Itay Fainmesser defended his dissertation yesterday.
One of the papers in his dissertation concerns job markets that have “unraveled” so that a large part of the market consists of early, exploding offers. He develops a network model, motivated by the observation that when many markets unravel (as when medical labor markets start to hire doctors well over a year before they begin employment), hiring also becomes more local (as hospitals start to hire students from local medical schools, etc.). Itay takes this as evidence that when hiring is very early, employers are forced to rely more on their local networks for information. He builds a network model that allows him to investigate which properties of local networks lead to unraveling, and which lead to later hiring. In this model, information about the quality of candidates eventually becomes widely available, but early information about candidate quality can only be reliably transmitted along links of a network. (When Markets Unravel: Social Networks, Information Transmission, and the 'Hiring Frenzy' older version here.)
Another of his papers tackles the question of cooperation in repeated games, where the possible interactions are constrained by a network, and he asks which buyer-seller network structures will support persistent cooperation (where sellers have an opportunity to cooperate by shipping a high quality good, or to defect by shipping a low quality good). It’s a hard problem, and (in a third paper) he and a coauthor invent models and tools to deal with it (in a large-network framework), that allow him to turn some difficult non-monotonic relationships among networks into well behaved statements about the value of links. (Community Structure and Market Outcomes: Towards a Theory of Repeated Games in Networks )
Itay will be an assistant professor of economics at Brown next year.
Welcome to the club, Itay.
Saturday, April 10, 2010
Friday, April 9, 2010
Liver exchange
Living Donor Exchange Poses New Option for Liver Transplantation
"Two major transplant centers in Hong Kong and South Korea released results from their paired donor exchange programs for living donor liver transplantation (LDLT). A single paired exchange, performed by the Hong Kong team under emergency circumstances, was a success. The Korean team reported 16 donor exchanges conducted over a 6-year period were successful.
Full details of this novel approach to organ transplantation appear in the April issue of Liver Transplantation."
And here are the two papers and abstracts:
Paired Donor Interchange to Avoid ABOIncompatible Living Donor Liver Transplantation, by See Ching Chan, Chung Mau Lo, Boon Hun Yong, Wilson J. C. Tsui, Kelvin K. C. Ng, and Sheung Tat Fan, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
"We report an emergency paired donor interchange living donor liver transplant performed on January 13, 2009. The 4 operations (2 liver transplants) were performed simultaneously. The aim was to avoid 2 ABO-incompatible liver transplants. One recipient in acute liver failure underwent transplantation in a high-urgency situation. The abdomen of the other recipient had severe adhesions from previous spontaneous bacterial peritonitis that rendered the recipient operation almost impossible. The ethical and logistical issues are discussed. Approaches adopted in anticipation of potential adverse outcomes are explained in view of the higher donor and recipient mortality and morbidity rates in comparison with kidney transplantation."
Liver Transpl 16:478-481, 2010
Exchange Living Donor Liver Transplantation to Overcome ABO Incompatibility in Adult Patients, by Shin Hwang, Sung-Gyu Lee, Deok-Bog Moon, Gi-Won Song, Chul-Soo Ahn, Ki-Hun Kim, Tae-Yong Ha, Dong-Hwan Jung, Kwan-Woo Kim, Nam-Kyu Choi, Gil-Chun Park, Young-Dong Yu, Young-Il Choi, Pyoung-Jae Park, and Hea-Seon Ha, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
"ABO incompatibility is the most common cause of donor rejection during the initial screening of adult patients with end-stage liver disease for living donor liver transplantation (LDLT). A paired donor exchange program was initiated to cope with this problem without ABO-incompatible LDLT. We present our results from the first 6 years of this exchange adult LDLT program. Between July 2003 and June 2009, 1351 adult LDLT procedures, including 16 donor exchanges and 7 ABO-incompatible LDLT procedures, were performed at our institution. Initial donor-recipient ABO incompatibilities included 6 A to B incompatibilities, 6 B to A incompatibilities, 1 A to O incompatibility, 1 A+O (dual graft) to B incompatibility, 1 O to AB incompatibility, and 1 O to A incompatibility. Fourteen matches (87.5%) were ABO incompatible, but 2 (12.5%) were initially ABO-compatible. All ABO-incompatible donors were directly related to their recipients, but 2 compatible donors were each undirected and unrelated directed. After donor reassignment through paired exchange (n = 7) or domino pairing (n = 1), the donor-recipient ABO status changed to A to A in 6, B to B in 6, O to O in 1, A to AB in 1, A+O to A in 1, and O to B in 1, and this made all matches ABO identical (n = 13) or ABO-compatible (n = 3). Two pairs of LDLT operations were performed simultaneously on an elective basis in 12 and on an emergency basis in 4. All donors recovered uneventfully. Fifteen of the 16 recipients survived, but 1 died after 54 days. In conclusion, an exchange donor program for adult LDLT appears to be a feasible modality for overcoming donor-recipient ABO incompatibility."Liver Transpl 16:482-490, 2010. V
Thursday, April 8, 2010
Organ trafficking: a black market for kidneys
Israeli police arrest suspected black market brokers, after complaints were made by unpaid donor/sellers.
Reserve general suspected of organ trafficking: Six arrested in organ-trafficking scandal after donors complain they were not paid for their kidneys
"Police have uncovered a large organ-trafficking ring that made its members millions, a court cleared for publication Wednesday.
...
"According to the police, the ring members advertised online offering people waiting for years for a kidney transplant an alternate solution, for the price of $140,000.
Other online ads made offers of $10,000 for kidneys. To those who remained hesitant, the suspects allegedly offered up to $100,000. However the donors were never paid.
Police were given their first clue when a 50-year old woman from Nazareth issued a complaint saying she had donated a kidney due to financial difficulties, for which she expected to receive $100,000. She said she was called in to undergo a series of tests and then flown to Azerbaijan with another donor, where she was relieved of her kidney.
Upon returning to Israel, she said, she asked those who had sent her for the money but never received it. Police launched an investigation and meanwhile received another complaint, this time from an 18-year old boy. He said he was promised $80,000 and flown to the Philippines to donate his kidney.
