Managerial Incentives and Capital Management

In Holmstrom (1982) an example is given, which shows that a manager's concern for the value of his human capital will lead to a natural incongruity in risk-preferences between himself and the owners, even when no effort considerations are involved. In this paper we present a formal model of this channel of incongruity based on learning about managerial talent. We also explore the nature of an optimal incentive contract in the case where the manager may withhold but not misrepresent information about investment returns. The optimal contract is an option on the manager's human capital value with a possible bonus for investing. The optimal investment rule accepts fewer investments than under the cost of capital -- a commonly observed real world feature. Another phenomena the model helps explain is the extensive use of capital budgeting and rationing schemes in place of linear or non-linear price decentralization, which are shown to be less efficient modes of allocation.Incentives, managerial incentives, capital budgeting

A Search for Sigma^0_5, N^0_5 and Theta^++ Pentaquark States

A high-resolution (sigma_instr. = 1.5 MeV) search for narrow states (Gamma < 10 MeV) with masses of M_x approx 1500-1850 MeV in ep -> e'K^+ X, e'K^- X and e' pi^+ X electroproduction at small angles and low Q^2 was performed. These states would be candidate partner states of the reported Theta^+(1540) pentaquark. No statistically significant signal was observed in any of the channels at 90% C.L. Upper limits on forward production were determined to be between 0.7% and 4.2% of the Lambda(1520) production cross section, depending on the channel and the assumed mass and width of the state.Comment: 5 pages, 5 figures, to appear in Phys. Rev. C, update with responses to referee suggestion

A systematic review to examine the relationship between objective and patient-reported outcome measures in sinonasal disorders: Recommendations for use in research and clinical practice

Background: Common sinonasal disorders include chronic rhinosinusitis (CRS), allergic rhinitis (AR), and a deviated nasal septum (DNS), which often coexist with shared common symptoms including nasal obstruction, olfactory dysfunction, and rhinorrhea. Various objective outcome measures and patient-reported outcome measures (PROMs) are used to assess disease severity; however, there is limited evidence in the literature on the correlation between them. This systematic review aims to examine the relationship between them and provide recommendations.  Methods: A search of MEDLINE and EMBASE identified studies quantifying correlations between objective outcome measures and PROMs for the sinonasal conditions using a narrative synthesis.  Results: In total, 59 studies met inclusion criteria. For nasal obstruction, rhinomanometry shows a lack of correlation whereas peak nasal inspiratory flow (PNIF) shows the strongest correlation with PROMs (r > 0.5). The Sniffin’ Stick test shows a stronger correlation with PROMs (r > 0.5) than the University of Pennsylvania Smell Identification Test (UPSIT) (r < 0.5). Computed tomography (CT) sinus scores show little evidence of correlation with PROMs and nasal endoscopic ratings (weak correlation, r < 0.5).  Conclusion: Overall, objective outcome measures and PROMs assessing sinonasal symptoms are poorly correlated, and we recommend that objective outcome measures be used with validated PROMs depending on the setting. PNIF should be used in routine clinical practice for nasal obstruction; rhinomanometry and acoustic rhinometry may be useful in research. The Sniffin’ Sticks test is recommended for olfactory dysfunction with UPSIT as an alternative. CT scores should be excluded as a routine CRS outcome measure, and endoscopic scores should be used in combination with PROMs until further research is conducted

Implementing telephone triage in general practice: a process evaluation of a cluster randomised controlled trial

Background: Telephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. However, limited evidence exists of the challenges GP practices face in implementing telephone triage. We conducted a qualitative process evaluation alongside a UK-based cluster randomised trial (ESTEEM) which compared the impact of GP-led and nurse-led telephone triage with usual care on primary care workload, cost, patient experience, and safety for patients requesting a same-day GP consultation. The aim of the process study was to provide insights into the observed effects of the ESTEEM trial from the perspectives of staff and patients, and to specify the circumstances under which triage is likely to be successfully implemented. Here we report perspectives of staff. Methods: The intervention comprised implementation of either GP-led or nurse-led telephone triage for a period of 2-3 months. A qualitative evaluation was conducted using staff interviews recruited from eight general practices (4 GP triage, 4 Nurse triage) in the UK, implementing triage as part of the ESTEEM trial. Qualitative interviews were undertaken with 44 staff members in GP triage and nurse triage practices (16 GPs, 8 nurses, 7 practice managers, 13 administrative staff). Results: Staff reported diverse experiences and perceptions regarding the implementation of telephone triage, its effects on workload, and on the benefits of triage. Such diversity were explained by the different ways triage was organised, the staffing models used to support triage, how the introduction of triage was communicated across practice staff, and by how staff roles were reconfigured as a result of implementing triage. Conclusion: The findings from the process evaluation offer insight into the range of ways GP practices participating in ESTEEM implemented telephone triage, and the circumstances under which telephone triage can be successfully implemented beyond the context of a clinical trial. Staff experiences and perceptions of telephone triage are shaped by the way practices communicate with staff, prepare for and sustain the changes required to implement triage effectively, as well as by existing practice culture, and staff and patient behaviour arising in response to the changes made. Trial registration: Current Controlled Trials ISRCTN20687662. Registered 28 May 2009

