Multisite analysis of the timing and outcomes of unplanned transfers from subacute to acute care

Objective The aim of the present study was to examine the timing and outcomes of patients requiring an unplanned transfer from subacute to acute care. Methods Subacute care in-patients requiring unplanned transfer to an acute care facility within four Victorian health services from 1 January to 31 December 2010 were included in the study. Data were collected using retrospective audit. The primary outcome was transfer within 24h of subacute care admission. Results In all, 431 patients (median age 81 years) had unplanned transfers; of these, 37.8% had a limitation of medical treatment (LOMT) order. The median subacute care length of stay was 43h: 29.0% of patients were transferred within 24h and 83.5% were transferred within 72h of subacute care admission. Predictors of transfer within 24h were comorbidity weighting (odds ratio (OR) 1.1, P≤0.02) and LOMT order (OR 2.1, P<0.01). Hospital admission occurred in 87.2% of patients and 15.4% died in hospital. Predictors of in-hospital mortality were comorbidity weighting (OR 1.2, P<0.01) and the number of physiological abnormalities in the 24h preceding transfer (OR 1.3, P<0.01). Conclusions There is a high rate of unplanned transfers to acute care within 24h of admission to subacute care. Unplanned transfers are associated with high hospital admission and in-hospital mortality rates. What is known about the topic? Subacute care is becoming a high acuity environment where many patients are at significant risk of clinical deterioration. Systems for recognising and responding to deteriorating patients are well developed in acute care, but still developing in subacute care. What does this paper add? This is the first Australian multisite study of clinical deterioration in patients situated in subacute care facilities. One-third of unplanned transfers occur within 24h of admission to subacute care. Patients who require unplanned transfer from subacute to acute care have unexpectedly high hospital admission rates and high in-hospital mortality rates. The frequency and completeness of physiological monitoring preceding transfer was low. What are the implications for practitioners? Patients in subacute care require regular physiological assessment and early escalation of care if there are physiological abnormalities. Risk of clinical deterioration should be a factor in the decision to admit patients to subacute care after an acute illness or injury. There is a need to improve systems for recognising and responding to deteriorating patients in subacute care settings.

Culture and corporate voluntary reporting: a comparative exploration of the chairperson's report in India and New Zealand

Purpose – The purpose of this paper is to explore the cultural underpinnings of accounting practices through a comparative analysis of India and New Zealand, using the chairperson's report, which is increasingly becoming one of the most important segments of the corporate annual report.
Design/methodology/approach – The annual reports of Indian and New Zealand companies from 2001 to 2005 were selected to investigate the extent and nature of information disclosure in their chairperson's report. “Content analysis” is the main methodological orientation of the paper.
Findings – The paper argues that, contrary to propositions based on Hofstede's cultural framework, Indian companies provide more disclosure in their chairperson's report than their New Zealand counterparts. This leads to the conclusion that voluntary disclosure, more generally, is a complex phenomenon and cultural variables alone may not be sufficient predictors of the voluntary disclosure practices of a country.
Originality/value – Using India and New Zealand, two countries with significant cultural differences, according to Hofstede's typology, the paper extends the literature by focusing on the chairperson's report, a more recent accounting phenomenon which is gaining popularity across the globe.

The impact of mandatory versus voluntary auditor switches on stock liquidity: some Korean evidence

Using Korean listed firms subject to the auditor "designation rule", this paper shows that (1) firms that switch auditors exhibit lower stock liquidity than firms that do not switch auditors, and (2) the negative liquidity effect of auditor switches is concentrated in firms that switch to low-quality auditors. Meanwhile, firms that switch auditors under the auditor designation system do not exhibit lower stock liquidity, consistent with audit designation mitigating the concerns about audit quality deterioration around auditor changes. Furthermore, we find that foreign ownership has a mitigating impact on the negative relation between auditor switches and stock liquidity, suggesting that investors are less concerned about auditor switches when an alternative monitoring mechanism exists.

