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Moses III H.,Alerion Institute and Alerion Advisors LLC | Matheson D.H.M.,Boston Consulting Group | Dorsey E.R.,University of Rochester | George B.P.,University of Rochester | And 2 more authors.
JAMA - Journal of the American Medical Association | Year: 2013

Health care in the United States includes a vast array of complex interrelationships among those who receive, provide, and finance care. In this article, publicly available data were used to identify trends in health care, principally from 1980 to 2011, in the source and use of funds ("economic anatomy"), the people receiving and organizations providing care, and the resulting value created and health outcomes. In 2011, US health care employed 15.7%of the workforce, with expenditures of $2.7 trillion, doubling since 1980 as a percentage of US gross domestic product (GDP) to 17.9%. Yearly growth has decreased since 1970, especially since 2002, but, at 3%per year, exceeds any other industry and GDP overall. Government funding increased from 31.1%in 1980 to 42.3%in 2011. Despite the increases in resources devoted to health care, multiple health metrics, including life expectancy at birth and survival with many diseases, shows the United States trailing peer nations. The findings from this analysis contradict several common assumptions. Since 2000, (1) price (especially of hospital charges [+4.2%/y], professional services [3.6%/y], drugs and devices [+4.0%/y], and administrative costs [+5.6%/y]), not demand for services or aging of the population, produced 91%of cost increases; (2) personal out-of-pocket spending on insurance premiums and co-payments have declined from 23%to 11%; and (3) chronic illnesses account for 84%of costs overall among the entire population, not only of the elderly. Three factors have produced the most change: (1) consolidation, with fewer general hospitals and more single-specialty hospitals and physician groups, producing financial concentration in health systems, insurers, pharmacies, and benefit managers; (2) information technology, in which investment has occurred but value is elusive; and (3) the patient as consumer, whereby influence is sought outside traditional channels, using social media, informal networks, new public sources of information, and self-management software. These forces create tension among patient aims for choice, personal care, and attention; physician aims for professionalism and autonomy; and public and private payer aims for aggregate economic value across large populations. Measurements of cost and outcome (applied to groups) are supplanting individuals' preferences. Clinicians increasingly are expected to substitute social and economic goals for the needs of a single patient. These contradictory forces are difficult to reconcile, creating risk of growing instability and political tensions. A national conversation, guided by the best data and information, aimed at explicit understanding of choices, tradeoffs, and expectations, using broader definitions of health and value, is needed. Copyright 2013 American Medical Association. All rights reserved.


Druke M.,John Deere Werke Mannheim | Hoenig D.,Boston Consulting Group
International Journal of Production Research | Year: 2011

Uncertainty and the need for lean processes forces manufacturing companies to intensively deal with supply chain risk issues. The purpose of this article is the empirical investigation of supply chain risk management in small and medium-sized enterprises (SMEs). Using data from 67 manufacturing plants from the German automotive industry, differences between large-scale enterprises and SMEs are identified. After addressing the general question whether SMEs consider their supply chain as vulnerable, the key drivers of supply chain risks are analysed. Furthermore, instruments of supply chain risk management are investigated in terms of their suitability for creating a resilient supply chain by comparing SMEs with large-scale companies. Finally, this article examines existing differences with respect to how companies deal with risk. The analyses show that SMEs predominantly focus on reactive instruments that absorb risks through the creation of redundancies instead of preventing risks. © 2011 Taylor & Francis.


