Doing Well and Doing Good: Pioneer Employers Discover Profits and Deliver Opportunity for Frontline Workers

A new study of business practices reveals powerful ways to create strategic and financial gains. Lower-wage workers, when supported by effective policies, boost productivity, quality, innovation, and revenues from new markets. In the process, the value added by frontline employees rises and they garner significant and sustained wage gains and career advancement. The successful formulas of these firms are models adoptable by thousands of similar businesses

Recent results from COMPTEL observations of Cygnus X‐1

The COMPTEL experiment on the Compton Gamma‐Ray Observatory (CGRO) has now observed Cyg X‐1 on four separate occasions during phase 1 and phase 2 of its orbital mission (April, 1991 to August, 1993). Here we report on the results of the latest analysis of these data, which provide a spectrum extending to energies greater than 2 MeV. A spectral analysis of these data, in the context of a classical Comptonization model, indicates an electron temperature much higher than previous hard X‐ray measurements would suggest (200 keV vs 60–80 keV). This implies either some limitations in the standard Comptonization model and/or the need to incorporate a reflected component in the hard X‐ray spectrum. Although significant variability near 1 MeV has been observed, there is no evidence for any ‘MeV excess.

The HTA risk analysis chart: visualising the need for and potential value of managed entry agreements in health technology assessment

Background Recent changes to the regulatory landscape of pharmaceuticals may sometimes require reimbursement authorities to issue guidance on technologies that have a less mature evidence base. Decision makers need to be aware of risks associated with such health technology assessment (HTA) decisions and the potential to manage this risk through managed entry agreements (MEAs). Objective This work develops methods for quantifying risk associated with specific MEAs and for clearly communicating this to decision makers. Methods We develop the ‘HTA risk analysis chart’, in which we present the payer strategy and uncertainty burden (P-SUB) as a measure of overall risk. The P-SUB consists of the payer uncertainty burden (PUB), the risk stemming from decision uncertainty as to which is the truly optimal technology from the relevant set of technologies, and the payer strategy burden (PSB), the additional risk of approving a technology that is not expected to be optimal. We demonstrate the approach using three recent technology appraisals from the UK National Institute for Health and Clinical Excellence (NICE), each of which considered a price-based MEA. Results The HTA risk analysis chart was calculated using results from standard probabilistic sensitivity analyses. In all three HTAs, the new interventions were associated with substantial risk as measured by the P-SUB. For one of these technologies, the P-SUB was reduced to zero with the proposed price reduction, making this intervention cost effective with near complete certainty. For the other two, the risk reduced substantially with a much reduced PSB and a slightly increased PUB. Conclusions The HTA risk analysis chart shows the risk that the healthcare payer incurs under unresolved decision uncertainty and when considering recommending a technology that is not expected to be optimal given current evidence. This allows the simultaneous consideration of financial and data-collection MEA schemes in an easily understood format. The use of HTA risk analysis charts will help to ensure that MEAs are considered within a standard utility-maximising health economic decision-making framework

Social Perspective Taking

The current mindset of the Army is that it must be able to win our Nation’s wars while at the same time ready to assist in stability operations (U.S. Department of the Army, 2008). A challenge is that Soldiers often have to bridge large cultural gaps and may lack the language skills to effectively engage with the host of individuals now present in these operations including the local populace, host nation security forces, coalition partners and other foreign governmental and nongovernmental agencies. Perspective taking – described more formally as “Social Perspective Taking” (SPT) – is an interpersonal technique which may address these challenges. SPT is a skill often learned throughout life but may be very difficult in cross-cultural interactions. This report describes the results of a literature review and SME and Soldier interviews regarding the knowledge, skills, and abilities (KSAs) needed to develop SPT and the methods used to train SPT. Based on this information a four module curriculum is proposed which utilizes a four-step method for the development of SPT. The curriculum trains Soldiers how to accurately consider the host-national’s perspective without cultural bias and erroneous assumptions and allows Soldiers to meet host-national goals while accomplishing U.S. missions and objectives

Selective deletion of cochlear hair cells causes rapid age-dependent changes in spiral ganglion and cochlear nucleus neurons

During nervous system development, critical periods are usually defined as early periods during which manipulations dramatically change neuronal structure or function, whereas the same manipulations in mature animals have little or no effect on the same property. Neurons in the ventral cochlear nucleus (CN) are dependent on excitatory afferent input for survival during a critical period of development. Cochlear removal in young mammals and birds results in rapid death of target neurons in the CN. Cochlear removal in older animals results in little or no neuron death. However, the extent to which hair-cell-specific afferent activity prevents neuronal death in the neonatal brain is unknown. We further explore this phenomenon using a new mouse model that allows temporal control of cochlear hair cell deletion. Hair cells express the human diphtheria toxin (DT) receptor behind the Pou4f3 promoter. Injections of DT resulted in nearly complete loss of organ of Corti hair cells within 1 week of injection regardless of the age of injection. Injection of DT did not influence surrounding supporting cells directly in the sensory epithelium or spiral ganglion neurons (SGNs). Loss of hair cells in neonates resulted in rapid and profound neuronal loss in the ventral CN, but not when hair cells were eliminated at a more mature age. In addition, normal survival of SGNs was dependent on hair cell integrity early in development and less so in mature animals. This defines a previously undocumented critical period for SGN survival

