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This paper uses truncated count model with endogeneity and simulated maximum likelihood estimation technique to estimate gender differences in moral hazard in health care insurance. We use the dataset that consists of invoices for all outpatient services from a regional hospital in Croatia. Our theoretical model predicts that higher risk aversion is associated with smaller ex-post moral hazard effect. If women are more risk averse than men, then the moral hazard effect due to health insurance should be lower in women than in men. After adjusting for the sample selection in the estimation, we found a statistically significant evidence of moral hazard for the general population but statistically insignificant difference in moral hazard between men and women.

We investigate contract elements and growing conditions associated with anomalous claims behaviour in the U.S. Federal Crop Insurance Program. In this study the measure of “anomalous claims behaviour” is based on the number of producers (in a county) placed on the “Spot Check List” (SCL)—a list generated from government compliance efforts that aim to detect and deter fraud, waste, and abuse in the U.S. Federal Crop Insurance Program. Using county-level data and various econometric approaches that control for features of this data set (e.g., the count nature of the dependent variable, censoring, potential endogeneity, and spatial/temporal dependence), we find that the following crop insurance contract attributes influence the extent of anomalous claims behaviour in a county: (a) the ability to insure individual fields through “optional units”; (b) the coverage level choice; and (c) the total number of acres insured. In addition, our empirical analyses suggest that anomalous claims behaviour significantly increases when extreme weather events occur (e.g., droughts, floods) and when economic conditions are unfavourable (i.e., high input costs that lower profit levels). Results from this study have important implications for addressing potential underwriting vulnerabilities in crop insurance contracts and the frequency of more rigorous compliance inspections.

We conduct the first econometric analysis of the determinants of the formation of Taobao villages, the rural e-commerce clusters recently appeared in China. We examine the roles of various factors such as location, education, transportation infrastructure, the structure of local economy, urban-rural income difference, local government policies and spillover from nearby Taobao villages in the formation of Taobao villages. We find that education plays an important and positive role in the formation of Taobao villages, while credit support for other businesses makes the formation of new Taobao villages less likely.

Background: For fresh thoracolumbar burst fracture, a new method which can not only promote the fracture healing, but also retain the movement segment, and restore the spinal movement function to the maximum extent is needed. The purpose of this study is to determine the performance of stabilization of a semi-rigid stabilization system combined with transpedicular intracorporeal bone grafting for thoracolumbar burst fractures.Methods Six thoracolumbar cadaver spines were used for testing. A controlled L2 burst fracture was created. The L1-3 motions were determined.Results In extension, flexion and lateral bending, the semi-rigid fixator stabilized the segment to a range of motion(ROM) and neutral zone(NZ) below the magnitude of the intact spine, but showed increased ROM and NZ of axial rotation (P < 0.05) compared with the intact spine.Conclusions Restoration of stability with the semi-rigid dynamic system combined with transpedicular intracorporeal bone grafting is possible in flexion, extension, right and left lateral bending for thoracolumbar burst fracture but for axial rotation.

Waardenburg syndrome (WS) is a genetic disorder characterized by hearing loss and pigmentary abnormalities with variable penetrance. Though heterozygous mutations in MITF are a major cause for Waardenburg syndrome type 2 (WS2), homozygous mutations in this gene and the associated phenotype have been rarely characterized. In this study, we identified a novel p.R223H mutation in MITF in a Chinese Han family with variable WS features. Both parents carried a heterozygous p.R223H mutation. They had normal hearing, and premature greying of the hair is their only pigmentary abnormality. In contrast, their two children both carried a homozygous p.R223H mutation and had classic WS features including profound hearing loss, heterochromia irides and marked pigmentary abnormalities in hair and skin. Interestingly, the two affected children also have persistent chronic constipation since the neonatal period, symptoms suggestive of Waardenburg syndrome type 4 (WS4). Our study revealed a likely association between homozygous mutations in MITF and WS4, which implies a dosage effect for the underlying pathogenesis mechanism.