Chang H.H.,Boston Consulting Group | Larson J.,Boston Consulting Group | Blencowe H.,London School of Hygiene and Tropical Medicine | Spong C.Y.,U.S. National Institutes of Health | And 9 more authors.
The Lancet | Year: 2013

Background Every year, 1•1 million babies die from prematurity, and many survivors are disabled. Worldwide, 15 million babies are born preterm (<37 weeks' gestation), with two decades of increasing rates in almost all countries with reliable data. The understanding of drivers and potential benefit of preventive interventions for preterm births is poor. We examined trends and estimate the potential reduction in preterm births for countries with very high human development index (VHHDI) if present evidence-based interventions were widely implemented. This analysis is to inform a rate reduction target for Born Too Soon. Methods Countries were assessed for inclusion based on availability and quality of preterm prevalence data (2000-10), and trend analyses with projections undertaken. We analysed drivers of rate increases in the USA, 1989-2004. For 39 countries with VHHDI with more than 10 000 births, we did country-by-country analyses based on target population, incremental coverage increase, and intervention efficacy. We estimated cost savings on the basis of reported costs for preterm care in the USA adjusted using World Bank purchasing power parity. Findings From 2010, even if all countries with VHHDI achieved annual preterm birth rate reductions of the best performers for 1990-2010 (Estonia and Croatia), 2000-10 (Sweden and Netherlands), or 2005-10 (Lithuania, Estonia), rates would experience a relative reduction of less than 5% by 2015 on average across the 39 countries. Our analysis of preterm birth rise 1989-2004 in USA suggests half the change is unexplained, but important drivers include nonmedically indicated labour induction and caesarean delivery and assisted reproductive technologies. For all 39 countries with VHHDI, five interventions modelling at high coverage predicted a 5% relative reduction of preterm birth rate from 9•59% to 9•07% of livebirths: smoking cessation (0•01 rate reduction), decreasing multiple embryo transfers during assisted reproductive technologies (0•06), cervical cerclage (0•15), progesterone supplementation (0•01), and reduction of non-medically indicated labour induction or caesarean delivery (0•29). These findings translate to roughly 58 000 preterm births averted and total annual economic cost savings of about US$3 billion. Interpretation We recommend a conservative target of a relative reduction in preterm birth rates of 5% by 2015. Our findings highlight the urgent need for research into underlying mechanisms of preterm births, and development of innovative interventions. Furthermore, the highest preterm birth rates occur in low-income settings where the causes of prematurity might differ and have simpler solutions such as birth spacing and treatment of infections in pregnancy than in high-income countries. Urgent focus on these settings is also crucial to reduce preterm births worldwide. Funding March of Dimes, USA, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and National Institutes of Health, USA.


Fei J.,Columbia University | Fei J.,University of Illinois at Urbana - Champaign | Richard A.C.,Columbia University | Richard A.C.,National Institute of Arthritis and Musculoskeletal and Skin Diseases | And 3 more authors.
Nature Structural and Molecular Biology | Year: 2011

Translocation of tRNAs through the ribosome during protein synthesis involves large-scale structural rearrangement of the ribosome and ribosome-bound tRNAs that is accompanied by extensive and dynamic remodeling of tRNA-ribosome interactions. How the rearrangement of individual tRNA-ribosome interactions influences tRNA movement during translocation, however, remains largely unknown. To address this question, we used single-molecule FRET to characterize the dynamics of ribosomal pretranslocation (PRE) complex analogs carrying either wild-type or systematically mutagenized tRNAs. Our data reveal how specific tRNA-ribosome interactions regulate the rate of PRE complex rearrangement into a critical, on-pathway translocation intermediate and how these interactions control the stability of the resulting configuration. Notably, our results suggest that the conformational flexibility of the tRNA molecule has a crucial role in directing the structural dynamics of the PRE complex during translocation. © 2011 Nature America, Inc. All rights reserved. (c) 2011 Nature America, Inc. All rights reserved.