Mechanism of Muscle Vibrations During Stimulated and Voluntary Isometric Contractions of Mammalian Skeletal Muscle

When a muscle contracts it produces vibrations. The origin of these vibrations is not known in detail. The purpose of this study was to determine the mechanism associated with muscle vibrations. Mechanisms which have been proposed in the literature were described as theories (cross-bridge cycling, vibrating string and unfused motor unit theories). Specific predictions were derived from each theory, and tested in three conceptually different studies. In the first study, the influence of recruitment strategies of motor units (MUs) on the vibromyographic (VMG) signal was studied in the in-situ cat soleus using electrical stimulation of the soleus nerve. VMG signals increased with increasing recruitment and decreased with increasing firing rates of MUs. Similar results were obtained for the human rectus femoris (RF) muscle using percutaneous electrical stimulation of the femoral nerve. The influence of MU activation on muscle vibrations was studied in RF by analyzing VMG signals at different percentages (0-100%) of the maximal voluntary contraction (MVC). In our second study, we tested the effects of changing the material properties of the in-situ cat soleus (through muscle length changes) on the VMG signal. The magnitude of the VMG signal was higher for intermediate muscle lengths compared to the longest and the shortest muscle lengths. The decreased magnitude of the VMG signal at the longest and at the shortest muscle lengths was associated with increased passive stiffness and with decreased force transients during unfused contractions, respectively. In the third study, the effect of fatigue on muscle vibrations was studied in human RF and vastus lateralis (VL) musc1es during isometric voluntary contractions at a leveI of 70% MVC. A decrease in the VMG signal magnitude was observed in RF (presumably due to derecruitment of MUs) and an increase in VL (probably related to the enhancement of physiological tremor, which may have occurred predorninantly in a mediolateral direction) with fatigue. The unfused MU theory, which is based on the idea that force transients produced by MUs during unfused tetanic contraction is the mechanism for muscle vibrations, was supported by the results obtained in the above three studies.

Dual resource transfers and interruption in external debt service

Externai debt service requires a dual resource transfer. Trade surpluses have to be generated in order to make foreign exchange revenues available for debt repayment. In addition, with developing countries' externai debt being largely a public liability, debt service requires that resources can be effectively transferred from the private to the public sector. This paper derives a statistical model for dealing with dual constraints in the presence of binary dependent variables and applies it to the dual resource transfer problem. The results from the estimation of the model for a sample of 31 middle-income developing countries in the period of 1980 to 1990, strongly support the hypothesis that both externai and fiscal constraints are important in explaining externai debt service disruptions.

Effects on school enrollment and performance of a conditional transfers program in Mexico

We study the effects of a conditional transfers program on school enrollment and performance in Mexico. We provide a theoretical framework for analyzing the dynamic educational decision and process inc1uding the endogeneity and uncertainty of performance (passing grades) and the effect of a conditional cash transfer program for children enrolled at school. Careful identification of the program impact on this model is studied. This framework is used to study the Mexican social program Progresa in which a randomized experiment has been implemented and allows us to identify the effect of the conditional cash transfer program on enrollment and performance at school. Using the mIes of the conditional program, we can explain the different incentive effects provided. We also derive the formal identifying assumptions needed to provide consistent estimates of the average treatment effects on enrollment and performance at school. We estimate empirically these effects and find that Progresa had always a positive impact on school continuation whereas for performance it had a positive impact at primary school but a negative one at secondary school, a possible consequence of disincentives due to the program termination after the third year of secondary school.

Technology adoption and effects of transfers across locations

This paper develops a two-period model with heterogeneous agents to analyze the e¤ects of transfers across locations on convergence, growth and welfare. The model has two important features. First, locations are asymmetric as it is assumed that there are more specialized occupations in the more developed one. Second, the returns on the investment to acquire new technology depend positively on the level of each region’s knowledge and on the level of the world knowledge assumed to be available to all. In one hand, the poor region has a disadvantage as it has a lower stock of knowledge. On the other hand, it has the advantage of not having yet exploited a greater stock of useable knowledge available in the world. Hence, there are two possible cases. When the returns are greater in the poor region, we obtain the following results: (i) the rich location grows slower; (ii) the transfers to the poor location enhances the country’s growth rate; and (iii) there is a positive amount of transfers to the poor region that is welfare improving. When the returns are greater in the rich region, the …rst two results are reversed and transfers to the rich region are welfare improving. In both cases, the optimal amount of transfer increases with the level of income disparity across regions and is not dependent on the level of the country’s economic development (measured by its income per capita). Barriers to the adoption of new technology available in the world can constrain the convergence process as it harms in greater length the poor region. The results do not change whether migration is allowed or not.

