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PurposeMeasuring the efficacy of workplace culture-shift efforts presented a substantial challenge in the author's research exploring how culture shifts during deliberate change initiatives. In response to this challenge this conceptual article proposes that the relative value participants attribute to desired culture outcomes can function as a proxy for measuring culture shift over time, providing applied researchers and practitioners with a simple way to measure efficacy of change initiatives.Design/methodology/approachThis conceptual article reviews the difficulties of defining and measuring workplace culture using widely known, contemporary models and instruments. It then builds an argument for using differential measurement of the relative value attributed to culture shift outcomes (valuing) as a proxy for workplace culture shift, followed by discussion of how to conduct measurement.FindingsThis article deductively demonstrates that parsimonious measurement of culture shift is not only simple and feasible, but that practitioners and researchers alike can use a valuing approach to determine the efficacy of efforts to shift workplace culture.Originality/valueUsed to complement existing methods and instruments, or on its own, this approach to measurement can build deeper insights into what is going on during deliberate change initiatives, while answering the reflexive questions “are we doing the right things,” and “are we doing those things the right way?”

Background: Pay for performance (P4P) is one of the most important issues in the health systems that promotes clinical quality, productivity, and patient satisfaction. Objectives: The current study aimed to identify and explain factors affecting the relative value of services and applying them in P4P in Iranian teaching-therapeutic centers. Methods: The current study was performed following a thematic analysis framework with an interview technique. The study population consisted of P4P experts in the six national-wide region of the country. Participants were selected using the purposeful and gradual sampling technique. Sampling was stopped upon reaching data saturation (i.e. 11 participants). Lincoln and Guba's evaluation method was used to determine reliability and validity. Qualitative data were analyzed using Nvivo version 12. Results: In total 13 basic themes and two organizer themes (i.e. technical and professional components) were identified regarding the factors affecting the relative value of health care services. Seven important elements in determining the professional component of the relative value of services included required time to perform the service, stress, knowledge, skill, experience, risk, as well as difficulty and complexity of the service. Conclusion: The model developed in the present study can be used to determine the total relative value of each service and setting tariff of medical services provided by health staff, including nurses.

Time-driven activity-based costing (TDABC) provides a powerful approach to more targeted cost accounting based on resources actually used by patients during a cycle of care. Since its introduction in 2004 by Kaplan and Anderson, TDABC has gained increasing popularity in defining the actual costs of care for various orthopaedic processes and pathways. TDABC may demonstrate lower costs of care compared with traditional cost accounting methods, including ratio of costs to charges and relative value units. Weaknesses of traditional methods include approaching costs through the lens of charges, revenue, processes and procedures, adopting a “top-down” approach, and potentially overestimating costs. In contrast, TDABC builds costs from the individual level, taking a front-line, condition-focused, and patient-centered view. Existing organizational decision-making is oriented around revenue metrics (relative value units and ratio of costs to charges) rather than cost metrics, yet alternative payment models are shifting toward fixed revenues for certain conditions or procedures. The variability, including both financial upside and loss, will primarily be a function of the cost of care—a number that is profoundly opaque in most health care settings. We view TDABC as an approach that sheds light on variation, offers a more granular differentiation of costs compared with traditional approaches, mitigates risk, and sparks opportunities for increasing operational efficiency and waste reduction. The goal is to identify and provide the greatest-value orthopaedic care.

Premise of research. Ex situ plant conservation can be improved through genetic analysis. One area of interest is the relative value of conserving smaller or larger populations and how sampling str...

Relative value units (RVUs) are the measure of value used in United States Medicare and Medicaid reimbursement. The Relative Update Committee (RUC) determines physician work RVU (wRVUs) based on operative time, technical skill and effort, mental effort and judgment, and stress. The primary aim of this study was to assess whether operative time is adequately accounted for in the wRVU system in pediatric urology.The American College of Surgeons National Surgical Quality Improvement Program Pediatric Participant User File (ACS-NSQIPP-PUF) was reviewed from 2012 to 2017. Most common single pediatric urology current procedural terminology (CPT) codes were included. The primary variable was wRVU per hour of operative time (wRVU/h). Linear regression analysis was used to assess the relative influence that operative time had on wRVU/h.25,432 cases were included in the final study population from 45 unique CPT codes. The median operative time was 79 min, and the median RVU/h was 12.2. Procedures with operative time less than 79 min had higher wRVU/h compared with procedures longer than 79 min (14.5 vs 10.5, p 0.001). Procedures with higher than average incidence of any complications had a lower wRVU/h (9.0 vs. 14.6 p 0.001). Linear regression analysis revealed that each additional hour of operative time was expected to decrease wRVU/h by 4.2 (-0.70 per 10 min, 95% CI: -0.71 to -0.69, p 0.001; RThis analysis of contemporary large pediatric population national-level data suggests that the wRVU system significantly favors shorter and less complex procedures in Pediatric Urology. Pediatric urologists performing longer and more complex procedures are not adequately compensated for the increase in complexity.Retrospective comparative study.

Positional control systems are characterized by the limitation of intermediate coordinates in transients. Such restrictions are implemented by a system with cascading controllers. The N-i switching method provides optimization of the speed of such control systems. In this paper, we study the three-loop system of subordinate regulation. The parameters of the relay-modal controllers were varied based on a change in the calculated amplitude of the control action without changing its real value. The parametric synthesis of such a system is based on optimal trajectories in terms of speed. The study of the control system at various settings revealed a different degree of deviation of transitional trajectories from the calculated one. This effect is due to the replacement of optimal regulator settings with modal ones in order to give the system a margin of stability. The obtained families of transient characteristics make it possible to construct empirical dependences of the duration of regulation on the relative value of the calculated amplitude of the control action. Such dependencies have pronounced extremes, which makes it possible to tune the system to a near optimal speed by preventing the regulators from entering the sliding mode prematurely. The performed simulation of the positional system with extremal settings confirms the effectiveness of the proposed methodology for the correction of dynamic characteristics. The results of the study open up the prospects of the practical implementation of relay-modal control algorithms for cascading systems, the synthesis of which is based on the N-i switching method.