Using household survey data from three Agro‐Taobao villages, which are clusters of e‐commerce agribusinesses recently appeared in China, and three nearby non‐Agro‐Taobao villages, we examine whether originating from an Agro‐Taobao village influences a farmer’s migration decision. Results show that individuals from Agro‐Taobao villages are 26% less likely to migrate than their counterparts from non‐Agro‐Taobao villages, after controlling for various factors that are likely to influence the migration decision such as demographic characteristics, migration experience, educational background, and health status. Policy implications of our findings are also discussed. [EconLit citations: Q13; Q12]

Background Reactive oxygen species modulator 1 (ROMO1) is recognized to be involved in cell proliferation and is elevated in serum of various cancer patients. However, ROMO1 had little research in distinguishing between malignant pleural effusions (MPEs) and benign pleural effusions (BPEs). Methods Malignant pleural effusion samples from patients with non–small‐cell lung cancer (NSCLC) and benign pleural effusion (BPE) samples containing tuberculous and inflammatory pleural effusions were collected. The samples were tested for ROMO1, pleural effusion adenosine deaminase (pADA), pleural effusion carbohydrate antigen (pCA125, pCA153, pCA199), pleural effusion ferritin (pFER), and pleural effusion lactate dehydrogenase (pLDH) levels, and the other relevant partial clinical data that were gathered were used to conduct statistical analysis. Results The ROMO1, pCA125, pCA199, pCA153, pADA + ROMO1, pCA153 + ROMO1, pCA125 + ROMO1, and pCA199 + ROMO1 levels in MPE were appreciably higher in comparison with BPE group (all P = .000). The concentration of pADA in MPE was markedly lower than BPE (P = .000). When the cutoff = 0.38, the sensitivity of combined detection of ROMO1 + pADA is 98.67% and the specificity is 70.73%, respectively, and the AUC (0.941) is the highest among other parameters. Conclusion The combined detection of ROMO1 + ADA in pleural effusion is an effective biomarker for identifying MPE caused by NSCLC.

Objective: To compare and analyze the clinical effects of internal fixation of minimally invasive elastic stable intramedullary nail and plate in the treatment of pediatric femoral shaft fracture. Methods: A total of 120 children with femoral shaft fractures who were admitted to our hospital from December 2016 to April 2018 were enrolled. The children were divided into an observation group and a control group by random number table, with 60 children in each group. The children in the observation group underwent internal fixation of minimally invasive elastic stable intramedullary nail, while those in the control group underwent open reduction based on internal fixation of plate. The surgical status and postoperative complications of the two groups were observed and compared, and Kolmert knee function scoring criteria were used for assessing the surgical effects of children. Results: The operation duration, intraoperative blood loss, hospitalization duration, fracture healing time and time of off-bed loaded activity of the observation group were significantly shorter than those of the control group, and the differences were statistically significant (P0.05). Conclusion: Pediatric femoral shaft fractures can be treated with internal fixation of minimally invasive elastic intramedullary nail, and it has advantages of significant curative effect, small trauma and fast postoperative recovery, which is conducive to fracture healing and worth promoting. doi: https://doi.org/10.12669/pjms.35.5.513 How to cite this:Wang W, Zheng X, Sun Z. Comparison of efficacy between internal fixation of minimally invasive elastic stable intramedullary nail and plate in the treatment of pediatric femoral shaft fracture. Pak J Med Sci. 2019;35(5):1417-1421. doi: https://doi.org/10.12669/pjms.35.5.513 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

In the US-China international flight market, airlines sell tickets in two different distribution channels at vastly different prices. This provides a rare opportunity to examine how airlines practice price discrimination across different ticket distribution channels. Using a unique dataset collected from this market, we find that price discrimination across different ticket distribution channels is not influenced by market competition but increases with demand.

