Abstract Information asymmetry in the financial market, especially in the financial organization, usually generates more serious consequences than those in the commodity market. How to reduce or remove the asymmetric information in a bank¡¦s credit rationing has been a challenge for a commercial bank. On the basis of the models developed by Stiglitz and Weiss (1981) and Barro (1986), this study attempts to analyze the issues, faced by a typical commercial bank, of adverse selection, moral hazard, and agent¡¦s reputation, and to simulate the results of such issues in a game-theoretic approach. The study has reached the following conclusions: 1. With regard to the adverse selection issue, this study concludes that if a bank wants to solve the problem of adverse selection on debit and credit, the decision must be made upon the objective evaluation that considers not only the reality and rational assumption but also the external signaling and screening information to assess the enterprise and its investment plan. 2. Regarding the moral hazard issue, this study concludes that if a bank has an effective incentive, the enterprise will automatically select the most beneficial items to the bank on debit. This mechanism reduces the bank¡¦s risk. On the other hand, if a penalty is set forth, then it will be more likely to prevent the moral hazard problem to occur. 3. By the moral hazard model, this study concludes that if an enterprise needs to enter the market to collect funds, it would imply that the game will continue infinitely. Owing to the benefits from reputation is increasing as the number of stage of the game increases, an enterprise will have a strong incentive to build his non-cheating reputation based on a long term consideration. Keywords: Asymmetric Information, Adverse Selection, Moral Hazard, Reputation, Game Theory.

The intrinsic features of woker, ``ability' and ``motivation', are useful resources of human capital that makes profit for the firm. The purpose of the study is to examine how the firm designs the optimal wage policy when worker's intrinsic features are private information. The study follows the mechainsm-design approach, by which models with single, as well as double, intrinsic feature(s) of worker are established, and best ``incentive wage packages' are deduced. We finded out that, under single intrinsic feature, the firm's optimal wage package entails that, the more output the higher wages; under double intrinsic features, the firm must takes the relative strength of intrinsic features of the worker into account when making the optimal incentive wage package.

SAMMANFATTNING Sjuksköterskan tillämpar omvårdnadsprocessen genom att observera, värdera, prioritera, dokumentera och vid behov åtgärda och hantera förändringar i allmäntillståndet, samt motverka komplikationer i samband med sjukdom, vård och behandling. Andningsfrekvens (AF) är den vitalparameter som först förändras och signalerar en förändring i allmäntillståndet. Vid de flesta hjärtstopp på sjukhus finns tecken till försämring hos patienten redan några timmar eller upp till ett dygn före.  Syftet var att undersöka sjuksköterskans inställning och följsamhet till att mäta och bedöma AF hos akuta sjuka patienter, för att tidigt upptäcka en försämring i patientens hälsotillstånd. Genom en litteraturstudie framkom fyra teman. Rutiners betydelse, sjuksköterskans inställning till AF och varför den inte mättes, värdet av förändringsarbete samt möjliga arbetssätt för att undvika vårdskador. Rutiner för mätning av AF, olika poängsystem och mätmallar för bedömning av vitalparametrar, påverkade antalet mätningar och registreringar av AF. Den enskilda sjuksköterskans inställning inverkade på mätningen och bedömningen av AF. Flera anledningar till varför AF inte mättes fanns. Studier visade att förändringsarbete och implementering av nya arbetssätt var ett komplext område, insatser krävdes inom flera områden på olika nivåer. Vårdskador och plötslig oväntad död minskade när nya rutiner och arbetssätt kombinerades med utbildning, uppföljning och återkoppling till personalen. AF är en viktig vitalparameter. Används inte den kunskapen för att hitta patienter på väg att försämras, riskerar patienterna att drabbas av vårdskador. Ett utbildningsbehov finns, den senaste forskningen har påvisat att rätt genomförd implementering av övervakningsrutiner och förändrat arbetssätt kan ge ett bra utfall i minskat antal vårdskador och oförutsedd död. / ABSTRACT The nurse applies the nursing process by observing, evaluating, prioritising, documenting and when necessary manage changes in the condition of the patient, and to prevent complications associated with disease, care and treatment. Respiratory Rate (RR) is the vital sign that first changes and signals changes in a patient’s condition. In most cardiac arrests there are signs of deterioration of the patient a few hours up to a day before the event.    The aim of this study was to investigate the nurse´s attitude and adherence to measure and assess RR in acutely ill patients, for an early detection of deterioration in the patient's state of health. Through a literature study four themes were emerged. The importance of guidelines, the nurses' attitude and why the RR was not measured, the value of change of management and possible ways to avoid injuries. Guidelines for the measurement of RR, different scoring systems and observations charts for the assessment of vital signs all affected the measuring and scorings of RR. The individual nurse's attitude affected the measurement and assessment of RR. Several reasons why RR was not measured were found. The studies showed that the process of change and implementation of new ways of working is a complex, and efforts were needed in several areas and at different levels. Care injuries and sudden unexpected deaths decreased when new routines and working procedures were combined with training, monitoring and feedback to the staff.   Research shows that RR is an important vital sign. If this knowledge is not used to find patients about to deteriorate, these patients risk suffering from permanent health effects. There is a need for significant training in this area and recent research has shown that a correct implementation of the procedures provide a good outcome in a decreased number of medical injuries and unexpected death

