Conflicts of Interest and Outcomes of Cardiovascular Trials.

Conflicts of interests have long been recognized as potential sources of influence in the conduct and reporting of clinical trials. This controversy was again rekindled after the publication of the latest statin guidelines and a series of studies regarding competing interests in leading medical journals. We investigate the association between declared author conflicts and the outcomes of large cardiovascular trials. We searched the Medline (PubMed) database to identify "phase 2" and "phase 3" clinical trials using the search term "cardiovascular" over the past decade using "10 years" as the filter. We perceived the competing interest as present regardless of the nature such as consulting fees, honoraria, travel imbursements, stock holding, and employment. Of the 699 titles retrieved, 114 studies met the inclusion criteria. Nearly 80% of studies had at least a single author with competing interests. The 114 studies had a total of 1,433 investigators, of which 725 had declared conflicts of interests (50.6%). A total of 66 studies (58%) had half or >50 percent of investigators who had some conflicts of interests. Of these studies, 54 studies had favorable outcomes and only 12 had unfavorable outcomes (p <0.001). Among the type of competing interests, consulting or personal fees was the most common present in 58 investigators (51%). This was followed by research grants present in 55 the researchers (48%). Among 25 (22%) studies, at least one investigator reported stakes in the industry, of which only 2 studies had unfavorable outcomes for the intervention being investigated. Just 1 of the 25 clinical trials with a sample size of >1,000 had no investigators with competing interests. In conclusion, authors conflicts are associated with favorable outcomes in cardiovascular outcome trials.

Sole agency vs multi-agency: An investigation of agency practice across England and Wales

Purpose: The purpose of this paper is to investigate the impact of different agency practice on agency fees, business efficiency, and housing market liquidity. Design/methodology/approach: The paper studies the effect of sole and multiple agency practices on estate agent efficiency, housing market liquidity, and commission fee levels. The analysis uses the survey data from 2000 to 2006 to investigate the different agency practices across England and Wales and their effect on estate agency business efficiency, housing market liquidity, selling price, and fee levels. Findings: The empirical analysis confirms that agency practice has a locality bias, that is, some regions are more likely to adopt sole agency practice than other regions. The estate agents with a sole agency practice charge a lower agency fee, help clients to achieve better selling price and are more efficient; whereas multiple agency practice facilitates liquidity in the housing market, but experiences higher fall-through rate. Research limitations/implications: The research focuses on estate agent rather than consumers due to the limitation of the data based on a research project concerning transaction costs designed prior to this analysis. Originality/value: There is little other research that investigates the residential estate agency practice and its impact on housing market in the past three decades in England and Wales. The findings are a useful guide for practitioners to better understand the issues associated with different agency practices and should enhance business efficiency and performance.

The origins of the Irish hospitals' sweepstake

This article examines the two main reasons for the setting up of the Irish sweepstakes in 1930; the financial crisis facing voluntary hospitals and the tradition of using sweepstake gambling to raise funds for charitable purposes. Such gambling, although technically illegal, was prevalent and widely tolerated during the late 19th and early 20th centuries. The change of government that accompanied Irish independence in 1921 led to much confusion surrounding the law on gambling and large-scale sweepstakes proliferated during the early 1920s, many of them selling tickets illegally in Britain. At the same time the Irish voluntary hospitals faced a financial crisis that threatened their future, brought about by the adverse impact of war-time inflation on the value of their endowments, the emigration of supporters of the Protestant voluntary hospitals after independence, the political upheaval of the revolutionary period, the decline in fees from medical students and the increasing cost of and demand for hospital treatment. This article provides a detailed account of the enactment of the sweepstake legislation and of the first sweepstake on the 1930 Manchester November Handicap.

‘Making Older People Equal: Reforming the Law on Access to Education and Other Services’

Age-based discrimination in the supply of goods and services (including educational services) has only very recently been outlawed in the United Kingdom by the Equality Act 2010, the relevant sections of which have not yet been brought into force. This paper critically considers the Act and its implications, as well as the current proposal for an EU Directive on Goods and Services.The greatest immediate potential of the Equality Act lies in the general prohibition against age discrimination and the scope of the exceptions to it. The paper argues that exceptions permitting service providers to discriminate against older people (i.e. negative exceptions) should be very specifically set out in the reforming legislation.There should be no general defence to a claim of age discrimination based around the concept of ‘reasonableness’, which would not be consistently interpreted by courts and tribunals in a way that steers clear of traditional ageist assumptions and stereotyping.The paper argues that service providers should be permitted to discriminate in favour of older people (i.e. make positive exceptions) if the reason for doing do so satisfi es legislative criteria which are designed, amongst other things, to meet the particular needs of older persons or to promote social inclusion. Under this proposal, preferential treatment such as age-related concessionary fees for adult education courses and programmes would be lawful.