Background Knowledge of Medicare reimbursement is essential for plastic surgeons providing care to Medicare beneficiaries. The authors sought to evaluate changes in Medicare reimbursement for common plastic surgery procedures from 2010 to 2020. Methods The authors assessed the Physician Fee Schedule of the Centers for Medicare and Medicaid Services website. Rates of work-, facility-, or malpractice-related relative value units and total monetary units for 26 common plastic surgery procedures between 2010 and 2020 were evaluated. Descriptive statistics were used to calculate relative differences and to compare observed changes over time with the rate of inflation. Results For the selected procedures, the authors found an average relative difference in terms of monetary units of an increase by 2.02 percent. However, after adjusting for inflation, the average relative difference was a decrease by 14.31 percent. The authors' analysis indicates that, on average, there was a 1.55 percent decrease in physician relative value units between 2010 and 2020. Conclusions Medicare reimbursement rates have changed significantly over the past decade. However, these changes did not keep pace with the rate of inflation. Plastic surgeons should be aware of these trends and advocate for more fair reimbursement rates.

Background Academic medical centers have increasingly adopted productivity-based compensation models for faculty. The potential exists for conflict between financial incentives and the quality of surgical resident education. This study aims to examine surgical residents’ perceptions regarding the impact of productivity-based compensation on education. Methods Following implementation of a productivity-based compensation plan, a survey of surgical residents (general surgery, plastic surgery, otolaryngology, urology, orthopedic surgery, and neurosurgery) was conducted to examine perceptions of its impact on didactics, patient care, surgical technique, teaching in the operating room, and financial considerations. Survey data were prospectively collected and analyzed. A retrospective analysis of relative value units (RVUs) was also performed. Results Following implementation of the productivity-based compensation plan, annual work RVUs increased by 8.9% in surgery as a whole, with increases observed within all surgical subspecialties. A total of 100 surveys were sent and 35 were completed (35% response rate and at least 30% within each surgical subspecialty). Forty-nine percent of participants perceived an increased focus on clinical productivity by faculty. Thirty-seven percent reported learning more about RVUs and Current Procedural Terminology coding. Most residents reported that the compensation plan did not have an impact on their education with respect to didactics (77%), patient care (94%), surgical technique (97%), and teaching in the operating room (83%). Conclusions Increased clinical productivity in the setting of an RVU-based compensation plan was not perceived by most surgical residents to have impacted their education. In some cases, this model may enhance education in relation to RVUs, Current Procedural Terminology coding, and the financial aspects of surgery.

EXECUTIVE SUMMARY Intensive care unit (ICU) telemedicine has grown exponentially to the point that approximately 10% of U.S. hospitals use such programs. However, no studies have focused on strategic decision tools in the context of rural hospitals. We applied the pervasive balanced scorecard framework and used a sequential, mixed methods design with qualitative and quantitative data sources. We then triangulated them to generate value scorecards for four rural South Carolina hospitals. Four domains, each with numerous components, were identified and compiled to create a composite value scorecard. Domains and numbers of components included organizational (n = 10), clinical (n = 5), financial (n = 8), and strategic (n = 3) effects of ICU telemedicine. When weighting each component within domains and then comparing across hospitals, we identified substantial variation in the relative value derived from ICU telemedicine. Our novel, multidimensional value scorecard could be prospectively applied by hospitals seeking a structured approach to decision-making for ICU telemedicine investments.

In order to simplify the workload and find a reliable method for screening soybeans with different phosphorus (P) efficiencies, 47 soybean varieties were screened from 90 varieties according to yield under normal phosphorus, and 10 indicators including root phenotype, phosphorus utilization efficiency at the seedling stage and yield were measured. Through single-index cluster analysis, the performance value and relative value of the above-mentioned indexes under low-phosphorus conditions were analyzed, and then, the combined indexes were analyzed by principal components method. The membership function method and the cluster analysis method was used to calculate and analyze the comprehensive score value. Three indexes of root P utilization efficiency (X1), relative value of root P utilization efficiency (X2), and root volume (X3) under low P at the seedling stage were selected as the most consistent with the yield screening results under low P condition, and the mathematical model of the comprehensive score value was obtained: D ​= ​1.218X1 + 0.320X2 + 0.007X3-0.664 (P ​= ​0.000, R2 ​= ​1.000). The comprehensive score can screen and identify the P efficiency of soybeans with fewer indexes in the early growth stages, which provides a more rapid and reliable mathematical model for screening and identifying a larger number of germplasm resources for P efficiency.

Objectives To evaluate monetary trends in government (Medicare) reimbursement rates for 20 commonly used orthopedic trauma surgical procedures over a 20-year period. Methods The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was queried for the 20 common Current Procedural Terminology (CPT) codes in orthopaedic trauma, and reimbursement data were extracted. All monetary data were adjusted for inflation to 2020 US dollars (USD) using changes to the US Consumer Price Index. Both the average annual and the total percentage change in reimbursement and in Relative Value Units were calculated for all included procedures. Results After adjusting for inflation, the average reimbursement for all procedures decreased by 30.0% from 2000 to 2020. Total Relative Value Units during this time increased by 4.4% on average. Procedures about the foot and ankle demonstrated the greatest decrease in the mean adjusted reimbursement at -42.6%, whereas procedures about the shoulder and upper extremity demonstrated the smallest mean decrease at 23.7% during the study period. From 2000 to 2020, the adjusted reimbursement rate for all included procedures decreased by an average of 1.5% each year. Conclusion To the best of our knowledge, this is the first study to comprehensively evaluate trends in procedural Medicare reimbursement for orthopaedic trauma. When adjusted for inflation, Medicare reimbursement for included procedures has steadily decreased from 2000 to 2020. Increased awareness and consideration of these trends will be important for policy makers, hospitals, and surgeons to assure continued access to meaningful surgical orthopaedic trauma care in the United States.

