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This chapter examines megaproject design and planning in two “shrinking cities” – Philadelphia, PA and Detroit, MI – and concludes that megaproject “metastasis,” or repeated expansions into surrounding urban fabrics, is promoting the reduction of downtown into a series of self-contained enclaves. While political coalitions are constructing megaprojects, or large public works and/or single buildings, in cities around the world, in the United States, single-building megaprojects motivated by “growth coalitions” of public and private development actors have proliferated in downtowns since 1990. The urban design impacts of these megaprojects on the surrounding urban fabric have been little studied. Data on the institutional history, physical expansion, and relationship of the megaprojects to the urban fabric is combined with a qualitative analysis of megaproject theory and its application to the American condition, as well as to the political economy of development in American shrinking cities. The chapter concludes that megaprojects such as convention centers and casinos tend to expand inexorably once they are introduced into the American downtown. This metastasis results in the destruction of existing older buildings and street networks, the consolidation of street blocks into ever-larger superblocks, and the eventual physical restructuring of downtowns into enclaves of older fabric amidst clusters of megaproject superblocks. Applying Jacobs’ (1992) theory of “moral hybrids” between “commerce and politics” to megaproject metastasis, the chapter argues that while megaprojects may be inevitable in American downtowns, they should be sited away from active, small-scale urban fabrics to reduce the negative impacts of future metastases. The chapter takes a design-oriented perspective on a phenomenon that is almost always understood from a political economy perspective alone. Megaprojects are significant physical entities, and the chapter clarifies their physical impacts on the urban fabric while indicating urban design policy directions to reduce these impacts in future.

Many individuals are concurrently eligible for multiple sources of government-reimbursed health care services (e.g. Department of Veterans Affairs (VA) and Medicare). Unclear is whether combined eligibility translates into increased access to care and/or improved outcomes of care. Alternatively continuity of care may suffer, promoting health inequalities when patients receive health services from multiple unrelated sources of care. The current study examines the impact of dual eligibility for government-reimbursed care on long-term outcomes of care for a population of veterans diagnosed with colorectal cancer and initially treated surgically at Department of Veterans Affairs Medical Centers.

This chapter proposes a more holistic approach to understanding work stress by incorporating eustress, the positive response to stressors. We begin by casting the study of eustress as part of a contemporary movement in both psychology and organizational behavior that accentuates the positive aspects of human adaptation and functioning. We discuss the development of the concept of eustress, and provide extensive evidence, both psychological and physiological, for the purpose of developing an explicit construct definition. An exploratory study of hospital nurses is presented as an initial test of our holistic model of stress. We conclude by asserting that there must exist a complement to coping with distress such that rather than preventing or resolving the negative side of stress, individuals savor the positive side of stress.

Misinterpretation of a negative test results in health screening may initiate less preventive effort and more future lifestyle-related disease. We predict that misinterpretation occurs more frequently among individuals with a low level of education compared with individuals with a high level of education.

The empirical analyses are based on unique data from a randomized controlled screening experiment in Norway, NORCCAP (NORwegian Colorectal Cancer Prevention). The dataset consists of approximately 50,000 individuals, of whom 21,000 were invited to participate in a once only screening with sigmoidoscopy. For all individuals, we also have information on outpatient consultations and inpatient stays and education. The result of health behaviour is mainly measured by lifestyle-related diseases, such as COPD, hypertension and diabetes type 2, identified by ICD-10 codes.

The results according to intention-to-treat indicate that screening does not increase the occurrence of lifestyle related diseases among individuals with a high level of education, while there is an increase for individuals with low levels of education. These results are supported by the further analyses among individuals with a negative screening test.

Health disparities exist because discrimination and poverty exist. However, health equity is the right of all. Regardless of differing backgrounds, all human beings should be able to access healthcare services when they experience a change in their physiological, psychological, and spiritual health. Misdiagnoses happen in health care. However, once data yield definitive researched findings of health disparities, the accountability of healthcare professionals begs the question of social justice. The patient is left angry and dismayed. It would seem the best way to move forward would be to forgive so that emotional healing can begin.

This chapter discusses the design of the LHS and the steps taken to ensure data privacy and security. Usage of the application programming interface (API) is discussed, paying attention to how an Electronic Health Record (EHR) provider would use the API. Finally, the clinician’s interaction with the system is discussed.

Purpose – Intravenous leiomyomatosis (IVL) is a very rare subtype of leiomyoma, involving the right obstruction of the heart, and is an unusual cause of outflow tract obstruction. The IVL grows from the vessel’s smooth muscle, protruding into the vessel’s lumen, and can expand to the right atrium and even beyond causing death due to blood flow obstruction into the right atrium and even to pulmonary artery.

Design/Methodology/Approach – We present a 33-year-old Indonesian woman with cardiopulmonary symptoms predominantly, and marked by an intravascular leiomyoma extending from inferior vena cava (IVC) to right chamber atrium, with the chief complaint being easily fatigued since seven months.

Findings – Echocardiography observations found a mass in the right atrium and the IVC that caused dynamics obstructed in tricuspid valve, right atrium and ventricle were dilated, no left ventricular (LV) hypertrophy, normal LV and right ventricular (RV) functions, and no valve abnormality except the tricuspid valve gradient being 21 mmHg with mild regurgitation. Venography resulted in a mobile tumor mass in IVC mouth which partially flew into the right atrium, and partially blocked the IVC mouth. Tumor size was 6.4 cm × 4.8 cm. Abdominal multislice computed tomography resulted in a residual soft tissue mass (leiomyoma) along the IVC extended to the right atrium. The tumor mass size in the IVC and the right atrium was bigger compared to tumor mass on July 2008. The correct diagnosis was established during surgery; therefore a two-stage resection was done.

Originality/Value – Surgical resection is the best treatment for intracardiac extension of intravenous leiomyoma. To remove the ilio-caval portion, iliac venotomy was recommended for the tumor in both stages of the surgeries.

Purpose – To estimate the impact of diabetic drug adherence on hospitalizations, emergency room (ER) visits, and hospital costs.

Methods – It is often difficult to measure the impact of drug adherence on hospitalizations since both adherence and hospitalizations may be correlated with unobservable patient severity. We control for such unobservables using propensity score methods and instrumental variables for adherence such as drug coinsurance levels and direct-to-consumer advertising.

Findings – We find a significant bias due to unobservable severity in that patients with more severe health are more apt to comply with medications. Thus, the relationship between adherence and hospitalization will be underestimated if one does not control for unobservable severity. Overall, we find that increasing diabetic drug adherence from 50% to 100% reduces the hospitalization rate by 23.3% from 15% to 11.5%. ER visits reduce by 46.2% from 17.3% to 9.3%. Although such an increase in adherence increases diabetic drug spending by $776 a year per diabetic, the cost savings for averted hospitalizations and ER visits are $886 per diabetic, a cost offset of $1.14 per $1.00 spent on diabetic drugs.

Originality – Most of the drug cost-offset literature focuses only on the impact of cost-sharing and drug spending on cost-offsets, making it impossible to back-out the empirical impact of actual drug adherence on cost-offsets. In this chapter, we estimate the direct impact of adherence on hospitalizations and costs.