The Cost of Care: New Insights into Healthcare Spending Growth

[Excerpt] The Bureau of Labor Statistics (BLS) is celebrating the first anniversary of experimental disease-based price indexes, which adjust expenditures on disease for inflation. Statistical agencies have long collected price information on medical procedures, drugs, equipment, and services, but the cost of treating a patient is typically some combination of these goods and services. Many users of the Federal Statistical System have asked that medical care spending be reported on a disease basis. Creating price indexes on a disease basis helps provide greater understanding of the cost of care for a given condition. The indexes are the result of a long-term research effort by staff in the BLS Office of Prices and Living Conditions. Using existing data products, we met the need for a new product, without incurring more data collection expenses. We construct the experimental indexes using two publicly available datasets: 1) the monthly producer price index (PPI) and consumer price index (CPI) published by BLS and 2) the Medical Expenditure Panel Survey (MEPS) published by the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. The monthly BLS data allow our experimental disease-based price indexes to be timely. MEPS supplies data on the use of medical service and products for the treatment of each disease. After a year of constructing the experimental disease-based index we reveal the wealth of information that the data show. This Beyond the Numbers article examines the reasons for reporting by disease rather than by service and explains the reasons behind the spending growth for each disease

A Robust Estimation of the Effects of Taxation on Charitable Contributions

While many studies find that the tax-price elasticity of giving exceeds unity, several recent studies find the contrary. This is important because it can be shown that if the elasticity exceeds one, then allowing taxpayers to deduct charitable giving from their taxable income is efficient in the sense that the amount donated exceeds the loss to the treasury. Here we use Consumer Expenditure Survey data to estimate the price elasticity of all deductible contributions. Because specification tests reject the consistency of estimators such as Tobit or the two-stage Heckman we use the semiparametric method of Ahn and Powell (1993). Rather than selecting bandwidths through cross-validation we demonstrate that because high and low bandwidths lead to the standard linear model one may use visual inspection for bandwidth selection. We also do not use the covariance matrix estimator of Ahn and Powell, instead bootstrapping a confidence interval. These bootstraps are also used to remove the finite sample bias inherent in nonlinear estimators. In our results we find an elasticity estimate greater than unity for the Tobit and Heckman methods but less than one for the Ahn and Powell method. Because specification tests suggest that the likelihood assumptions ensuring the consistency of the Tobit and Heckman do not hold, our results suggest that previous high tax-price elasticities may be caused by misspecification. However, our estimate of the elasticity of contributions to just social welfare organizations exceeds unity. In this sense the deduction for those types of contributions is efficient.

A Study of the Role of Churches in the Enactment of the Arkansas Prohibition Law of 1917

Churches have been involved in the moral and ethical standards of the United States and its political subdivisions since the formation of the nation. Major questions about the churches\u27 involvement as a social force in the nation or in the community concern: (1) the degree of involvement, (2) the methods employed and (3) the relative effectiveness of church influence upon the mores and laws of any society or state. To answer these questions, a historical study must be made of a particular moral problem in a specific locale and of the role that church influence or direct action played in its solution. The purpose of this study was to ascertain the role that churches and Christian leaders had in Arkansas\u27 enactment of the Bone Dry Law of 1917 and of the numerous less important prohibition laws which led to its enactment.... With the signature of Governor Charles Hillman Brough, Senate Bill 36 of 1917 became law, Act 13 of the Arkansas General Assembly. The Bone Dry Law, as Act 13 was popularly known, made Arkansas the first Bone Dry state in the United States. The basic contention underlying this study was that churches and Christian leaders in various denominations were primarily responsible for the Bone Dry Law and the previously enacted laws upon which it was predicated. The purpose of this study, consequently, was to determine the validity of this basic contention and to determine what methods or approaches were used in securing the passage of Act 13

Theory and Practice of Translation: An Original Translation of Regina E. G. Schymiczek’s Die Weide Der Seepferde (The Pasture of the Seahorses)

This study outlines the original translation of the recently published Die Weide der Seepferde (2013) from Regina E. G. Schymizcek. We employ known translation techniques by following Hervey’s (2006) suggested gradients of degrees of translation and cultural transposition. While translating the work we discovered a unique aspect of German-English translation which we believe fundamentally adds to knowledge of translation theory

Model Validation of an RSRM Transporter Through Full-scale Operational and Modal Testing