We study the productivity-survival link in the U.S. poultry processing industry using longitudinal data constructed from 5 censuses of manufactures between 1987 and 2007. First, we study the effects of physical productivity and demand-specific factors on plant survival and ownership change. Second, we analyze the determinants of the firm-level expansion. The results show that higher demand-specific factors decrease the probability of exit and increase the probability of ownership change. The effect of physical productivity on the probability of exit or ownership change is generally insignificant. Also, firms with higher demand-specific factors have higher probability to expand, whereas average firm-level physical productivity turns out to be an insignificant determinant of firm expansion. Since demand specific factors all favor large companies, this could expedite industry concentration process already well under way and could raise new concerns over contract growers' income and consumers' welfare.

Using household scanner data and a discrete choice modeling approach, we estimate demand for milk products at the micro-level and compute the distribution of welfare effects from introducing organic milk across households with different characteristics within the partial equilibrium framework. The price effects of introducing organic milk are larger for low-income households than for high-income households, and the differences in the variety effects of introducing organic milk to groups with various levels of education are larger than the differences in the variety effects among groups with different income levels. Policy implications of these findings are discussed. Copyright 2013, Oxford University Press.

We use a structural approach to separately estimate moral hazard and adverse selection effects in health care utilization using hospital invoices data. Our model explicitly accounts for the heterogeneity in the non-insurable transactions costs associated with hospital visits which increase the individuals' total cost of health care and dampen the moral hazard effect. A measure of moral hazard is derived as the difference between the observed and the counterfactual health care consumption. In the population of patients with non life-threatening diagnoses, our results indicate statistically significant and economically meaningful moral hazard. We also test for the presence of adverse selection by investigating whether patients with different health status sort themselves into different health insurance plans. Adverse selection is confirmed in the data because patients with estimated worse health tend to buy the insurance coverage and patients with estimated better health choose not to buy the insurance coverage.

Ultrasound-guided fine needle aspiration (USG-FNA) has enabled cytopathologists to accurately diagnose smaller or non-palpable lymph nodes (LN) on a regular basis. Pre-FNA clinical and ultrasonographic factors, such as a patient's age, ratio of short to long axis diameter (S/L ratio), internal echogenicity, and the vascular pattern of a LN, are reported to be able to predict the benign or malignant nature of a LN. This study is designed to test the formula “0.06 × (age) + 4.76 × (S/L ratio) + 2.15 × (internal echo) + 1.80 × (vascular pattern)” generated from the study of Liao et al. as a scoring system for predicting LN malignancy in a cytopathologist operated USG-FNA practice. Eighty-three reports of USG-FNA of LNs issued between 7/1/2008 and 4/28/2010 were reviewed. Patient's age, S/L ratio, internal echo, and vascular pattern were used to generate scores based on the aforementioned formula. A score of seven was used as a cutoff for predicting benign ( 7) LNs. FNA cytology diagnosis, flow cytometric analysis as well as subsequent surgical diagnosis in some cases served as gold standard for statistical analysis. Among 46 USG-FNA of LNs with scores > 7, 38 were malignant and eight were benign. All 37 USG-FNA of LNs with scores < 7 were proven to be benign. The scoring system achieved 100% sensitivity, 82% specificity, 83% positive predictive value, 100% negative predictive value, and 90% accuracy. Further study of the eight “false-positive” cases revealed that three of them (37.5%) were found to be malignant in follow-up FNA and/or surgical biopsy. This scoring system may serve as a complementary tool in determining how aggressive a FNA procedure should be performed, how a FNA sample of LN should be triaged for ancillary study, and how closely a patient with lymphadenopathy should be followed up. Diagn. Cytopathol. 2013;41:1100–1106. © 2011 Wiley Periodicals, Inc.

Count measures of health care utilization are often correlated with other measures of utilization. In addition, utilization measures display a high proportion of zero observations. This article attempts to accommodate both data features in one model, with an application to medical care usage of husbands and wives. A bivariate count representation is used to model dependence between husbands’ and wives’ utilizations, and a finite mixture specification accommodates the problem of excess zeros. Results show that married couples are characterized by two distinct subpopulations according to the intensity of utilization of the wife.