As a result of studies demonstrating a correlation between a patent’s value and its forward citation count, patent valuation using forward citations has been increasingly used by practitioners when a patent’s value has not been otherwise established. Although potential limitations of patent citation analysis have been discussed in the past, there is little empirical research demonstrating the sensitivity of estimated patent values to various assumptions embedded within the method. We first summarize an approach that has been used by prior practitioners to estimate the relative value of patents within a portfolio using forward citations, and then perform various analyses to investigate the sensitivity of the approach to certain assumptions. We find that some concerns of prior literature are well-founded, while others are less so. For example, we confirm that biased valuations will result from failure to properly control for patent age and technology. Our analysis also finds that truncation bias is a problem when analyzing recently issued patents, which confirms findings from existing literature. We estimate the rate at which such truncation bias dissipates as patents age and find that the bias for the median patent is reduced to below 10% within five years from the date of publication, although additional variation can remain on an individualized level. Regarding the issue of self-citations, we find that the valuation approach using forward citation analysis can be (but is not always) sensitive to the issue of self-citations, with a median difference of 16.8%. Finally, the valuation approach using forward citation analysis appears to be robust to assumptions underlying patent cohort construction.

Assortment optimization refers to the problem of designing a slate of products to offer potential customers, such as stocking the shelves in a convenience store. The price of each product is fixed in advance, and a probabilistic choice function describes which product a customer will choose from any given subset. We introduce the combinatorial assortment problem, where each customer may select a bundle of products. We consider a choice model in which each consumer selects a utility-maximizing bundle subject to a private valuation function, and study the complexity of the resulting optimization problem. Our main result is an exact algorithm for additive k -demand valuations, under a model of vertical differentiation in which customers agree on the relative value of each pair of items but differ in their absolute willingness to pay. For valuations that are vertically differentiated but not necessarily additive k -demand, we show how to obtain constant approximations under a “well-priced” condition, where each product’s price is sufficiently high. We further show that even for a single customer with known valuation, any sub-polynomial approximation to the problem requires exponentially many demand queries when the valuation function is XOS and that no FPTAS exists even when the valuation is succinctly representable.

Backgroud Many U.S. health care institutions have adopted compensation models based on work relative value units (wRVUs) to standardize payments and incentivize providers. A major determinant of payment and wRVU assignments is operative time. We sought to determine whether differences in estimated operative times between the Centers for Medicare & Medicaid Services (CMS) and the National Surgical Quality Improvement Program (NSQIP) contribute to payment and wRVU misvaluation for the most common shoulder/elbow procedures. Methods We collected data on wRVUs, payments, and operative times from CMS for 29 types of isolated arthroscopic and open shoulder/elbow procedures. Using regression analysis, we compared relationships between these variables, in addition to median operative times reported by NSQIP (2013-2016). We then determined the relative valuation of each procedure based on operative time. Results Seventy-nine percent of CMS operative time were longer than NSQIP time (R2 = 0.58), including, but not limited to, shoulder arthroplasty and arthroscopic shoulder surgery. The correlation between payments and operative times was stronger between CMS data (R2 = 0.61) than NSQIP data (R2 = 0.43). Similarly, the correlation between wRVUs and operative times was stronger when using CMS data (R2 = 0.87) than NSQIP data (R2 = 0.69). Nearly all arthroscopic shoulder procedures (aside from synovectomy, debridement, and decompression) were highly valued according to both datasets. Per NSQIP, compensation for revision total shoulder arthroplasty ($10.14/min; 0.26 wRVU/min) was higher than that for primary cases ($9.85, 0.23 wRVU/min) and nearly twice the CMS rate for revision cases ($5.84/min; 0.13 wRVU/min). Conclusions CMS may overestimate operative times compared to actual operative times as recorded by NSQIP. Shorter operative times may render certain procedures more highly valued than others. Case examples show that this can potentially affect patient care and incentivize higher compensating procedures per operative time when less-involved, shorter operations have similar patient-reported outcomes.

Due to increasing urbanization, the distribution of human settlements is changing and this has led to the rapid decline of vegetation cover in cities and townships. Urbanization tends to decrease the proportion of land that is dedicated to public green spaces. Therefore, residential gardens (private gardens) will need to play a major role in contributing to urban green space in future though presently little attention is given to their relative value and importance. Several factors influence the function of residential gardens in an urban area. The main objective of this paper is to evaluate the socio demographic factors that influence the size and presence of residential green spaces in an urban residential zone. As a case study, this research selected a primary residential zone in Galle City, Sri Lanka. Every housing unit (n=280) in a residential zone was surveyed to collect the data for multiple regression analysis. The analysis showed that factors such as land extent (LE), nature orientation (NO), perceptions about advantages of growing residential greenery (PA), perception about disadvantages resulting from residential garden (PDA), occupational status (husband and wife are not occupied) (D1), and their educational level (higher than degree) (D2) significantly affect to the extent of green area maintained by an urban residence. The relationship between extent of residential green space (EGA) and socio demographic factors can be explained by this model: EGA = 0.091 + 0.003LE + 0.060NO + 0.030PA – 0.040PDA + 0.198D1 + 0.240D2.

In this study, we evaluate the relationship between long-term variability of facial hue information in physiological and psychological regions of interests (ROIs) and health condition. Long-term facial hue information, RGB, and L*a*b* color space, were obtained from 13 physiological and psychological ROIs in visible facial images measured for approximately six months. In this study, the evaluation was performed based on four conditions (absolute value of RGB, absolute value of L*a*b*, relative value of RGB, and relative value of L*a*b*). These four long-term variabilities of facial hue information were applied to principal component analysis to clarify the relationship between facial hue information and health condition. The results suggested that long-term variability of chromaticity information around the periorbital region may be related to health conditions. Furthermore, physiological and psychological states related to health condition were estimated with the accuracy of approximately 80% using relative chromaticity information around the periorbital region.

