Excessive Entry Research Articles

Association of Electronic Health Record Design and Use Factors With Clinician Stress and Burnout

Many believe a major cause of the epidemic of clinician burnout is poorly designed electronic health records (EHRs). To determine which EHR design and use factors are associated with clinician stress and burnout and to identify other sources that contribute to this problem. This survey study of 282 ambulatory primary care and subspecialty clinicians from 3 institutions measured stress and burnout, opinions on EHR design and use factors, and helpful coping strategies. Linear and logistic regressions were used to estimate associations of work conditions with stress on a continuous scale and burnout as a binary outcome from an ordered categorical scale. The survey was conducted between August 2016 and July 2017, with data analyzed from January 2019 to May 2019. Clinician stress and burnout as measured with validated questions, the EHR design and use factors identified by clinicians as most associated with stress and burnout, and measures of clinician working conditions. Of 640 clinicians, 282 (44.1%) responded. Of these, 241 (85.5%) were physicians, 160 (56.7%) were women, and 193 (68.4%) worked in primary care. The most prevalent concerns about EHR design and use were excessive data entry requirements (245 [86.9%]), long cut-and-pasted notes (212 [75.2%]), inaccessibility of information from multiple institutions (206 [73.1%]), notes geared toward billing (206 [73.1%]), interference with work-life balance (178 [63.1%]), and problems with posture (144 [51.1%]) and pain (134 [47.5%]) attributed to the use of EHRs. Overall, EHR design and use factors accounted for 12.5% of variance in measures of stress and 6.8% of variance in measures of burnout. Work conditions, including EHR use and design factors, accounted for 58.1% of variance in stress; key work conditions were office atmospheres (β̂ = 1.26; P < .001), control of workload (for optimal control: β̂ = -7.86; P < .001), and physical symptoms attributed to EHR use (β̂ = 1.29; P < .001). Work conditions accounted for 36.2% of variance in burnout, where challenges included chaos (adjusted odds ratio, 1.39; 95% CI, 1.10-1.75; P = .006) and physical symptoms perceived to be from EHR use (adjusted odds ratio, 2.01; 95% CI, 1.48-2.74; P < .001). Coping strategies were associated with only 2.4% of the variability in stress and 1.7% of the variability in burnout. Although EHR design and use factors are associated with clinician stress and burnout, other challenges, such as chaotic clinic atmospheres and workload control, explain considerably more of the variance in these adverse clinician outcomes.

The Circular City with Heterogeneous Firms

The paper extends the Salop model of localized competition by allowing rms to have heterogeneous costs. We provide a general but highly tractable analytical solution for the equilibrium prices, and we study the long-run properties of the model using two dierent entry games. We show that cost heterogeneity aects the eciency of the market equilibrium by increasing welfare and inducing less excessive entry. Further, we illustrate the positive eects of the existence of a selection mechanism, which induces less ecient rms not to start production. The model also replicates some recent results on dense markets.

Efficiency Wages in Cournot-Oligopoly

Abstract In a Cournot-oligopoly with free but costly entry and business stealing, output per firm is too low and the number of competitors excessive, assuming labor productivity to depend on the number of employees only or to be constant. However, a firm can raise the productivity of its workforce by paying higher wages. We show that such efficiency wages accentuate the distortions occurring in oligopoly. Specifically, excessive entry is aggravated and the welfare loss due to market power rises.

Welfare‐enhancing Trade Unions in an Oligopoly with Excessive Entry

Trade unions are often argued to cause allocative inefficiencies and to lower welfare. We analyze whether this evaluation is also justified in a Cournot‐oligopoly with free but costly entry. If input markets are competitive and output per firm declines with the number of firms (business stealing), there is excessive entry into such oligopoly. If trade unions raise wages above the competitive level, output and profits per firm decline, which could deter entry and thus improve welfare. We find that an increase in the union’s bargaining power raises welfare if the (inverse) demand curve is (sufficiently) concave. We also show that collective bargaining loosens the linkage between business stealing and excessive entry.

