Essays in the Industrial Organization of Regulatory Policy

Governments use a wide variety of policy instruments to achieve their goals, including price signals, constraints on firms’ behavior, and direct action. The consequences of such policies depend on how they interact with the underlying economic system. Measuring the impact of an intervention can be difficult, especially when the policy was not designed or implemented with evaluation in mind. Moreover, it is often ex ante prediction of a policy’s costs and benefits, rather than ex post evaluation, which is relevant for decision making. This dissertation examines issues related to both evaluating and predicting the effects of regulations in two important contexts: financial inclusion and industrial carbon emissions.Mandates requiring banks to open a minimum share of their new branches in un- banked villages have been a pillar of the Indian government’s rural financial inclusion strategy for decades. By explicitly linking branch licenses in banked municipalities to rural branch expansion, these mandates increase the costs of entry in banked markets and may reduce access there. In the first two chapters of this dissertation, I study the impact of a 25% unbanked share mandate implemented in July 2011 on the size, geographic distribution, and profitability of the national branch network. In the first chapter, I describe the context of the reform and use novel, comprehen- sive records of branch licenses, to document the scope of the post-reform rural branch expansion. Over 11,000 unbanked villages, home to more than 40 million people, were entered in the five years post-reform. These villages are substantially smaller, poorer, and more remote than those entered prior to the reform. In the second chapter, I use an economic model of branch entry to estimate banks’ profits, compute their regulatory compliance costs, and simulate equilibrium entry and profits under coun- terfactual policies. Compared to a free-entry counterfactual, the mandate reduces total profits from new branches by about 26% and shifts entry from banked to un- banked markets roughly one-for-one, with disproportionate losses in smaller banked markets. These costs increase rapidly in the mandatory unbanked share. Allow- ing banks to comply by trading permits in a competitive market modestly increases profits but does not result in net new entry. In the final chapter, co-authored with Katherine Wagner, we study the implica- tions of low energy prices today for industrial energy efficiency and climate policy in the future. If adjustment costs mediate manufacturing plants’ responses to increases in energy prices, incumbents may be limited in their ability to re-optimize energy- inefficient production technologies chosen based on past market incentives. Using U.S. Census data and quasi-experimental variation in state energy prices, we first show that the initial electricity prices that manufacturing plants pay in their first year of operations are important determinants of long-run energy intensity. Plants that open when the prices of electricity and fossil fuel inputs into electricity are low consume more energy throughout their lifetime, regardless of current electricity prices. We then measure the relative contributions of initial productivity and capital adjustment frictions to creating this “technology lock-in” by estimating a model of plant input choices. We find that lock-in can be largely explained by persistent differences in the relative productivity of energy inputs chosen at entry. We discuss how these long-run effects of low entry-year energy prices increase the emissions costs of delayed action on carbon policy. Cost-benefit analysis of existing and proposed regulations is central to the pol- icymaking process. This dissertation aims to provide useful insights on how recent advances in industrial organization can inform these analyses

Mechanical thrombectomy in acute ischemic stroke : Consensus statement by ESO-Karolinska Stroke Update 2014/2015, supported by ESO, ESMINT, ESNR and EAN

The original version of this consensus statement on mechanical thrombectomy was approved at the European Stroke Organisation (ESO)-Karolinska Stroke Update conference in Stockholm, 16-18 November 2014. The statement has later, during 2015, been updated with new clinical trials data in accordance with a decision made at the conference. Revisions have been made at a face-to-face meeting during the ESO Winter School in Berne in February, through email exchanges and the final version has then been approved by each society. The recommendations are identical to the original version with evidence level upgraded by 20 February 2015 and confirmed by 15 May 2015. The purpose of the ESO-Karolinska Stroke Update meetings is to provide updates on recent stroke therapy research and to discuss how the results may be implemented into clinical routine. Selected topics are discussed at consensus sessions, for which a consensus statement is prepared and discussed by the participants at the meeting. The statements are advisory to the ESO guidelines committee. This consensus statement includes recommendations on mechanical thrombectomy after acute stroke. The statement is supported by ESO, European Society of Minimally Invasive Neurological Therapy (ESMINT), European Society of Neuroradiology (ESNR), and European Academy of Neurology (EAN).Peer reviewe

Projeto Fanzine: som perdido

Este trabalho trata da proposta de criação de um fanzine cujo tema é a música underground. Em tempos onde as músicas que aparecem nos canais de comunicação parecem ser cada vez menos trabalhadas e novos artistas com grande potencial não têm a mesma oportunidade para mostrarem seu trabalho, este fanzine tem o objetivo de ser um meio de divulgação para músicos independentes. Para a composição do fanzine, foram realizadas pesquisas bibliográfica, documental e entrevista com uma banda local, ao final deste, o projeto Som Perdido, um fanzine que aborda sobre músicos de vários gêneros musicais

The unruptured intracranial aneurysm treatment score A multidisciplinary consensus

