Publication Type: Abstract
Abstract: Background
Antibiotic resistant infections are an increasing problem in hospitals in terms of the number of resistant organisms and their prevalence. Consequently, the costs of these infections, in terms of mortality, disability, and money, are also increasing. Antibiotic resistance (AR) increases the costs of care in various ways including increased length of stay, more admissions to ICU, and more intensive resource use by inpatients. Furthermore, these additional costs of care often go unreimbursed. Despite the implied incentive to adopt infection prevention guidelines to reduce these AR related costs, hospitals have implemented these guidelines to varying degrees.

Implementing clinical practice guidelines improves health care quality but, because providers incur the implementation costs while resulting savings accrue to payors, the third party payment system typically poses a barrier to guideline implementation. However, implementing infection prevention guidelines may generate provider savings by reducing hospital acquired, including AR, infections. If AR infection levels are to be contained or reduced, economic research must first focus on potential cost savings to the entity with the greatest influence over the adoption and implementation of preventive interventions—the hospital. In this study, we sought to assess the impact of AR levels, outbreaks, and control measures on hospital level expenses-per-admission.

Methods
We surveyed a nationally representative sample of 670 hospitals (stratified by bed size, teaching status, geographic region, and VA versus non-VA status) regarding levels and outbreaks of AR, their adherence to recommended AR prevention and control guidelines, and availability of information technology. Survey data were linked to the American Hospital Association Annual Survey to incorporate other hospital level financial and operational capacity characteristics. We use regression analysis to assess the impact of AR levels, outbreaks, and control measures on hospital expenses-per-admission.

Results
We estimate two cost models with expenses-per-admission as the dependent variable: one assesses the impact of AR levels and outbreaks; the other the impact of specific infection prevention measures. We find that hospital expenses-per-admission increase with levels of MRSA (the most common AR organism). This result was consistent both when pooling VA and non-VA hospitals, and analyzing non-VA hospitals separately. For non-VA hospitals, higher expenses-per-admission are also related to more recent outbreaks of another AR organism, K-ESBL. Cost models incorporating infection prevention measures found that, for non-VA hospitals, (1) using information technology to automate decisions to reduce errors (including, but not limited to, antibiotic prescribing) have lower expenses-per-admission, and (2) hospitals reporting active involvement of their infection control committee in AR prevention and control have higher expenses-per-admission. The former suggests a cost-saving means for hospitals equipped with the necessary IT, while the latter may just reflect the cost of improving quality.

Discussion
The successful implementation of infection prevention and control measures cannot occur without hospital administration support, and administrators will not support such measures until there is evidence that they are associated with cost savings. In presenting evidence that AR increases costs at the hospital level, the results of this study are a first step in providing the business case for improving infection prevention and control.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: This essay addresses challenges of collecting research data from various respondents in Russia. It discusses how data collection in Russia can affect validity and credibility of the study among respondents who have limited experience or never participated in empirical social scientific research. The paper argues that the difficulty comes from historical and socio-cultural traditions of conducting social science research in Russia. The paper provides recommendations for minimizing methodological flaws while collecting empirical data in Russia.

Publication Type: Proceeding
Abstract: The State of Minnesota funds its public schools primarily through a funding formula that provides school districts the same amount of revenue per pupil regardless of the size of their enrollment. In an earlier paper (Thorson and Edmondson 2000), we demonstrated that, similar to other areas of the economy, larger school districts incur less cost per pupil due to savings attributed to increased efficiency derived from the economic principle of “economies of scale.” The purpose of this study is to evaluate whether smaller school districts, as a result of their higher costs per pupil, experience greater hardship in the areas of infrastructure, resources, and staffing. To test this hypothesis, we surveyed school superintendents throughout Minnesota. Over 88 percent of public school superintendents responded to the survey. Some of our most important findings include:

• In many key areas of infrastructure and technology, small school districts had significantly lower quality levels compared to larger school districts in the state.
• Smaller school districts had much more difficulty than larger school districts in attracting and retaining teachers.
• The disparities between small and large school districts are even larger when one compares the low referendum small districts with other school districts in the state.
• To help eliminate these disparities, we recommend altering the state’s basic funding formula (currently $4,601 per student) to provide 8 percent more funding for a district’s first 500 students and an additional 4 percent to the next 500 students. All additional students beyond the first 1,000 in each district would be funded at the $4,601 level. These increased revenues would be available to all school districts in the state. The total cost of the proposal is $77 million (less than 2 percent of state educational revenues).

Publication Type: Session Presentation
Abstract: The aim of the session is to show current research run by the Università per Stranieri di Siena on several topics
regarding languages in contact. Participants will be Massimo Vedovelli, Monica Barni, Carla Bagna, Sabrina Machetti.

Publication Type: Symposium Paper
Abstract: Attorneys often suggest a per diem argument (PDA) or mathematical formula to help jurors determine non-economic damages in civil cases. We examined whether different dollar/time quantifications (none, $10/hour, $240/day, $7,300/month) and a lump sum (none, $175,000) influenced pain and suffering awards in a simulated personal injury case. Jurors (N=317) awarded less damages and exerted less cognitive effort when presented a larger dollar/time quantification ($7,300/month) compared to $10/hour or no PDA/no lump sum. Jurors who received the PDA alone were less influenced by the plaintiff attorney’s closing argument and awarded less damages than those who received a combined lump sum/PDA argument.