Trade liberalization, firm entry, and income inequality

AbstractThis paper examines the short‐ and long‐run effects of trade liberalization via tariff reductions on income inequality in an economy, which is characterized by an imperfectly competitive urban manufacturing sector and a perfectly competitive rural agricultural sector. Tariff reductions reduce domestic output in the importable urban manufacturing sector, leading to shifts of capital from the urban sector to the rural agricultural sector. This can narrow the wage gap between skilled and unskilled labor in the short run. However, the lowered capital cost attracts new firms, and subsequently excessive entry of firms, to the urban manufacturing sector. This firm entry effect can mitigate the favorable effect of tariff reductions on wage inequality in the long run. Empirical study confirms the findings.

Two Rationales for Insufficient Entry

Abstract This study offers two new rationales for insufficient entry in a given industry. The first is the presence of complementary industries. Suppose there is free entry in an industry and the complementary industries are monopolistic. If the number of complementary industries is sufficiently high, then there is insufficient entry. However, if these industries are substitutes, then there is always excessive entry. The second rationale is that there is cost-reducing R&amp;D investment and spillover. When the spillover rate is sufficiently high, there is insufficient entry. Further, we consider the general model and obtain similar results.

Excessive entry and exit in export markets

Using transaction-level data for all Chinese firms exporting between 2000 and 2006, we find that on average 78% of exporters to a country in a given year are new exporters. Among these new exporters, an average of 60% stopped serving the same country the following year. These rates are higher if the destination country is a market with which Chinese firms are less familiar. We build a simple two-period model with imperfect information, in which beliefs about their foreign demand are determined by learning from neighbors. In the model, a high variance of the prior distribution of foreign demand induces firms to enter new markets. This is because the profit function is convex in perceived foreign demand due to the option of exiting, which insures against the risk of low demand realization. We then use our micro data to empirically examine several model predictions, and find evidence to support the hypothesis that firms’ high entries and exits are outcomes of their rational self-discovery of demand in an unfamiliar market.

Tax policy and entrepreneurial entry with information asymmetry and learning

We study a market with entrepreneurial and worker entry where both entrepreneurs’ abilities and workers’ qualities are private information. We develop an agent-based computable model to mimic the mechanisms described in a previous analytical model (Boadway and Sato in Int Tax Public Finance 18(2):166–192, 2011). Then, we introduce the possibility that agents may learn over time about abilities and qualities of other agents, by means of Bayesian inference over informative signals. We show how such different assumptions affect the optimality of second-best tax and subsidy policies. While with no information, it is optimal to have a subsidy to labour and a simultaneous tax on entrepreneurs to curb excessive entry, with learning the detrimental effects of excessive entry are partly compensated by surplus-increasing faster learning.

Gender robustness of overconfidence and excess entry

Camerer and Lovallo (1999; henceforth CL) present thought-provoking experimental evidence that overconfidence might lead to excess entry into markets. As their findings are based on the majority of sessions exclusively consisting of male participants, we conduct two experiments in an attempt to replicate their study while including both men and women in all of our sessions. Our Experiment 1 closely follows CL’s design whereas Experiment 2 employs a gender-neutral addition task and provides more control in assessing gender differences in overconfidence and excess entry. Using participants of both genders we are unable to replicate CL’s main finding that market entry decisions are driven by overconfidence. Contrary to CL, where self-selection increases the entry rate, in our Experiment 1 self-selection leads to less entry. This result is driven by self-selected females who rationally enter the market less often than self-selected males as their rank-determining performance on a sports and current events trivia quiz is weaker than the performance of self-selected males. In Experiment 2 we find no effect of self-selection on entry and no gender differences in entry rates or performance in the addition task. Our results point out that (i) the finding that overconfidence leads to excess entry is not robust to a population consisting of both genders; and (ii) the self-selection effect is sensitive to both gender and task that is used to determine the rank upon entry.

Urban development, excessive entry of firms and wage inequality in developing countries

AbstractThis paper examines the short and long‐term effects of urbanisation, via favourable urban development policies, on income distribution and social welfare for a developing country, in which the urban manufacturing sector is characterised by imperfect competition and free entry. Urbanisation shifts rural workers to the highly productive urban sector, while causing production in urban firms to expand because of scale economies. However, urbanisation may worsen wage inequality between skilled and unskilled labour in the short term. In the long term, urbanisation can attract new firms to the urban sector and favourable urban development policies may result in excessive entry of firms, which can amplify wage inequality in the economy. This entry‐amplifying effect is confirmed empirically, especially for low and lower‐middle‐income countries. If the entry effect is not considered, the impact of urbanisation on wage inequality could be understated by 13% for low and lower‐middle‐income countries.

