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Despite heated debate about the pros and cons of online physician ratings, little systematic work has examined the correlation between physicians’ online ratings and their actual medical quality. Using the ratings of cardiac surgeons at RateMDs and the patient outcomes of coronary artery bypass graft surgeries in the 2013 Florida Hospital Inpatient Discharge Data, we investigate whether online ratings are informative about physicians’ medical quality. To account for potentially nonrandom matchings of patients of different severity levels to surgeons of different rating categories, we focus on patients who arrived through the emergency department and explicitly consider how observed and unobserved patient health conditions jointly affect the matching arrangements and surgical outcomes. Both reduced form and two-stage estimation results show that, compared with surgeons rated four stars or higher, or those without rating information, lower rated surgeons are associated with significantly higher in-hospital mortality rates. Our findings suggest that online physician ratings could be a valuable information source for patients to learn about physician quality, at least for cardiac surgeons, a specialty for which treatment outcomes are relatively observable to patients and their family members. The online appendix is available at https://doi.org/10.1287/mnsc.2017.2741 . This paper was accepted by Anandhi Bharadwaj, information systems.

Over the past 10 years, many healthcare organizations have made significant investments in automating their clinical operations, mostly through the introduction of advanced information systems. Yet the impact of these investments on staffing is still not well understood. In this paper, we study the effect of information technology (IT)-enabled automation on staffing decisions in healthcare facilities. Using unique nursing home IT data from 2006 to 2012, we find that the licensed nurse staffing level decreases by 5.8% in high-end nursing homes but increases by 7.6% in low-end homes after the adoption of automation technology. Our research explains this by analyzing the interplay of two competing effects of automation: the substitution of technology for labor and the leveraging of complementarity between technology and labor. We also find that increased automation improves the ratings on clinical quality by 6.9% and decreases admissions of less profitable residents by 14.7% on average. These observations are consistent with the predictions of an analytical staffing model that incorporates technology adoption and vertical differentiation. Overall, these findings suggest that the impact of automation technology on staffing decisions depends crucially on a facility’s vertical position in the local marketplace. The online appendix is available at https://doi.org/10.1287/mnsc.2016.2695 . This paper was accepted by Chris Forman, information systems.

During the 2000s, over a dozen U.S. states passed laws that prohibit healthcare employers from mandating overtime for nurses. Using a nationwide panel data set from 2004 to 2012, we find that these mandatory overtime laws reduced the service quality of nursing homes, as measured by an increase in deficiency citations. This outcome can be explained by two undesirable changes in the staffing hours of registered nurses : decreased hours of permanent nurses and increased hours of contract nurses per resident day. We observe that the increase in deficiency citations concentrates in the domains of administration and quality of care rather than quality of life, and the severity levels of the increased citations tend to be minor rather than major. We also find that the laws’ negative effect on quality is more severe in nursing homes with higher percentages of Medicare-covered residents. These observations are consistent with the predictions of a stochastic staffing model that incorporates demand uncertainty and operational flexibility. Furthermore, we rule out an alternative hypothesis that the quality decline is induced by an increase in nurse wages. This paper was accepted by Gad Allon, operations management .

An antagonist (MK-7123) of the cytokine receptor CXCR2 reduces neutrophil chemotaxis and thus may alleviate airway inflammation in chronic obstructive pulmonary disease (COPD). To assess the efficacy, safety, and tolerability of three dose levels of MK-7123, compared with placebo, in patients with moderate to severe COPD. This 6-month, double-blind study randomized patients with moderate to severe COPD (already on standard therapy) to daily MK-7123 at 10, 30, or 50 mg or placebo. The primary endpoint was change from baseline in post-bronchodilator FEV1. A total of 616 patients (71% male; mean age, 63 yr; 45% current smokers; baseline FEV1 [SD], 1.43 L [0.45]; mean FEV1 percent predicted, 43.9%) were randomized. Only MK-7123 50 mg led to significant improvement in FEV1 over placebo (mean difference [SE], 67 ml [32]). Reduced sputum neutrophil count was observed among the 122 patients examined; P = 0.003 (3 mo) and P = 0.092 (6 mo) (MK-7123 50 mg vs. placebo). The stratum of current smokers, but not that of nonsmokers, showed significant improvement versus placebo in FEV1 (168 ml) and time-to-first exacerbation, and showed numerical improvement in St. George's Respiratory Questionnaire for COPD score. MK-7123 caused a dose-dependent decrease in absolute neutrophil count (ANC) and reduced inflammatory biomarkers matrix metallopeptidase-9 and myeloperoxidase in plasma and sputum; ANC lower than 1.5 × 10(9)/L led to discontinuations with higher doses of MK-7123 (18% in the MK-7123 50-mg group vs. 1% in placebo). Plasma C-reactive protein and fibrinogen increased with MK-7123 treatment. Rates of infections at 6 months were similar in all groups. Treatment with MK-7123 50 mg versus placebo led to significant improvement in FEV1 in patients with COPD, suggesting clinically important antiinflammatory effects with CXCR2 antagonism, although dose-related discontinuations were observed because of ANC decreases with MK-7123. Greater response was observed in smokers versus ex-smokers. Clinical trial registered with www.clinicaltrials.gov (NCT 01006616).

