Physician Investment in Hospitals: Specialization, Incentives, and the Quality of Cardiac Care

Physician ownership of hospitals involves several competing economic forces. Physician-owners may be incentivized to cherry-pick and treat profitable patients at their facilities. However, physician-owned hospitals are often specialized and may provide higher-quality care. This paper uses a structural choice-outcome model to estimate hospital quality, patient-hospital matching, and preferences for treating patients at owned vs. competing hospitals. Instrumental variables analysis of cardiac mortality is used to capture quality; I document a significant mortality improvement at physician-owner preferences; controlling for matching and baseline patient preferences, there is little evidence of physician-owner cherry-picking

The Heated Trumpet Stand and Combating External Temperature Changes Solving Intonation Issues for Trumpet Players

This project began after spending many years sitting through frigid football games for marching band and performing in a variety of ensemble and orchestral settings with long breaks and tacets. My intonation would be negatively affected by the varying external temperatures, which in turn impacted the full ensembles in which I participated until my instrument returned to the approximate temperature of human breath, around 86-90 degrees Fahrenheit. I also witnessed marching band competitions in colder weather, where soloists would end up with frozen valves and could not perform. This project was the result of ruminating on this problem and aiming to find an accessible solution, that would create a more seamless transition from rest to performance.Research has been conducted with the Washington State University trumpet professor, Dr. David Turnbull, and the Washington State University trumpet studio. The priority of the design was efficient airflow from the stand through the trumpet itself. The stand is switch operated and rechargeable for the most efficient usage as well as for ease of transportation.While the focus of this project is based around the physical stand, there is an accompanying document that contains an introduction, the history of trumpet intonation, methods that have been attempted to remedy intonation issues, the design and construction process, a collection of data showing the stands efficiency, surveys from study participants, and a bibliography.With the invention of this product, I have brought an accessible method of reducing intonation issues that will allow trumpet players to maintain their intonation and match the ensemble more effectively. The result of this project is a trumpet stand that can easily replace traditional trumpet stands, while providing additional functions that aid in the instrument’s intonation. This design can also serve as a template for heated stands to benefit other brass instruments

Preferred Pharmacy Networks: Health Care Savings on the Margins

While policymakers have talked a lot recently about finding a comprehensive fix for escalating health care costs, such as Medicare-for-all, many economists have been exploring the possibility that the answer for excessive health care spending may rest instead in series of smaller adjustments. This issue brief presents research on one such small fix: preferred pharmacy networks. This is a relatively new tool whereby health insurers aim to steer consumers to lower cost “preferred” pharmacies, where insurers are able to negotiate lower drug prices. The research concludes that preferred pharmacy contracting results in a roughly 1 percent decrease in Medicare Part D drug costs among plans utilizing this tool—a fact that should be encouraging to policymakers concerned about reigning in costs, especially in light of other research demonstrating that health care consumers do not shop around for lower priced care. If this practice of “steering” consumers toward lower cost drugs were applied to the entire pharmaceutical industry, the savings could be much greater.https://repository.upenn.edu/pennwhartonppi/1065/thumbnail.jp

Neuronal pentraxin 2, brain atrophy and cognitive decline

Chronic neuroinflammation is thought to potentiate medial temporal lobe (MTL) atrophy and memory decline in Alzheimer’s disease (AD). It has become increasingly important to find novel immunological biomarkers of neuroinflammation or other processes that can track AD development and progression. Our study explored which pro- or anti-inflammatory cerebrospinal fluid (CSF) biomarkers best predicted AD neuropathology over 24 months. Using Alzheimer’s Disease Neuroimaging Initiative data (N=285), CSF inflammatory biomarkers from mass spectrometry and multiplex panels were screened using stepwise regression, followed up with 50%/50% model retests for validation. Neuronal Pentraxin 2 (NPTX2) and Chitinase-3-like-protein-1 (C3LP1), biomarkers of glutamatergic synaptic plasticity and microglial activation respectively, were the only consistently significant biomarkers selected. Once these biomarkers were selected, linear mixed models were used to analyze their baseline and longitudinal associations with bilateral MTL volume, memory decline, global cognition, and established AD biomarkers including CSF amyloid and tau. Higher baseline NPTX2 levels corresponded to less MTL atrophy [R2= .287, p\u3c.001] and substantially less memory decline [R2=.560, p\u3c.001] by month 24. Conversely, higher C3LP1 modestly predicted more MTL atrophy [R2=.083, p\u3c.001], yet did not significantly track memory decline over time. In conclusion, NPTX2 is a novel pro-inflammatory cytokine that predicts AD-related outcomes better than any immunological biomarker to date, substantially accounting for brain atrophy and especially memory decline. C3LP1 as the microglial biomarker, by contrast, performed modestly and did not predict longitudinal memory decline. This research may advance the current understanding of AD etiopathogenesis, while expanding early diagnostic techniques through the use of novel pro-inflammatory biomarkers, such as NPTX2. Future studies should also see if NPTX2 causally affects MTL morphometry and memory performance. Keywords: Alzheimer’s disease; medial temporal lobe; inflammation; immunology; amyloid; tau; memory; biomarkers; NPTX2; C3LP

