Three Essays on Finance and Health Care Organizations.

This dissertation includes three essays that examine the interactions between financial arrangements and product market outcomes in the health care industry theoretically and empirically. Integrating finance and health economic theories, particularly the coexistence of mixed ownerships and the private provision of public goods, my dissertation presents unique opportunities to explore the interaction of the fields of health care finance and industrial organization. Chapter 2 includes an evaluation of nursing home quality, which provides a valuable opportunity to clarify the cyclical fluctuation of quality and the role of financial constraints in explaining such fluctuation. As such, I use local unemployment rates to provide exogenous cost shocks. During recessions, lower labor costs ease financial constraints and thus lead to higher nurse staffing, lower employee turnover, and better quality. Such counter-cyclical quality fluctuation is most profound among financially constrained facilities that tend to be more leveraged. This counter-cyclical quality is also more pronounced among nursing homes that are for-profit, belong to multi-facility chains, and focus largely on Medicaid residents. Overall, I find that financial constraints hinder quality, nursing home quality is counter-cyclical, and financial constraints slightly amplify counter-cyclical quality fluctuations. Chapter 3 examines the impacts of financial leverage on hospitals’ technology adoptions. To account for the potential endogeneity between financing and producing decisions, the California Seismic Retrofit Mandate is used as an exogenous financial shock that crowds out hospitals’ financial resources. Surprisingly, I did not find significant results to identify the association between financial leverage and technology adoption. Using a unique 8-year nursing home CEOs’ compensation dataset, I make inferences of the objective functions of for-profit and not-for-profit organizations, particularly the differential weights of financial and altruistic (quality) performance. Surprisingly, I find that compensation is not tied to performance. Rather, managers are compensated for more concrete measures including the size of the nursing home, payer-mix, and manager experience. I further separate managers into three groups (not-for-profit managers, for-profit and owner-managers, and for-profit and non-owner managers). Among these three types of managers, I find consistently significant evidence that owner-managers earn significantly higher compensation than do the other two types of managers.PhDHealth Services Organization & PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/102320/1/shenghsi_1.pd

The Impact of Timing and Dose of Rehabilitation Delivery on Functional Recovery of Stroke Patients

BackgroundTo investigate the impact of both timing and dose of rehabilitation delivery on the functional recovery of stroke patients.MethodsFrom chart review, we included 76 patients who were admitted to a regional hospital for first-ever stroke, and who had received multidisciplinary rehabilitation programs including physical therapy (PT) and occupational therapy (OT) at the inpatient department, and continuous rehabilitation therapy at the outpatient department for at least 3 months. The collected data included age, sex, type of stroke (hemorrhage/infarction), onset of stroke, initial motor status by Brunnstrom's motor recovery stages, time to rehabilitation intervention (from onset of stroke), length of stay, existence of aphasia, craniotomy (yes/no), and total units of rehabilitation. Main outcome measures were serial Barthel Index (BI) at initial assessment, 1 month, 3 months, 6 months, and 1 year post-stroke.ResultsAge was inversely correlated with BI and BI improvement at 3 months and 6 months post-stroke. Rehabilitation intervention time from onset was negatively correlated with BI improvement at 1 month and 1 year, and with BI at 1 month, 3 months, 6 months, and 1 year post-stroke. The total units of inpatient PT and/or OT were positively correlated with BI improvement at 1 month, 3 months, and 6 months post-stroke. The total units of PT and/or OT were positively correlated with BI improvement at 3 months and 6 months post-stroke. And the initial BI was positively correlated with BI at 1 month, 3 months, and 6 months post-stroke. The total units of OT can significantly predict BI improvement at 3 months and 6 months post-stroke, while the initial BI capacity can significantly predict BI status at 1 month, 3 months, and 6 months post-stroke.ConclusionThere is a dose-dependent effect of rehabilitation on functional improvement of stroke patients for the first 6 months post-stroke, and earlier delivery of rehabilitation has lasting effects on the functional recovery of stroke patients up to 1 year

Sliding and pressure evaluation on conventional and V-shaped seats of reclining wheelchairs for stroke patients with flaccid hemiplegia: a crossover trial