The Reusable Solid Rocket Motor (RSRM) segments, which are part of the current Space Shuttle system and will provide the first stage of the Ares launch vehicle, must be transported from their manufacturing facility in Promontory, Utah, to a railhead in Corinne, Utah. This approximately 25-mile trip on secondary paved roads is accomplished using a special transporter system which lifts and conveys each individual segment. ATK Launch Systems (ATK) has recently obtained a new set of these transporters from Scheuerle, a company in Germany. The transporter is a 96-wheel, dual tractor vehicle that supports the payload via a hydraulic suspension. Since this system is a different design than was previously used, computer modeling with validation via test is required to ensure that the environment to which the segment is exposed is not too severe for this space-critical hardware. Accurate prediction of the loads imparted to the rocket motor is essential in order to prevent damage to the segment. To develop and validate a finite element model capable of such accurate predictions, ATA Engineering, Inc., teamed with ATK to perform a modal survey of the transport system, including a forward RSRM segment. A set of electrodynamic shakers was placed around the transporter at locations capable of exciting the transporter vehicle dynamics. Forces from the shakers with varying phase combinations were applied using sinusoidal sweep excitation. The relative phase of the shaker forcing functions was adjusted to match the shape characteristics of each of several target modes, thereby customizing each sweep run for exciting a particular mode. The resulting frequency response functions (FRF) from this series of sine sweeps allowed identification of all target modes and other higher-order modes, allowing good comparison to the finite element model. Furthermore, the survey-derived modal frequencies were correlated with peak frequencies observed during road-going operating tests. This correlation enabled verification of the most significant modes contributing to real-world loading of the motor segment under transport. After traditional model updating, dynamic simulation of the transportation environment was compared to the measured operating data to provided further validation of the analysis model. KEYWORDS Validation, correlation, modal test, rocket motor, transporte

Effect of electrolyzed high-pH alkaline water on blood viscosity in healthy adults.

BACKGROUND: Previous research has shown fluid replacement beverages ingested after exercise can affect hydration biomarkers. No specific hydration marker is universally accepted as an ideal rehydration parameter following strenuous exercise. Currently, changes in body mass are used as a parameter during post-exercise hydration. Additional parameters are needed to fully appreciate and better understand rehydration following strenuous exercise. This randomized, double-blind, parallel-arm trial assessed the effect of high-pH water on four biomarkers after exercise-induced dehydration. METHODS: One hundred healthy adults (50 M/50 F, 31 ± 6 years of age) were enrolled at a single clinical research center in Camden, NJ and completed this study with no adverse events. All individuals exercised in a warm environment (30 °C, 70% relative humidity) until their weight was reduced by a normally accepted level of 2.0 ± 0.2% due to perspiration, reflecting the effects of exercise in producing mild dehydration. Participants were randomized to rehydrate with an electrolyzed, high-pH (alkaline) water or standard water of equal volume (2% body weight) and assessed for an additional 2-h recovery period following exercise in order to assess any potential variations in measured parameters. The following biomarkers were assessed at baseline and during their recovery period: blood viscosity at high and low shear rates, plasma osmolality, bioimpedance, and body mass, as well as monitoring vital signs. Furthermore, a mixed model analysis was performed for additional validation. RESULTS: After exercise-induced dehydration, consumption of the electrolyzed, high-pH water reduced high-shear viscosity by an average of 6.30% compared to 3.36% with standard purified water (p = 0.03). Other measured biomarkers (plasma osmolality, bioimpedance, and body mass change) revealed no significant difference between the two types of water for rehydration. However, a mixed model analysis validated the effect of high-pH water on high-shear viscosity when compared to standard purified water (p = 0.0213) after controlling for covariates such as age and baseline values. CONCLUSIONS: A significant difference in whole blood viscosity was detected in this study when assessing a high-pH, electrolyte water versus an acceptable standard purified water during the recovery phase following strenuous exercise-induced dehydration

Can Who-Edits-What Predict Edit Survival?

As the number of contributors to online peer-production systems grows, it becomes increasingly important to predict whether the edits that users make will eventually be beneficial to the project. Existing solutions either rely on a user reputation system or consist of a highly specialized predictor that is tailored to a specific peer-production system. In this work, we explore a different point in the solution space that goes beyond user reputation but does not involve any content-based feature of the edits. We view each edit as a game between the editor and the component of the project. We posit that the probability that an edit is accepted is a function of the editor's skill, of the difficulty of editing the component and of a user-component interaction term. Our model is broadly applicable, as it only requires observing data about who makes an edit, what the edit affects and whether the edit survives or not. We apply our model on Wikipedia and the Linux kernel, two examples of large-scale peer-production systems, and we seek to understand whether it can effectively predict edit survival: in both cases, we provide a positive answer. Our approach significantly outperforms those based solely on user reputation and bridges the gap with specialized predictors that use content-based features. It is simple to implement, computationally inexpensive, and in addition it enables us to discover interesting structure in the data.Comment: Accepted at KDD 201

On Discrimination Discovery and Removal in Ranked Data using Causal Graph

Predictive models learned from historical data are widely used to help companies and organizations make decisions. However, they may digitally unfairly treat unwanted groups, raising concerns about fairness and discrimination. In this paper, we study the fairness-aware ranking problem which aims to discover discrimination in ranked datasets and reconstruct the fair ranking. Existing methods in fairness-aware ranking are mainly based on statistical parity that cannot measure the true discriminatory effect since discrimination is causal. On the other hand, existing methods in causal-based anti-discrimination learning focus on classification problems and cannot be directly applied to handle the ranked data. To address these limitations, we propose to map the rank position to a continuous score variable that represents the qualification of the candidates. Then, we build a causal graph that consists of both the discrete profile attributes and the continuous score. The path-specific effect technique is extended to the mixed-variable causal graph to identify both direct and indirect discrimination. The relationship between the path-specific effects for the ranked data and those for the binary decision is theoretically analyzed. Finally, algorithms for discovering and removing discrimination from a ranked dataset are developed. Experiments using the real dataset show the effectiveness of our approaches.Comment: 9 page