Theoretical models of market entry imply that sunk costs are an important factor in the decision to export. Following Helpman, Melitz, and Rubinstein (2008), we develop a simple model of foreign market participation and use a Bayesian method to estimate the resulting dynamic discrete-choice model with lagged dependent variable. Employing a balanced panel data that follows 81 trading partners for 30 years from 1971 to 2000, we estimate our model and compute the marginal effect of sunk costs on the likelihood of export market participation. We find that such costs are economically and statistically important for trade in all of the six major agricultural commodities (Cereals, Dairy, Fish, Meat, Vegetables and Fruits, and Sugar), for agricultural producers in both developed and developing countries. We also find evidence suggesting that, in general, market access for both developed and developing exporters had improved in the years following the Uruguay round of trade negotiations (1995–2000).

Background Midkine (MK) level has been shown to be elevated in serum of patients with nonsmall cell lung cancer (NSCLC). However, the diagnostic value of MK in pleural effusion in NSCLC has not been well validated and established. Methods Samples of NSCLC-associated malignant pleural effusions (MPE) and benign effusions (BPE) were collected. The pleural fluid MK (pMK), pleural fluid adenosine deaminase (pADA), pleural fluid lactate dehydrogenase (pLDH), pleural fluid glucose (pGLU), pleural fluid ferritin (pFER), pleural fluid CA199 (pCA199), pleural fluid CA125 (pCA125), pleural effusion white cell count (pWBC), and pleural effusion red cell count (pRBC) were analyzed, and the clinical data of each group were collected for statistical analysis. Result The level of pMK, pCA125, pMK + pCA125, and pMK + pCA125 + pADA in the MPE was significantly higher than the BPE group (P = .003, .000, .000, .000). The pADA level in the BPE was significantly higher than the MPE group (P = .003). It showed that the area under the ROC curve (AUC) (0.816) of jointly detection pMK, pCA125, and pADA was significantly higher than other markers for the diagnosis of MPE. Therefore, joint detection of pMK + pCA125 + pADA suggested that the sensitivity, specificity, and AUC was 82.54%, 74.19% at the cutoff 0.47 and diagnostic performance was higher than others. Conclusion Joint detection of pMK + pCA125 + pADA can be used as a good indicator for the identification of MPE of NSCLC.

I. INTRODUCTION This article examines how racial differences in medical care utilization vary with respect to intensity of demand. There are many studies of health-care consumption among nonwhite minorities, most of which compare racial differences in utilization between blacks and whites. Results vary depending on the measure of utilization and population of interest, but the general consensus is that blacks consume fewer health-care services than whites (e.g., Currie and Thomas, 1995; Gilbert et al., 2002; Johnson-Lans and Bellemore, 1997; LaVeist et al., 2002). These findings reveal an important social problem in which nonwhite minorities face disadvantages in receiving health care. The issue is particularly urgent if racial differences in health-care utilization have detrimental effects on overall health among minority groups. While empirical evidence of racial differences in utilization is convincing and not usually disputed, it is not clear whether racial differences are pervasive among all members of a given racial group. If differences in utilization apply to one type of individual more than another then policies aimed at reducing racial differences that are targeted toward all members of a particular minority group are an inefficient allocation of resources. Deb and Trivedi (1997, 2002) provide evidence that health-care consumers can be characterized into two groups consisting of heavy and light users. Furthermore, they show that heavy users tend to be relatively unhealthy. If racial differences in utilization apply equally to all members of a minority group and do not depend on whether individuals are healthy or unhealthy then differences are a general race-related concern that should be addressed. However, if differences depend, in part, on health status then policy implications depend significantly on who is most affected. For example, if the difference between white and black utilization is largest among relatively unhealthy individuals but not among healthy individuals then this would indicate an urgent social concern in which minorities most in need of care have difficulty obtaining it. In this case, health-care policy should focus on reducing racial differences among unhealthy minorities. On the other hand, if racial differences mainly apply to healthy individuals then minorities most in need of care are able to obtain it, but policy should focus on potential reasons that healthy minorities use fewer services, such as lack of knowledge of routine treatments and physicals, distrust of physicians and medical personnel, or potential overuse by white users. This article offers several contributions to the debate on racial differences in utilization. First, health-care utilization is estimated for different subpopulations with respect to various measures of health status, which allows for the classification of health-care consumers into subgroups with different intensities of demand. This specification allows us to determine whether racial differences vary between subgroups of consumers. In addition to blacks, we also consider utilization by Hispanics. Second, the model is estimated separately for five measures of utilization recorded on an annual basis: office-based physician visits, office-based nonphysician visits, outpatient department visits, emergency room (ER) visits, and hospital discharges. (1) Thus, one can determine whether racial differences are more related to office-based services or hospital-related emergency care. Finally, the models of health-care utilization explicitly control for access-related factors such as insurance status, which allows us to examine whether racial differences in utilization are still present after controlling for such factors. These remaining differences are more of a policy concern as they reflect racial "disparities" in health-care utilization. (2) As Medical Expenditure Panel Survey (MEPS) tabulations show below, African Americans and Hispanics have lower rates of private insurance coverage and higher rates of public insurance coverage than other Americans. …

