The 'off-hour' effect in trauma care: a possible quality indicator with appealing characteristics

A recent paper has drawn attention to the paucity of widely accepted quality indicators for trauma care. At the same time, several studies have measured whether mortality of trauma patients changes between normal working time and other parts of the day/week, i.e. the so-called 'off-hour' or 'weekend' effect. This measure has the characteristics to become an accepted quality indicator because it combines the advantages of both outcome and process indicators. As an outcome indicator it would not need validation, a procedure particularly difficult in trauma care where gathering scientific evidence is more difficult than in other disciplines. As a process indicator it would provide indications about where to intervene to improve quality

Is social identity belief independent?

In this paper we aim to disentangle the effects on in-group favoritism driven by beliefs from those stemming from group identity, with the final goal of testing the relative power of three potential explanations of this bias: The Beliefs Driven Explanation (BDE), the Group Identity Explanation (GIE) and the Belief-mediated Group Identity Explanation (BGE). The BDE suggests that in-group favoritism is only driven by the desire not to let others’ expectations down. The GIE claims that people have a preference, per se, for members of their group. According to the BGE, people also have a preference for members of their group, but this is mediated by their second-order beliefs. To this aim, we built an experimental design able to produce exogenous variations in both group membership and expectations, hence providing a genuine test for the rationale of in-group bias. The results of our experiment suggest that beliefs per se are not a significant explanation of in-group favoritism and hence do not provide support to the BDE. Our experimental evidence does not provide support also to the BGE. We conclude that our experiment suggests to single out the GIE as the most powerful explanation of social identity

Dare per avere e dare per dare: due universi paralleli

Questo lavoro si propone di distinguere le differenti motivazioni che si trovano alla base delle scelte effettuate in un gioco dell’investimento. In particolare attraverso metodi diretti, basati sull’osservazione dei playoff e delle scelte, e indiretti, basati su questionari, si vogliono distinguere le motivazioni legate a preferenze sociali condizionate (come fiducia e reciprocità) da quelle incondizionate (altruismo e avversione alla diseguaglianza).Conditional and unconditional other-regarding preferences, trust, reciprocity, investment game, frame effect

A stranger in a strange land: Promises and identity

Social identity and communication are topics of increasing interest in management science. One’s social identity tends to lead one to favor those belonging to one’s group; this in-group bias may lead to problematic relationships. At the same time, communication has been found to have beneficial social consequences in controlled laboratory experiments. An important question is whether communication, by signaling a meeting of the minds, can improve trust and therefore outcomes between out-group members. We construct a simple weak mechanism of group favoritism that does in fact show in-group favoritism. When both paired individuals, one of whom will become the dictator, promise to make the pro-social dictator choice if they become dictator, favorable behavior is much more likely in all cases. But there is an intriguing pattern across group membership concerning the degree of improvement: Without mutual promises, people make more favorable choices for in-group members. Interestingly, this gap is eliminated by such promises. In this sense, strangers become partners

Promises and Partner-Switch

Abstract: Building on a partner-switching mechanism, we experimentally test two theories that posit different reasons why promises breed trust and cooperation. The expectation-based explanation (EBE) operates via belief-dependent guilt aversion, while the commitment-based explanation (CBE) suggests that promises offer commitment power via a (belief-independent) preference to keep one’s word. Previous research performed a similar test, which we however argue should be interpreted as concerning informal agreements rather than (unilateral) promises

The evolution of social pacts: An analytical perspective

In this paper we revisit the case for corporatist agreements in a model where labor markets are unionized, the government controls the fiscal stance, and an independent central bank sets monetary policy. We can then analyze the scope for a political exchange between public expenditure and wage setting choices, showing that corporatism may generate quite different macroeconomic outcomes from the traditional exchange between wage restraint and high public expenditure. In fact our model can easily encompass both first and second-generation corporatist agreements.Corporatism; trade unions; fiscal policy; monetary conservativeness; policy game

Guilt Aversion: Eve versus Adam

Our study contributes to a large literature in experimental economics that explores gender differences in how people are motivated. We focus on guilt aversion (GA), a surprisingly rather unexplored issue. Our experiment supports the idea that men are more GA than women. Our results also support different rationales in explaining observed similar behaviors, e.g., promise keeping. We provide a potential intuition for our findings, which is based on the pregnancy-related biological asymmetry between genders