The past decade witnessed a rapid rise in the public reporting of surgeon- and hospital-specific quality-of-care measures. However, patients’ interpretations of star ratings and their importance relative to other considerations (for example, cost, distance traveled) are poorly understood. We conducted a discrete choice experiment in an outpatient setting (an academic joint arthroplasty practice) to study trade-offs that patients are willing to make in choosing a provider for a hypothetical total joint arthroplasty. Two hundred consecutive new patients presenting for hip or knee pain in 2018 were included. The average patient was willing to pay $2,607 and $3,152 extra for an additional hospital or physician star, respectively, and an extra $11.45 to not travel an extra mile for arthroplasty care. History of prior surgery and prior experience with rating systems reduced the relative value of an incremental star by $539.25 and $934.50, respectively. Patients appear willing to accept significantly higher copayments for higher quality of care, and surgeon quality seems relatively more important than hospital quality. Further study is needed to understand the value and trust patients place in publicly reported hospital and surgeon quality ratings.

Based on a Friends episode, this text investigates perceptions concerning museum education, discusses disparities in regard to the relative value and power assigned to professionals in museums, and reflects on the relevance of education as a core purpose of these institutions. It comments on the conceptual heritage left by the first public policies of culture and reflects on the updating of and decolonizing actions in museums. It discusses how knowledge is constructed and questions the rise of new nomenclatures for museum education. Finally, it reflects on the new definition of museum, and the unfortunate removal of the term “education” from the definition as one of the institution’s main purposes. Teniendo como referencia un episodio de la serie Friends, el texto investiga examina las percepciones sobre la acción educativa en los museos, analiza las disparidades internas relativas al valor y poder entre los profesionales de los museos y reflexiona sobre la relevancia de la educación como núcleo de estas instituciones. Comenta los legados conceptuales de las primeras políticas públicas de cultura y reflexiona sobre las actualizaciones decolonizadoras en los museos. Debate cómo se construye el conocimiento y cuestiona el surgimiento de nuevas nomenclaturas para la educación museal. Por último, reflexiona sobre la nueva definición de Museo, y la eliminación o falta del término educación como uno de los principales propósitos de esta institución.

One of the processed milk products is Ultra Taro UHT milk. The aim of this research was to analyze Ultra Taro UHT milk’s importance level of attributes and combinations of the attributes which are preferred based on consumer preferences. This study was quantitative correlational using a questionnaire with a full profile presentation method. The study was conducted for one month, with 60 respondents determined by the purposive sampling method. Data was processed using the conjoint method. In this research, 4 product attributes were used, there are flavor with 3 levels, volume with 3 levels, fat content with 2 levels, and type of packaging with 2 levels. The results showed the level of importance value, attribute flavor with a relative value of 34.44%, volume and packaging types have similar relative value of 27.79%, and fat content with a relative value of 9.97%. The combination of attributes favored by consumers was the fifth stimuli with a total use value of 3.8283 consisting of taro balanced milk flavor attributes, 200 ml volume contents, low fat, and tetra pack packaging types. The results of the conjoint have significant correlation with the opinion of respondents with a positive Kendall Tau correlation value of 0.889.

Global self-esteem is a component of individual personality that impacts decision-making. Many studies have discussed the different preferences for decision-making in response to threats to a person’s self-confidence, depending on global self-esteem. However, studies about global self-esteem and non-social decision-making have indicated that decisions differ due to reward sensitivity. Here, reward sensitivity refers to the extent to which rewards change decisions. We hypothesized that individuals with lower global self-esteem have lower reward sensitivity and investigated the relationship between self-esteem and reward sensitivity using a computational model. We first examined the effect of expected value and maximum value in learning under uncertainties because some studies have shown the possibility of saliency (e.g. maximum value) and relative value (e.g. expected value) affecting decisions, respectively. In our learning task, expected value affected decisions, but there was no significant effect of maximum value. Therefore, we modelled participants’ choices under the condition of different expected value without considering maximum value. We used the Q-learning model, which is one of the traditional computational models in explaining experiential learning decisions. Global self-esteem correlated positively with reward sensitivity. Our results suggest that individual reward sensitivity affects decision-making depending on one’s global self-esteem.

Background It's estimated that 40% to 60% of patients undergoing major orthopedic surgery of the hip or knee who do not receive thromboprophylaxis will develop deep venous thrombosis Instituto Nacional de Traumatologia e Ortopedia has established a guideline to prevent DVT with the administration of the Enoxaparin. Recently, institute stakeholders have been questioning this guideline as new oral anticoagulants that offer more comfort and efficacy, but present higher risk of bleeding, have been appearing in the market for treating deep venous thrombosis. Objective This study aims to validate the application of a multicriteria decision analysis in a real-world problem, the use of rivaroxaban and enoxaparin to prevent deep venous thrombosis. Methods The multicriteria method MACBETH (Measuring Attractiveness by a Categorical Based Evaluation Technique) was used in a decision conferencing process to develop an evaluation model for measuring the relative value of the drugs on each evaluation criterion, separately and globally. The model-building process was informed by a literature review and meta-analysis of randomized clinical trials with a critical appraisal of the evidence. Results We report a model-structure with eight criteria, each one associated with a weighting coefficient and value function. Following a simple additive aggregation process, the model-outputs showed that Rivaroxaban was considered a robust option for DVT. Sensitivity analysis and robustness analysis were performed and testify the consistency of the results. Conclusion This article contributes to literature by showing how MACBETH method can be combined with scientific evidence and participatory group processes, for health technology assessment in hospitals.

With growing social science interest in the potential for images to facilitate access to embodied experience, this study re-examines the relative value of visual and verbal methods in body-oriented research. Taking one lead from Kyrölä’s (2016) idea of body image as the relationship between representation and corporeality, and another from Gendlin’s (1993, 1995, 1997) methods for attending to and articulating from pre-reflective experience, we develop a method that juxtaposes words and images to explore the role of pre-reflective understanding on body image among teenage girls. The study highlights both an influencing role for pre-reflective understanding in body image and the availability of pre-reflective understanding to participants. While recognising persistent challenges in communicating embodied experience, we propose a method for engaging and working with embodied or pre-reflective experience in social science research by integrating the verbal and the visual in a specific way.