Superintendant Aharon Galor told Ynet, "We ran an undercover investigation and were shocked by the proportions of this. Despite the few complaints we received, we learned that there are many people willing to sell a kidney for just $10,000. These are people who have severe financial difficulties, for whom such a sum is a dream come true." "
More details here: Israel police uncovers organ trafficking ring in north
""The ring is operating throughout Israel and not only in the north, and appeals to the public through local media and internet," a police official said. "The organ traffickers somehow receive details about potential transplant candidates and they offer them their services," he said.
"The investigators said that the traffickers usually demand around 120,000 dollars for a kidney transplant. While the donors, the majority of which are in serious financial troubles, are taken advantage of and receive around 10,000 dollars. Some of them get even smaller sums, and some do not receive any money at all.
"The donors sign a contract and fill out fraudulent affidavits claiming a family connection between the donor and the recipient - a requirement in the countries where the surgeries take place.
"Afterwards, the donors undergo medical examinations where they are categorized by blood types and other medical conditions, and are then flown to countries in Eastern Europe, the Philippines, and Ecuador.
"There, the donors undergo surgery to extract their kidney, and shortly afterwards return to Israel without any medical documentation, many times suffering from medical complications. "
Reserve general suspected of organ trafficking: Six arrested in organ-trafficking scandal after donors complain they were not paid for their kidneys
"Police have uncovered a large organ-trafficking ring that made its members millions, a court cleared for publication Wednesday.
...
"According to the police, the ring members advertised online offering people waiting for years for a kidney transplant an alternate solution, for the price of $140,000.
Other online ads made offers of $10,000 for kidneys. To those who remained hesitant, the suspects allegedly offered up to $100,000. However the donors were never paid.
Police were given their first clue when a 50-year old woman from Nazareth issued a complaint saying she had donated a kidney due to financial difficulties, for which she expected to receive $100,000. She said she was called in to undergo a series of tests and then flown to Azerbaijan with another donor, where she was relieved of her kidney.
Upon returning to Israel, she said, she asked those who had sent her for the money but never received it. Police launched an investigation and meanwhile received another complaint, this time from an 18-year old boy. He said he was promised $80,000 and flown to the Philippines to donate his kidney.
Superintendant Aharon Galor told Ynet, "We ran an undercover investigation and were shocked by the proportions of this. Despite the few complaints we received, we learned that there are many people willing to sell a kidney for just $10,000. These are people who have severe financial difficulties, for whom such a sum is a dream come true." "
More details here: Israel police uncovers organ trafficking ring in north
""The ring is operating throughout Israel and not only in the north, and appeals to the public through local media and internet," a police official said. "The organ traffickers somehow receive details about potential transplant candidates and they offer them their services," he said.
"The investigators said that the traffickers usually demand around 120,000 dollars for a kidney transplant. While the donors, the majority of which are in serious financial troubles, are taken advantage of and receive around 10,000 dollars. Some of them get even smaller sums, and some do not receive any money at all.
"The donors sign a contract and fill out fraudulent affidavits claiming a family connection between the donor and the recipient - a requirement in the countries where the surgeries take place.
"Afterwards, the donors undergo medical examinations where they are categorized by blood types and other medical conditions, and are then flown to countries in Eastern Europe, the Philippines, and Ecuador.
"There, the donors undergo surgery to extract their kidney, and shortly afterwards return to Israel without any medical documentation, many times suffering from medical complications. "
Wednesday, April 7, 2010
Update on economics job market scramble
Registration on the 2010 Economics Job Market Scramble for new Ph.D.s is now closed, and those who have registered will be able to view the site for another week.
67 employers registered 71 positions this year (with 24 of those employers choosing to remain invisible to viewers). There's no obvious difference between the visibles and the invisibles (e.g. the visibles include 14 universities with graduate programs, the invisibles include 11).
374 job candidates registered, in line with previous years (there were 361 and 395 in 2008 and 2009).
All this is from the revised version of our paper on the job market:
Peter Coles, John Cawley, Phillip B. Levine, Muriel Niederle, Alvin E. Roth, and John J. Siegfried , " The Job Market for New Economists: A Market Design Perspective," revised April 6, 2010, forthcoming in Journal of Economic Perspectives, Summer 2010.The current version of that paper can be found here .
Good luck to all those still on the market.
67 employers registered 71 positions this year (with 24 of those employers choosing to remain invisible to viewers). There's no obvious difference between the visibles and the invisibles (e.g. the visibles include 14 universities with graduate programs, the invisibles include 11).
374 job candidates registered, in line with previous years (there were 361 and 395 in 2008 and 2009).
All this is from the revised version of our paper on the job market:
Peter Coles, John Cawley, Phillip B. Levine, Muriel Niederle, Alvin E. Roth, and John J. Siegfried , " The Job Market for New Economists: A Market Design Perspective," revised April 6, 2010, forthcoming in Journal of Economic Perspectives, Summer 2010.The current version of that paper can be found here .
Good luck to all those still on the market.
Tuesday, April 6, 2010
The first kidney exchange in the U.S., and other accounts of early progress
The Student BMJ (a student run affiliate of the British Medical Journal) has an article interviewing the pioneering surgeons who conducted the first kidney exchange in the U.S., in 2000. (It's gated, but you can register for free.)
Anthony P Monaco and Paul E Morrissey: a pioneering paired kidney exchange
Transplant surgeons Anthony P Monaco and Paul E Morrissey performed the first paired kidney exchange in the United States
By: Prizzi Zarsadias
Published: 24 March 2010, Cite this as: Student BMJ 2010;18:c1562
The article is in interview form. Some highlights:
"When two patients found they were ABO incompatible with their live kidney donors it seemed that a long wait on the organ donor list awaited them. But by coincidence the donors were a match for each other’s recipient. Rather than lose this chance for both patients to receive a live kidney donation Anthony P Monaco and Paul E Morrissey saw an opportunity, and in 2000 they performed the first paired kidney donation in the United States. "
How did the first paired kidney donation come about?
Paul E Morrissey: We knew about paired donation from an experience in Korea. We had encountered articles about paired donation. Then these pairs simultaneously presented to us; it just clicked that we could exchange the donors. I wouldn’t attribute the idea to myself or Dr Monaco but to the entire team. We discussed it with 15 of our doctors and nurses, social workers, and various other people, and we agreed that it would be something that we would propose to the family.