Valuing Breastfeeding:Health Care Professionals’ Experiences of Delivering a Conditional Cash Transfer Scheme for Breastfeeding in Areas With Low Breastfeeding Rates

Alongside a randomized controlled trial testing the effectiveness of offering a cash transfer scheme (shopping vouchers) to mothers in areas with low breastfeeding rates, qualitative interviews were conducted with health care professionals delivering the scheme to explore their experiences. Health care professionals (n = 34; mainly midwives and health visitors) were interviewed in depth. Transcripts from recorded interviews were analyzed using a Framework Analysis approach. There was widespread acceptance of the scheme by health care professionals, with prior concerns regarding bribery and coercion being quickly allayed. Health care professionals reported that the scheme fitted in well with their routine ways of promoting and endorsing breastfeeding. They described their experiences of women’s positive reaction toward the scheme and how the scheme encouraged breastfeeding and gave breastfeeding higher value. Health care professionals reported that the incentives helped them engage women and promote and support breastfeeding in areas with low breastfeeding rates.</p

Improved COMPTEL maps of the milky way

In the course of the mission we have gradually developed an analysis method that separates in an iterative manner the celestial emission and the (a priori unknown) instrumental background. It has become our standard analysis tool for point sources. We illustrate here that this method is widely applicable now. It provides mutually consistent sets of model-fitting parameters (spectra) and sky maps, both for continuum and line studies. Because of the wide applicability, it has been possible to make various cross-checks while building up confidence in this procedure

Calculating the Expected Value of Sample Information in Practice: Considerations from Three Case Studies

Investing efficiently in future research to improve policy decisions is an important goal. Expected Value of Sample Information (EVSI) can be used to select the specific design and sample size of a proposed study by assessing the benefit of a range of different studies. Estimating EVSI with the standard nested Monte Carlo algorithm has a notoriously high computational burden, especially when using a complex decision model or when optimizing over study sample sizes and designs. Therefore, a number of more efficient EVSI approximation methods have been developed. However, these approximation methods have not been compared and therefore their relative advantages and disadvantages are not clear. A consortium of EVSI researchers, including the developers of several approximation methods, compared four EVSI methods using three previously published health economic models. The examples were chosen to represent a range of real-world contexts, including situations with multiple study outcomes, missing data, and data from an observational rather than a randomized study. The computational speed and accuracy of each method were compared, and the relative advantages and implementation challenges of the methods were highlighted. In each example, the approximation methods took minutes or hours to achieve reasonably accurate EVSI estimates, whereas the traditional Monte Carlo method took weeks. Specific methods are particularly suited to problems where we wish to compare multiple proposed sample sizes, when the proposed sample size is large, or when the health economic model is computationally expensive. All the evaluated methods gave estimates similar to those given by traditional Monte Carlo, suggesting that EVSI can now be efficiently computed with confidence in realistic examples.Comment: 11 pages, 3 figure

Re-examining Larson's Scaling Relationships in Galactic Molecular Clouds

The properties of Galactic molecular clouds tabulated by Solomon etal (1987) (SRBY) are re-examined using the Boston University-FCRAO Galactic Ring Survey of 13CO J=1-0 emission. These new data provide a lower opacity tracer of molecular clouds and improved angular and spectral resolution than previous surveys of molecular line emission along the Galactic Plane. We calculate GMC masses within the SRBY cloud boundaries assuming LTE conditions throughout the cloud and a constant H2 to 13CO abundance, while accounting for the variation of the 12C/13C with Galacto-centric radius. The LTE derived masses are typically five times smaller than the SRBY virial masses. The corresponding median mass surface density of molecular hydrogen for this sample is 42 Msun/pc^2, which is significantly lower than the value derived by SRBY (median 206 Msun/pc^2) that has been widely adopted by most models of cloud evolution and star formation. This discrepancy arises from both the extrapolation by SRBY of velocity dispersion, size, and CO luminosity to the 1K antenna temperature isophote that likely overestimates the GMC masses and our assumption of constant 13CO abundance over the projected area of each cloud. Owing to the uncertainty of molecular abundances in the envelopes of clouds, the mass surface density of giant molecular clouds could be larger than the values derived from our 13CO measurements. From velocity dispersions derived from the 13CO data, we find that the coefficient of the cloud structure functions, vo=sigma_v/R^{1/2}, is not constant, as required to satisfy Larson's scaling relationships, but rather systematically varies with the surface density of the cloud as Sigma^{0.5} as expected for clouds in self-gravitational equlibrium.Comment: Accepted by ApJ. Newest version includes modifications from the refere