Health systems strengthening (HSS) is firmly on the global health and development agenda. While a growing evidence base seeks to understand the effectiveness of HSS, there is limited evidence regarding cost and cost-effectiveness. Without such evidence, it is hard to argue that HSS represents value for money and the level of investment needed cannot be quantified. This paper seeks to review the literature regarding the economic evaluation of HSS from low- and middle-income country (LMIC) settings, and to contribute towards the development of methods for the economic evaluation of HSS. A systematic search for literature was conducted in PubMed, Scopus and the Health Systems Evidence database. MeSH terms related to economic evaluation were combined with key words related to the concept of HSS. Of the 204 records retrieved, 52 were retained for full text review and 33 were included. Of these, 67% were published between January 2015 and June 2019. While many HSS interventions have system wide impacts, most studies (71%) investigated these impacts using a disease-specific lens (e.g. the impact of quality of care improvements on uptake of facility deliveries). HSS investments were categorized, with the majority being investments in platform efficiency (e.g. quality of care), followed by simultaneous investment in platform efficiency and platform capacity (e.g. quality of care and task shifting). This review identified a growing body of work seeking to undertake and/or conceptualize the economic evaluation of HSS in low- and middle-income countries. The majority assess HSS interventions using a disease-specific or programmatic lens, treating HSS in a similar manner to the economic evaluation of medicines and diagnostics. While this approach misses potential economies of scope from HSS investments, it allows for a preliminary understanding of relative value for money. Future research is needed to complement the emerging evidence base.

Commonsense morality seems to feature both agent-neutral and agent-relative elements. For a long time, the core debate between consequentialists and deontologists was which of these features should take centerstage. With the introduction of the consequentializing project and agent-relative value, however, agent-neutrality has been left behind. While I likewise favor an agent-relative view, agent-neutral views capture important features of commonsense morality.This article investigates whether an agent-relative view can maintain what is attractive about typical agent-neutral views. In particular, I argue that the agent-relative reasons-wielding deontologist is ultimately able to capture those features ordinarily associated with agent-neutral views, while the agent-relative value wielding consequentialist is left with a dilemma. The consequentializer either succumbs to the concerns of her agent-neutral opponents or else abandons the distinctive and attractive features of her view. Either way, I conclude that agent-relative value is best left behind.

Implementing quantitative signals in a corporate bond portfolio can be challenging owing to high transaction costs, large variations of liquidity across individual bonds, and the requirement to follow a benchmark index. The authors design realistic simulations that illustrate the performance and characteristics of quantitatively managed portfolios of liquid corporate bonds with attractive value and momentum characteristics. They show how to implement a turnover budget to explicitly control rebalancing volumes. Such realistic strategy portfolios have significantly outperformed the Bloomberg Barclays US Corporate Bond Index after transaction costs, with information ratios above 1 since 2007. The results of this study support the case for style factor investing in credit. TOPICS:Performance measurement, portfolio construction, simulations, style investing Key Findings ▪ Relative value and equity momentum styles can be successfully implemented in corporate bond portfolios net of transaction costs. ▪ We explain how to overcome challenges related to identifying liquid tradable securities with attractive value and momentum characteristics, keeping transaction costs in check, and following a benchmark index at the same time. ▪ Index-tracking portfolios that match key exposures of the US Corporate index, but also overweight bonds with attractive value and momentum characteristics, significantly outperformed the benchmark index after transaction costs, with information ratios above 1 since 2007.

Experimental studies on newsvendor ordering behavior offer conflicting explanations as to the cause of the deviation from the optimal risk-neutral behavior. With one exception, studies have neither explored prospect theory as possible explanations, nor investigated exactly how this prospecting behavior comes to be. We conduct two experiments and demonstrate that a newsvendor, indeed, exhibits prospecting behavior and that this behavior is triggered by the relative value of the overage and the underage costs. These relative values help create a frame of reference that puts the newsvendor in either a gain-frame or a loss-frame. When the overage cost is less than the underage cost, a newsvendor is in a loss-frame and acts in a risk-seeking manner by ordering more than the optimal, and when the overage cost is more than the underage cost, the newsvendor is in a gain-frame and acts in a risk-averse manner by ordering less than the optimal, as prospect theory suggests. We also show the newsvendor does not use mean demand anchoring with insufficient adjustment heuristic to determine either the initial or the subsequent order quantity. The newsvendor is willing to change the decision in response to changes in parameters, consistent with prospect theory. Two forms of feedback are also supplied; however, feedback does not result in improved decision-making with a commensurate reduction in either systematic bias or prospecting behavior. Surprisingly, the newsvendor becomes more risk-seeking over time rather than risk-neutral. We conclude with a discussion of our findings, managerial insights, and possible future directions.

Akeel Bilgrami (2016) has argued against the scientistic method and its treatment of ethical values by declaring it a superstition of science for not considering values to be part of nature. This paper agrees with the concept of the engaged self discussed by Bilgrami in order to make sense of ethical values. However, it attempts to argue against the conceptual incoherence by juxtaposing value properties and the engaged self. The incoherence can be avoided by following a Wittgensteinian understanding of ethical values which has been explicated very briefly, yet in a significant way, in Tractatus Logico–Philosophicus and also in A Lecture on Ethics in some detail., Akeel Bilgrami (2016) zauzeo je stav protiv sijentističke metode i njezina postupanja prema etičkim vrijednostima tako da ju je proglasio praznovjerjem znanosti s obzirom na to da ne smatra da su vrijednosti dio prirode. Autor ovoga rada suglasan je s konceptom zauzetoga ja, o čemu Bilgrami raspravlja kako bi učinio smislenima etičke vrijednosti. Međutim rad nastoji argumentirati protiv koncepcijske nekoherentnosti tako da suprotstavlja svojstva vrijednosti i zauzeto ja. Nekoherentnost se može izbjeći slijedeći wittgensteinsko shvaćanje etičkih vrijednosti, što je obrazloženo vrlo sažeto, ali na istaknut način, u djelu Tractatus Logico–Philosophicus, a također u Predavanju o etici nešto detaljnije.