Conditional cash transfers, schooling and child labor : micro-simulating bolsa escola

Cash transfers targeted to poor people, but conditional on some behavior on their part, such as school attendance or regular visits to health care facilities, are being adopted in a growing number of developing countries. Even where ex-post impact evaluations have been conducted, a number of policy-relevant counterfactual questions have remained unanswered. These are questions about the potential impact of changes in program design, such as benefit levels or the choice of the means-test, on both the current welfare and the behavioral response of household members. This paper proposes a method to simulate the effects of those alternative program designs on welfare and behavior, based on microeconometrically estimated models of household behavior. In an application to Brazil’s recently introduced federal Bolsa Escola program, we find a surprisingly strong effect of the conditionality on school attendance, but a muted impact of the transfers on the reduction of current poverty and inequality levels.

Unconditional transfers goes to health? Evidence from Brazilian municipalities

This study assesses the impact of unconditional transfer resources on the health indicators of Brazilian municipalities. This transfer refers to the Participation Fund of Municipalities (FPM) where at least 15% of its value should be spent on public health. Based on a discontinuity of the rules of transfers, we explore Regression Discontinuous Design for the years 2002 to 2010, and find: (i) no significant effect of FPM on mortality reduction; (ii) a robust and significant reduction in morbidity, treated municipalities – on the right side of thresholds – on average have a per capita rate of morbidity 0.00821% lower than those on the left side of the cutoff points; (iii) the mechanisms through which a reduction on morbidity could be operated would be due to estimated increases in preventive measures such as consultations and medical and nurses visits, these were bigger for the treated group in, respectively, 0.32%, 0.038% and 0.039%.

Intergovernmental transfers and public spending in Brazilian municipalities

We estimate the effects of unconditional (full fiscal decentralization) versus conditional (partial fiscal decentralization) block grants on local public spending in Brazilian municipalities. Our results suggest that the effect of unconditional and conditional transfers do not differ statistically. Their combination promotes a full crowding-in effect on aggregate public spending — i.e., for $1 of unconditional and conditional grant receipts; we find $1 of additional local public expenditures, greater than the corresponding effect of local income, providing further evidence for the flypaper effect. Moreover, the effect of unconditional transfers on education (health) spending is smaller than the effect of conditional education (health) transfers but greater than the corresponding effect of local income. We consider four strategies to identify causal effects of federal grants and the local income on fiscal responses regarding Brazilian local governments: (i) a fuzzy regression discontinuity design, (ii) Redistributive rules of education funds, (iii) Oil and Gas production, and (iv) Rainfall deviations from the historical mean.

The long-term effects of conditional cash transfers on child labor and school enrollment

This paper investigates the long-term e ects of conditional cash transfers on school attainment and child labor. To this end, we construct a dynamic heterogeneous agent model, calibrate it with Brazilian data, and introduce a policy similar to the Brazilian Bolsa Fam lia. Our results suggest that this type of policy has a very strong impact on educational outcomes, sharply increasing primary school completion. The conditional transfer is also able to reduce the share of working children from 22% to 17%. We then compute the transition to the new steady state and show that the program actually increases child labor over the short run, because the transfer is not enough to completely cover the schooling costs, so children have to work to be able to comply with the program's schooling eligibility requirement. We also evaluate the impacts on poverty, inequality, and welfare.

Coffee voluntary standards systems a study of the states of Minas Gerais and São Paulo

In order to adapt to new markets, the coffee supply chain has gone through numerous changes during the last years, which led to the creation of the voluntary standard systems. Adopting a Voluntary Standard System (VSS) consists of becoming a member of a certifier or verifier, in which an independent third party sets specific criteria to ensure a product complies with standards. Yet, the segment is still relatively new and raises some doubts about the economic and financial advantages of investing in sustainability-related certification. This study analyzes the perception of coffee producers about VSS – whether it brings economic benefits. The literature review covers various VSS in the coffee sector, the brief history of the commodity in Brazil, as well as the description of the supply chain. Certified and non-certified producers in the States of Sao Paulo and Minas Gerais, answered questionnaires to indicate the perceived advantages of certification. The results show that, despite some added value that certification can bestow, the quality is what really matter, since it allows producers to sell the product at higher prices and to gain advantage over competitors.