We examine the evolution of economics research using a machine-learning-based classification of publications into fields and styles. The changing field distribution of publications would not seem to favor empirical papers. But economics' empirical shift is a within-field phenomenon; even fields that traditionally emphasize theory have gotten more empirical. Empirical work has also come to be more cited than theoretical work. The citation shift is sharpened when citations are weighted by journal importance. Regression analyses of citations per paper show empirical publications reaching citation parity with theoretical publications around 2000. Within fields and journals, however, empirical work is now cited more.

Climb atop shoulders and wait for funerals. That, suggested Newton and then Planck, is how science advances (more or less). We've come far since then, but many notions about how people and practices, policies, and resources influence the course of science are still more rooted in traditions and intuitions than in evidence. We can and must do better, lest we resign ourselves to “intuition-based policy” when making decisions and investments aimed at driving scientific progress. Science invited experts to highlight key aspects of the scientific enterprise that are steadily yielding to empirical investigation—and to explain how Newton and Planck got it right (and Einstein got it wrong). — Brad Wible

Teamwork pervades modern production, yet teamwork can make individual roles difficult to ascertain. The Mattheweffect suggests that communities reward eminent team members for great outcomes at the expense of less eminent team members. We study this phenomenon in reverse, investigating credit sharing after damaging events. Our context is article retractions in the sciences. We find that retractions impose little citation penalty on the prior work of eminent coauthors, but less eminent coauthors experience substantial citation declines, especially when teamed with eminent authors. These findings suggest a reverse Mattheweffect for team-produced negative events. A Bayesian model provides a candidate interpretation.

This paper describes the design of a low-current, multichannel, handheld electronic device integrated with nanostructured chemiresistor sensor arrays. A key design feature of the electronic circuit board is its low excitation current for achieving optimal performance with the arrays. The electronics can rapidly acquire the resistances for different sensors, not only spanning several orders of magnitude, but also as high as several hundreds of megaohms. The device tested is designed using a chemiresistor array with nanostructured sensing films prepared by molecularly-mediated assemblies of gold nanoparticles for detection. The low-current, wide-range, and auto-locking capabilities, along with the effective coupling with the nanostructured chemiresistor arrays, meet the desired performances of a low excitation current and low power consumption, and also address the potential instability of the sensors in a complex sensing environment. The results are promising for potential applications of the device as a portable sensor for the point-of-need monitoring of air quality and as a biosensor for point-of-care human breath screening for disease biomarkers.

Models of horizontal integration typically describe a trade-off between multiunit efficiencies and managerial agency costs. In extreme cases where managers cannot be incented contractually, private ownership is thought to be the primary organizational substitute. In this paper we explore geographic clustering as an alternative strategy for controlling managerial agency costs within the chain form of organization. Clustering may facilitate scale efficiencies in both monitoring and supervision, resulting in reduced agency costs and improved application of the chain's business model. We test this hypothesis in the nursing home industry, which is characterized by managerial contract costs resulting from multitask models of production. We find that clustered nursing homes achieve higher quality, conditional on labor inputs and patient characteristics. The clustering effect is concentrated on reductions in minor/potential harm violations, which are difficult to observe without close monitoring. Several proxies for local organizational experience (\"local learning\") cannot account for our findings, which are robust to a variety of alternative clustering definitions and competing explanations based on gaming behavior. Further tests indicate that chains endogenously pursue clustering, presumably to realize the benefits of improved quality outcomes. This paper was accepted by Bruno Cassiman, business strategy.

As one of the noninvasive screening and diagnostic tools for human breath monitoring of various diseases, chemiresistive devices with nanomaterials as the sensing interfaces for detecting volatile organic compounds (VOCs) have attracted increasing interests. A key challenge for the practical applications is an effective integration of all components in a system level. By integrating with the system components, it provides reliable and rapid results as a fast‐screening method for healthcare, safety, and environmental monitoring. This paper highlights some of the latest developments in chemiresistive sensors designed for the detection of VOCs and human breaths. It begins with a brief introduction to the fundamental principles of chemiresistive sensors with nanoparticle‐structured sensing interfaces. This is followed by a discussion of the recent fabrication methods, with an emphasis on nanostructured materials. Some of the recent examples will be highlighted in terms of recent innovative approaches to sensor applications and system integrations. Challenges and opportunities will also be discussed for the advancement and refinement of the chemiresistive sensor technologies in breath screening and monitoring of diseases.