A case-crossover study of alcohol consumption, meals and the risk of road traffic crashes

<p>Abstract</p> <p>Background</p> <p>The case-crossover (CC) design has proved effective to investigate the association between alcohol use and injuries in general, but has never been applied to study alcohol use and road traffic crashes (RTCs) specifically. This study aims at investigating the association between alcohol and meal consumption and the risk of RTCs using intrapersonal comparisons of subjects while driving.</p> <p>Methods</p> <p>Drivers admitted to an Italian emergency room (ER) after RTCs in 2007 were interviewed about personal, vehicle, and crash characteristics as well as hourly patterns of driving, and alcohol and food intake in the 24 hours before the crash. The odds ratio (OR) of a RTC was estimated through a CC, matched pair interval approach. Alcohol and meal consumption 6 and 2 hours before the RTC (case exposure window) were compared with exposures in earlier control windows of analogous length.</p> <p>Results</p> <p>Of 574 patients enrolled, 326 (56.8%) reported previous driving from 6 to 18 hours before the RTC and were eligible for analysis. The ORs (mutually adjusted) were 2.25 (95%CI 1.11-4.57) for alcohol and 0.94 (0.47-1.88) for meals. OR for alcohol was already increased at low (1-2 units) doses - 2.17 (1.03-4.57) and the trend of increase for each unit was significant - 1.64 (95%CI 1.05-2.57). In drivers at fault the OR for alcohol was 21.22 (2.31-194.79). The OR estimate for meal consumption seemed to increase in case of previous sleep deprivation, 2.06 (0.25-17.00).</p> <p>Conclusion</p> <p>Each single unit of acute alcohol consumption increases the risk of RTCs, in contrast with the 'legal' threshold allowed in some countries. Meal consumption is not associated with RTCs, but its combined effects with sleepiness need further elucidation.</p

ISS mapped from ICD-9-CM by a novel freeware versus traditional coding: a comparative study

<p>Abstract</p> <p>Background</p> <p>Injury severity measures are based either on the Abbreviated Injury Scale (AIS) or the International Classification of diseases (ICD). The latter is more convenient because routinely collected by clinicians for administrative reasons. To exploit this advantage, a proprietary program that maps ICD-9-CM into AIS codes has been used for many years. Recently, a program called ICDPIC trauma and developed in the USA has become available free of charge for registered STATA^®users. We compared the ICDPIC calculated Injury Severity Score (ISS) with the one from direct, prospective AIS coding by expert trauma registrars (dAIS).</p> <p>Methods</p> <p>The administrative records of the 289 major trauma cases admitted to the hospital of Udine-Italy from 1 July 2004 to 30 June 2005 and enrolled in the Italian Trauma Registry were retrieved and ICDPIC-ISS was calculated. The agreement between ICDPIC-ISS and dAIS-ISS was assessed by Cohen's Kappa and Bland-Altman charts. We then plotted the differences between the 2 scores against the ratio between the number of traumatic ICD-9-CM codes and the number of dAIS codes for each patient (DIARATIO). We also compared the absolute differences in ISS among 3 groups identified by DIARATIO. The discriminative power for survival of both scores was finally calculated by ROC curves.</p> <p>Results</p> <p>The scores matched in 33/272 patients (12.1%, k 0.07) and, when categorized, in 80/272 (22.4%, k 0.09). The Bland-Altman average difference was 6.36 (limits: minus 22.0 to plus 34.7). ICDPIC-ISS of 75 was particularly unreliable. The differences increased (p < 0.01) as DIARATIO increased indicating incomplete administrative coding as a cause of the differences. The area under the curve of ICDPIC-ISS was lower (0.63 vs. 0.76, p = 0.02).</p> <p>Conclusions</p> <p>Despite its great potential convenience, ICPIC-ISS agreed poorly with its conventionally calculated counterpart. Its discriminative power for survival was also significantly lower. Incomplete ICD-9-CM coding was a main cause of these findings. Because this quality of coding is standard in Italy and probably in other European countries, its effects on the performances of other trauma scores based on ICD administrative data deserve further research. Mapping ICD-9-CM code 862.8 to AIS of 6 is an overestimation.</p