The mandibular condyles represent important growth sites within the facial skeleton. Condylar growth is not a pacemaker of mandibular development, but it provides regional adaptive growth that is of considerable clinical significance, as the condyle’s upward and backward growth movement regulates the anteriorly and inferiorly directed displacement of the mandible as a whole. Orthopedic problems of the temporomandibular joint (TMJ), such as displacement of the TMJ disk, are common in the adolescent population. Clinical studies of mandibular asymmetry and mandibular retrognathia in adults as well as in children and adolescents, have reported an association with coexisting non-reducing displacement of the TMJ disk without identifying the cause and effect. Through experimental studies causality has been established, and unilateral affliction during growth has been shown to retard ipsilateral mandibular development with facial asymmetry as the sequel. It was hypothesized that bilateral non-reducing TMJ disk displacement during growth would impair mandibular development bilaterally, resulting in mandibular retrognathia. TMJ disk displacement has repeatedly been demonstrated to induce histological reactions of the condylar cartilage. An additional assumption was therefore that a non-deranged TMJ disk function is crucial for the maintenance of the growing condyle’s biophysical environment, and that a connection ought to exist between the amount of condylar cartilage changes caused by TMJ disk displacement and the amount of subsequent adverse mandibular growth. It was also hypothesized that non-reducing displacement of the TMJ disk in growing individuals would result in qualitative and quantitative changes of the condylar subchondral bone. An improved experimental cephalometric method was developed in order to optimize the reliability of longitudinal radiographic evaluation of fast growing small animals. Bilateral non-reducing TMJ disk displacement was surgically created in ten growing New Zealand White rabbits, with ten additional rabbits serving as a sham operated control group. The amount and direction of craniofacial growth was followed over time in serial cephalograms, aided by tantalum implants in the jaws. The study period was chosen to correspond to childhood and adolescence in man. The assessed growth of each side of the mandible was correlated to the histological feature of ipsilateral condylar cartilage at the end of the growth period. The amount and composition of subchondral bone from three regions of interest in the condyle, and the expression of local growth factors in the adjacent condylar cartilage was evaluated. The results verified that bilateral non-reducing TMJ disk displacement retarded mandibular growth bilaterally; the extent corresponding to mandibular retrognathia in man. Displacement of the TMJ disk during the growth period induced condylar cartilage adaptive reactions that were associated with both an adverse amount and direction of mandibular growth, manifesting in a retrognathic mandibular growth pattern. Growth impairment fluctuated over time, with the most striking retardation occurring during periods of increased general growth, implying a local growth reduction explicitly counteracting general hormonal growth acceleration. A significant decrease of the total amount of subchondral bone, in spite of a general increase of new bone formation in the experimental condyles, pointed to a reparative compensation for an extensive resorption of subchondral bone due to displacement of the TMJ disk, but not to the extent that normal growth would be maintained. These results constitute an explanation for the adverse mandibular development following non-reducing TMJ disk displacement in growing individuals. This project has shown that non-reducing displacement of the TMJ disk during growth has significant consequences on facial development. The findings strongly advocate early and accurate diagnosis and treatment of TMJ disk displacement in the adolescent population, thereby presumably reducing the need for future orthodontic and surgical craniofacial corrective therapy. The results furthermore enhance the need for full appraisal of TMJ disk function in the adolescent population during orthodontic functional therapy, as the condylar cartilage and subchondral bone reactions to a concomitantly displaced non-reducing TMJ disk must be expected to interfere with the intended growth stimulating treatment. The findings of intact articular layers in spite of gross histological and morphological soft and hard tissue changes as a sequel to TMJ disk displacement in growing individuals, implicate a clinical risk of false positive radiographic diagnosis of degenerative changes of the TMJ in children and adolescents.