How did the patients in the first exchange fare?
PEM: The surgeries were uneventful. One recipient had great kidney function. The second had recurrence of the original disease and a bad acute rejection shortly after the transplant and went back onto dialysis several weeks after the transplant. One outcome was not good. The other patient did fantastically. Any time that a living donation doesn’t work is sad. And in this circumstance, to have had a child make a donation for a parent and to have it work out for the person she donated to but not work out for the parent was sad and unfortunate.
What was the worst case scenario?
PEM: This would be close to it; the success rate for a live kidney donation is in the neighbourhood of 98% or so. This might happen once in every 50. It’s an extremely unusual circumstance for any living donation, and in this setting it adds to the unhappiness. There was a lot of hand holding for the recipient with the failed kidney but also for the donor. There was a lot of follow-up on a longitudinal basis. They are both alive and well today but who knows exactly what emotion they harbour, and I hope that the other patient is enjoying the outcome of her operation.
APM: The worst case scenario for any living transplant would be that the recipient or donor die because of surgery. We haven’t seen that, but that’s the risk in this scenario. We’ve had recipients who have died a week or two later, but that has not happened with swap transplants.
PEM: We inform the patients more of the adverse outcomes. It was, of course, at the forefront of our minds when we proceeded the second time.
During the first exchange did you envisage the technique’s success?
APM: We did not envision it, but we were not surprised that it has grown because it works well. There is a natural evolutionary process to extend it into other situations. We do swaps that involve not just ABO incompatibility; we also swap kidneys between pairs that are incompatible because of HLA antibodies. We are also currently working on a five-way swap.
PEM: The credit obviously goes to countless groups throughout the country that have pushed it forward. In particular the group in our organ procurement organisation, the New England Organ Bank, has really been a leader in taking this forward nationally but at the time that we did this, we didn’t have thoughts about expanding it beyond the reaches of our own programme. I think that they’ll continue to grow out of necessity.
The article begins with these biographical details:
Anthony P Monaco
Peter Medawar professor of transplantation surgery, Harvard University, emeritus director of the Beth Israel Deaconess Harvard Medical Center Transplant Program, and director of the Rhode Island Hospital Transplant Services
Biography—After graduating from Harvard Medical School in 1956 his career has spanned five decades. In that time he has published more than 470 papers and has held the post of editor of Transplantation for 32 years until 2001 and has been the special features editor for the same journal ever since. He is also a trustee of the New England Organ Bank.
Paul E Morrissey
Associate professor of surgery and transplant surgeon at Rhode Island Hospital and assistant medical director for the New England Organ Bank
Biography—Trained at the University of Massachusetts and held residencies and research fellowships at Yale and Harvard Medical Schools. He has been a transplant surgeon at Rhode Island Hospital since 1997 and has been surgical director of the Division of Organ Transplant since 2002. He has been awarded many honours, including the Thomas Murray award from the Rhode Island Organ Donor Awareness Coalition. "
As the article indicates, an earlier exchange had been carried out in S. Korea. Another country that has been active in kidney exchange is Holland, and a recent report of their experience is in the April 2010 issue of the American Journal of Transplantation: "Altruistic Donor Triggered Domino-Paired Kidney Donation for Unsuccessful Couples from the Kidney-Exchange Program" by Roodnat, J. I.; Zuidema, W.; van de Wetering, J.; de Klerk, M.; Erdman, R. A. M.; Massey, E. K.; Hilhorst, M. T.; IJzermans, J. N. M.; Weimar, W.
The New England Program for Kidney Exchange (the institutional descendent of that first U.S. exchange by Monaco and Morrissey) maintains a page listing Kidney Exchange:A Chronology of Scientific Contributions (scroll to the bottom of that page).
While I'm on the subject of important firsts, donating a kidney became much easier with the introduction of laproscopic kidney nephrectomies for donor kidneys (taking the kidney out via a small incision instead of a big one). Here's the article by Lloyd Ratner et al. reporting the first one:
Laparoscopic live donor nephrectomy.
Ratner LE, Ciseck LJ, Moore RG, Cigarroa FG, Kaufman HS, Kavoussi LR., Transplantation. 1995 Nov 15;60(9):1047-9.
"A laparoscopic live-donor nephrectomy was performed on a 40-year-old man. The kidney was removed intact via a 9-cm infraumbilical midline incision. Warm ischemia was limited to less than 5 min. Immediately upon revascularization, the allograft produced urine. By the second postoperative day, the recipient's serum creatinine had decreased to 0.7 mg/dl. The donor's postoperative course was uneventful. He experienced minimal discomfort and was discharged home on the first postoperative day. We conclude that laparoscopic donor nephrectomy is feasible. It can be performed without apparent deleterious effects to either the donor or the recipient. The limited discomfort and rapid convalescence enjoyed by our patient indicate that this technique may prove to be advantageous."
Anthony P Monaco and Paul E Morrissey: a pioneering paired kidney exchange
Transplant surgeons Anthony P Monaco and Paul E Morrissey performed the first paired kidney exchange in the United States
By: Prizzi Zarsadias
Published: 24 March 2010, Cite this as: Student BMJ 2010;18:c1562
The article is in interview form. Some highlights:
"When two patients found they were ABO incompatible with their live kidney donors it seemed that a long wait on the organ donor list awaited them. But by coincidence the donors were a match for each other’s recipient. Rather than lose this chance for both patients to receive a live kidney donation Anthony P Monaco and Paul E Morrissey saw an opportunity, and in 2000 they performed the first paired kidney donation in the United States. "
How did the first paired kidney donation come about?
Paul E Morrissey: We knew about paired donation from an experience in Korea. We had encountered articles about paired donation. Then these pairs simultaneously presented to us; it just clicked that we could exchange the donors. I wouldn’t attribute the idea to myself or Dr Monaco but to the entire team. We discussed it with 15 of our doctors and nurses, social workers, and various other people, and we agreed that it would be something that we would propose to the family.
How did the patients in the first exchange fare?