Welfare-Enhancing Trade Unions in an Oligopoly with Excessive Entry

If input markets are competitive and output per firm declines with the number of firms (business stealing effect), there will be excessive entry into a Cournot oligopoly for a homogeneous commodity. However, input markets are often imperfectly competitive and the price of labor is determined by collective bargaining. The resulting rise in wages reduces output and profits and can deter entry. We analyze under which conditions greater bargaining power by the trade union reduces entry and raises welfare. Furthermore, we show that collective bargaining loosens the linkage between business stealing and excessive entry.

Consumer Behavior in Bidding Markets with Participation Costs

Consumer bidding is common in a wide variety of markets. An important source of friction in many markets with bidding is the cost of participation. We investigate the impact of participation costs on bidder entry and bidding behavior using incentive-compatible laboratory experiments with participation costs in the form of “bidding fees.” Instead of a standard auction, our experiments utilize the more tractable name-your-own-price (NYOP) setting. We find that both entry frequencies and bid magnitudes exceed the predictions of a risk-neutral benchmark model. Although the bids we observe can be rationalized with a standard risk-averse expected utility model, the entry decisions cannot, because more than half of our subjects enter when a risk-neutral bidder would not. We identify two important moderators of such “excess entry” — experience with the task and reduced task difficulty due to a decision aid. In contrast to their effect on entry decisions, experience and difficulty have no effect on bid magnitude, which suggests figuring out the bid amount is easier than deciding whether to enter. We also apply our data to examine the profitability of two-part tariffs in NYOP settings, and we find such a pricing strategy can only be profitable when consumers are relatively inexperienced and when they do not have access to an effective decision support tool.

Bounded rationality and excess entrepreneurial entry

Bounded rationality and excess entrepreneurial entry

Analysis of the Present Situation and Prospects of Development of Sharing Economy—Taking Dazhou, Sichuan Province as an Example

Based on mobile Internet, third-party payment, big data, cloud computing and other technologies, excessive idle resources, consumption upgrading, and entry of the economy into a new normal led to the emergence and development of the sharing economy. Based on the analysis of the current situation and development trend of the sharing economy in China, this paper analyses the development prospects of the sharing economy in Dazhou according to the current situation of the development of Dazhou.

Exchange Competition, Entry, and Welfare

We integrate a market microstructure model with an exchange competition model with entry in which exchanges supply technological services that enhance market participation, and have market power. We find that technological services can be strategic substitutes or complements in platform competition. Free entry of platforms delivers a superior outcome in terms of liquidity and (generally) welfare compared to the case of an unregulated monopoly. Controlling entry or, even better, platform fees may serve as an instrument to limit market power, further increasing welfare. The market may deliver excessive or insufficient entry.

Evaluation of drainage problems in Antalya Konyaalti parks in the context of landscape engineering.

In this study, factors that cause drainage problems in 23 Nisan Park and Mevlana Park have been investigated in the scope of landscape design and landscape engineering. To propose regulations to protect the natural topography and natural drainage lines, evaluations and observations were conducted, and these data were digitized. Water accumulation analyses were performed using field observations, which were used to create a water accumulation analysis map that was compared with water collection area maps created using Arc Hydro extension in ArcGIS. The results show that surface waters accumulate in areas such as pedestrian ways and playgrounds due to deficiencies in landscape design. Surface water quantities were calculated using the rational method. To prevent structural damage and excessive water entry, deep drainage and concrete or grass-covered parabolic surface drainage systems are recommended. Additional suggestions are provided for other studies to be conducted in this regard.