This study constructs a two-step model to test the most prominent market timing factors. We decompose equity issuances into 1) firm-specific components, which are predicted by firms’ characteristics, and 2) market-wide components, which are predicted by aggregate time series measures. Our evidence shows that, at the firm level, firms with higher market-to-book ratio, smaller size, more growth opportunities, and fewer tangible assets are more likely to issue equity. At the aggregate level, a greater proportion of firms issue equity in years with higher aggregate market-to-book ratio and lower asymmetric information. After controlling for the aggregate market-to-book ratio and information asymmetry, sentiment has no direct effect on equity issuance. This paper provides direct evidence that firms time their favorable market conditions to reduce adverse selection costs, and to exploit higher individual security valuations or capture growth opportunities.

How does a drug with a limited safety and efficacy record become an international blockbuster? In June 2006 the FDA approved and recommended a new vaccine directed against 4 types of sexually transmitted human papillomavirus, associated with 70% of cervical cancer cases and 90% of genital wart cases. Branded as a "cervical cancer vaccine" Gardasil has been met with as much fanfare as controversy, and retains blockbuster status in Merck's portfolio. Sold as a cancer risk-reduction method, Gardasil carries its own risks, with startlingly low efficacy and elevated likelihood of serious adverse events (side effects). Through the lens of risk, this dissertation examines Gardasil's popularity in the face of evidence that it is neither as safe nor as effective as advertised. Through three distinct research projects, I identify (a) five sociological factors responsible for Gardasil's success on the heels of Vioxx, one of the biggest drug scandals in history; (b) how amongst healthy vaccinated girls, cervical cancer is experienced as a "risk object," yet when a young woman experiences a serious adverse event that "object of risk" and her "experience of risk" shift toward Gardasil; and (c) that Gardasil is so trusted among young women, that warnings about potential side effects from others made some girls more likely to get vaccinated and have a positive opinion on the vaccine, suggesting that Gardasil benefits from a broader cultural assumption that vaccines are inherently safe and effective. Physicians and pharmaceutical marketing also play an important role. Gardasil is a risk-reduction drug and vaccine purported to treat risk while it simultaneously creates new risk for further health problems in some consumers. This dissertation contributes to sociological literatures on pharmaceuticalization, pharmaceutical pseudoscience, the social construction of risk, research on regulatory agencies, and the sociology of medicine more broadly.

Previous research has established a consensus that in-hospital adverse events are ubiquitous, cause significant harm to patients, and have important financial consequences. However, information on the extent, consequences and costs of adverse events in Canada is limited. For example, there is, as yet, no published study that has investigated the costs of adverse events in a Canadian context. This dissertation aims to redress this situation by providing Ontario-based estimates of the impact of eleven nursing sensitive adverse events on cost, death, readmission, and ambulatory care use within 90 days after hospitalization. This dissertation also aims to contribute more broadly to the patient safety literature by quantifying the impact of diagnostic coding error in administrative data on estimates of the excess costs attributable to adverse events. Given the increasing importance of these estimates in Canada and elsewhere for hospital payment policy and for assessments of the business case for patient safety, this is an important gap in the literature. Each of the adverse events was associated with positive excess costs, ranging from $29,501 (metabolic derangement) to $66,412 (pressure ulcers). Extrapolation from the study hospitals yielded a provincial estimate of $481 million in annual excess costs attributable to the adverse events, which represents 2.8 percent of Ontario’s total hospital expenditures. Several of the adverse events were also associated with significant excess rates of death, readmission, and ambulatory care use. These results suggest that there are economic as well as ethical reasons to improve patient safety in Ontario hospitals. Estimates of adverse event costs were highly sensitive to coding error. The excess cost of adverse events is likely to be significantly underestimated if the error is ignored. This finding, coupled with the observation that the likelihood of error is ignored in most studies, suggests that previous assessments of the business case for patient safety may have been biased against the cost effectiveness of patient safety improvements. Furthermore, the observed extent of institutional level variation in adverse event coding indicates that administrative data are an inadequate basis for adverse event payment policies or for public reporting of adverse event rates.