<p>Abstract</p> <p>Background</p> <p>Reclining wheelchairs are commonly used to transport elderly stroke patients in Taiwan. However, there is concern that the patient's body in the wheelchair often slides forward when they return to a seated position, increasing the sitting pressure. Therefore, a novel reclining wheelchair with an ergonomic "V-Seat" was designed to prevent forward sliding and pressure sores. The use of these reclining chairs by stroke patients has not yet been studied. Thus, we investigated the effects of V-shaped and conventional seats in reclining wheelchairs on the extent of forward sliding and on the sitting pressure of stroke patients with flaccid hemiplegia and of able-bodied elders.</p> <p>Methods</p> <p>We recruited 13 able-bodied elders and 11 stroke patients with flaccid hemiplegia and performed 5 reclining cycles in both types of wheelchair. The amount of sliding along the backrest (BS) plane and the seat (SS) plane, the mean sitting pressure (MP), and the sacral peak pressure (SPP) of the subjects were recorded. We used the Wilcoxon signed-rank test to compare the BS, SS, MP, and SPP in wheelchairs with conventional and V-shaped seats, and we used the Wilcoxon rank sum test to compare the differences in BS and SS between stroke patients and able-bodied elders in both types of reclining wheelchair.</p> <p>Results</p> <p>The BS, SS, and SPP of stroke patients were significantly lower in the wheelchairs with V-shaped seats than in conventional wheelchairs in most comparisons; however, the BS of able-bodied elders was higher in V-shaped seats than in conventional seats. The SS and SPP of stroke patients were significantly higher than those of able-bodied elders in both types of reclining wheelchair, and the BS of stroke patients was significantly higher than that of able-bodied elders only in conventional reclining wheelchairs.</p> <p>Conclusions</p> <p>The use of V-shaped seats in reclining wheelchairs can help reduce the forward sliding and sacral peak pressure of stroke patients with flaccid hemiplegia. The back displacement of able-bodied subjects when using both conventional and V-shape seats in reclining positions differs from the back displacement of stroke patients with flaccid hemiplegia when using such seats. These results are of paramount value and should be considered when prescribing the use of reclining wheelchairs to subjects with flaccid hemiplegia.</p

Neel tensor torque at the ferromagnet/antiferromagnet interface

Antiferromagnets (AFMs) exhibit spin arrangements with no net magnetization, positioning them as promising candidates for spintronics applications. While electrical manipulation of the single-crystal AFMs, composed of periodic spin configurations, is achieved recently, it remains a daunting challenge to characterize and to manipulate polycrystalline AFMs. Utilizing statistical analysis in data science, we demonstrate that polycrystalline AFMs can be described using a real, symmetric, positive semi-definite, rank-two tensor, which we term the Neel tensor. This tensor introduces a unique spin torque, diverging from the conventional field-like and Slonczewski torques in spintronics devices. Remarkably, Neel tensors can be trained to retain a specific orientation, functioning as a form of working memory. This attribute enables zero-field spin-orbit-torque switching in trilayer devices featuring a heavy-metal/ferromagnet/AFM structure and is also consistent with the X-ray magnetic linear dichroism measurements. Our findings uncover hidden statistical patterns in polycrystalline AFMs and establishes the presence of Neel tensor torque, highlighting its potential to drive future spintronics innovations.Comment: main text 18 pages, supplementary information 10 page

Topological surface electronic states in candidate nodal-line semimetal CaAgAs

We investigate systematically the bulk and surface electronic structure of the candidate nodal-line semimetal CaAgAs by angle resolved photoemission spectroscopy and density functional calculations. We observed a metallic, linear, non-$k_z$-dispersive surface band that coincides with the high-binding-energy part of the theoretical topological surface state, proving the topological nontriviality of the system. An overall downshift of the experimental Fermi level points to a rigid-band-like $p$-doping of the samples, due possibly to Ag vacancies in the as-grown crystals.Comment: 6 pages, 5 figure

Ample Pairs

We show that the ample degree of a stable theory with trivial forking is preserved when we consider the corresponding theory of belles paires, if it exists. This result also applies to the theory of $H$-structures of a trivial theory of rank $1$.Comment: Research partially supported by the program MTM2014-59178-P. The second author conducted research with support of the programme ANR-13-BS01-0006 Valcomo. The third author would like to thank the European Research Council grant 33882