This paper claims that deontological and consequentialist ethics are best distinguished with reference to different assumptions concerning moral accountability and accounting. Deontological ethics can thereby be defended against the accusation of inordinate concern with the moral purity of agents. Moreover, deontological ethics can and should reject being based on the concept of agent-relative value. Even under the assumption that deontological ethics can be consequentialized, agent-relative value need not play a fundamental role. This is not the same as denying agent-relativity a key role in deontological ethics. Deontological moral accounting of universal value should be regarded as agent-relative, whereas consequentialist accounting assumes a shared moral account of all moral agents.

OBJECTIVES To determine the personnel costs and revenue generated by embedding a behavioral health nurse practitioner (BHNP) in primary care clinics to evaluate and manage adolescent behavioral health needs. STUDY DESIGN We estimated personnel costs and revenue from a quality improvement project undertaken at 4 clinic sites between August 1, 2016, and July 31, 2018, at a large multispecialty medical group in northern California. METHODS Costs were estimated by identifying the actual hours spent by the BHNP and for medical assistant (MA) support and using Bureau of Labor Statistics national data on wages and benefits. Revenue was estimated by analyzing Current Procedural Terminology (CPT) codes for BHNP visits from the Epic electronic health record and corresponding relative value units (RVUs), based on 135% of 2018 nationally unadjusted Medicare rates. RESULTS We estimate 2-year revenue of $144,449 and personnel costs (salary + benefits) of $90,431. The BHNP work totaled 1083 hours, and MA support totaled 312 hours. Using a nurse practitioner wage of $53.70/hour and an MA wage of $16.95/hour, total salary costs were $63,451; we then added benefits costs. Using the CPT codes assigned to the 768 encounters with 207 unique patients, we estimated generation of 1640 RVUs and total revenue of $144,449. CONCLUSIONS This analysis found that personnel costs ($90,514) of a primary care-embedded BHNP are 63% of the potential revenue generated ($144,449). This analysis suggests that a primary care BHNP could be a cost-saving and patient-centered way to reduce the burden on primary care providers while meeting the growing needs of adolescents with behavioral health needs.

Although relative value units are used to measure physician productivity, research has demonstrated incongruencies between relative value units and actual surgeon work effort. We sought to determine whether this variation extends across surgical specialties.A retrospective review of surgical cases was conducted using the 2017 American College of Surgeons National Surgical Quality Improvement Program database. For each case, we identified the primary Current Procedural Terminology, surgical specialty, total relative value units, and 5 alternative measures of work effort. We then examined the correlation between a Current Procedural Terminology's mean total relative value unit and work effort. Finally, we constructed a multivariable linear regression model to evaluate the association between surgical specialty and the expected mean total relative value unit adjusting for work effort and patient characteristics.A total of 876,515 cases met the inclusion criteria. Overall, median operative time correlated well with mean total relative value unit (R = 0.85), though it was lowest for cardiac surgery (R = 0.51) and highest for otolaryngology (R = 0.97). Neurosurgery had the greatest increase in mean total relative value unit per hour of operative time (12.9/h). Mean total relative value unit correlated modestly with length of stay (R = 0.58) and serious adverse events (R = 0.61) and weakly with readmission (R = 0.42) and mortality (R = 0.29). When holding these metrics constant, the multivariable model showed mean total relative value units differed according to surgical specialty alone. Compared with general surgery, neurosurgery and cardiac surgery earned 3.41 to 3.61 additional mean total relative value units (P.05), while orthopedics, otolaryngology, thoracic, urology, and vascular surgery received fewer mean total relative value units (-1.84 to -4.43, P.05).Surgeon productivity is increasingly measured using relative value units. While mean total relative value units correlate well with operative time, they may not reflect other aspects of work effort. Differences in mean total relative value units by surgical specialty demonstrate potential inequities in the determination of physician productivity.

Background Understanding the differences in how patient complexity varies across surgical specialties can inform policy decisions about appropriate resource allocation and reimbursement. This study evaluated variation in patient complexity across surgical specialties and the correlation between complexity and work relative value units. Study design The 2017 American College of Surgeons National Surgical Quality Improvement Program was queried for cases involving otolaryngology and general, neurologic, vascular, cardiac, thoracic, urologic, orthopedic, and plastic surgery. A total of 10 domains of patient complexity were measured: American Society of Anesthesiologists class ≥4, number of major comorbidities, emergency operation, major complications, concurrent procedures, additional procedures, length of stay, non-home discharge, readmission, and mortality. Specialties were ranked by their complexity domains and the domains summed to create an overall complexity score. Patient complexity then was evaluated for correlation with work relative value units. Results Overall, 936,496 cases were identified. Cardiac surgery had the greatest total complexity score and was most complex across 4 domains: American Society of Anesthesiologists class ≥4 (78.5%), 30-day mortality (3.4%), major complications (56.9%), and mean length of stay (9.8 days). Vascular surgery had the second greatest complexity score and ranked the greatest on the domains of major comorbidities (2.7 comorbidities) and 30-day readmissions (10.1%). The work relative value units did not correlate with overall complexity score (Spearman’s ρ = 0.07; P Conclusion Substantial differences exist between patient complexity across specialties, which do not correlate with work relative value units. Physician effort is determined largely by patient complexity, which is not captured appropriately by the current work relative value units.

