Reoperations in intramedullary fixation of pertrochanteric hip fractures

Objective: This study evaluated the frequency of reoperation within 1 year of initial intramedullary fixation for patients with pertrochanteric hip fracture and compared 1-year healthcare resource utilization and cost burden for patients with and without reoperation.

Methods: This is a retrospective evaluation of medical claims from the US Centers for Medicare and Medicaid Standard Analytic File. Patients aged ≥65?years who underwent fixation with an intramedullary implant for a pertrochanteric fracture between 2013 and 2015 were included. Healthcare resources that were evaluated included skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), readmissions, and outpatient hospital visits. All-cause payments for these services comprised overall cost burden. Generalized Linear Models were used to evaluate healthcare resources and cost burden over 1-year post-surgery and to adjust for confounding between patients with and without a reoperation.

Results: A total of 6,423 Medicare patients were included in the analysis. Mean (SD) age was 82.4 (7.8) years, 76.0% were female, and 93.3% were white. A second hip surgery within 1 year after the index fixation procedure was performed in 414 patients (6.4%): 121 (29.2%) contralateral, 115 (27.8%) ipsilateral, and 178 (43.0%) without specified laterality. After adjusting for confounding factors, Medicare patients with ipsilateral reoperations had statistically significantly higher readmissions (100% vs 32.5%, p?p?=?0.018), admissions to a SNF (88.5% vs 80.4%, p?=?0.024), and admissions to an IRF (38.8% vs 22.0%, p?p?Conclusions: Patients who require a second hip surgery after initial fixation with an intramedullary implant for pertrochanteric hip fractures have significantly higher 1-year healthcare resource utilization and 63.5% higher costs than patients without reoperation.     

Community Attributes Influencing Local Food Processing Growth in the U.S. Corn Belt

This paper examines local and regional attributes associated with growth in the food processing industry. The paper uses industrial location studies to develop a model of food processing plants'growth. Ordinary least squares (OLS) models are estimated to analyze which local, regional and state attributes are associated with county level growth, measured by a change in the number of establishments. The results suggest that food processing growth is associated with factors similar to those influencing the location of footloose manufacturing plants. However, growth in food processing sectors is associated with different local attributes depending on a firm's industry type (demand-oriented, supply-oriented, footloose).     

A Single Welfare Benefit Level for Europe? Efficiency Implications of Policy Harmonization in a Federal System

Within the European Union, it has been suggested that greater economic integration will help European economies regardless of the kind of integration Europe chooses to pursue. In this paper, I examine economic integration in the context of redistributive policy and lind that the effects of such integration are crucially dependent upon the level of redistribution to be adopted as a common policy, with higher welfare benefit levels associated with lower levels of federation output. This suggests that the case for policy harmonization at a generous level must rest on equity rather than efficiency considerations.     

Subsidizing research programs with “if” and “when” uncertainty in the face of severe informational constraints

We study subsidy policies for research programs when firms have private information about the likelihood of project viability, but the government cannot form a unique prior about this likelihood. When the shadow cost of public funds is zero, first‐best welfare can be attained as a (belief‐free) ex post equilibrium under both monopoly and competition, but it cannot be attained when the shadow cost is positive. However, max‐min subsidy policies exist under monopoly and competition and consist of pure matching subsidies. Under a Research and Development (R&D) consortium, the highest max‐min matching rate is lower than under competition, and R&D investment intensity is higher.     

Government auditing in China: Problems and reform

This paper evaluates the current government auditing system in China and the proposal to move it from the control of the executive body (the State Council) to the control of the legislature (the National People's Congress). Interviews with government auditors, government and people's congress officials, and leading academics identify the problems caused by lack of audit independence. Although audit independence can be increased by moving the control of government auditing to the legislature, many of our interviewees considered such a move as infeasible in the current political climate. To smooth the reform toward a legislature-led audit system, we propose a “Dual-Track System” in which the different audit responsibilities currently undertaken by the government auditing system are separated. The responsibility for auditing the use and control of fiscal budgets by the central and regional governments would be under the control of the legislature as this area of government auditing has a clear need for audit independence. Other audit functions including economic responsibility auditing, special purpose funds auditing, financial service auditing and state-owned enterprise auditing would remain under the control of the government. This dual track approach would, we argue, be a politically acceptable compromise as it would strengthen audit independence where it is most needed but also enable the government to maintain strong economic control.     

Gender,social salience,and social performance: how women pursue and perform in social ventures

Abstract

We investigate how women that start organizations contribute to the creation of social value in communities and society. We draw on theory from gender self-schemas and social identity theory to explain how women with a female gender-self schema have a natural inclination to create organizations with social goals and intentions in mind. We label these social goals and intentions as social salience and draw on goal theory and existing understandings on intentions to explain how the presence of a social salience in an organization is related to the social performance of their organization. Utilizing structural equation modeling, we show that gender positively influences social salience that subsequently has a positive relationship with the social performance of the organization. We also show that social salience fully mediates the relationship between gender and social performance implying that gender alone is not enough to explain the social performance of an organization. We conclude by highlighting the implications, contributions, and future research that result from our findings.     

Price Dispersion in Mortgage Markets

Using transaction‐level data on Canadian mortgage contracts, we document an increase in the average discount negotiated off the posted price and in rate dispersion. Our aim is to identify the beneficiaries of discounting and to test whether dispersion is caused by price discrimination. The standard explanation for dispersion in credit markets is risk‐based pricing. Our contracts are guaranteed by government‐backed insurance, so risk cannot be the main factor. We find that lenders set prices that reflect consumer bargaining leverage, not just costs. The presence of dispersion implies a lack of competition, but our results show this to be consumer specific.     

Public and private intervention for next-generation access deployment: Possibilities for three European countries

How next-generation access (NGA) deployment can be encouraged is a challenge that many countries are facing, and one that has been widely and actively discussed around the globe. This discussion has highlighted a dilemma that ultimately shapes investment—how to encourage the widespread deployment of NGA while enabling operators to achieve reasonable returns. This paper focuses on the tensions that arise as a consequence of this investment challenge in three countries – the Netherlands, Sweden and the United Kingdom (UK) – and uses the analysis of extensive data collection with k7ey actors to argue the case for the injection of public or private incentives. The paper finds that markets with competitive infrastructure will not benefit from public investment while markets with geographical constraints are in need of public support. The paper also explains that regulatory intervention is necessary in the early stage of NGA roll-out, even in currently competitive markets. In all the discussions it becomes evident that, among the three cases, the UK is most in need of public intervention.