The case of the unhealthy hospital

On a cold March morning, Bruce Reid, Blake Memorial Hospital's new CEO, visited the Lorris housing project clinic, one of six off-site clinics operated by Blake Memorial. He was not encouraged by what he saw: peeling paint, leaking pipes, and cramped conditions. When he asked Renée Dawson, the clinic's primary care physician, how she endured the conditions, she just stared at him. "What are my options?" she asked. That was a good question. Blake Memorial was in poor financial health, due to rising costs and stagnating revenue. The hospital's quality of care was also a major problem. In addition, the clinics were losing over $250,000 a year. As Reid worked on Blake Memorial's 1992 budget, he saw he would have to cut some services in order to fund others. One of the services he was considering cutting was the clinic program. But there were a number of conflicting forces that Reid had to consider. On the political front, the recently appointed commissioner of health services said she would challenge Blake Memorial's tax-exempt status if Reid dismantled the clinics. Within the hospital were two warring factions. One wanted more high-tech services for the hospital and favored closing the clinics. "Instead of clinics, we should have a shuttle bus from the housing projects to the hospital," one doctor suggested. The other faction wanted to expand the clinics. "Wherever the service is most needed, that is where the hospital should be," argued the clinics' director. Reid must decide what to cut and what to keep. But to do so, he must first settle on Blake Memorial's long-term mission.(ABSTRACT TRUNCATED AT 250 WORDS)     

绿色生态城区运营阶段碳排放量测量、验证与报告管理体制

目前我国对绿色生态城区建设的指标体系与评价标准主要关注的还是项目在规划设计阶段的技术目标,虽然评价内容可以分为规划设计评价、实施运管评价两个阶段,但具体的评价体制并未能提供城区在运营阶段的实际碳排放量值的定量评价。要对绿色生态城区在运营阶段对城市整体低碳发展的碳排放减缓贡献有明确的监控方法,必须要建立我国城市绿色生态城区运营阶段温室气体特别是碳排放量的测量、验证与报告(MVR-Monitoring,Verification,Reporting)管理体制。梳理目前有关城市碳排放量度监控方面提出相关的方法,再通过对城区建设管理流程和责任主体的分析,提出一套运营阶段碳排放量测量、验证与报告体制建议。管理体制包括针对我国城区尺度建设项目的 7个排放板块,提出对每个板块的报告主体、核算物理边界、核算周期、核算气体种类、核算运行边界、数据获取方式以及报告指标等要求。同时,为了保障实施,建议明确执行主体层级结构和报告关系,包括对各主体在项目生命周期不同阶段的要求,建立责任约束效应的测量、验证与报告保障制度。     

Volume, volatility, and the dispersion of beliefs

I examine a two-period noisy rational expectations model ofa futures market and show that the dispersion of expectationsabout a weighted average of future prices measures both theadditional volatility and the additional expected volume oftrade associated with noisy information. The role played bydispersion helps clarify several stylized facts concerning volumeand price behavior. Specifically, dispersion can be a factorcontributing to the positive correlation between volume andabsolute price changes, and the positive correlation betweenconsecutive absolute price changes.     

How should we collect data on the nursing workforce?

R esearchers who study the nursing workforce use data about nurses and data about nursing jobs. Diifferent approaches - sample surveys and relicensure surveys - used to collect data on RNs, and the benefits and weaknesses of these approaches, are reviewed. Predicting the future supply of nurses is more complex than estimating the current supply, as factors that affect future supply must be considered. Simple forecasts can be created with relatively few variables, which could be collected through relicensure surveys. However, more detailed assessments of potential retirement patterns, changing family norms regarding childcare and household work, and movements into higher education require the rich data more often found in sample surveys.     

Venture capital investment cycles: The impact of public markets

It is well documented that the venture capital industry is highly volatile and that much of this volatility is associated with shifting valuations and activity in public equity markets. This paper examines how changes in public market signals affected venture capital investing between 1975 and 1998. We find that venture capitalists with the most industry experience increase their investments the most when public market signals become more favorable. Their reaction to an increase is greater than the reaction of venture capital organizations with relatively little industry experience and those with considerable experience but in other industries. The increase in investment rates does not affect the success of these transactions adversely to a significant extent. These findings are consistent with the view that venture capitalists rationally respond to attractive investment opportunities signaled by public market shifts.     

'Affordable' death in the United States: an action plan based on lessons learned from the Nursing Economic$ special issue

An eight-point action plan is proposed for lowering costs associated with end-of-life health care in the United States, as well as improving the quality of life experienced by patients and their families. This action plan was derived from an analysis of the six articles presented in this special issue of Nursing Economic$. The two major features of this action plan are: (a) expansion of hospice and palliative care, as well as (b) increased use of advance directives. Additionally, as pre-conditions for the effective operation of this action plan, the political, cultural, and legislative contexts that merit attention are discussed. Finally, arguments as to the desirability, feasibility, and sustainability of this action plan are offered.     

Performance persistence in entrepreneurship

This paper presents evidence of performance persistence in entrepreneurship. We show that entrepreneurs with a track record of success are much more likely to succeed than first-time entrepreneurs and those who have previously failed. In particular, they exhibit persistence in selecting the right industry and time to start new ventures. Entrepreneurs with demonstrated market timing skill are also more likely to outperform industry peers in their subsequent ventures. This is consistent with the view that if suppliers and customers perceive the entrepreneur to have market timing skill, and is therefore more likely to succeed, they will be more willing to commit resources to the firm. In this way, success breeds success and strengthens performance persistence.     

Doing Well by Doing Good? Community Development Venture Capital

This paper examines the investments and performance of community development venture capital (CDVC). We find substantial differences between CDVCs and traditional VCs: CDVC investments are far more likely to be in nonmetropolitan regions and in regions with little prior venture activity. CDVC investments are likely to be in earlier stage investments and in industries outside the venture capital mainstream that have lower probabilities of successful exit. Even after controlling for this unattractive transaction mixture, the probability of a CDVC investment being successfully exited is lower. One benefit of CDVCs may be their effect in bringing traditional VCs to underserved regions—controlling for the presence of traditional VC investments, each additional CDVC investment results in an additional 0.06 new traditional VC firms in a region.     

Mental disorders, DRGs, and the elderly

Results of this study indicate a significant positive relationship among mental disorder, length of hospital stay, and number of nursing diagnoses. The sample included 110 patients admitted to a teaching hospital and classified under DRG 210 (hip fracture with surgery).