Objective: We endeavored to develop an unruptured intracranial aneurysm (UIA) treatment score (UIATS) model that includes and quantifies key factors involved in clinical decision-making in the management of UIAs and to assess agreement for this model among specialists in UIA management and research. Methods: An international multidisciplinary (neurosurgery, neuroradiology, neurology, clinical epidemiology) group of 69 specialists was convened to develop and validate the UIATS model using a Delphi consensus. For internal (39 panel members involved in identification of relevant features) and external validation (30 independent external reviewers), 30 selected UIA cases were used to analyze agreement with UIATS management recommendations based on a 5-point Likert scale (5 indicating strong agreement). Interrater agreement (IRA) was assessed with standardized coefficients of dispersion (v(r)*) (v(r)* 5 0 indicating excellent agreement and v(r)* = 1 indicating poor agreement). Results: The UIATS accounts for 29 key factors in UIA management. Agreement with UIATS (mean Likert scores) was 4.2 (95% confidence interval [CI] 4.1-4.3) per reviewer for both reviewer cohorts; agreement per case was 4.3 (95% CI 4.1-4.4) for panel members and 4.5 (95% CI 4.3-4.6) for external reviewers (p = 0.017). Mean Likert scores were 4.2 (95% CI 4.1-4.3) for interventional reviewers (n = 56) and 4.1 (95% CI 3.9-4.4) for noninterventional reviewers (n = 12) (p = 0.290). Overall IRA (v(r)*) for both cohorts was 0.026 (95% CI 0.019-0.033). Conclusions: This novel UIA decision guidance study captures an excellent consensus among highly informed individuals on UIA management, irrespective of their underlying specialty. Clinicians can use the UIATS as a comprehensive mechanism for indicating how a large group of specialists might manage an individual patient with a UIA.Peer reviewe

Bridging intravenous thrombolysis in patients with atrial fibrillation

Atrial fibrillation; Intravenous thrombolysis; Oral anticoagulationFibrilación auricular; Trombólisis intravenosa; Anticoagulación oralFibril·lació auricular; Trombolisi intravenosa; Anticoagulació oralBackground and purpose: 40% of acute ischemic stroke patients treated by mechanical thrombectomy (MT) have a clinical history of atrial fibrillation (AF). The safety of bridging intravenous thrombolysis (IVT) (MT + IVT) is currently being discussed. We aimed to analyze the interaction between oral anticoagulation (OAC) status or AF with bridging IVT, regarding the occurrence of symptomatic intracranial hemorrhage (sICH) and functional outcome. Materials and Methods: Multicentric observational cohort study (BEYOND-SWIFT registry) of consecutive patients undergoing MT between 2010 and 2018 (n = 2,941). Multinomial regression models were adjusted for prespecified baseline and plausible pathophysiological covariates identified on a univariate analysis to assess the association of AF and OAC status with sICH and good outcomes (90-day modified Rankin Scale score 0–2). Results: In the total cohort (median age 74, 50.6% women), 1,347 (45.8%) patients had AF. Higher admission National Institutes of Health Stroke Scale (NIHSS) score (aOR 1.04 [95% 1.02–1.06], per point of increase) and prior medication with Vitamin K antagonists (VKA) (aOR 2.19 [95% 1.27–3.66]) were associated with sICH. Neither AF itself (aOR 0.71 [95% 0.41–1.24]) nor bridging IVT (aOR 1.08 [0.67–1.75]) were significantly associated with increased sICH. Receiving bridging IVT (aOR 1.61 [95% 1.24–2.11]) was associated with good 90-day outcome, with no interaction between AF and IVT (p = 0.92). Conclusion: Bridging IVT appears to be a reasonable clinical option in selected patients with AF. Given the increased sICH risk in patients with VKA, subgroup analysis of the randomized controlled trials should analyze whether patients with VKA might benefit from withholding bridging IVT.This study was funded by the Bangerter-Rhyner Foundation and the Swiss Academy of Medical Sciences. Open access funding provided by University of Bern

Vascular Perforation During Coil Embolization of an Intracranial Aneurysm: the Incidence, Mechanism, and Clinical Outcome

PurposeThe occurrence of a vascular perforation during an endovascular procedure is an unexpected and feared complication which can be fatal. However, the incidence, risk or the mechanism of vascular perforation which can occur in the endovascular management of aneurysms remains unclear. The purpose of the present study was to evaluate the incidence of vascular perforation during endovascular coil embolization of a cerebral aneurysm, and to reveal characteristics and clinical outcomes.Materials and MethodsWe reviewed the endovascular coil embolization procedures performed for the treatment of 459 aneurysms. Incidence and clinical, radiological and technical data of patients concerning the vascular perforation were reviewed from medical records and radiological findings.ResultsThe incidence of procedure-related vascular perforation in our patient group was 0.87% (4/459). For all four occurrences, the cause of vascular perforation involved the guidewire or microcatheter. Clinical outcome was poor in 2 cases and favorable in 2 cases.ConclusionAlthough rare, the occurrence of vascular perforation during coil embolization for treatment of an aneurysm may be fatal. Therefore, careful management of the guidewire is suggested for the prevention of vascular rupture during an endovascular procedure

Safe use of medications: learning needs and strengths for teaching mediated by virtual technologies

Objective: To identify the learning needs of undergraduate nursing students about patient safety and medication safety. Methods: Descriptive and cross-sectional study, developed from March 2019 to December 2020, with a non-probabilistic and intentional sample consisting of 45 undergraduate nursing students. Data were analyzed using descriptive statistics. Results: There was a predominance of female students (73.3%) with family income between 1 and 2 minimum wages. All confirmed having access to the internet, with a daily frequency of use by participants (93.3%). The smartphone was the most used device to access the internet (77.8%), with the home being the predominant place of access (80.0%). Regarding the learning needs about patient safety and medication safety, the classification “essential” stood out among the evaluated questions. Conclusion: The main identified learning needs of the participants were: working effectively as part of a team, understanding the systems and the effect of the complexity of patient care and defining the key concepts. In addition to that, there were weaknesses in differentiating between common terms in the medication administration process