Assessing the need for and potential role of a day hospice:A qualitative study

We conducted a qualitative case study as part of a needs assessment for a day hospice in a small Ontario city. Data were gathered from semi-structured interviews with 28 stakeholders: nine health care administrators, 11 health care providers, and eight lay people (terminally ill adults and informal caregivers). Respondents described support, counselling, social activities, and respite as key day hospice services. They also described several barriers to accessing services, including location, transportation, admission criteria, referrals, and fees. For most respondents, the ideal staff mix includes both volunteers and paid professionals in either a free-standing organization or institutionally linked hospice. Although the vast majority of participants were reluctant to impose admission criteria or other limitations on hospice clientele, they expressed the need to ensure equitable access to this scarce resource. Opinions varied greatly across stakeholder groups, highlighting the need to collect information from ail relevant stakeholder groups when planning hospices.

An Ethical Production of Place:A Case for Economy in Architectural Design

Architects typically interpret Heidegger to mean that dwelling in the Black Forest, was more authentic than living in an industrialised society however we cannot turn back the clock so we are confronted with the reality of modernisation. Since the Second World War production has shifted from material to immaterial assets. Increasingly place is believed to offer resistance to this fluidity, but this belief can conversely be viewed as expressing a sublimated anxiety about our role in the world – the need to create buildings that are self-consciously contextual suggests that we may no longer be rooted in material places, but in immaterial relations.
This issue has been pondered by David Harvey in his paper From Place to Space and Back Again where he argues that the role of place in legitimising identity is ultimately a political process, as the interpretation of its meaning is dependent on whose interpretation it is. Doreen Massey has found that different classes of people are more or less mobile and that mobility is related to class and education rather than to nationality or geography. These thinkers point to a different set of questions than the usual space/place divide – how can we begin to address the economic mediation of spatial production to develop an ethical production of place? Part of the answer is provided by the French architectural practice Lacaton Vassal in their book Plus. They ask themselves how to produce more space for the same cost so that people can enjoy a better quality of life. Another French practitioner, Patrick Bouchain, has argued that architect’s fees should be inversely proportional to the amount of material resources that they consume. These approaches use economics as a starting point for generating architectural form and point to more ethical possibilities for architectural practice

Short-Sale Constraints and the Pricing of Managerial Skills

We investigate the impact of the absence of short selling on the pricing of managerial skills in the mutual fund industry. In the presence of divergent opinions regarding managerial skills, fund managers can strategically use fees to attract only the most optimistic capital. The recognition of this fee strategy helps explain a set of stylized observations and puzzles in the mutual fund industry, including the underperformance of active funds, the existence of flow convexity, and the negative correlation between gross-of-fee α and fees.

Managerial Representations of Achieving Competitive Advantage in Architectural Firms within the United Kingdom

Purpose - The purpose is to unearth managerial representations of achieving competitive advantage in relation to architectural firms operating within the United Kingdom (UK).
Design/Methodology/Approach - A sequential qualitative methodology is applied, underpinned by nine managerial interviews in five architectural practices; all of which are analysed using computer assisted qualitative data analysis software.
Findings - 108 representations are identified with highly rated concepts discussed in detail. Subsequently, the leading concepts include reputation, client satisfaction, fees and staff resources, among others.
Research Limitations/Implications - There are numerous studies conducted on this subject; however, there has been no research done to date documenting managerial representations within the UK on achieving competitive advantage in the context of architectural firms.
Practical Implications – The need for architectural firms to develop a competitive advantage within their market sector is ever more apparent, particularly during times of increased competitiveness.
Originality/Value – This paper fulfils a gap in knowledge by contributing to underlying research on the subject of competitive advantage, but focusing on the managerial representations, specifically within UK practices. The findings are of relevance to architects in both the UK and beyond, as well as perhaps forming the basis of identifying further research with the area.

"No Encores" The Royal Dublin Society Concert Archive Recitals in Retrospect: 1925-50

