In this observational study of Medicare beneficiaries who underwent LEJR, hospital participation in Bundled Payments for Care Improvement was not associated with changes in market-level lower extremity joint replacement volume and largely was not associated with changes in hospital case mix. These findings may provide reassurance regarding 2 potential unintended effects associated with bundled payments for LEJR.

Background: Extreme wildfire events are becoming more common and while the immediate risks to susceptible populations (i.e. elderly, asthmatics) are appreciated, the long-term health effects are not known. Historically, wildfire smoke exposure studies have consisted almost exclusively of retroactive health reports, including emergency department visits, hospital admissions, provider visits with emphasis on specific ICD codes. In 2017, the Seeley Lake, MT area experienced unprecedented levels of wildfire smoke from July 31 to September 18, with a daily average of 220.9 mg/m3. The aim of this study was to provide health assessments in the community as temporally close to the fires as possible and evaluate potential adverse health effects with multiple visits over two years. Additionally, the members of the community of Thompson Falls, MT were evaluated in 2018 as a comparison, due to their Northern Rockies location and 5-fold less smoke exposure during the same time period.Methods: Using the IPHARM (Improving Health Among Rural Montanans) infrastructure and experience to perform mobile health screenings, the Seeley Lake community was visited following the fires. The study resulted in the recruitment of a cohort (n=95, average age: 63 years), for a rapid response screening activity shortly following the wildland fire event, and two follow-up visits in 2018 and 2019. Results: The community experienced 35 of 49 days with >150 mg/m3 of PM2.5 which fell within the range of the Environmental Protection Agency designation of “very unhealthy”. Analysis of spirometry data found a significant decrease in lung function (FEV1/FVC ratio: forced expiratory volume in first second/forced vital capacity) and a more than doubling of participants that fell below the lower limit of normal (13.2% in 2017 to 41.7% in 2018) one year following the wildfire event, and remained decreased two years (35.9%) post exposure. In addition, observed FEV1 was significantly lower than predicted values. Conclusion: These findings suggest that wildfire smoke can have long-lasting effects on human health. As wildfires continue to increase both here and globally, understanding the health implications is vital to understanding the respiratory impacts of these events as well as developing public health strategies to mitigate the effects.

Much of the data underlying global poverty and inequality estimates is not in the public domain, but can be accessed in small pieces using the World Bank's PovcalNet online tool. To overcome these limitations and reproduce this database in a format more useful to researchers, we ran approximately 23 million queries of the World Bank's web site, accessing only information that was already in the public domain. This web scraping exercise produced 10,000 points on the cumulative distribution of income or consumption from each of 942 surveys spanning 127 countries over the period 1977 to 2012. This short note describes our methodology, briefly discusses some of the relevant intellectual property issues, and illustrates the kind of calculations that are facilitated by this data set, including growth incidence curves and poverty rates using alternative PPP indices. The full data can be downloaded at www. cgdev.org/povcalnet.

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and the USC Leonard Davis School for helpful comments. Alpert and Dykstra gratefully acknowledge financial support from a Leonard Davis Institute Pilot Grant. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.NBER working papers are circulated for discussion and comment purposes. They have not been peer-reviewed or been subject to the review by the NBER Board of Directors that accompanies official NBER publications.