Transparency and Negotiated Prices: The Value of Information in Hospital-Supplier Bargaining

Hospitals that join a pricing database are able to reduce the negotiated prices they pay to medical technology companies. Reductions are concentrated among hospitals previously paying high prices relative to other hospitals and for products purchased in relatively large volumes. Transparency may offer significant savings on medical devices

Do Schools Mater for High Math Achievement? Evidence from the American Mathematics Competitions

This paper uses data from the American Mathematics Competitions to examine the rates at which different high schools produce high-achieving math students. There are large differences in the frequency with which students from seemingly similar schools reach high achievement levels. The distribution of unexplained school effects includes a thick tail of schools that produce many more high-achieving students than is typical. Several additional analyses suggest that the differences are not primarily due to unobserved differences in student characteristics. The differences are persistent across time, suggesting that differences in the effectiveness of educational programs are not primarily due to direct peer effects

Evaluation And Treatment Of A Patient Diagnosed With Adhesive Capsulitis Classified As A Derangement Using The McKenzie Method: A Case Report

The McKenzie Method of mechanical diagnosis and therapy (MDT) is supported in the literature as a valid and reliable approach to spine injuries. It can also be applied to the peripheral joints, but has not been explored through research to the same extent. A previous case series detailed the use of MDT in the shoulder; however, the application of MDT in the treatment of adhesive capsulitis has not been previously reported in the literature. The purpose of this report is to demonstrate the assessment, intervention, and clinical outcomes of a patient diagnosed with adhesive capsulitis, who was classified as having a shoulder derangement using MDT methodology.https://dune.une.edu/pt_studcrposter/1041/thumbnail.jp

Social Impact Bonds in Nonprofit Health Care: New Product or New Package?

This note considers a relatively new form of financing for social services, the Social Impact Bond. Proponents of Social Impact Bonds argue that they present a solution to several problems in funding social services, including performance measurement and the distribution of risk. Using a simple model, we demonstrate that Social Impact Bonds have many features present in standard financing arrangements. They will lead to greater program success when investors\u27 effort can positively influence outcomes, but are unlikely to do so otherwise. We conclude that the value of this funding innovation will be strongly context-dependent

The Gender Gap in Secondary School Mathematics at High Achievement Levels: Evidence from the American Mathematics Competitions

This paper uses a new data source, American Mathematics Competitions, to examine the gender gap among high school students at very high achievement levels. The data bring out several new facts. There is a large gender gap that widens dramatically at percentiles above those that can be examined using standard data sources. An analysis of unobserved heterogeneity indicates that there is only moderate variation in the gender gap across schools. The highest achieving girls in the U.S. are concentrated in a very small set of elite schools, suggesting that almost all girls with the ability to reach high math achievement levels are not doing so.

Do Schools Matter for High Math Achievement? Evidence from the American Mathematics Competitions

This paper uses data from the American Mathematics Competitions to examine the rates at which different high schools produce high-achieving math students. There are large differences in the frequency with which students from seemingly similar schools reach high achievement levels. The distribution of unexplained school effects includes a thick tail of schools that produce many more high-achieving students than is typical. Several additional analyses suggest that the differences are not primarily due to unobserved differences in student characteristics. The differences are persistent across time, suggesting that differences in the effectiveness of educational programs are not primarily due to direct peer effects