Analysis of chronic emergency department use

This retrospective emergency department (ED) chart review study examined the relationship between acuity level and the type of insurance in a patient population who used the ED on a chronic basis (seven or more times in the calendar year 1996). Of 1,185 patients seen in the ED in 1996, 122 had between 7 and 29 visits. In the study population: 62.5% of their visits were classified as nonurgent; 42.6% of the nonurgent visits were made by those with insurance; the highest frequency of visits took place between 8:00 am and 4:00 pm when most alternative nonemergency facilities are open. Some of the factors seen as influencing overuse of the ED include: the fact that some chronic use appeared to be associated with psychiatric conditions including substance abuse and patients with recurrent chest pain; and patient's perceptions that access to lab and X-ray facilities are readily available within the ED.     

Employee contributions: a primer on their use, historical trends and overall fit within benefits strategy

This article focuses on the use of employee contributions as a strategic tool within employee health plans. While most employers require some form of employee contributions for health care, there is no clear "one-size-fits-all" solution. A myriad of strategies are in place, some active and some passive. This article reviews both common and emerging strategies and how they differ based on industry, employer size and region; discusses how employee contribution strategy fits within overall benefits strategy; and provides a strategic framework for approaching employee contributions in the future.     

Der deutsche Leistungsbilanzüberschuss — Fluch oder Segen?

Germany has one of the highest current account surpluses in the world. This is criticised by its global trading partners and is subject to the European Macroeconomic Imbalance Procedure. The authors interpret this phenomenon quite disparately. Some state that the surplus is not the result of continuously and structurally slower imports relative to export growth. Instead, two periods of weak domestic demand have left lasting traces. This should not result in programmes to stimulate the demand side. Others, however, find that Germany should identify ways to increase its domestic demand, especially its public and private investment, in order to reduce its surplus. It is hard to exactly quantify and target an appropriate level of the current account, and thus political action should focus directly on the distortions and misallocations that potentially result from an imbalance. By 2020, however, the German surplus is likely to decrease due to demographic developments, the housing boom and slowing globalisation. Since the rotation of fixed income assets out of Europe (“Euroglut”) is likely to continue, the outlook for the future value of the euro is therefore even more bearish.     

Estimating dynamic R&D choice: an analysis of costs and long‐run benefits

This article estimates a dynamic structural model of discrete Research and Development (R&D) investment and quantifies its cost and long‐run benefit for German manufacturing firms. The model incorporates linkages between R&D choice, product and process innovations, and future productivity and profits. The long‐run payoff to R&D is the proportional difference in expected firm value generated by the investment. It increases firm value by 6.7% for the median firm in high‐tech industries but only 2.8% in low‐tech industries. Simulations show that reductions in maintenance costs of innovation significantly raise investment rates and productivity, whereas reductions in startup costs have little effect.     

Understanding Absorptive Capacity from a Network Perspective

The term absorptive capacity refers to the notion that firms may have differing capabilities to innovate and to recognise the value of new knowledge, assimilate it, and apply it to creating business value. Developing such capabilities often requires firms to become part of a value network. We therefore apply the notion of absorptive capacity to the level of both the firm, and the wider value network in that it is embedded. The purpose of this research is to understand how absorptive capacity process may be moderated by contingent factors so that a more complete picture of absorptive capacity development emerges from our research. We identify from the literature on learning, innovation, and networks several theoretical perspectives that may help researchers to understand how contingent factors may facilitate and/or inhibit the development of absorptive capacity capabilities. We offer a set of propositions that may guide research into learning and innovation in business networks, and we discuss the managerial implications of these propositions.     

The role of conflict, culture, and myth in creating attitudinal commitment

Using qualitative methods, the authors examine commitment in the sports industry and specifically in a NASCAR context. Commitment, or the culmination of the customer-service provider relationship, plays a particularly critical role in NASCAR, for which more than 70% of fans consciously choose a current sponsor's brand over a competitor's. Previous research, primarily in the domain of business-to-business marketing, focuses on attitudinal, instrumental, and temporal components of commitment; this article examines attitudinal commitment within the NASCAR context. Whereas previous research conceptualizes attitudinal commitment as identification, value congruence, and affiliation, this research presents a wider view. Specifically, within the NASCAR consumption culture, hero/villain myths surrounding drivers create conflict that heightens attitudinal commitment to the sport. This research therefore offers implications regarding non-traditional components of attitudinal commitment.     

Competition among mechanism designers in a common value environment

A competitive economy is studied in which sellers offer alternative direct mechanisms to buyers who have private information about their own private use value for the commodity being traded. In addition the commodity has a common value to all buyers, perhaps represented by the future resale value of the commodity. A competitive equilibrium in mechanisms is described. In every such equilibrium it is shown that sellers must offer mechanisms that are allocationally equivalent to English ascending price auctions. The reservation prices that sellers set are shown to be below their ex post cost of trading the commodity. Received: 24 April 1998 / Accepted: 8 March 1999     

莲子心饮片含量测定方法优化

为了解决提取效率低而导致的市售莲子心含量项鲜有合格的问题,对莲子心饮片中有效成分的提取方法进行优化.分别对莲心碱的提取方式、提取溶剂以及提取溶剂体积进行了考察,利用优化后的提取方法制备莲子心饮片供试品溶液,选用Kromasil 100-5-C18(4.6 mm×150 mm)色谱柱,以乙腈-0.015 mol/L十二烷...     

Schooling,numeracy, and wealth accumulation: A study involving an agrarian population

Accumulating wealth is one of the main concerns for consumers. Higher education is widely associated with higher wealth, but the underlying reasons for this association remain unclear. Using data from a field study conducted with 218 adults in agrarian communities in Peru's Andean highlands, we explored the extent to which education, non-numeric fluid intelligence, crystallized intelligence, and numeracy skills were related to wealth. Wealth was measured using data on asset ownership (e.g., owning a fridge) and housing characteristics (e.g., toilet facilities). Structural equation modeling revealed that the level of schooling was associated with greater numeracy as well as greater non-numeric fluid and crystallized intelligence; only greater numeracy was associated with greater wealth. Our findings are consistent with the idea that education is linked with financial outcomes, at least in part, through the enhancement of cognitive skills, particularly numeracy that then leads to greater wealth accumulation.     

The impact of infrastructure investments on income inequality: Evidence from US states

Our analysis of US state-level data on an annual frequency, from 1976 to 2008, sheds new light on a plausible causal link between infrastructure investments, namely public spending on highways, and income inequality. This causal relationship is drawn out using the number of seats in the US House of Representatives Committee on Appropriations (HRCA) as an instrument to identify quasi-random variations in state-level spending on highways. An exogenous pattern which emerges when a state gains an additional member to the HRCA is that it is allocated with new federal grants. This increase in federal transfers for infrastructure financing results in slashing of expenditures on highways and a crowding-out effect of federal funding for state investments on highways. Spending cuts on highways produced by a new HRCA member being attained by a state can unwittingly cause income inequality to rise over a short 2-year time horizon. Similar challenges with decentralized development to finance infrastructure via federal transfers to state and sub-national governments may be encountered by other industrially advanced, emerging and low-income developing economies. US data over the mentioned period reveal a strong positive correlation with state spending on highways and wages paid for construction jobs. Suggestive evidence indicates that the construction sector also plays an important role in the transmission channel from a rise in state spending on highways to lowering income inequality, albeit during specific intervals, as opposed to on a long-term basis.