Risk Estimation and Value-of-Information Analysis for Three Proposed Genetic Screening Programs for Chronic Beryllium Disease Prevention

Genetic differences (polymorphisms) among members of a population are thought to influence susceptibility to various environmental exposures. In practice, however, this information is rarely incorporated into quantitative risk assessment and risk management. We describe an analytic framework for predicting the risk reduction and value-of-information (VOI) resulting from specific risk management applications of genetic biomarkers, and we apply the framework to the example of occupational chronic beryllium disease (CBD), an immune-mediated pulmonary granulomatous disease. One described Human Leukocyte Antigen gene variant, HLA-DP beta 1*0201, contains a substitution of glutamate for lysine at position 69 that appears to have high sensitivity (approximately 94%) but low specificity (approximately 70%) with respect to CBD among individuals occupationally exposed to respirable beryllium. The expected postintervention CBD prevalence rates for using the genetic variant (1) as a required job placement screen, (2) as a medical screen for semiannual in place of annual lymphocyte proliferation testing, or (3) as a voluntary job placement screen are 0.08%, 0.8%, and 0.6%, respectively, in a hypothetical cohort with 1% baseline CBD prevalence. VOI analysis is used to examine the reduction in total social cost, calculated as the net value of disease reduction and financial expenditures, expected for proposed CBD intervention programs based on the genetic susceptibility test. For the example cohort, the expected net VOI per beryllium worker for genetically based testing and intervention is $13,000, $1,800, and $5,100, respectively, based on a health valuation of $1.45 million per CBD case avoided. VOI results for alternative CBD evaluations are also presented. Despite large parameter uncertainty, probabilistic analysis predicts generally positive utility for each of the three evaluated programs when avoidance of a CBD case is valued at $1 million or higher. Although the utility of a proposed risk management program may be evaluated solely in terms of risk reduction and financial costs, decisions about genetic testing and program implementation must also consider serious social, legal, and ethical factors.     

Supervising Professional Work under New Public Management: Evidence from an ‘Invisible Trade’

This paper assesses the extent to which the new public management (NPM) project has succeeded in replacing the custodial mode of professional work supervision with a more bureaucratic approach. The paper conceptualizes the key components of each mode within two ideal types of professional work supervision. It then draws on findings from a study of local‐authority social service departments to consider current arrangements against these ideal type configurations. The findings demonstrate that elements of the bureaucratic mode have emerged unevenly. So far, they have not displaced the emphasis that the supervisors of professional work place on protecting autonomy and limiting management control systems. This suggests that custodial approaches to the supervision of professional work may be more resilient than has been assumed within previous analyses of NPM.     

Who Reaps the Benefits,Who Bears the Risks? Comparative Optimism,Comparative Utility,and Regulatory Preferences for Mobile Phone Technology

Although the issue of risk target (e.g., self, others, children) is widely acknowledged in risk perception research, its importance appears underappreciated. To date, most research has been satisfied with demonstrating comparative optimism, i.e., lower perceived risk for the self than others, and exploring its moderators, such as perceived controllability and personal exposure. Much less research has investigated how the issue of target may affect benefit perceptions or key outcomes such as stated preferences for hazard regulation. The current research investigated these issues using data from a public survey of attitudes toward mobile phone technology (N= 1,320). First, results demonstrated comparative optimism for this hazard, and also found moderating effects of both controllability and personal exposure. Second, there was evidence of comparative utility, i.e., users believed that the benefits from mobile phone technology are greater for the self than others. Third, and most important for policy, preferences for handset regulation were best predicted by perceptions of the risks to others but perceived benefits for the self. Results suggest a closer awareness of target can improve prediction of stated preferences for hazard regulation and that it would be profitable for future research to pay more attention to the issue of target for both risk and benefit perceptions.     

Life cycles of growing organizations: A review with implications for knowledge and learning

Conceptualizing growth trajectories of organizations in organismic terms describing transitions through a series of stages, from birth to maturity, has considerable intuitive appeal. Recently, the assumptions underpinning the life‐cycle perspective (growth is linear, sequential, deterministic and invariant) have been argued not to pertain to organizations. This paper reviews the literature on life‐cycle growth models, traces the development of a growing sophistication of conceptualizing growth and highlights some of the limitations of the literature. The authors make a contribution by proposing an alternative conceptual framework for thinking about growing businesses. The framework consists of two dimensions. First, a typology of key issues that are likely to be faced by all growing firms, and the discussion is shaped by M. Gladwell's (The Tipping Point: How Little Things Can Make a Big Difference. Boston: Little Brown, 2000) notion of ‘tipping points’. The second dimension is developed by drawing on the knowledge management literature and the concept of absorptive capacity ( Cohen, W.M. and Levinthal, D.A. (1990 ). Absorptive capacity: a new perspective on learning and innovation. Administrative Science Quarterly, 35 , 128–152). This concept is applied to a discussion of the state of an organization regarding its ability to absorb and use new knowledge. Further, it is suggested that the framework has value for both policy and practice and can be used for the design and specification of interventional support and, to identify and evaluate their impact. If interventions are to help firms to grow, they must provide the right knowledge or support in forms that the firm can utilize. Together, these two dimensions provide a framework to examine firm growth issues and to analyse the effectiveness of different interventions on firms in different states within this framework.     

Competitive and Cooperative Positioning in Supply Chain Logistics Relationships*

Cooperative logistics relationships require the sharing of information, which must be enabled by the integration of disparate information systems across partners. In this article, we theorize business‐to‐business logistics relationships should be managed using cooperative and competitive postures. Based on data from 91 dyadic relationships using interorganizational information technology (IT), we find that performance gains accrue when parties share strategic information and customize IT; mutual trust enables IT customization and strategic‐information flows and equitable relationship‐specific investments positively impact IT customization, mutual trust, and performance. Among other scholarly and practical implications discussed, partners should compete on resources for IT customization and cooperate to share strategic information. Managers tend to think of relationships with firms as polar opposites and view them as entirely cooperative or entirely competitive. Our results support active balancing and understanding of both competitive and cooperative stances. Such an approach enables conditions for participation symmetry that yields greater performance gains.     

Learning How and Learning What: Effects of Tacit and Codified Knowledge on Performance Improvement Following Technology Adoption

This paper examines effects of tacit and codified knowledge on performance improvement as organizations gain experience with a new technology. We draw from knowledge management and learning curve research to predict improvement rate heterogeneity across organizations. We first note that the same technology can present opportunities for improvement along more than one dimension, such as efficiency and breadth of use. We compare improvement for two dimensions: one in which the acquisition of codified knowledge leads to improvement and another in which improvement requires tacit knowledge. We hypothesize that improvement rates across organizations will be more heterogeneous for dimensions of performance that rely on tacit knowledge than for those that rely on codified knowledge (H1), and that group membership stability predicts improvement rates for dimensions relying on tacit knowledge (H2). We further hypothesize that when performance relies on codified knowledge, later adopters should improve more quickly than earlier adopters (H3). All three hypotheses are supported in a study of 15 hospitals learning to use a new surgical technology. Implications for theory and practice are discussed.