Regional differences of outpatient physician supply as a theoretical economic and empirical generalized linear model

BACKGROUND: Regional differences in physician supply can be found in many health care systems, regardless of their organizational and financial structure. A theoretical model is developed for the physicians' decision on office allocation, covering demand-side factors and a consumption time function. METHODS: To test the propositions following the theoretical model, generalized linear models were estimated to explain differences in 412 German districts. Various factors found in the literature were included to control for physicians' regional preferences. RESULTS: Evidence in favor of the first three propositions of the theoretical model could be found. Specialists show a stronger association to higher populated districts than GPs. Although indicators for regional preferences are significantly correlated with physician density, their coefficients are not as high as population density. CONCLUSIONS: If regional disparities should be addressed by political actions, the focus should be to counteract those parameters representing physicians' preferences in over- and undersupplied regions.

Protecting databases from schema disclosure: a CRUD-based protection model

Database schemas, in many organizations, are considered one of the critical assets to be protected. From database schemas, it is not only possible to infer the information being collected but also the way organizations manage their businesses and/or activities. One of the ways to disclose database schemas is through the Create, Read, Update and Delete (CRUD) expressions. In fact, their use can follow strict security rules or be unregulated by malicious users. In the first case, users are required to master database schemas. This can be critical when applications that access the database directly, which we call database interface applications (DIA), are developed by third party organizations via outsourcing. In the second case, users can disclose partially or totally database schemas following malicious algorithms based on CRUD expressions. To overcome this vulnerability, we propose a new technique where CRUD expressions cannot be directly manipulated by DIAs any more. Whenever a DIA starts-up, the associated database server generates a random codified token for each CRUD expression and sends it to the DIA that the database servers can use to execute the correspondent CRUD expression. In order to validate our proposal, we present a conceptual architectural model and a proof of concept.

Business model evolution and firm performance of entrepreneurial companies

This research explores the business model (BM) evolution process of entrepreneurial companies and investigates the relationship between BM evolution and firm performance. Recently, it has been increasingly recognised that the innovative design (and re-design) of BMs is crucial to the performance of entrepreneurial firms, as BM can be associated with superior value creation and competitive advantage. However, there has been limited theoretical and empirical evidence in relation to the micro-mechanisms behind the BM evolution process and the entrepreneurial outcomes of BM evolution. This research seeks to fill this gap by opening up the ‘black box’ of the BM evolution process, exploring the micro-patterns that facilitate the continuous shaping, changing, and renewing of BMs and examining how BM evolutions create and capture value in a dynamic manner. Drawing together the BM and strategic entrepreneurship literature, this research seeks to understand: (1) how and why companies introduce BM innovations and imitations; (2) how BM innovations and imitations interplay as patterns in the BM evolution process; and (3) how BM evolution patterns affect firm performances. This research adopts a longitudinal multiple case study design that focuses on the emerging phenomenon of BM evolution. Twelve entrepreneurial firms in the Chinese Online Group Buying (OGB) industry were selected for their continuous and intensive developments of BMs and their varying success rates in this highly competitive market. Two rounds of data collection were carried out between 2013 and 2014, which generates 31 interviews with founders/co-founders and in total 5,034 pages of data. Following a three-stage research framework, the data analysis begins by mapping the BM evolution process of the twelve companies and classifying the changes in the BMs into innovations and imitations. The second stage focuses down to the BM level, which addresses the BM evolution as a dynamic process by exploring how BM innovations and imitations unfold and interplay over time. The final stage focuses on the firm level, providing theoretical explanations as to the effects of BM evolution patterns on firm performance. This research provides new insights into the nature of BM evolution by elaborating on the missing link between BM dynamics and firm performance. The findings identify four patterns of BM evolution that have different effects on a firm’s short- and long-term performance. This research contributes to the BM literature by presenting what the BM evolution process actually looks like. Moreover, it takes a step towards the process theory of the interplay between BM innovations and imitations, which addresses the role of companies’ actions, and more importantly, reactions to the competitors. Insights are also given into how entrepreneurial companies achieve and sustain value creation and capture by successfully combining the BM evolution patterns. Finally, the findings on BM evolution contributes to the strategic entrepreneurship literature by increasing the understanding of how companies compete in a more dynamic and complex environment. It reveals that, the achievement of superior firm performance is more than a simple question of whether to innovate or imitate, but rather an integration of innovation and imitation strategies over time. This study concludes with a discussion of the findings and their implications for theory and practice.

Impact de la cécité sur le système nociceptif

La vision joue un rôle très important dans la prévention du danger. La douleur a aussi pour fonction de prévenir les lésions corporelles. Nous avons donc testé l’hypothèse qu’une hypersensibilité à la douleur découlerait de la cécité en guise de compensation sensorielle. En effet, une littérature exhaustive indique qu’une plasticité intermodale s’opère chez les non-voyants, ce qui module à la hausse la sensibilité de leurs sens résiduels. De plus, plusieurs études montrent que la douleur peut être modulée par la vision et par une privation visuelle temporaire. Dans une première étude, nous avons mesuré les seuils de détection thermique et les seuils de douleur chez des aveugles de naissance et des voyants à l’aide d’une thermode qui permet de chauffer ou de refroidir la peau. Les participants ont aussi eu à quantifier la douleur perçue en réponse à des stimuli laser CO2 et à répondre à des questionnaires mesurant leur attitude face à des situations douloureuses de la vie quotidienne. Les résultats obtenus montrent que les aveugles congénitaux ont des seuils de douleur plus bas et des rapports de douleur plus élevés que leurs congénères voyants. De plus, les résultats psychométriques indiquent que les non-voyants sont plus attentifs à la douleur. Dans une deuxième étude, nous avons mesuré l’impact de l'expérience visuelle sur la perception de la douleur en répliquant la première étude dans un échantillon d’aveugles tardifs. Les résultats montrent que ces derniers sont en tous points similaires aux voyants quant à leur sensibilité à la douleur. Dans une troisième étude, nous avons testé les capacités de discrimination de température des aveugles congénitaux, car la détection de changements rapides de température est cruciale pour éviter les brûlures. Il s’est avéré que les aveugles de naissance ont une discrimination de température plus fine et qu’ils sont plus sensibles à la sommation spatiale de la chaleur. Dans une quatrième étude, nous avons examiné la contribution des fibres A∂ et C au traitement nociceptif des non-voyants, car ces récepteurs signalent la première et la deuxième douleur, respectivement. Nous avons observé que les aveugles congénitaux détectent plus facilement et répondent plus rapidement aux sensations générées par l’activation des fibres C. Dans une cinquième et dernière étude, nous avons sondé les changements potentiels qu’entrainerait la perte de vision dans la modulation descendante des intrants nociceptifs en mesurant les effets de l’appréhension d’un stimulus nocif sur la perception de la douleur. Les résultats montrent que, contrairement aux voyants, les aveugles congénitaux voient leur douleur exacerbée par l’incertitude face au danger, suggérant ainsi que la modulation centrale de la douleur est facilitée chez ces derniers. En gros, ces travaux indiquent que l’absence d’expérience visuelle, plutôt que la cécité, entraine une hausse de la sensibilité nociceptive, ce qui apporte une autre dimension au modèle d’intégration multi-sensorielle de la vision et de la douleur.