Purpose – The purpose of this paper is to determine the factors influencing Malaysian consumer toward intention to purchase Takaful scheme for mental health disorders. Design/methodology – This paper adopts a quantitative approach by using an extended Theory of Reasoned Action (TRA) model. A pilot study with the total of 60 questionnaires were obtained from online survey to examine the significance relationship using multiple regression analysis. Findings – The result from this study portrays that subjective norm are strong predictors of a Malaysian consumer intention to purchase Takaful scheme for mental health disorders. Moreover, factors such as awareness, perception and attitude have positive and significant impacts on consumer intention to purchase takaful scheme for mental health disorders in Malaysia. Research limitation – There are some constraints. First, it focuses only on the actions of Malaysian consumers against a takaful scheme for mental health disorders; thus, the findings cannot be generalized to other takaful schemes. Therefore, more studies in other takaful settings, such as general takaful, need to begin. Second, this study considered only four factors were awareness, perception, attitude and subjective norm, and the factors selected might not cover all the factors which may have an effect on Malaysia's intentions toward takaful mental health disorders scheme. Originality - This study not only helps takaful operators design, develop and promote better approved takaful products and services, but also offers a new insight into how these products and services can be marketed to these particular consumers. Previous empirical studies that employed TRA focused on various types of variables, such as attitude and subjective norm, especially in the financial service environment. This research thus adds to the body of information by analysing the relative value of the goal affecting it.

The purpose of this article is to describe this use of relative value units (RVUs) among nurse practitioners (NP), including the challenges NPs may experience. Relative value units were developed as a means to determine reimbursement for health care based on time spent with the patient and skills required to complete the interaction, while addressing any disparities of reimbursement based on geography or insurance. Increasingly, providers such as NPs are being evaluated based in large part on how many RVUs they generate, which seems to prioritize productivity and may overlook many nonbillable aspects of the NP role such as emotional support or patient education. Nurse practitioners working in settings that require more invasive procedures may seem to be more productive on paper, regardless of the number of patients seen. Relative value units may not adequately reflect the skill and time taken to care for patients with chronic illness. Gender differences have been noted, both in terms of the number of RVUs generated for care of male or female patients, and those generated by male or female providers. If NPs are evaluated primarily based on productivity as measured by RVUs, we must consider how this might minimize or even invalidate the therapeutic relationship and holistic approach to patient care. Relative value units may negatively affect the willingness of NPs to serve as preceptors. Finally, as NPs experience less face-to-face time with patients and more demands for productivity, there may be a loss of quality care and professional integrity, which raises the risk of burnout among NPs.

OBJECTIVE The cost of training neurosurgical residents is especially high considering the duration of training and the technical nature of the specialty. Despite these costs, on-call residents are a source of significant economic value, through both indirectly and directly supervised activities. The authors sought to identify the economic value of on-call services provided by neurosurgical residents. METHODS A personal call log kept by a single junior neurosurgical resident over a 2-year period was used to obtain the total number of consultations, admissions, and procedures. Current Procedural Terminology (CPT) codes were used to estimate the resident’s on-call economic value. RESULTS A single on-call neurosurgical resident at the authors’ institution produced 8172 work relative value units (wRVUs) over the study period from indirectly and directly supervised activities. Indirectly supervised procedures produced 7052 wRVUs, and directly supervised activities using the CPT modifier 80 yielded an additional 1120 wRVUs. Using the assistant surgeon billing rate for directly supervised activities and the Medical Group Management Association nationwide median neurosurgery reimbursement rate, the on-call activities of a single resident generated a theoretical billing value of $689,514 over the 2-year period, or $344,757 annually. As a program, the on-call residents collectively produced 39,550 wRVUs over the study period, or 19,775 wRVUs annually, which equates to potential reimbursements of $1,668,386 annually. CONCLUSIONS Neurosurgery residents at the authors’ institution theoretically produce enough economic value exclusively from on-call activities to far exceed the cost of their education. This information could be used to more precisely estimate the true overall cost of neurosurgical training and determine future graduate medical education funding.

Humans usually assess options not in terms of absolute value, but relative to reference points. The framing of alternatives can strongly affect human decision-making, leading to different choices depending on the context within which options are presented. Similar reference-point effects have been recently reported in ants, in which foragers show contrast effects: Ants overvalue a medium-quality food source if they were expecting a poor one, and vice versa for expectations of good food. However, studies of human consumer psychology have demonstrated that expectations, for instance, from product labels, can drive value perception in the opposite direction, via a process of assimilation. For example, an expensive bottle of wine is perceived as more enjoyable compared with a cheaper bottle, even if the wine is the same. In this study, we demonstrate a similar labeling-association effect in an insect: Ants showed assimilation effects by spending twice as long drinking at medium-quality food if it was scented with an odor previously associated with high quality than if it was scented with a poor-quality label. The presence of odor cues in the food during consumption and evaluation is critical, as without them, odor-driven expectations of quality result in contrast, not assimilation effects. The addition of a quality label in the food thus reverses contrast effects and causes value to be aligned with expectations, rather than being contrasted against them. As value judgment is a key element in decision-making, relative value perception strongly influences which option is chosen and ultimately how choices are made. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Humans have, since time immemorial, contested over territory and, given its connection to resource access, attached great importance thus. Contestation over territory, especially when it is of significant scale, typically occurs via group-level articulation rather than individual. Such claims are all too often rooted in, legitimised by, and resisted on the grounds of, the ethnicity of the group(s) in question—hence ethno-national conflict. Indeed, conflict between ethnic groups, be it violent or non-violent, while not a constant, has been a frequent feature of our modern age. This article aims to identify the key contributory factors that sit behind ethno-national conflict. Particular attention will be paid to factors spanning across categories that hold a considerable amount of explanatory sway, namely, structural, political, and economic. However, light attention will also be given to ‘other factors’ such as those that fall within environmental and cultural categories. For all the contributory factors identified, supportive empirical evidence will be used to demonstrate their relative value.