PEM: The surgeries were uneventful. One recipient had great kidney function. The second had recurrence of the original disease and a bad acute rejection shortly after the transplant and went back onto dialysis several weeks after the transplant. One outcome was not good. The other patient did fantastically. Any time that a living donation doesn’t work is sad. And in this circumstance, to have had a child make a donation for a parent and to have it work out for the person she donated to but not work out for the parent was sad and unfortunate.
What was the worst case scenario?
PEM: This would be close to it; the success rate for a live kidney donation is in the neighbourhood of 98% or so. This might happen once in every 50. It’s an extremely unusual circumstance for any living donation, and in this setting it adds to the unhappiness. There was a lot of hand holding for the recipient with the failed kidney but also for the donor. There was a lot of follow-up on a longitudinal basis. They are both alive and well today but who knows exactly what emotion they harbour, and I hope that the other patient is enjoying the outcome of her operation.
APM: The worst case scenario for any living transplant would be that the recipient or donor die because of surgery. We haven’t seen that, but that’s the risk in this scenario. We’ve had recipients who have died a week or two later, but that has not happened with swap transplants.
PEM: We inform the patients more of the adverse outcomes. It was, of course, at the forefront of our minds when we proceeded the second time.
During the first exchange did you envisage the technique’s success?
APM: We did not envision it, but we were not surprised that it has grown because it works well. There is a natural evolutionary process to extend it into other situations. We do swaps that involve not just ABO incompatibility; we also swap kidneys between pairs that are incompatible because of HLA antibodies. We are also currently working on a five-way swap.
PEM: The credit obviously goes to countless groups throughout the country that have pushed it forward. In particular the group in our organ procurement organisation, the New England Organ Bank, has really been a leader in taking this forward nationally but at the time that we did this, we didn’t have thoughts about expanding it beyond the reaches of our own programme. I think that they’ll continue to grow out of necessity.
The article begins with these biographical details:
Anthony P Monaco
Peter Medawar professor of transplantation surgery, Harvard University, emeritus director of the Beth Israel Deaconess Harvard Medical Center Transplant Program, and director of the Rhode Island Hospital Transplant Services
Biography—After graduating from Harvard Medical School in 1956 his career has spanned five decades. In that time he has published more than 470 papers and has held the post of editor of Transplantation for 32 years until 2001 and has been the special features editor for the same journal ever since. He is also a trustee of the New England Organ Bank.
Paul E Morrissey
Associate professor of surgery and transplant surgeon at Rhode Island Hospital and assistant medical director for the New England Organ Bank
Biography—Trained at the University of Massachusetts and held residencies and research fellowships at Yale and Harvard Medical Schools. He has been a transplant surgeon at Rhode Island Hospital since 1997 and has been surgical director of the Division of Organ Transplant since 2002. He has been awarded many honours, including the Thomas Murray award from the Rhode Island Organ Donor Awareness Coalition. "
As the article indicates, an earlier exchange had been carried out in S. Korea. Another country that has been active in kidney exchange is Holland, and a recent report of their experience is in the April 2010 issue of the American Journal of Transplantation: "Altruistic Donor Triggered Domino-Paired Kidney Donation for Unsuccessful Couples from the Kidney-Exchange Program" by Roodnat, J. I.; Zuidema, W.; van de Wetering, J.; de Klerk, M.; Erdman, R. A. M.; Massey, E. K.; Hilhorst, M. T.; IJzermans, J. N. M.; Weimar, W.
The New England Program for Kidney Exchange (the institutional descendent of that first U.S. exchange by Monaco and Morrissey) maintains a page listing Kidney Exchange:A Chronology of Scientific Contributions (scroll to the bottom of that page).
While I'm on the subject of important firsts, donating a kidney became much easier with the introduction of laproscopic kidney nephrectomies for donor kidneys (taking the kidney out via a small incision instead of a big one). Here's the article by Lloyd Ratner et al. reporting the first one:
Laparoscopic live donor nephrectomy.
Ratner LE, Ciseck LJ, Moore RG, Cigarroa FG, Kaufman HS, Kavoussi LR., Transplantation. 1995 Nov 15;60(9):1047-9.
"A laparoscopic live-donor nephrectomy was performed on a 40-year-old man. The kidney was removed intact via a 9-cm infraumbilical midline incision. Warm ischemia was limited to less than 5 min. Immediately upon revascularization, the allograft produced urine. By the second postoperative day, the recipient's serum creatinine had decreased to 0.7 mg/dl. The donor's postoperative course was uneventful. He experienced minimal discomfort and was discharged home on the first postoperative day. We conclude that laparoscopic donor nephrectomy is feasible. It can be performed without apparent deleterious effects to either the donor or the recipient. The limited discomfort and rapid convalescence enjoyed by our patient indicate that this technique may prove to be advantageous."
Monday, April 5, 2010
Sniping in auctions with substitutes
On an auction site like eBay, many copies of the same good may be on offer for different auctions. A new sniping site, goSnipe, allows bidders to specify a group of auctions on which to submit last minute bids, one at a time, but to stop when the desired purchase is made.
Here's some research on bid sniping, and the underlying game theory.
Here's some research on bid sniping, and the underlying game theory.
Sunday, April 4, 2010
Repugnant transactions in New Zealand: Easter Sunday sales
The NZ Herald reports on Illegal Trading.
"The number of shops found to be trading illegally over the Easter weekend appears to be similar to last year, the Department of Labour says. The Department will consider the prosecution of 38 retailers after 19 were caught trading on Good Friday and another 19 on Easter Sunday.
"The issue of Easter trading hours remained a contentious issue this year, with business owners calling for more clarity on the laws. Auckland business advocate Cameron Brewer, who was lobbying this year for changes to the law, said "confusion reigned high" as some towns were banned from trading while others were not. Licensed premises, cafes, gardening and hardware stores were also a problem, he said. "Cafes can open if they have ready-to-eat food, but what is ready-to-eat food? More and more hardware stores, most of which have big gardening departments, are opening and facing $1000 fines, even though gardening shops can legally open on Easter Sunday. "This weekend there has been more confusion and frustration than ever before around Easter trading laws. It can't go on any longer."
"The number of shops found to be trading illegally over the Easter weekend appears to be similar to last year, the Department of Labour says. The Department will consider the prosecution of 38 retailers after 19 were caught trading on Good Friday and another 19 on Easter Sunday.