Optimal Reciprocal Import Tariffs Under Variable Elasticity of Substitution

We explore the impact of reciprocal, specific or ad valorem, import tariffs on welfare among N symmetric countries (a free-trade agreement)—using the standard Krugman’s one-sector trade model, with unspecified variable-elasticity preferences (mostly under decreasing elasticity of utility). Without transport costs, any tariff is harmful, a specific import subsidy (export tariff) can be welfare-improving, whereas ad valorem tariffs or subsidies are always harmful. Under transport costs, a small ad valorem tariff can be beneficial; moreover, under sufficiently high transport costs, both kinds of tariffs can be become beneficial. The reason is mitigated distortion: excessive entry under decreasingly elastic utility.

The Digital Services Tax: A Conceptual Defense

Since 2018, the UK government, the European Commission, and several European national governments have advanced bold proposals for a new “digital services tax” (DST), with the aim of capturing profits earned by multinationals that reflect value contributed by users of digital platforms. I offer a novel set of arguments in support of the DST, which appeal to both efficiency and fairness considerations. In particular, the DST would allow location-specific rent (LSR) earned by digital platforms to be captured by the countries in which such rent arises. I argue that platform LSR is often hidden from view under the traditional international income taxation paradigm, due to that paradigm’s focus on physical presence, source of payment, and profit allocation among related entities. Moreover, that paradigm ignores a basic intuition about how rent accruing to mobile intangible assets should be assigned: when the deployment of a technology is non-rival with respect to multiple locations, it is both efficient and fair to assign any rent earned from the technology’s deployment with respect to a given location to that location. The principle of taxing platform rent where it arises is both distinct from and superior to the principle of allocating profit to “destination” (i.e. buyer or consumer) jurisdictions. Platform rent can arise in origin, destination, or residence jurisdictions, and the location of “user value creation” is not reducible to consumer location. Moreover, claims to taxing rights based on the location of rent inherently appeals to equity considerations, whereas destination-based apportionment generally ignores equity issues in allocation. I discuss misunderstandings of DST proposals, and reject certain common assertions about the DST’s likely effects, including that DST costs will simply be passed on domestic consumers or producers, and that a revenue-based tax is inherently flawed. Finally, I suggest that the potential of the DST to reduce excessive entry in platform markets also deserves further consideration.

Entry and exit of small self-employed businesses in Korea’s service industries

This study examines the effect of unemployment on the entry of small self-employed businesses (SSBs) in Korea’s service industries and assesses whether the excess entry of SSBs has resulted in their excess exit. Twelve service industries that are frequently regarded as being SSB intensive in Korea are chosen. The Hausman–Taylor model is applied to Korean regional panel data for the period 2006–2014. The empirical results indicate that the relationship between unemployment and SSB formation varies across the sample industries. In particular, the unemployment-push (pull) hypothesis is confirmed in three (six) industries. Additionally, the results show that an increase in the number of existing businesses in the previous year, partly as a result of increased entries, has increased the number of closed SSBs. On the basis of these results, this study assesses the Korean government’s SSB policies and suggests several policy recommendations.

N-methyl-D-aspartate receptor–mediated calcium influx connects amyloid-β oligomers to ectopic neuronal cell cycle reentry in Alzheimer's disease

IntroductionAlzheimer's disease (AD) symptoms reflect synaptic dysfunction and neuron death. Amyloid-β oligomers (AβOs) induce excess calcium entry into neurons via N-methyl-D-aspartate receptors (NMDARs), contributing to synaptic dysfunction. The study described here tested the hypothesis that AβO-stimulated calcium entry also drives neuronal cell cycle reentry (CCR), a prelude to neuron death in AD. MethodsPharmacologic modulators of calcium entry and gene expression knockdown were used in cultured neurons and AD model mice. ResultsIn cultured neurons, AβO-stimulated CCR was blocked by NMDAR antagonists, total calcium chelation with 1,2-Bis(2-aminophenoxy)ethane-N,N,N′,N′-tetraacetic acid tetrakis(acetoxymethyl ester) (BAPTA-AM), or knockdown of the NMDAR subunit, NR1. NMDAR antagonists also blocked the activation of calcium-calmodulin-dependent protein kinase II and treatment of Tg2576 AD model mice with the NMDAR antagonist, memantine, prevented CCR. DiscussionThis study demonstrates a role for AβO-stimulated calcium influx via NMDAR and CCR in AD and suggests the use of memantine as a disease-modifying therapy for presymptomatic AD.