A survey of physicians in a large group practice

Job satisfaction surveys among physicians, a recent phenomenon, are a very important managerial tool to determine the work motivation needs of physician-employees. The first MD Job Survey was done in 1984 by Lichtenstein on physicians employed by prisons. The largest survey of salaried physicians to date has been the 1987 Health Services Research Center of Chapel Hill survey of physicians employed in group practices. Currently, individual group practices are surveying their staffs with job satisfaction questions in order to enhance the work environment.     

The RFad Method--a new fatigue recovery time assessment for industrial activities

This paper presents a study about fatigue recovery time assessment processes in work activities. It came about due to a demand presented by an automotive industry giant, in need of updating existing cycle time sheets and TAKT time parameters. The company decided to hire an Ergonomics Laboratory with ties to a major Brazilian University in order to evaluate current conditions and establish a new method to either calculate recovery times or validate existing assessment criteria, based in the ergonomics evaluation of the work activities. It is clear that there has been evident evolution in the industrial sector in the past two decades. It brought up fast modernization of industrial processes, not only in production but also in terms of management systems. Due to improved computer and robotics systems, combined with overall operational advancements - like the use of lighter hand tools and more effective hoist systems - most work activities have had its physical effort requirements reduced in the past decades. Thus, compensation factors built into production times need to be reviewed in order to avoid unnecessary costs associated to them. By using ergonomics considerations, we prevent simply removing the physical variables built in rest time calculations without taking on account, for example, additional cognitive load represented by the use of more sophisticated pieces of equipment.     

Modeling healthcare costs in simultaneous presence of asymmetry,heteroscedasticity and correlation

Highly skewed outcome distributions observed across clusters are common in medical research. The aim of this paper is to understand how regression models widely used for accommodating asymmetry fit clustered data under heteroscedasticity. In a simulation study, we provide evidence on the performance of the Gamma Generalized Linear Mixed Model (GLMM) and log-Linear Mixed-Effect (LME) model under a variety of data-generating mechanisms. Two case studies from health expenditures literature, the cost of strategies after myocardial infarction randomized clinical trial on the cost of strategies after myocardial infarction and the European Pressure Ulcer Advisory Panel hospital prevalence survey of pressure ulcers, are analyzed and discussed. According to simulation results, the log-LME model for a Gamma response can lead to estimations that are biased by as much as 10% of the true value, depending on the error variance. In the Gamma GLMM, the bias never exceeds 1%, regardless of the extent of heteroscedasticity, and the confidence intervals perform as nominally stated under most conditions. The Gamma GLMM with a log link seems to be more robust to both Gamma and log-normal generating mechanisms than the log-LME model.     

Experiences and issues in evaluating tool requirements using genetic algorithms

This paper is concerned with the optimization of tool requirements in flexible manufacturing systems (FMSs). The main aim is to determine the best tool spectrum (i.e. the number of duplicates for each tool type to be provided) considering different layouts of the tool management area (tool rooms). The optimization method is based on the reciprocal interaction between a genetic algorithm (GA) and the simulation model of the FMS considered. Thus, the results proposed refer to the efficacy of the technique adopted and its practical application to tool management.     

Understanding the Risk of an Avian Flu Pandemic: Rational Waiting or Precautionary Failure?

The precautionary principle (PP) has been proposed as the proper guide for the decision-making criteria to be adopted in the face of the new catastrophic risks that have arisen in the last decades. This article puts forward a workable definition of the PP based on the so-called alpha-maximin expected utility approach, applying it to the possible outbreak of the avian flu disease among humans. Moreover, it shows how the shortage and/or lack of effective drugs against the infection of the virus A(H5N1) among humans can be considered a precautionary failure.     

BANKS,DEBT AND RISK: ASSESSING THE SPILLOVERS OF CORPORATE TAXES

We find evidence of tax-driven strategic allocation of debt and asset risk across group entities of European banks. We evaluate the effects that establishing tax neutrality between debt and equity finance has on systemic risk, and show that the degree of coordination in implementing the hypothetical tax reform matters. In particular, a coordinated elimination of the tax advantage of debt would significantly reduce systemic losses in the event of a severe banking crisis. By contrast, uncoordinated tax reforms are not equally beneficial precisely because national tax policies generate spillovers through cross-border bank activities. (JEL G21, G28, H25)     

A visual planning solution to streamline the processes of hybrid cross-dockings

Cross-docking is a logistic strategy widely adopted both in manufacturing and distribution contexts. Despite the huge number of researches on this topic, most of them remain rather theoretical as they do not pay enough attention to operational aspects and daily functioning patterns of cross-dockings. This article aims at introducing a new focus for cross-docking research by proposing a visual planning solution to manage daily operation of a manufacturing cross-docking. By avoiding complex optimization algorithms and by adopting concepts belonging to the lean management theory, the article shows the potential of visual planning techniques to improve performance of cross-dockings. Starting from a specific industrial context, the shipping warehouse of an Italian company of the oil andand gas sector, a visual management methodology has been proposed to support the operation of cross-dockings. Although developed in a particular context, the proposed methodology and its underlying principles are to be considered general and potentially applicable to a wide range of cross-dockings. The methodology fully exploits an analytical tool, namely, the Safety Margin coefficientthat could be used for capacity planning purposes and to evaluate quantitatively the system performance at a given time instant.     

Explaining Italian “exceptionalism” and its end: Minimum income from neglect to hyper-politicization

Traditionally at the margins of the political debate, minimum income protection has recently become a key issue in Italian politics. After decades of social and political “neglect” letting Italy the only European country (with Greece) still lacking an anti-poverty minimum income safety net in the 2010s, finally a national programme called Inclusion Income was introduced in 2018, then replaced by a more robustly financed scheme, the Citizenship Income in 2019. The introduction of these new programmes was the object of an intense political debate, which raises two main puzzles. Why a policy field characterized by the low political resources of would be beneficiaries and low incidence on the overall welfare budget has become so important in the political debate? How did it occur in Italy, where minimum income protection had been absent in political discourses for at least five decades after World War II? To answer these questions, this article first elaborates a novel theoretical framework which combines the main properties of socio-political demand and political supply in order to explain the scope and direction of minimum income reforms. Second, it provides an analytically oriented reconstruction of MIS policy trajectory in Italy in the three different phases: the phase of MIS “neglect” (1948–1992) characterized by inertia; the period of political “contentiousness” (1993–2012), marked by attempts of path departure followed by policy reversals; the more recent phase leading to the introduction and institutionalization of a MIS. Third, the article provides a theoretically framed interpretation of the overall MIS trajectory in Italy.