"The issue of Easter trading hours remained a contentious issue this year, with business owners calling for more clarity on the laws. Auckland business advocate Cameron Brewer, who was lobbying this year for changes to the law, said "confusion reigned high" as some towns were banned from trading while others were not. Licensed premises, cafes, gardening and hardware stores were also a problem, he said. "Cafes can open if they have ready-to-eat food, but what is ready-to-eat food? More and more hardware stores, most of which have big gardening departments, are opening and facing $1000 fines, even though gardening shops can legally open on Easter Sunday. "This weekend there has been more confusion and frustration than ever before around Easter trading laws. It can't go on any longer."
Work hours of surgical residents
The culture is changing to comply with the law, but it's hard.
For doctors, a matter of time: MGH residents cut back to 80-hour weeks, but with mixed feelings
"The hospital had a wake-up call last year, when a national accrediting agency put the program on probation for violating patient-protection rules that limit trainees’ work hours. Some junior surgeons, called residents, had been staying too late because they didn’t want to sign over their very sick patients to other doctors, out of a combination of duty to patients, work ethic, and unspoken peer pressure.
"Now, say senior surgeons and residents alike, the program is in complete compliance with the rules that require trainees to average no more than 80 hours of work a week and have 10 hours off between shifts."
The story makes the case that residents sometimes need and want to work long hours.
A related story about sleeplessness makes the case that it would be good both for patients and young docs if they got enough sleep: At Midnight, All the Doctors…
For doctors, a matter of time: MGH residents cut back to 80-hour weeks, but with mixed feelings
"The hospital had a wake-up call last year, when a national accrediting agency put the program on probation for violating patient-protection rules that limit trainees’ work hours. Some junior surgeons, called residents, had been staying too late because they didn’t want to sign over their very sick patients to other doctors, out of a combination of duty to patients, work ethic, and unspoken peer pressure.
"Now, say senior surgeons and residents alike, the program is in complete compliance with the rules that require trainees to average no more than 80 hours of work a week and have 10 hours off between shifts."
The story makes the case that residents sometimes need and want to work long hours.
A related story about sleeplessness makes the case that it would be good both for patients and young docs if they got enough sleep: At Midnight, All the Doctors…
Saturday, April 3, 2010
Presumed consent and deceased donor organ donation
Kim Krawiec writes: "Duke sociologist (and Crooked Timber blogger) Kieran Healy visited my Taboo Trades and Forbidden Markets seminar this week to discuss his book, Last Best Gifts (University of Chicago Press, 2006) -- a study of the social organization of exchange in human blood and organs – as well as his research on presumed consent laws (See, Do Presumed Consent Laws Raise Organ Procurement Rates? DePaul Law Review, 55:1017–1043 (2006)) (PDF). Healy has also written several other articles about gift and market exchange in human blood and organs and, in addition, studies the moral order of market society (See, for example, Marion Fourcade and Kieran Healy, Moral Views of Market Society. Annual Review of Sociology 33:285–311 (2007) (PDF.))"
...
[The article on presumed consent] "is a comparative study of rates of cadaveric organ procurement in seventeen OECD countries between 1990 and 2002. Those in the United States (and other countries, including the UK) concerned with insufficient cadaveric donor rates frequently advocate a switch to a presumed-consent legal regime (as opposed to the US informed consent regime), as a quick fix to the problem of under-supply. This seems logical enough – in other contexts we have reason to believe that alterations to the default rule, and particularly from an opt-in to an opt-out regime, may meaningfully impact behavior. This is especially plausible when the law functions as some sort of signaling device about societal norms or when, as in the case of organ donation, choosing involves scenarios – death – that one prefers not to contemplate, perhaps causing inertia.
But in the case of cadaveric organ donation an additional argument is typically put forward in favor of presumed consent: the removal of next of kin from the decision-making process. Though the Revised Uniform Anatomical Gift Act specifies that family consent or concurrence is not required, the reluctance of procurement organizations in the U.S. to proceed with organ retrieval against next-of-kin wishes has been generally recognized.
Yet Healey finds that presumed consent laws do not make a material difference to the procurement rate. Importantly, presumed consent laws typically do not remove the next of kin from the procurement process. Although presumed-consent countries have somewhat better procurement rates on average than informed-consent countries, Healy concludes that this is not because of any direct effect of the law on individual choices. Instead, improved donation rates appear driven by substantial investment in the logistics of organ procurement – better training, clear delegation of responsibility, and a strong presence in hospitals, for example. "
...
[The article on presumed consent] "is a comparative study of rates of cadaveric organ procurement in seventeen OECD countries between 1990 and 2002. Those in the United States (and other countries, including the UK) concerned with insufficient cadaveric donor rates frequently advocate a switch to a presumed-consent legal regime (as opposed to the US informed consent regime), as a quick fix to the problem of under-supply. This seems logical enough – in other contexts we have reason to believe that alterations to the default rule, and particularly from an opt-in to an opt-out regime, may meaningfully impact behavior. This is especially plausible when the law functions as some sort of signaling device about societal norms or when, as in the case of organ donation, choosing involves scenarios – death – that one prefers not to contemplate, perhaps causing inertia.
But in the case of cadaveric organ donation an additional argument is typically put forward in favor of presumed consent: the removal of next of kin from the decision-making process. Though the Revised Uniform Anatomical Gift Act specifies that family consent or concurrence is not required, the reluctance of procurement organizations in the U.S. to proceed with organ retrieval against next-of-kin wishes has been generally recognized.
Yet Healey finds that presumed consent laws do not make a material difference to the procurement rate. Importantly, presumed consent laws typically do not remove the next of kin from the procurement process. Although presumed-consent countries have somewhat better procurement rates on average than informed-consent countries, Healy concludes that this is not because of any direct effect of the law on individual choices. Instead, improved donation rates appear driven by substantial investment in the logistics of organ procurement – better training, clear delegation of responsibility, and a strong presence in hospitals, for example. "
Friday, April 2, 2010
Fortune-telling is repugnant in Saudi Arabia (and a capital crime)
This headline caught my eye this morning: Lebanese Not to Be Beheaded Friday for Witchcraft
"A Lebanese man condemned to death for witchcraft by a Saudi court will not be beheaded Friday as had been expected, his lawyer said.