We estimate farmers’ health care consumption given their insurance status, explicitly taking into account the possible endogeneity of insurance. Data come from the 1996‐2001 waves of the Medical Expenditure Panel Survey conducted by the Agency for Healthcare Research and Quality. Results show that farmers have problems accessing affordable health insurance coverage, and these access problems lead to an overall reduction in the utilization of health care services by uninsured farmers. After controlling for selection, we observe quantitatively large and statistically significant direct effects of uninsurance on the utilization of health care services. This article investigates health insurance coverage among U.S. farmers, and whether insurance status has an effect on farmers’ consumption of health care services. The topic is important, as farmers do not typically work in employee groups. The majority of private health insurance coverage in the United States is financed through employers in the form of fringe benefits, because employee compensation in the form of health insurance is not taxed, whereas wage income is subject to income and payroll taxes. The basic premise of group insurance is that by pooling risks across a large number of individuals, health care utilization by unhealthy high-risk enrollees is effectively subsidized by healthier low-risk members. One concerning feature of this system is that employees who cannot be conveniently included in a group setting might be unable to afford relatively expensive straight-to-consumer policies offered by insurance companies. This concern is particularly pertinent to farmers, as many farmers and their families are individually employed as self proprietorships. According to our tabulations (discussed below), approximately 19% of farmers between ages 18 and 64 years do

In this paper we study the productivity-survival link in the U.S. poultry processing industry using the longitudinal data constructed from five Censuses of Manufactures between 1987 and 2007. First, we study the effects of physical productivity and demand-specific factors on plant survival and ownership change. Second, we analyze the determinants of the firm-level expansion. The results show that higher demand-specific factors decrease the probability of exit and increase the probability of ownership change. The effect of physical productivity on the probability of exit or ownership change is generally insignificant. Also, firms with higher demand-specific factors have higher probability to expand whereas the average firm-level physical productivity turns out to be an insignificant determinant of firm expansion.

Nested variant of urothelial carcinoma (NVUC) is an uncommon variant with minimally atypical cytology, which may overlap with benign urothelial lesions such as von Brunn nests, cystitis cystica, cystitis glandularis, and nephrogenic adenoma. Because of the tumor's deceptively bland appearance, these cancers can potentially be misdiagnosed as benign lesions, leading in some cases to a significant delay in correct diagnosis and appropriate treatment. Prior studies suggest that Ki67 and p53 are useful markers in distinguishing NVUC from benign lesions. However, the overlap in the rates of immunoreactivity has prevented pathologists from using these markers as reliable adjunct markers in differentiating NVUC from mimickers. In addition, large nested variant urothelial carcinoma (LNVUC), a relatively new entity, shares features of both the NVUC and papillary urothelial carcinomas with an inverted growth pattern. They also mimic benign lesions, such as proliferation of von Brunn nests and inverted urothelial papilloma. With the recent demonstration of a strong association of TERT promoter mutations and urothelial carcinoma, we hypothesized that TERT promoter mutations would be a useful marker to distinguish NVUC and LNVUC from other benign urothelial lesions. We have therefore sequenced the TERT promoter region of 20 cases of NVUC, 10 cases of LNVUC, 5 cases of von Brunn nests, 3 cases of cystitis cystica, 3 cases of cystitis glandularis, and 3 cases of nephrogenic adenoma. We found that 17 of 20 cases of NVUC and 8 of 10 cases of LNVUC had TERT promoter mutation: C228T; no mutation was found in any of the benign mimickers (0/14). This result strongly suggests that TERT promoter mutation is a useful adjunct biomarker to distinguish NVUC and LNVUC from benign mimickers.

