Trends, Random Walks and the Expectations-Augmented Phillips-Curve- A Summary

In most macroeconomic models, variations in nominal variables, such as inflation or money growth, are considered to be important determinants of cyclical fluctuations in real activity. The major hypothesis in that respect is the so-called Phillips-curve. In its modern interpretation, it maintains that only unexpected changes in nominal magnitudes produce real effects. Reliable empirical evidence on these effects is therefore crucial for the building of macroeconomic models and the conduct of monetary policy. Time series of output, industrial production or employment however contain growth and seasonal components in addition to cyclical elements. The empirical implementation of business cycle models therefore requires assumptions with respect to growth and seasonal parts as well, in order to isolate cyclical movements and to avoid misspecified equations. It has become general practice to assume that economic growth can be reasonably well approximated by a deterministic linear time trend. Seasonality is either captured through the explicit introduction of dummy variables or the use of seasonally adjusted data. Again, these procedures assume a deterministic seasonal structure. It is generally concluded in this literature, that unanticipated and possibly also expected changes in nominal magnitudes have non-negligible real effect

Financial impact of introducing the Swiss-DRG reimbursement system on potentially avoidable readmissions at a university hospital.

QUESTION UNDER STUDY: Thirty-day readmissions can be classified as potentially avoidable (PARs) or not avoidable (NARs) by following a specific algorithm (SQLape®). We wanted to assess the financial impact of the Swiss-DRG system, which regroups some readmissions occurring within 18 days after discharge within the initial hospital stay, on PARs at our hospital. METHODS: First, PARs were identified from all hospitalisations recorded in 2011 at our university hospital. Second, 2012 Swiss-DRG readmission rules were applied, regrouped readmissions (RR) were identified, and their financial impact computed. Third, RRs were classified as potentially avoidable (PARRs), not avoidable (NARRs), and others causes (OCRRs). Characteristics of PARR patients and stays were retrieved, and the financial impact of PARRS was computed. RESULTS: A total of 36,777 hospitalisations were recorded in 2011, of which 3,140 were considered as readmissions (8.5%): 1,470 PARs (46.8%) and 1,733 NARs (53.2%). The 2012 Swiss-DRG rules would have resulted in 910 RRs (2.5% of hospitalisations, 29% of readmissions): 395 PARRs (43% of RR), 181 NARRs (20%), and 334 OCRRs (37%). Loss in reimbursement would have amounted to CHF 3.157 million (0.6% of total reimbursement). As many as 95% of the 395 PARR patients lived at home. In total, 28% of PARRs occurred within 3 days after discharge, and 58% lasted less than 5 days; 79% of the patients were discharged home again. Loss in reimbursement would amount to CHF 1.771 million. CONCLUSION: PARs represent a sizeable number of 30-day readmissions, as do PARRs of 18-day RRs in the 2012 Swiss DRG system. They should be the focus of attention, as the PARRs represent an avoidable loss in reimbursement

Assisted suicide in an acute care hospital: 18 months' experience

QUESTION UNDER STUDY: In 2006 the University Hospital of Lausanne (CHUV) introduced an institutional directive specifying the conditions for assisted suicide, in accordance with professional guidelines and the recommendation of the Swiss National Advisory Commission on Biomedical Ethics that every acute care hospital take up a position on this subject. METHODS: 18-months follow-up analysis of patient requests and application of the directive by hospital staff. RESULTS: Of the 54,000 patients hospitalised between January 1, 2006, and June 30, 2007, six requests were recorded, all within the first 7 months after introduction of the directive and in the context of severe and life-threatening diseases. However, only one of the six patients, living in a nursing home belonging to the hospital, died by assisted suicide. Two patients died from their diseases, one during the assessment procedure and the other shortly after. One patient withdrew his request after pain control, returned home and died several weeks later. Another patient, although she was severely ill and died several months later, was denied the procedure because her condition was improving. Only one patient was declared incompetent and his request refused. The time distribution of requests seems to be associated with initial media coverage of the assisted-suicide directive's introduction. Only minor amendments to the directive were needed. CONCLUSIONS: The recommendations of the Swiss National Advisory Commission on Biomedical Ethics are applicable in an acute care hospital

Comparison of HIV-infected patients' characteristics, healthcare resources use and cost between native and migrant patients

