The payment of hospital services: a waiting lists model

This paper analyses the incentive properties of prospective payment systems for hospital contracts, a key feature in many health systems’ reforms. Building on current literature, the model explicitly allows for the existence of waiting time, modelled as adversely affecting patients’ utility and therefore reducing social welfare. The model shows that rewarding hospitals for their demand leads to the first best solution, identified with respect to the relevant quality and quantity variables. The additional separate payment of a price per case is instead required when the social cost of waiting is introduced alongside the private costs. 1. Introduction. The last two decades have witnessed major changes in the organisation of health services. Various factors, among which the aging of the population and technical progress, led to growing demand levels and expectations; then to discontent, cost increases and general financial crisis. In general terms this scenario has characterised

STUDIO DELL'ATTIVITA' ANTITUMORALE DI AM251 IN CELLULE UMANE DI MELANOMA CUTANEO

Il melanoma cutaneo è la neoplasia più aggressiva tra i tumori che possono insorgere a carico della cute. La scarsa responsività alla chemioterapia convenzionale rende necessario lo sviluppo di nuove strategie farmacologiche capaci di modificare la storia naturale della malattia. Il lavoro sperimentale svolto in questa tesi è stato finalizzato alla valutazione dell’attività antitumorale di AM251 nella linea cellulare di melanoma cutaneo umano A375 e nei fibroblasti umani isolati da derma adulto (HDFa), impiegati come controllo. Gli esperimenti sono stati condotti valutando la vitalità cellulare con WST-1 su cellule A375 e HDFa in seguito a trattamento con AM251. Inoltre, è stata effettuata l’analisi del ciclo cellulare in A375 trattate. L’apoptosi è stata esaminata attraverso l’analisi dei livelli di espressione di Bax, Bcl-2 e Survivina in real-time PCR e valutando le alterazioni della morfologia nucleare dopo colorazione con DAPI. Studi funzionali sono stati condotti per determinare il coinvolgimento del recettore GPR55, trattando le cellule con O1602 (agonista), LPI (agonista endogeno), CID16020046 (antagonista) e del recettore TRPA1 attraverso studi antagonista-agonista e mediante l’analisi dei livelli di calcio intracellulare. Il possibile ruolo degli enzimi COX-1 e COX-2 nel meccanismo d’azione di AM251 è stato esaminato confrontando l’attività con COX-inibitori quali, indometacina, celecoxib e rofecoxib. Oltre a ciò, sono stati anche valutati i livelli di AMPc nelle cellule esposte ad AM251. I risultati ottenuti hanno dimostrato che AM251 ha, nelle cellule A375, un’attività antiproliferativa dipendente dalla concentrazione e dal tempo di esposizione, mentre il composto non modifica in modo significativo la vitalità nelle cellule HDFa. AM251 determina l’arresto del ciclo cellulare a livello della transizione G2/M e induce apoptosi, portando a frammentazione e condensazione della cromatina, a un incremento di Bax ed a una riduzione dei livelli di Survivina e Bcl-2. I recettori CB1, GPR55 e gli enzimi non sembrano essere coinvolti nell’attività antitumorale in vitro del composto AM251, mentre sembra emergere un possibile coinvolgimento indiretto del recettore-canale per il calcio, TRPA1. In conclusione, i dati ottenuti indicano che AM251 ha un’attività pro-apoptotica nelle cellule di melanoma cutaneo maligno, che si realizza attraverso un meccanismo d’azione non mediato dai recettori conosciuti essere implicati nell’attività farmacologica di questa molecola

Deregulation and productivity growth: a study of Indian commercial banking

This paper examines the impact of regulatory reform on the performance of Indian commercial banks. Using a balanced panel data set covering from the beginning of the deregulation period (1992) to the most recent years (2004) and employing a DEA-based Malmquist index of total factor productivity change, this paper attempts to quantify the magnitude of total factor productivity change and identify its main sources. We also explore whether deregulation has had a different impact on the performance of public, private and foreign banks and whether it affected the risk-taking behaviour of market participants. The empirical results seem to indicate that, after an initial adjustment phase, the Indian banking industry experienced sustained productivity growth, driven mainly by technological progress. Banks’ ownership structure seems to have an impact on bank efficiency but does not appear to have an influence on total factor productivity change. Although ownership per se does not seem to matter as much as increased competition, during the deregulation process foreign banks appear to have acted as technological innovators, thereby increasing even further the competitive pressure in the Indian banking market. Finally, our results also indicate an increase in risk-taking behaviour along with the whole deregulation process.Deregulation; Indian banking; Productivity Change; Malmquist Index

The internal market and hospitals efficiency: a stochastic distance function approach.

The UK internal market was one of the first European attempts to introduce a competitive mechanism in the provision of hospital services. The assumption was that competition would have led hospitals to increase efficiency in the use their resources. The aim of this paper is to analyse the effectiveness of this kind of reforms by measuring the changes in technical efficiency of a panel of 52 acute Scottish hospitals observed from 1991/92 to 1996/97. The time period covers the whole duration of the internal market and the sample contains a different mix of both trusts and non-trusts, where the former embed the proper working of the reform. The selected model is a stochastic output distance function that includes an interaction dummy variable to allow for parameters to change over time. The results show a structural break after which hospitals change not only the way in which they provide their services, but also the kind of services they provide, favouring the quicker treatment of patients on a day basis. No significant improvement in technical efficiency is detected instead over time, nor any significant difference in efficiency between trusts and non trusts

Hysteria, Fear, and/or Delight

My Bachelor of Fine Arts thesis statement, Hysteria, Fear, and/or Delight, establishes the forms and concepts of my art practice as it stands as of May, 2020: performance-based and interdisciplinary. My practice implies narrative while acknowledging the audience. Physical language, in both dance and gesture, can be a means of communication or subversion. Pieces exist as ephemeral, often private, performances and then separately in archival forms ranging from video, to photography, to installation. The body of the statement details my thesis project, a remaking of Giselle, a 19th century Romantic-era ballet, into a performance series and video trilogy. The works walk the viewer down a non-linear path that is reminiscent of the original ballet, but my reinterpretations, new framework, and integration of external stories all distort the narrative. I use the romantic story to first perpetuate the original themes present in the story and later to subtly exploit them. I tread closely to those whom I admire such as Ana Mendieta, Pina Bausch, and Z Behl who all work near or within the greater realms of dance, theater, and performance. I acknowledge ways to interact with and subvert the spectator who may choose to experience delight in watching