A large archive of sources for the RDS classical music recitals is extant in the Society’s Library, Ballsbridge, Dublin. The recitals were established in 1886 for the promotion of chamber music and in order to expose Dublin audiences to the works of the great composers. Extant in the collection are minute books; autographed programmes; newspaper cuttings which include previews, reviews and advertisements; correspondences with artists and agents; promotional material; selections of photographs; records of attendance, artists fees and takings; and volumes of printed music.
This paper will document the organisation, management and occurrence of the RDS classical music recitals for the period 1925 to 1950 and will encompass the opening of the current concert hall (The Members’ Hall, 1925), the Society’s bi-centenary celebrations (1931) and the continuance of the recitals within the context of the Second World War (1939- 45). The paper will examine and analyse the following: networks, repertoire and reception.
The RDS music committee established significant links with many performers and UK-based classical music agents. Recitalists include musicians of international renown; Myra Hess, Isolde Menges, Lili Kraus, Joseph Szigeti, Leon Goossens, Sir Hamilton Harty and The Hallé Orchestra, The Catterall Quartet and many local, Dublin-based musicians; Raidió Éireann Orchestra, Dublin String Orchestra, Dublin Philharmonic Orchestra and Culwick Choral Society. The compromises and collaborations in evidence between the music committee, agents and performers resulted in the presentation of varied and well-balanced programmes featuring sonatas, quartets, trios, concerti, overtures, symphonies and songs by composers including Beethoven, Mozart, Haydn and Brahms. Works by contemporary composers including Bax, Dohnanyi, Szymanowski and Suk were also regularly performed, as were works with an Irish influence or flavour. Audiences mainly consisted of members of the Society, music students were encouraged to attend at a reduced rate and reviews were regularly published in the Irish Times, Irish Independent and Irish Press.

Factors influencing the success of rural cataract surgery programs in China:The study of hospital administration and relative productivity (SHARP)

PURPOSE. To explore factors potentially influencing the success or failure of rural Chinese hospitals in increasing cataract surgical output and quality. METHODS. Focus groups (FGs, n = 10) were conducted with hospital administrators, doctors, and nurses at 28 county hospitals in Guangdong Province. Discussions explored respondents' views on increasing surgical volume and quality and improving patient satisfaction. Respondents numerically ranked possible strategies to increase surgical volume and quality and patient satisfaction. FG transcripts were independently coded by two reviewers utilizing the constant comparative method following the grounded theory approach, and numerical responses were scored and ranked. RESULTS. Ten FGs and 77 ranking questionnaires were completed by 33 administrators, 23 doctors, and 21 nurses. Kappa values for the two coders were greater than 0.7 for all three groups. All groups identified a critical need for enhanced management training for hospital directors. Doctors and nurses suggested reducing surgical fees to enhance uptake, although administrators were resistant to this. Although doctors saw the need to improve equipment, administrators felt current material conditions were adequate. Respondents agreed that patient satisfaction was generally high, and did not view increasing patient satisfaction as a priority. CONCLUSIONS. Our findings highlight agreements and disagreements among the three stakeholder groups about improving surgical output and quality, which can inform strategies to improve cataract programs in rural China. Respondents' beliefs about high patient satisfaction are not in accord with other studies in the area, highlighting a potential area for intervention. © 2013 The Association for Research in Vision and Ophthalmology, Inc.

Sources of patient knowledge and financing of cataract surgery in rural China: the Sanrao Study of Cataract Outcomes and Up-Take of Services (SCOUTS), report 6.

AIM: To study patient sources of knowledge about cataract surgical services, and strategies for financing surgery in rural China. DESIGN: Cross-sectional case series. METHODS: Patients undergoing cataract surgery by local surgeons in a government, village-level facility in Sanrao, Guangdong between 8 August and 31 December 2005 were examined and had standardised interviews an average of 12 months after surgery. RESULTS: Of 313 eligible patients, 239 (76%) completed the questionnaire. Subjects had a mean (SD) age of 69.9 (10.2) years, 36.4% (87/239) were male, and 87.0% (208/239) had been blind (presenting visual acuity < or = 6/60) before surgery. Word-of-mouth advertising was particularly important: 198 (85.0%) of the subjects knew a person who had undergone cataract surgery, of whom 191 (96.5%) had had cataract surgery at Sanrao itself. Over 70% of subjects (166/239) watched TV daily, whereas 80.0% (188/239) "never" read the newspaper. Nearly two-thirds of suggestions from participants (n = 211, 59.6%) favoured either TV advertisements or word-of-mouth to publicise the programme. While the son or daughter had paid for surgery in over 70% of cases (164/233), the patient's having paid without help was the sole predictor of undergoing second-eye surgery (OR 2.27 (95% CI 1.01 to 5.0, p = 0.04)). DISCUSSION: Strategies to increase uptake of cataract surgery in rural China may benefit from enhancing word-of-mouth advertising (such as with pseudophakic motivators), using television advertising where affordable, and micro-credit or other programmes to enable patients to pay their own fees, thus increasing uptake of second-eye surgery.