Objectives:: To assess whether patients' characteristics and healthcare resources consumption and costs were different between native and migrant populations in Switzerland. Methods:: All adult patients followed-up in the Swiss HIV-cohort study in our institution during 2000-2003 were considered. Patients' characteristics were retrieved from the cohort database. Hospital and outpatient resource use were extracted from individual charts and valued with 2002 tariffs. Results:: The 66 migrants were younger (29 ± 8years versus 37±11, p < 0.001), less often of male gender (38 % versus 70 %, p < 0.001), predominantly infected via heterosexual contact (87 % versus 52 %, p < 0.01), with lower mean CD4 level at enrolment (326 ± 235 versus 437± 305, p = 0.002) than their 200 native counterparts. Migrants had fewer hospitalizations, more frequent outpatient visits, laboratory tests, and lower total cost of care per year of follow-up (€ 2′215 ± 4′206 versus 4′155 ± 12′304, p = 0.037). Resource use and costs were significantly higher in people with < 200 CD4 cell counts in both groups. Conclusions:: Migrant population had more advanced disease, more outpatient visits but less hospitalizations, resulting in lower costs of care when compared with native populatio

Costs borne by families of children hospitalized in a pediatric intensive care unit: a pilot study.

Hospitalisation of a child in a paediatric intensive care unit (PICU) involves major stress for parents. They wish to stay at their child's bedside while at the same time giving the usual attention to their other children. The resultant out-of-pocket expenses have rarely been studied. Over a 6-month period all the families of children hospitalised in our PICU for more than 4 days, speaking French and insured by our social security system, were eligible for inclusion. Participation was proposed only after diagnosis, treatment and prognosis had been determined. Costs were retrieved from a diary list of customised items and computed as the amount in excess of usual expenses until the end of the hospital stay. 117 children were hospitalised in our PICU for a total of 131 stays. The families of 16 fulfilled the inclusion criteria. One dropped out after a week at the parents' request. The children's age was 2.9 +/- 3.8 years and 67% were male. The majority had malformations (53%) or infections (33%). The total length of stay was 49 +/- 51 days, of which 24 +/- 41 were spent in the PICU. On average, parents spent CHF 86 +/- 31 every day, mainly on travel and meals. Over the entire hospital stay their expenses amounted to CHF 4,078 +/- 4,552. Direct out-of-pocket expenses for parents of children hospitalised in the PICU are considerable. Improvement in the social security system may be necessary to address this issue

Pseudomurein endoisopeptidases PeiW and PeiP, two moderately related members of a novel family of proteases produced in Methanothermobacter strains

Sequence comparison of pseudomurein endoisopeptidases PeiW encoded by the defective prophage ΨM100 of Methanothermobacter wolfeii, and PeiP encoded by phage ΨM2 of Methanothermobacter marburgensis, revealed that the two enzymes share only limited similarity. Their amino acid sequences comprise an N-terminal domain characterized by the presence of direct repeats and a C-terminal domain with a catalytic triad C-H-D as in thiol proteases and animal transglutaminases. Both PeiW and PeiP catalyze the in vitro lysis of M. marburgensis cells under reducing conditions and exhibit characteristics of metal-activated peptidases. Optimal temperature and pH were determined to be 63°C and 6.4 for His-tagged PeiP and 71°C and 6.4 for His-tagged PeiW, respectively. Database search results suggest that PeiW and PeiP are the first two experimentally identified members of a novel family of proteases in a superfamily of archaeal, bacterial, and eukaryotic protein homologs of animal transglutaminase

Spectroscopic Studies and Characterization of a Novel Electron-Transfer Chain

A novel two-component enzyme system from Escherichia coli involving a flavorubredoxin (FlRd) and its reductase was studied in terms of spectroscopic, redox, and biochemical properties of its constituents. FlRd contains one FMN and one rubredoxin (Rd) center per monomer. To assess the role of the Rd domain, FlRd and a truncated form lacking the Rd domain (FlRd¢Rd), were characterized. FlRd contains 2.9 ( 0.5 iron atoms/subunit, whereas FlRd¢Rd contains 2.1 ( 0.6 iron atoms/subunit. While for FlRd one iron atom corresponds to the Rd center, the other two irons, also present in FlRd¢Rd, are most probably due to a di-iron site. Redox titrations of FlRd using EPR and visible spectroscopies allowed us to determine that the Rd site has a reduction potential of -140 ( 15 mV, whereas the FMN undergoes reduction via a red-semiquinone, at -140 ( 15 mV (Flox/Flsq) and -180 ( 15 mV (Flsq/Flred), at pH 7.6. The Rd site has the lowest potential ever reported for a Rd center, which may be correlated with specific amino acid substitutions close to both cysteine clusters. The gene adjacent to that encoding FlRd was found to code for an FAD-containing protein, (flavo)rubredoxin reductase (FlRd-reductase), which is capable of mediating electron transfer from NADH to DesulfoVibrio gigas Rd as well as to E. coli FlRd. Furthermore, electron donation was found to proceed through the Rd domain of FlRd as the Rd-truncated protein does not react with FlRd-reductase. In vitro, this pathway links NADH oxidation with dioxygen reduction. The possible function of this chain is discussed considering the presence of FlRd homologues in all known genomes of anaerobes and facultative aerobes