Traditional Chinese medicine (TCM) has unique therapeutic effects for complex chronic diseases. However, for the lack of an effective systematic approach, the research progress on the effective substances and pharmacological mechanism of action has been very slow. In this paper, by incorporating network biology, bioinformatics and chemoinformatics methods, an integrated approach was proposed to systematically investigate and explain the pharmacological mechanism of action and effective substances of TCM. This approach includes the following main steps: First, based on the known drug targets, network biology was used to screen out putative drug targets; Second, the molecular docking method was used to calculate whether the molecules from TCM and drug targets related to chronic kidney diseases (CKD) interact or not; Third, according to the result of molecular docking, natural product-target network, main component-target network and compound-target network were constructed; Finally, through analysis of network characteristics and literature mining, potential effective multi-components and their synergistic mechanism were putatively identified and uncovered. Bu-shen-Huo-xue formula (BSHX) which was frequently used for treating CKD, was used as the case to demonstrate reliability of our proposed approach. The results show that BSHX has the therapeutic effect by using multi-channel network regulation, such as regulating the coagulation and fibrinolytic balance, and the expression of inflammatory factors, inhibiting abnormal ECM accumulation. Tanshinone IIA, rhein, curcumin, calycosin and quercetin may be potential effective ingredients of BSHX. This research shows that the integration approach can be an effective means for discovering active substances and revealing their pharmacological mechanisms of TCM.

In this paper we estimate the farmers' side welfare effects of a hypothetical regulatory scenario that would partially eliminate production contracts in the hog industry. Using the Agricultural Resource Management Survey (ARMS) data for 2004, farmers' production costs under different marketing arrangements are estimated and then used to recover their individual risk aversion parameters with the help of a structural expected profit maximization model. The results show that farmers who use production contracts are more risk averse than farmers who use spot markets or marketing contracts. The regulation that forces producers to market their hogs in a riskier marketing channel relative to the channel they themselves selected imposes large welfare losses on the affected farmers.

Small cell carcinoma (SmCC) is a distinct clinicopathological entity first described in the lung. It represents approximately 15% of all bronchogenic carcinoma. Extrapulmonary small cell carcinoma (EPSmCC) morphologically indistinguishable from small cell lung cancer (SCLC) was first reported in 1930. Since its first description, EPSmCC has been reported in virtually all anatomical sites, including: gynecologic organs (ovary and cervix); genitourinary organs (urinary bladder and prostate); the gastrointestinal tract (esophagus); skin (Merkel cell carcinoma) and head and neck region. Regardless of the anatomic sites, all SmCCs have similar, if not identical, histo-pathology features and immunohistochemical profile. SmCC is one of the most aggressive malignancies. The molecular mechanisms underlying its development and progression remain poorly understood. Herein, we reviewed the literature in SmCC in respect to its site of occurrence, clinical features, immunohistochemical characteristics. SmCCs have heterogeneous molecular mutations. Dinstinct genetic alterations associated with SmCC from different body sites were reviewed. Some genetic alterations such as RB1, TP53 are commonly seen in different origins of SmCC. Other genes with site specificity were also summarized, such as bladder SmCC with TERT promoter mutations; prostate SmCC with ERG translocations; ovarian SmCC with SMARCA4 mutations; Merkel cell carcinoma (skin) and cervical SmCC with Merkel cell polyomavirus (MCV or MCPyV) and human papillomavirus (HPV). Further studies are needed to employ a genetically oriented approach for the diagnosis and therapy of SmCC.