A gestão praticada nos campos de golfe do barlavento algarvio e a sua adaptação à estratégia de desenvolvimento regional

A presente dissertação objetiva, essencialmente, estudar quais as tendências de gestão nos campos de golfe do barlavento algarvio. Sendo as perspetivas de gestão tão variadas, mesmo quando são introduzidas e aplicadas by the book, ainda mais desconcertante, e interessante, quando a gestão é efetuada segundo valores, convicções e diferentes personalidades. Esta pesquisa assume maior oportunismo porque é efetuada em período de crise. Segundo alguns autores “ (…) a mais grave intempérie económica desde os anos 1930 (…)”, em que as receitas baixaram (F&B, green fees, pro-shop, etc.) e as despesas tenderam a aumentar (água, energia, IVA, etc.). Para encontrarmos respostas às nossas questões estudámos de forma exploratória e qualitativa alguns procedimentos e opções que sustentam, ou que sustentavam, um negócio de sucesso… e para o qual não havia formação específica (diretor de campo de golfe). Desenvolvemos o estudo com recurso a dados secundários e a entrevistas semiestruturadas a cinco Diretores de campos de golfe, em representação de doze campos do barlavento algarvio. Os resultados permitem fazer uma caracterização de situações associadas à região em que os campos se inserem, aos recursos humanos que dinamizam o negócio, aos clientes que consomem este produto, e às estratégias adotadas, considerando as opiniões dos Diretores. Os factos identificados na investigação indicam que as dificuldades são não só de natureza externa, tais como a crescente concorrência por parte de destinos de golfe emergentes, mas também interna, como a ausência de uma verdadeira cooperação entre campos e as opções governamentais (aumento do IVA e acessibilidades) … mas também há oportunidades! As conclusões apuradas levaram à apresentação de uma caracterização nos domínios inicialmente estudados, tendo como base a gestão, tal como era objetivo do trabalho.

The relation between content providers and distributors: Lessons from the regulation of television distribution in the United Kingdom

Using the United Kingdom (UK) as a case study, this article analyses the growing commercial and regulatory significance of broadcaster-distributor relations within the contemporary television industry. The first part of the article argues that despite important changes in broadcast delivery technology, more recently shaped by the growth of the Internet, and the associated growth of options of receiving television content, the traditional delivery platforms (digital terrestrial, satellite and cable) remain by far the preferred choice for viewers in Britain. At the same time, public service broadcasters continue to be the biggest investors in domestic original non-sport content and account for over half of all television viewing. The strength of PSBs in content and their growing reliance on commercial proprietary subscription platforms (cable and satellite) and gradually on the Internet presents challenges in the nexus between broadcasters and distributors. The article focuses on the debate over retransmission fees between PSBs and Sky, and on the question of whether Sky should be required to offer some of its premium content to rival pay-TV platforms. These two examples highlight the impact regulatory intervention can have on the balance of power between broadcasters and distributors. The article concludes that such debates concerning the commercial relations between content providers and distributors will remain pivotal and become more heated given that similar issues are raised in the Internet environment.

O perfil do utilizador abusivo dos Serviços de Urgência Portugueses: um estudo no Hospital de São João

A afluência desmedida aos Serviços de Urgência é uma questão que acarreta preocupações a nível financeiro. Contribui para este fato, a mentalidade da população, que acredita que este serviço oferece mais facilidades de acesso, dispõe de mais recursos e fornece melhores cuidados de saúde. Novas medidas foram preconizadas, como o aumento das taxas moderadoras, para tentar travar este fenómeno. No entanto, apesar da descida dos episódios de urgência em cerca de 10%, em Portugal, estudos apontam para valores na ordem dos 30-35% de episódios não urgentes. Assim, torna-se importante que não só se enfatizem as novas medidas, como se eduque a população com vista à correta utilização destes serviços, através de campanhas de sensibilização. Torna-se, assim, necessário que se chegue ao perfil do utilizador abusivo. Para a identificação de um perfil de abusividade, foram solicitados dados de episódios de urgência ocorridos durante um período de 6 meses no Hospital de São João, tendo depois sido estimado um modelo de regressão logística. A metodologia permite identificar quais as características que influenciam uma utilização abusiva do serviço e quantificar o impacto de cada uma destas características na probabilidade de um utente apresentar um comportamento abusivo. Concluiu-se que, uma mulher entre os 18-30 anos, que resida em Vila Nova de Gaia, recorra à urgência durante a noite tendo-lhe sido atribuída uma pulseira azul e seja abrangida pelo Serviço Nacional de Saúde, apresenta 91,92% de probabilidade de utilizar este serviço de forma abusiva. Contrariamente, um homem com mais de 60 anos, residente na Maia, que recorra ao serviço durante o dia, esteja isento do pagamento de taxas moderadoras e seja abrangido pela ADSE, e lhe seja atribuída uma pulseira laranja, apresenta apenas 39,93% de probabilidade de ter um comportamento abusivo. Estes resultados são importantes para definir campanhas de sensibilização que diminuam comportamentos abusivos.

Estudo e desenvolvimento de sistema de cobrança de portagens baseado em NFC

Tese para obter o grau de Mestre em Engenharia Electrónica e Telecomunicações