The focus on short-term graduate employment metrics has catalysed the employability agenda as a strategic directive in universities. A raft of embedded, co-curricular, and extra-curricular activities has emerged for developing employability. Their relative value lacks empirical exploration. This study explored graduates’ self-reported participation in, and their perspectives on the value of, a range of embedded, extra-curricular, and co-curricular learning activities, as well as paid work, for employability. Survey data were gathered (N = 510) from Business and Creative Industries graduates from three Australian universities about the perceived value of activities for skill development, gaining relevant experience, networking, and creating employment opportunities. The activities were considered more useful for gaining experience and skills than for broadening networks and improving career outcomes. Embedded and extra-curricular internships, as well as extra-curricular activities, were believed to be important for enhancing employability. Internships organised as an extra-curricular activity rated better than those delivered as work-integrated learning. Implications for stakeholders responsible for curricular and co-curricular design are discussed.

Grand infrastructure projects, such as dam, power plant, petroleum, and gas industry projects, have several contractors working on them in several independent sub-projects. The concern of reducing the duration of these projects is one of the important issues among various aspects; thus, our aim is to fulfill the requirements by using the game theory approach. In this study, a mixed-integer programming model consisting of game theory and project scheduling is developed to reduce the duration of projects with a minimum increase in costs. In this model, two contractors in successive periods are entered into a step-by-step competition by the employer during dynamic games, considering an exchange in their limited resources. The optimum solution of the game in each stage are selected as the strategy, and the resources during the game are considered to be renewable and limited. The strategy of each contractor can be described as follows: 1) share their resources with the other contractor and 2) not share the resources with the other contractor. This model can act dynamically in all circumstances during project implementation. If a player chooses a non-optimum strategy, then this strategy can immediately update itself at the succeeding time period. The proposed model is solved using the exact Benders decomposition method, which is coded in GAMS software. The results suggest the implementation of four step-by-step games between the contractors. Then, the results of our model are compared with those of the conventional models. The projects’ duration in our model is reduced by 22.2%. The nominal revenue of both contractors has also reached a significant value of 46078 units compared with the relative value of zero units in the original model. Moreover, we observed in both projects the decreases of 19.5%, 20.9%, and 19.7% in the total stagnation of resources of types 1, 2, and 3, respectively.

Yermishev Oleh. The Method of Medical-Ecological Monitoring of Public Health and Environmentally Hazardous Areas. Journal of Education, Health and Sport. 2020;10(5):69-80. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2020.10.05.006 https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2020.10.05.006 https://zenodo.org/record/3825212 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2020; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 24.04.2020. Revised: 30.04.2020. Accepted: 13.05.2020. The Method of Medical-Ecological Monitoring of Public Health and Environmentally Hazardous Areas Oleh Yermishev Vasyl' Stus Donetsk National University, Faculty of Chemistry, Biology and Biotechnology, Department of Biophysics and Physiology 600-richya St.21, 21021, Vinnytsia, Ukraine Tel: +380676504433. E-mail: o.yermishev@donnu.edu.ua ORCID iD https://orcid.org/0000-0001-5854-9678 Abstract The main subject of the study of the ecological and medical zoning method is the complex state of the autonomic nervous system (ANS) of the child's organism and the analysis of the processes affecting it. The ANS performs adaptational trophic function - the regulation of the metabolism regarding the conditions of the environment. The analysis of possible ecological problems of the territory and its degree of ecological disturbance can be made due to the received data set on the state of functional health of the children's population of a certain territory and the averaged information on the deviation of the autonomic nervous system. In order to assess the disturbance of the territory, the relative value of the breach of vegetative homeostasis, which is defined as a percentage, is of particular importance. Various organs and systems of the body are known to be associated with certain areas of the skin called acupuncture points. With the appearance of the smallest deviations in the systems of the body and organs, they react at the stage of functional disorders long before the occurrence of organic changes at the expense of meridional bonds. Measuring the electrosurgical resistance in certain acupuncture points you can detect changes in the body still at the stage of functional disorders. For researches, the method of “biogalvanization” of 24 symmetrical representative active functional zones (12 on the arms and 12 on the legs), which reflect the functional activity of the sympathetic and parasympathetic nervous system has been used. This allows to record changes in the activity of sites of the ANS and to obtain systematic data that are subject to further complex analysis. The given method is unique and allows to conduct ecological analysis of the territory with the help of the target group of organisms - a person; method is non-invasive and low-cost, which allows conducting surveys of different age and sex groups and obtaining data with a minimum statistical error. Keywords: sympathetic activity; parasympathetic activity; autonomic nervous system; vegetative homeostasis; ecological

OBJECTIVES: To determine prospectively the sources of risk of non-sterility during aseptic handling and to quantify the risks of each of these sources.METHODS: A risk assessment (RA) of non-sterility according to Failure Mode and Effect Analysis was executed by a multidisciplinary team of (hospital) pharmacists and technicians, a consultant experienced in aseptic processing and an independent facilitator. The team determined the sources of risk of non-sterility, a 5 point scale for severity, occurrence and detection, and risk acceptance levels. Input about general applied risk reduction was collected by audits in 10 hospital pharmacies. The results of these audits were used for determining the remaining risks. The results, as well as scientific information and the experience of the team members, was used to determine scores for severity, occurrence and detection.RESULTS: Multiplying the scores for severity, occurrence and detection results in the risk prioritisation number (RPN) which is a relative value of the remaining risks of non-sterility for each source. Incorrect disinfection techniques of non-sterile materials and the chances of touching critical spots were estimated as the greatest risks. The risk of non-sterility via the airborne route was low. RPN values were helpful in prioritising measures for additional risk reduction (this will be described in an accompanying article).CONCLUSION: The RA, described here, was a systematic survey related to all sources of risk of non-sterility during aseptic handling. The determined RPN values were helpful in prioritising measures for additional risk reduction.

In 1992, the use of relative value units to link a particular payments with specific services was initiated to replace traditional fee for service. The system incentivizes volume rather than quality. In 1997, initiatives were formalized to emphasize quality measures. Physicians must participate in the Merit-based Incentive Payment System (MIPS). Physicians can opt out of MIPS if they participate in an Alternative Payment Model such as Bundled Payments. Reimbursement based on an episode of care reduces perceived incentive to increase volumes, but may result in difficulty with access to care for patients with complex medical issues or significant comorbidities.