Attorney May al-Khansa said Lebanon's justice minister told her that her client, Ali Sibat, will not be executed in Saudi Arabia on Friday -- the day executions are typically carried out in the kingdom after noon prayers.
She said it is still unclear whether the beheading had been waived or only postponed. "
...
"Sibat, a 49-year-old father of five, made predictions on an Arab satellite TV channel from his home in Beirut.
He was arrested by the Saudi religious police during his pilgrimage to the holy city of Medina in May 2008 and sentenced to death last November for witchcraft.
The Saudi justice system, which is based on Islamic law, does not clearly define the charge of witchcraft.
Sibat is one of scores of people reported arrested every year in the kingdom for practicing sorcery, witchcraft, black magic and fortunetelling. The deeply religious authorities in Saudi consider these practices polytheism. "
(Presumably the ability of fortune tellers to predict the future is imperfect, since otherwise Mr Sibat might have skipped this trip.)
Update 4/24/10: "But fraud, while a crime, is not punishable by death, said Mr. AlGasim, the retired judge. Only actual sorcery is a crime.
“You have to differentiate between acts that cheat or deceive people for money, which deserve to be punished, and dealing with magic,” he said. “There is no mechanism to prove it, and any confession is open to doubt, especially if someone confesses in prison.” "
"A Lebanese man condemned to death for witchcraft by a Saudi court will not be beheaded Friday as had been expected, his lawyer said.
Attorney May al-Khansa said Lebanon's justice minister told her that her client, Ali Sibat, will not be executed in Saudi Arabia on Friday -- the day executions are typically carried out in the kingdom after noon prayers.
She said it is still unclear whether the beheading had been waived or only postponed. "
...
"Sibat, a 49-year-old father of five, made predictions on an Arab satellite TV channel from his home in Beirut.
He was arrested by the Saudi religious police during his pilgrimage to the holy city of Medina in May 2008 and sentenced to death last November for witchcraft.
The Saudi justice system, which is based on Islamic law, does not clearly define the charge of witchcraft.
Sibat is one of scores of people reported arrested every year in the kingdom for practicing sorcery, witchcraft, black magic and fortunetelling. The deeply religious authorities in Saudi consider these practices polytheism. "
(Presumably the ability of fortune tellers to predict the future is imperfect, since otherwise Mr Sibat might have skipped this trip.)
Update 4/24/10: "But fraud, while a crime, is not punishable by death, said Mr. AlGasim, the retired judge. Only actual sorcery is a crime.
“You have to differentiate between acts that cheat or deceive people for money, which deserve to be punished, and dealing with magic,” he said. “There is no mechanism to prove it, and any confession is open to doubt, especially if someone confesses in prison.” "
Renal data: kidney exchange
A 2009 report of the United States Renal Data System includes this on the early growth of kidney exchange, through 2007.
"Living Donor Paired Donation was the only subgroup of living donor transplants that increased between 2006 and 2007, rising 125 percent to reach 216 transplants. Transplants from paired donations currently make up only 1 percent of transplants performed in the United States. The number of donations from living relations continues to decline, and is now 18 percent lower than the high observed in 2001. Donations from spouses or distant relatives have remained fairly constant. "
From Page 282 of the 2009 report, reporting on the rise from 96 recorded kidney exchange transplants in 2006 to 216 in 2007. http://www.usrds.org/2009/pdf/V2_07_09.PDF
"Living Donor Paired Donation was the only subgroup of living donor transplants that increased between 2006 and 2007, rising 125 percent to reach 216 transplants. Transplants from paired donations currently make up only 1 percent of transplants performed in the United States. The number of donations from living relations continues to decline, and is now 18 percent lower than the high observed in 2001. Donations from spouses or distant relatives have remained fairly constant. "
From Page 282 of the 2009 report, reporting on the rise from 96 recorded kidney exchange transplants in 2006 to 216 in 2007. http://www.usrds.org/2009/pdf/V2_07_09.PDF
Thursday, April 1, 2010
Transactions that are repugnant in Dubai
Britons sentenced to a month in prison for kissing in Dubai restaurant "At the appeal hearing on Sunday, their defence lawyer Khalaf al Hosany said the couple admitted kissing each other on the cheek but denied any intention to break the law. “It’s part of their culture to kiss on cheeks as a greeting,” he told the judge. But their pleas of not guilty to indecency were rejected and they were sentenced to a month in prison followed by deportation. They were also fined 1000 dirham (180 pounds) for being in a public place after consuming alcohol – an offence in Dubai, though drinking alcohol itself is not. "
Steamy Text Messages Lands Couple in Dubai Jail "A string of steamy text messages has landed an Indian couple in a Dubai jail. The conviction reported Wednesday said the sexual content of the texts suggested the unnamed pair planned to ''commit sin'' -- referring to an extramarital affair, which is illegal under Emirati law. The two Indians, who worked as cabin crew for Emirates airlines, were sentenced to three-month in jail, said authorities. "
Update (April 4): Dubai Jail Sentence Upheld for UK Kissing Couple
Steamy Text Messages Lands Couple in Dubai Jail "A string of steamy text messages has landed an Indian couple in a Dubai jail. The conviction reported Wednesday said the sexual content of the texts suggested the unnamed pair planned to ''commit sin'' -- referring to an extramarital affair, which is illegal under Emirati law. The two Indians, who worked as cabin crew for Emirates airlines, were sentenced to three-month in jail, said authorities. "
Update (April 4): Dubai Jail Sentence Upheld for UK Kissing Couple
Wednesday, March 31, 2010
Blog on school choice by Atila Abdulkadiroglu
Atila Abdulkadiroglu at Duke has a new blog called
School Choice: News and developments from schools and economics that matter to parents and districts.
His first two posts have been on the debate about choice in Wake County.
School Choice: News and developments from schools and economics that matter to parents and districts.
His first two posts have been on the debate about choice in Wake County.
Harvard's mysterious Z-list
One of the more unusual routes to admission at Harvard is the Z-list, which the Crimson writes about this week. Z-Listed Students Experience Year Off: Undergrads take mandatory gap year before coming to Harvard
Last year I wrote about it here: Harvard's "Z-list," waitlist admission with a difference .
