after the known or estimated date of HIV seroconversion. When measurements made 3 years after seroconversion were used, all markers except anti-p24 antibody were found to be significant estimators of AIDS risk in univariate analyses. In multivariate Cox regression modeling, the maximum information was obtained by including neopterin, interferon, and the CD4+ T-lymphocyte proportion. The predictive value of markers after HIV seroconversion could change considerably from one interval to another. Elevated levels of ß2-microglobulin and neopterin significantly predicted the development of Kaposi‘s sarcoma. These two markers were highly correlated (r=0. 74). The authors conclude that immunologic markers can be important for an HIV staging system for estimating prognosis and facilitating early therapeutic intervention in HIV-positive patients

Potential Unintended Consequences Due to Medicare’s “No Pay for Errors Rule”? A Randomized Controlled Trial of an Educational Intervention with Internal Medicine Residents

Medicare has selected 10 hospital-acquired conditions for which it will not reimburse hospitals unless the condition was documented as “present on admission.” This “no pay for errors” rule may have a profound effect on the clinical practice of physicians. To determine how physicians might change their behavior after learning about the Medicare rule. We conducted a randomized trial of a brief educational intervention embedded in an online survey, using clinical vignettes to estimate behavioral changes. At a university-based internal medicine residency program, 168 internal medicine residents were eligible to participate. Residents were randomized to receive a one-page description of Medicare’s “no pay for errors” rule with pre-vignette reminders (intervention group) or no information (control group). Residents responded to five clinical vignettes in which “no pay for errors” conditions might be present on admission. Primary outcome was selection of the single most clinically appropriate option from three clinical practice choices presented for each clinical vignette. Survey administered from December 2008 to March 2009. There were 119 responses (71%). In four of five vignettes, the intervention group was less likely to select the most clinically appropriate response. This was statistically significant in two of the cases. Most residents were aware of the rule but not its impact and specifics. Residents acknowledged responsibility to know Medicare documentation rules but felt poorly trained to do so. Residents educated about the Medicare’s “no pay for errors” were less likely to select the most clinically appropriate responses to clinical vignettes. Such choices, if implemented in practice, have the potential for causing patient harm through unnecessary tests, procedures, and other interventions

The Evaluation of a Graphical Pulmonary Display in Anesthesiology

We have developed graphic technology to display data from the respiratory monitors used during anesthesia. The display uses color, texture, shape and emergent features to highlight abnormal pulmonary physiology. Nineteen anesthesiologists participated in a simulator based evaluation (METI, Sarasota, FL.). Half the subjects used the metaphor display and half did not. Each subject was trained for 10 minutes on the pulmonary display. The time difference during the obstructed endotracheal tube did prove significant (p=0.02) in favor of the pulmonary display condition. During the intrinsic PEEP scenario, the subjects treated the patient earlier (positive trend p=0.l) with the pulmonary display compared to the control condition. The group that used the pulmonary display treated a restricted upper airway more quickly (2.3 min vs. 3.9 min). Subjects liked the simplicity of the design. In future studies, we hope to further reduce the time for the detection and treatment of all scenarios by improving the design\u27s intuitiveness, integration, and emergent features

Method and apparatus for monitoring dynamic cardiovascular function using n-dimensional representatives of critical functions

A method, system, apparatus and device for the monitoring, diagnosis and evaluation of the state of a dynamic pulmonary system is disclosed. This method and system provides the processing means for receiving sensed and/or simulated data, converting such data into a displayable object format and displaying such objects in a manner such that the interrelationships between the respective variables can be correlated and identified by a user. This invention provides for the rapid cognitive grasp of the overall state of a pulmonary critical function with respect to a dynamic system

Pulmonary Metaphor Design and Anesthesia Simulation Testing

Medical decision making is a crucial process to successfully treat a critical medical emergency. During an unexpected medical event, astronauts, like anesthesiologists, must react quickly in a complex environment. Tools, such as the pulmonary metaphor display, were created to aid the medical caregiver\u27s decision making process. The pulmonary metaphor display is designed to help the caregiver collect and integrate pulmonary data to provide a more accurate, quicker diagnosis and treatment. The following outline anesthesiology simulation study will provide the data to prove that the pulmonary metaphor display is beneficial to medical decision making

A nearly symmetric double-image gravitational lens

We report the discovery of a new double-image gravitational lens resulting from our search for lenses in the southern sky. Radio source PMN J2004-1349 is composed of two compact components separated by 1.13 arcseconds in VLA, MERLIN and VLBA images. The components have a flux ratio of 1:1 at radio frequencies ranging from 5 GHz to 22 GHz. The I-band optical counterpart is also an equal double, with roughly the same separation and position angle as the radio double. Upon subtraction of the components from the I-band image, we identify a dim pattern of residuals as the lens galaxy. While the present observations are sufficient to establish that J2004-1349 is a gravitational lens, additional information will be necessary (such as the redshifts of the galaxy and quasar, and precise astrometry and photometry of the lens galaxy) before constructing detailed mass models.Comment: 17 pp., 5 bitmapped figs. (contact [email protected] for nicer figs), in press, A.J. (substantially revised