Information frictions and access to the Paycheck Protection Program.

The Paycheck Protection Program (PPP) extended 669 billion dollars of forgivable loans in an unprecedented effort to support small businesses affected by the COVID-19 crisis. This paper provides evidence that information frictions and the "first-come, first-served" design of the PPP program skewed its resources towards larger firms and may have permanently reduced its effectiveness. Using new daily survey data on small businesses in the U.S., we show that the smallest businesses were less aware of the PPP and less likely to apply. If they did apply, the smallest businesses applied later, faced longer processing times, and were less likely to have their application approved. These frictions may have mattered, as businesses that received aid report fewer layoffs, higher employment, and improved expectations about the future.

Delivery quality assurance with ArcCHECK.

Radiation therapy requires delivery quality assurance (DQA) to ensure that treatment is accurate and closely follows the plan. We report our experience with the ArcCHECK phantom and investigate its potential optimization for the DQA process. One-hundred seventy DQA plans from 84 patients were studied. Plans were classified into 2 groups: those with the target situated on the diodes of the ArcCHECK (D plans) and those with the target situated at the center (C plans). Gamma pass rates for 8 target sites were examined. The parameters used to analyze the data included 3%/3 mm with the Van Dyk percent difference criteria (VD) on, 3%/3 mm with the VD off, 2%/2 mm with the VD on, and x/3 mm with the VD on and the percentage dosimetric agreement "x" for diode plans adjusted. D plans typically displayed maximum planned dose (MPD) on the cylindrical surface containing ArcCHECK diodes than center plans, resulting in inflated gamma pass rates. When this was taken into account by adjusting the percentage dosimetric agreement, C plans outperformed D plans by an average of 3.5%. ArcCHECK can streamline the DQA process, consuming less time and resources than radiographic films. It is unnecessary to generate 2 DQA plans for each patient; a single center plan will suffice. Six of 8 target sites consistently displayed pass rates well within our acceptance criteria; the lesser performance of head and neck and spinal sites can be attributed to marginally lower doses and increased high gradient of plans.

Early Life Health Interventions and Academic Achievement.

This paper studies the effect of improved early life health care on mortality and long-run academic achievement in school. We use the idea that medical treatments often follow rules of thumb for assigning care to patients, such as the classification of Very Low Birth Weight (VLBW ), which assigns infants special care at a specific birth weight cutoff. Using detailed administrative data on schooling and birth records from Chile and Norway, we establish that children who receive extra medical care at birth have lower mortality rates and higher test scores and grades in school. These gains are in the order of 0.15­0.22 standard deviations.

A case study for online plan adaptation using helical tomotherapy.

Helical tomotherapy's ability to provide daily megavoltage (MV) computed tomography (CT) images for patient set-up verification allows for the creation of adapted plans. As plans become more complex by introducing sharper dose gradients in an effort to spare healthy tissue, inter-fraction changes of organ position with respect to plan become a limiting factor in the correct dose delivery to the target. Tomotherapy's planned adaptive option provides the possibility to evaluate the dose distribution for each fraction and subsequently adapt the original plan to the current anatomy. In this study, 30 adapted plans were created using new contours based on the daily MVCT studies of a bladder cancer patient with considerable anatomical variations. Dose to the rectum and two planning target volumes (PTVs) were compared between the original plan, the dose that was actually delivered to the patient, and the theoretical dose from the 30 adapted plans. The adaptation simulation displayed a lower dose to 35% and 50% of the rectum compared to no adaptation at all, while maintaining an equivalent dose to the PTVs. Although online adaptation is currently too time-consuming, it has the potential to improve the effectiveness of radiotherapy.