It's that mandatory year off that makes the Z-list unusual (students who enter from the Z-list must delay a year and can't attend another school while they wait).
The mystery is to whom this admissions option is offered, and who chooses to accept. There's some signaling going on here, and some sorting.
Last year I wrote about it here: Harvard's "Z-list," waitlist admission with a difference .
It's that mandatory year off that makes the Z-list unusual (students who enter from the Z-list must delay a year and can't attend another school while they wait).
The mystery is to whom this admissions option is offered, and who chooses to accept. There's some signaling going on here, and some sorting.
Tuesday, March 30, 2010
Kidney exchange at NEPKE
The Sunday Globe has a good story about a recent three way kidney exchange at the New England Program for Kidney Exchange. One of the donors was a prominent local nephrologist.
Harvesting hope from a giving tree: The story of three couples, three kidneys and one goal: life.
It's a well written article that illustrates both some of the logistical complexities of a three way exchange, and some of the personal details of the six participants.
I'm always glad to see three way exchanges, in part because for a while it seemed like the logistical difficulties would preclude them.
Here are the papers which helped us make the case in New England:
Saidman, Susan L., Alvin E. Roth, Tayfun Sönmez, M. Utku Ünver, and Francis L. Delmonico, " Increasing the Opportunity of Live Kidney Donation By Matching for Two and Three Way Exchanges," Transplantation, ,81, 5, March 15, 2006, 773-782.
Roth, Alvin E., Tayfun Sonmez , and M. Utku Unver, "Efficient Kidney Exchange: Coincidence of Wants in Markets with Compatibility-Based Preferences," (May, 2005. NBER Paper w11402), American Economic Review, 97, 3, June 2007, 828-851. (And here is the online appendix with some of the proofs.)
One of the curious things about publishing in both economics and medical journals is that the paper which came first was published second...the AER takes a bit longer than Transplantation.
Harvesting hope from a giving tree: The story of three couples, three kidneys and one goal: life.
It's a well written article that illustrates both some of the logistical complexities of a three way exchange, and some of the personal details of the six participants.
I'm always glad to see three way exchanges, in part because for a while it seemed like the logistical difficulties would preclude them.
Here are the papers which helped us make the case in New England:
Saidman, Susan L., Alvin E. Roth, Tayfun Sönmez, M. Utku Ünver, and Francis L. Delmonico, " Increasing the Opportunity of Live Kidney Donation By Matching for Two and Three Way Exchanges," Transplantation, ,81, 5, March 15, 2006, 773-782.
Roth, Alvin E., Tayfun Sonmez , and M. Utku Unver, "Efficient Kidney Exchange: Coincidence of Wants in Markets with Compatibility-Based Preferences," (May, 2005. NBER Paper w11402), American Economic Review, 97, 3, June 2007, 828-851. (And here is the online appendix with some of the proofs.)
One of the curious things about publishing in both economics and medical journals is that the paper which came first was published second...the AER takes a bit longer than Transplantation.
Monday, March 29, 2010
The market for matzot
The Passover holiday is a time to think about matzah, whose plural is matzot. A little market history: Thoroughly Modern Matzah
"In 1888, Behr Manischewitz, an astute and pious immigrant from East Prussia, opened a matzah factory in Cincinnati. Soon facing local competition, he cut costs, improved quality, and burnished his image. His factory introduced the first square matzot, unmistakable products of industrial automation. Advertising his technology to English readers, he simultaneously won rabbinic endorsements in Yiddish and Hebrew periodicals.
Over time, Manischewitz and his competitors—Streit, Horowitz-Margareten, Goodman—created a distinctively American matzah for a a distinctively American Passover: a holiday coming to be seen less as the birth of a particular nation than as a celebration of freedom in general."
Some further background here: Those Magnificent Men and Their Matzah Machines*
Chag Pesach sameach, y'all. Let's all try to excel at being free.
"In 1888, Behr Manischewitz, an astute and pious immigrant from East Prussia, opened a matzah factory in Cincinnati. Soon facing local competition, he cut costs, improved quality, and burnished his image. His factory introduced the first square matzot, unmistakable products of industrial automation. Advertising his technology to English readers, he simultaneously won rabbinic endorsements in Yiddish and Hebrew periodicals.
Over time, Manischewitz and his competitors—Streit, Horowitz-Margareten, Goodman—created a distinctively American matzah for a a distinctively American Passover: a holiday coming to be seen less as the birth of a particular nation than as a celebration of freedom in general."
Some further background here: Those Magnificent Men and Their Matzah Machines*
Chag Pesach sameach, y'all. Let's all try to excel at being free.
Sunday, March 28, 2010
School choice in North Carolina
"A bitter fight over school choice in North Carolina grabbed national headlines in recent months," says a news release from Duke University, which notes that Duke is fortunate in having a local expert on school choice, in Atila Abdulkadiroglu.
News Tip: Economic Model Can Help Diversify U.S. Schools While Maintaining Community School Preferences, Expert Says
"The use of economic models to design flexible assignment policies can help school systems achieve racial and socioeconomic diversity while also keeping parents who prefer neighborhood schools happy, says a Duke University professor who researches the economics of education.
A key component is to incorporate parental preferences in school assignments “to the maximum extent possible,” says Atila Abdulkadiroglu, a professor in Duke’s Department of Economics."
Here's the background story: Duke Professor Says Diversity, Parental Choice Can Work Together.
"Earlier this week, the Wake County School Board voted 5-4 to end the district's diversity policy by stopping the practice of busing students to achieve socio-economic balance, and instead switch to neighborhood-based assignments."
News Tip: Economic Model Can Help Diversify U.S. Schools While Maintaining Community School Preferences, Expert Says
"The use of economic models to design flexible assignment policies can help school systems achieve racial and socioeconomic diversity while also keeping parents who prefer neighborhood schools happy, says a Duke University professor who researches the economics of education.
A key component is to incorporate parental preferences in school assignments “to the maximum extent possible,” says Atila Abdulkadiroglu, a professor in Duke’s Department of Economics."
Here's the background story: Duke Professor Says Diversity, Parental Choice Can Work Together.