A video life-world approach to consultation practice: The relevance of a socio-phenomenological approach

This article discusses the [development and] use of a video life-world schema to explore alternative orientations to the shared health consultation. It is anticipated that this schema can be used by practitioners and consumers alike to understand the dynamics of videoed health consultations, the role of the participants within it and the potential to consciously alter the outcome by altering behaviour during the process of interaction. The study examines health consultation participation and develops an interpretative method of analysis that includes image elicitation (via videos), phenomenology (to identify the components of the analytic framework), narrative (to depict the stories of interactions) and a reflexive mode (to develop shared meaning through a conceptual framework for analysis). The analytic framework is derived from a life-world conception of human mutual shared interaction which is presented here as a novel approach to understanding patient-centred care. The video materials used in this study were derived from consultations in a Walk-in Centre (WiC) in East London. The conceptual framework produced through the process of video analysis is comprised of different combinations of movement, knowledge and emotional conversations that are used to classify objective or engaged WiC health care interactions. The videoed interactions organise along an active or passive, facilitative or directive typical situation continuum illustrating different kinds of textual approaches to practice that are in tension or harmony. The schema demonstrates how practitioners and consumers interact to produce these outcomes and indicates the potential for both consumers and practitioners to be educated to develop practice dynamics that support patient-centred care and impact on health outcomes

Low Q^2 measurements of the proton form factor ratio mupGE/GMmu_p G_E / G_M

We present an updated extraction of the proton electromagnetic form factor ratio, mu_p G_E/G_M, at low Q^2. The form factors are sensitive to the spatial distribution of the proton, and precise measurements can be used to constrain models of the proton. An improved selection of the elastic events and reduced background contributions yielded a small systematic reduction in the ratio mu_p G_E/G_M compared to the original analysis.Comment: 12 pages, 5 figures, archival paper for proton form factor extraction from Jefferson Lab "LEDEX" experimen

A visual summary of the EUROCARE-4 results: a UK perspective

BACKGROUND: This paper provides a one-page visual summary of the previously published relative survival estimates for 42 types of cancers in 23 countries in Europe. METHODS: The cancer patients in these analyses were 15 years or older at the time of their diagnosis in the period 1995-1999. Follow-up was to the end of 2003 and relative survival estimates were computed by the cohort method. RESULTS: The analysis of 1-year survival had good discriminatory power and visibly separated a group of countries with consistently high survival estimates (Switzerland, France, Sweden, Belgium and Italy) and another group of countries with lower estimates (Poland, Czech Republic, Ireland, Denmark and United Kingdom-Northern Ireland). After the first year, there was less variation between the countries. CONCLUSION: To more fully understand the UK situation, a rational comparison would select countries with data-quality, prosperity and healthcare systems that are similar to the United Kingdom. In otherwise comparable populations, a pronounced difference in 1-year survival is most likely to be due to variation in a strong prognostic factor, which exerts its effect in the short term. A likely explanation for the short-term survival deficit in the United Kingdom compared with the Nordic countries is a less favourable stage distribution in the United Kingdom. However, the present superficial analysis does not exclude possible functions for other factors relating to the organisation and quality of cancer care services

Electroexcitation of the Δ+(1232)\Delta^{+}(1232) at low momentum transfer

We report on new p$(e,e^\prime p)\pi^\circ$ measurements at the $\Delta^{+}(1232)$ resonance at the low momentum transfer region. The mesonic cloud dynamics is predicted to be dominant and rapidly changing in this kinematic region offering a test bed for chiral effective field theory calculations. The new data explore the low $Q^2$ dependence of the resonant quadrupole amplitudes while extending the measurements of the Coulomb quadrupole amplitude to the lowest momentum transfer ever reached. The results disagree with predictions of constituent quark models and are in reasonable agreement with dynamical calculations that include pion cloud effects, chiral effective field theory and lattice calculations. The reported measurements suggest that improvement is required to the theoretical calculations and provide valuable input that will allow their refinements