Real-Time Remote Monitoring of Temperature and Humidity Within a Proton Exchange Membrane Fuel Cell Using Flexible Sensors

This study developed portable, non-invasive flexible humidity and temperature microsensors and an in situ wireless sensing system for a proton exchange membrane fuel cell (PEMFC). The system integrated three parts: a flexible capacitive humidity microsensor, a flexible resistive temperature microsensor, and a radio frequency (RF) module for signal transmission. The results show that the capacitive humidity microsensor has a high sensitivity of 0.83 pF%RH−1 and the resistive temperature microsensor also exhibits a high sensitivity of 2.94 × 10−3 °C−1. The established RF module transmits the signals from the two microsensors. The transmission distance can reach 4 m and the response time is less than 0.25 s. The performance measurements demonstrate that the maximum power density of the fuel cell with and without these microsensors are 14.76 mW·cm−2 and 15.90 mW·cm−2, with only 7.17% power loss

庭園風格差異與熟悉度對視覺專注程度影響之研究

本研究之目的在探討觀賞者觀看不同風格庭園時視覺專注程度的差異，並探究受測者對庭園熟悉度的差異是否會影響其視覺專注程度。研究採用瞳位追蹤技術記錄眼球落點分佈，配合問卷調查的進行，經由分層抽樣及方便性抽樣方式在中興大學不同學院學生間進行抽樣調查，共獲得有效問卷144份及有效瞳位追蹤記錄94份。資料分析方法採用描述性統計、卡方撿定及單因子雙異數分析。經由分析結果得到主要的結論如下: 1.不同庭園風格對視覺專注程度有顯著差異。整體觀之，受測者在觀看中國庭園時之專注程度最高，其次為英國庭園及義大利庭園，專注程度最低者為法國庭 園及日本庭園。 2.不同熟悉度對視覺專注程度有顯著差異。有修習過美學課程者專注程度較高;學院中則是以文學院以及對照組(造園景觀)視覺專注程度較高，工學院及社科學院較低。The purposes of this study were to explore the influences of different garden styles on observers' visual concentration and analyze whether different familiarity level of garden styles would have effects on visual concentration. The eye-tracking technique and distribution analysis of pupil location (fixation) were employed in this study. By using questionnaire survey, stratified sampling method, and convenient sampling method, this study obtained 144 valid samples from students studying in National Chung Hsing University. Of 144 valid samples, 94 samples with valid eye-tracking records were available for further analysis. Through utilizing descriptive statistics, Chi-square teat, and One-way ANOVE, this study obtained the following conclusions: 1. There were significant differences of observes; visual concentration among different garden styles. In Chinese garden, the observers' visual concentration were higher than those of English garden, and Italian garden. In French garden and Japanese garden, the observers' visual concentration were the lowest ones. 2. There were significant differences of observers; visual concentration among different familiarity level of garden styles

以支應性理論探討環境屬性與使用者行為關係之研究

本研究旨在以Gibson(1979)所提出的「支應性」理論，探討於開放空間中「環境物理特性」與「活動支應性」兩者之間的對應關係。研究以「台灣美術館前開放空間」作為調查樣區，對此開放空間中的使用者進行問卷調查．共得有效問卷400份。研究透過敘述性統計了解使用者之特性與使用情形，由平面照片所分析出來的結果發現，環境物理性質的確與支應的活動類型有一定程度的關聯性，使用者也能夠輕易的在特定環境外觀配受的地點，感知潛在的活動而促成行動，即使是透過2D介面展現出物理特徵，亦能讓人聯想到可能支應的活動，能夠有效的掌握關鍵使用者對環境的感知與使用行為。The major purpose of this study was to explore the relationship between environmental attributes and users' behavior by applying the affordance concept proposed by Gibson (1979). The study selected open spaces around Taiwan Art Museum as a survey area and employed questionnaire survey to obtain 400 valid samples. By using descriptive statistics and two-dimension photo analysis, the results showed that there was a certain association between environmental characteristics and types of affordance activity. Users could easily perceive potential activities in specified locations with different environmental attributes, and therefore enhance their real actions. The study also found out that even using two-dimension interface to display environmental characteristics could make users think about the potential affordance activities and understand users' environmental perception and use behavior