"Earlier this week, the Wake County School Board voted 5-4 to end the district's diversity policy by stopping the practice of busing students to achieve socio-economic balance, and instead switch to neighborhood-based assignments."
Usury and anti-semitism
From Ira Stoll's review of Capitalism and the Jews, by Jerry Z. Muller, Princeton University Press:
"The book by Mr. Muller, a professor of history at Catholic University, consists of a short introduction and four chapters. It's the first chapter, "The Long Shadow of Usury," that's the most enlightening.
"Usury was an important concept with a long shadow. It was significant because the condemnation of lending money at interest was based on the presumptive illegitimacy of all economic gain not derived from physical labor. That way of conceiving of economic activity led to a failure to recognize the role of knowledge and the evaluation of risk in economic life," he writes. "So closely was the reviled practice of usury identified with the Jews that St. Bernard of Clairvaux, the leader of the Cistercian Order, in the middle of the twelfth century referred to the taking of usury as 'Jewing'" says Mr. Muller."
"The book by Mr. Muller, a professor of history at Catholic University, consists of a short introduction and four chapters. It's the first chapter, "The Long Shadow of Usury," that's the most enlightening.
"Usury was an important concept with a long shadow. It was significant because the condemnation of lending money at interest was based on the presumptive illegitimacy of all economic gain not derived from physical labor. That way of conceiving of economic activity led to a failure to recognize the role of knowledge and the evaluation of risk in economic life," he writes. "So closely was the reviled practice of usury identified with the Jews that St. Bernard of Clairvaux, the leader of the Cistercian Order, in the middle of the twelfth century referred to the taking of usury as 'Jewing'" says Mr. Muller."
Saturday, March 27, 2010
China's theme park of dwarves
A Miniature World Magnifies Dwarf Life
Quotes reflecting opposing views of repugnance:
“I think it is horrible,” said Gary Arnold, the spokesman for Little People of America Inc., a dwarfism support group based in California. “What is the difference between it and a zoo?” Even the term “dwarf” is offensive to some; his organization prefers “person of short stature.”
"But there is another view, and Mr. Chen and some of his short-statured workers present it forcefully. One hundred permanently employed dwarfs, they contend, is better than 100 dwarfs scrounging for odd jobs. They insist that the audiences who see the dwarfs sing, dance and perform comic routines leave impressed by their skills and courage."
HT: Zhenyu Lai and Aytek Erdil
Quotes reflecting opposing views of repugnance:
“I think it is horrible,” said Gary Arnold, the spokesman for Little People of America Inc., a dwarfism support group based in California. “What is the difference between it and a zoo?” Even the term “dwarf” is offensive to some; his organization prefers “person of short stature.”
"But there is another view, and Mr. Chen and some of his short-statured workers present it forcefully. One hundred permanently employed dwarfs, they contend, is better than 100 dwarfs scrounging for odd jobs. They insist that the audiences who see the dwarfs sing, dance and perform comic routines leave impressed by their skills and courage."
HT: Zhenyu Lai and Aytek Erdil
Friday, March 26, 2010
School choice is serious business: litigation and politics in NYC and Chicago
In NYC, high school admissions have been delayed by a lawsuit motivated by the city's effort to close some schools: High school letters delayed.
"March 24 Update — Chancellor Joel Klein released a statement on the delay of high school letters today. “I understand you are anxious to receive this information, and rest assured, the Department of Education is doing everything possible to make the matches available soon,” it reads.
The statement acknowledges that the delay is being caused by the NAACP/teachers union lawsuit, but does not comment on the lawsuit or provide an estimated date for the letters’ release. It does state that the DOE will issue another update when it “knows more.”
March 23 — Eighth-graders anxiously awaiting receipt of high school acceptances letters tomorrow will have to be patient a while longer. How much longer is not clear. The letters, due to be distributed to students on March 24, are still being held up by court order because of a lawsuit filed against the Department of Education by the NAACP and the teachers union. The lawsuit charges that the DOE acted illegally in moving to close 19 schools."
Update: March 26, Judge Blocks Closing of 19 New York City Schools. The city will appeal. In the meantime, "The lawsuit had held up some 85,000 high school acceptance letters that were due out on Wednesday. The city’s interpretation of the ruling is that it clears the way for all those letters to go out next week, although the plaintiffs disagree.
Students were required to state their high school preferences in early December, around the time the department began to reveal which schools it wanted to close. About 8,500 applied to the schools proposed for closing and were notified later that they could not attend them. Those students will receive acceptance letters from other schools next week, along with a note saying that they could revert to their original choice if the school remains open. "
In Chicago, school assignments involved some high powered political wheeling and dealing: In Chicago, Obama Aide Had V.I.P. List for Schools.
HT: Parag Pathak
"March 24 Update — Chancellor Joel Klein released a statement on the delay of high school letters today. “I understand you are anxious to receive this information, and rest assured, the Department of Education is doing everything possible to make the matches available soon,” it reads.
The statement acknowledges that the delay is being caused by the NAACP/teachers union lawsuit, but does not comment on the lawsuit or provide an estimated date for the letters’ release. It does state that the DOE will issue another update when it “knows more.”
March 23 — Eighth-graders anxiously awaiting receipt of high school acceptances letters tomorrow will have to be patient a while longer. How much longer is not clear. The letters, due to be distributed to students on March 24, are still being held up by court order because of a lawsuit filed against the Department of Education by the NAACP and the teachers union. The lawsuit charges that the DOE acted illegally in moving to close 19 schools."
Update: March 26, Judge Blocks Closing of 19 New York City Schools. The city will appeal. In the meantime, "The lawsuit had held up some 85,000 high school acceptance letters that were due out on Wednesday. The city’s interpretation of the ruling is that it clears the way for all those letters to go out next week, although the plaintiffs disagree.
Students were required to state their high school preferences in early December, around the time the department began to reveal which schools it wanted to close. About 8,500 applied to the schools proposed for closing and were notified later that they could not attend them. Those students will receive acceptance letters from other schools next week, along with a note saying that they could revert to their original choice if the school remains open. "
In Chicago, school assignments involved some high powered political wheeling and dealing: In Chicago, Obama Aide Had V.I.P. List for Schools.
HT: Parag Pathak
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