Moses H.,Alerion Advisors LLC | Matheson D.H.M.,Boston Consulting Group | Cairns-Smith S.,Boston Consulting Group | George B.P.,University of Rochester | And 3 more authors.
JAMA - Journal of the American Medical Association | Year: 2015

IMPORTANCE: Medical research is a prerequisite of clinical advances, while health service research supports improved delivery, access, and cost. Few previous analyses have compared the United States with other developed countries. OBJECTIVES: To quantify total public and private investment and personnel (economic inputs) and to evaluate resulting patents, publications, drug and device approvals, and value created (economic outputs). EVIDENCE REVIEW: Publicly available data from 1994 to 2012 were compiled showing trends in US and international research funding, productivity, and disease burden by source and industry type. Patents and publications (1981-2011) were evaluated using citation rates and impact factors. FINDINGS: (1) Reduced science investment: Total US funding increased 6%per year (1994-2004), but rate of growth declined to 0.8%per year (2004-2012), reaching $117 billion (4.5%) of total health care expenditures. Private sources increased from 46%(1994) to 58% (2012). Industry reduced early-stage research, favoring medical devices, bioengineered drugs, and late-stage clinical trials, particularly for cancer and rare diseases. National Insitutes of Health allocations correlate imperfectly with disease burden, with cancer and HIV/AIDS receiving disproportionate support. (2) Underfunding of service innovation: Health services research receives $5.0 billion (0.3%of total health care expenditures) or only 1/20th of science funding. Private insurers ranked last (0.04%of revenue) and health systems 19th (0.1%of revenue) among 22 industries in their investment in innovation. An increment of $8 billion to $15 billion yearly would occur if service firms were to reach median research and development funding. (3) Globalization: US government research funding declined from 57%(2004) to 50% (2012) of the global total, as did that of US companies (50% to 41%), with the total US (public plus private) share of global research funding declining from 57%to 44%. Asia, particularly China, tripled investment from $2.6 billion (2004) to $9.7 billion (2012) preferentially for education and personnel. The US share of life science patents declined from 57%(1981) to 51%(2011), as did those considered most valuable, from 73% (1981) to 59%(2011). CONCLUSIONS AND RELEVANCE: New investment is required if the clinical value of past scientific discoveries and opportunities to improve care are to be fully realized. Sources could include repatriation of foreign capital, new innovation bonds, administrative savings, patent pools, and public-private risk sharing collaborations. Given international trends, the United States will relinquish its historical international lead in the next decade unless such measures are undertaken. Copyright 2014 American Medical Association. All rights reserved.


Beres E.,Boston Consulting Group | Adve R.,King's College
IEEE Transactions on Wireless Communications | Year: 2010

We consider a half-duplex mesh network wherein a single source communicates to a destination with the help of N potential decode-and-forward relays. We develop the optimal selection of a relaying subset and allocation of transmission time. This resource allocation is found by maximizing over the rates achievable for each possible subset of active relays; in turn, the optimal time allocation for each subset is obtained by solving a linear system of equations. An assumed relay numbering imposes a causality constraint. We also present a recursive algorithm to solve the optimization problem which reduces the computational load of finding the required matrix inverses and the number of required iterations. We show that (i) optimizing transmission time significantly improves achievable rate; (ii) optimizing over the channel resources ensures that more relays are active over a larger range of signal-to-noise ratios; (iii) linear network constellations significantly outperform grid constellations; (iv) the achievable rate is robust to node ordering. © 2006 IEEE.


Banta S.,Columbia University | Dooley K.,Columbia University | Shur O.,Columbia University | Shur O.,Boston Consulting Group
Annual Review of Biomedical Engineering | Year: 2013

Nature's reliance on proteins to carry out nearly all biological processes has led to the evolution of biomolecules that exhibit a seemingly endless range of functions. Much research has been devoted toward advancing this process in the laboratory in order to create new proteins with improved or unique capabilities. The protein-engineering field has rapidly evolved from pioneering studies in engineering protein stability and activity to an application-driven powerhouse on the forefront of emerging technologies in biomedical engineering and biotechnology. A classic protein-engineering technique in the medical field has focused on manipulating antibodies and antibody fragments for various applications. New classes of alternative scaffolds have recently challenged this paradigm, and these structures have been successfully engineered for applications including targeted cancer therapy, regulated drug delivery, in vivo imaging, and a host of others. This review aims to capture recent advances in the engineering of nonimmunoglobulin scaffolds as well as some of the applications for these molecular recognition elements in the biomedical field. Copyright © 2013 by Annual Reviews.


Schierz P.G.,Boston Consulting Group | Schilke O.,Stanford University | Wirtz B.W.,Institute of Management Sciences
Electronic Commerce Research and Applications | Year: 2010

Mobile technology has become increasingly common in today's everyday life. However, mobile payment is surprisingly not among the frequently used mobile services, although technologically advanced solutions exist. Apparently, there is still a lack of acceptance of mobile payment services among consumers. The conceptual model developed and tested in this research thus focuses on factors determining consumers' acceptance of mobile payment services. The empirical results show particularly strong support for the effects of compatibility, individual mobility, and subjective norm. Our study offers several implications for managers in regards to marketing mobile payment solutions to increase consumers' intention to use these services. © 2009 Elsevier B.V. All rights reserved.


Bode J.N.,California Institute of Technology | Bode J.N.,Boston Consulting Group | Wegg C.,California Institute of Technology | Wegg C.,Max Planck Institute for Extraterrestrial Physics
Monthly Notices of the Royal Astronomical Society | Year: 2014

We consider the formation of extreme mass-ratio inspirals (EMRIs) sourced from a stellar cusp centred on a primary supermassive black hole (SMBH) and perturbed by an inspiraling less massive secondary SMBH. The problem is approached numerically, assuming the stars are non-interacting over these short time-scales and performing an ensemble of restricted three-body integrations. From these simulations, we see that not only can EMRIs be produced during this process, but the dynamics are also quite rich. In particular, most of the EMRIs are produced through a process akin to the Kozai-Lidov mechanism, but with strong effects due to the non-Keplerian stellar potential, general relativity and non-secular oscillations in the angular momentum on the orbital time-scale of the binary SMBH system. © 2013 The Authors Published by Oxford University Press on behalf of the Royal Astronomical Society.


Smith J.A.,Imperial College London | Anderson S.-J.,Imperial College London | Harris K.L.,Bill and Melinda Gates Foundation | McGillen J.B.,Imperial College London | And 4 more authors.
The Lancet HIV | Year: 2016

Background Many ways of preventing HIV infection have been proposed and more are being developed. We sought to construct a strategic approach to HIV prevention that would use limited resources to achieve the greatest possible prevention impact through the use of interventions available today and in the coming years. Methods We developed a deterministic compartmental model of heterosexual HIV transmission in South Africa and formed assumptions about the costs and effects of a range of interventions, encompassing the further scale-up of existing interventions (promoting condom use, male circumcision, early antiretroviral therapy [ART] initiation for all [including increased HIV testing and counselling activities], and oral pre-exposure prophylaxis [PrEP]), the introduction of new interventions in the medium term (offering intravaginal rings, long-acting injectable antiretroviral drugs) and long term (vaccine, broadly neutralising antibodies [bNAbs]). We examined how available resources could be allocated across these interventions to achieve maximum impact, and assessed how this would be affected by the failure of the interventions to be developed or scaled up. Findings If all interventions are available, the optimum mix would place great emphasis on the following: scale-up of male circumcision and early ART initiation with outreach testing, as these are available immediately and assumed to be low cost and highly efficacious; intravaginal rings targeted to sex workers; and vaccines, as these can achieve a large effect if scaled up even if imperfectly efficacious. The optimum mix would rely less on longer term developments, such as long-acting antiretroviral drugs and bNAbs, unless the costs of these reduced. However, if impossible to scale up existing interventions to the extent assumed, emphasis on oral PrEP, intravaginal rings, and long-acting antiretroviral drugs would increase. The long-term effect on the epidemic is most affected by scale-up of existing interventions and the successful development of a vaccine. Interpretation With current information, a strategic approach in which limited resources are used to maximise prevention impact would focus on strengthening the scale-up of existing interventions, while pursuing a workable vaccine and developing other approaches that can be used if further scale-up of existing interventions is limited. Funding Bill & Melinda Gates Foundation. © 2016 Smith et al. Open Access article distributed under the terms of CC BY

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