Did governments in different countries regulate common concerns about patient safety differently? If so how and why did they do this? This thesis undertakes a historical comparison of the regulation of patient safety in Britain and Canada between 1980 and 2005. These jurisdictions began the period with very similar regulatory frameworks, but by 2005 there were distinct differences in each jurisdiction‘s regulatory response to patient safety. Britain was very actively regulating all aspects of service provision within its health system in the name of patient safety, whereas Canada‘s regulatory direction showed adherence to the 1980s model with only scattered incremental developments. This thesis assesses the broader sociopolitical context and the structure of the health systems in each jurisdiction and concludes there are differences in the logics of these systems that established a foundation for future regulatory divergence. It is argued that between 1980 and 2005 there were two factors that influenced regulatory directionality in each jurisdiction: changing political norms associated with the development of neoliberalism and the New Public Management; and events or scandals associated with the provision of health services. The differing levels of penetration of both the changing political norms into governance cultures and of scandals into the public and political consciousness are critical to explaining regulatory differences between jurisdictions. The thesis concludes that what and how governments chose to regulate is a function of the perceived need for action and the dominant social and political norms within that society. Context is everything in the formulation of regulatory approaches to address pressing social problems.

Research into adverse events in home care is at a very early stage worldwide. Adverse event research in other health care sectors has demonstrated that patients can and do suffer harm, much of which is preventable, during the receipt of health care services. A stratified, random sample of patients who had received home care nursing service and were discharged in 2004/05 from three Ontario home care programs was studied to develop basic exploratory and descriptive evidence to advance the understanding of AEs in home care. The outcome is an estimate of the incidence of adverse events among patients, description of adverse event types and factors associated with adverse events, and the development of models predictive of home care patients with higher and lower potential for adverse events, and of the location of patients with adverse events. Positive critical indicators were identified in 66.5% of 430 cases. Sixty-one adverse events were identified in 55 (19.2%) of these 286 cases. When adjusted for sampling methodology, the adverse event rate was 13.2 per 100 patients (95%, CI 10.4% - 16.6%, SE 1.6%). Thirty-three percent of the adverse events were rated as having more than a 50% probability of preventability; 1.4% of all patients experienced an adverse event related death. Eight of the 45 factors significantly associated with adverse events formed a single factor model predictive of adverse events. Six two-factor interactions and the absence of one factor were also predictive of the occurrence of adverse events. Five of the 12 critical indicators significantly related to adverse events, as well as 7 critical indicator combinations formed models that reliably located about two-thirds of patients who had, and almost all patients who had not, experienced an adverse event. This study suggests that a significant number of home care patients experience adverse events, two-thirds of which are preventable. Use of adverse event sensitive factors as a screening tool for patients that may benefit from enhanced case management and clinical vigilance, and those unlikely to be placed at increased adverse event risk by maintaining current levels of vigilance, presents an opportunity to improve patient safety. Retrospective critical indicator models identifying home care patients who have experienced an adverse event can be used to estimate adverse event incidence rates and changes in rates over time.

Research into adverse events in home care is at a very early stage worldwide. Adverse event research in other health care sectors has demonstrated that patients can and do suffer harm, much of which is preventable, during the receipt of health care services. A stratified, random sample of patients who had received home care nursing service and were discharged in 2004/05 from three Ontario home care programs was studied to develop basic exploratory and descriptive evidence to advance the understanding of AEs in home care. The outcome is an estimate of the incidence of adverse events among patients, description of adverse event types and factors associated with adverse events, and the development of models predictive of home care patients with higher and lower potential for adverse events, and of the location of patients with adverse events. Positive critical indicators were identified in 66.5% of 430 cases. Sixty-one adverse events were identified in 55 (19.2%) of these 286 cases. When adjusted for sampling methodology, the adverse event rate was 13.2 per 100 patients (95%, CI 10.4% - 16.6%, SE 1.6%). Thirty-three percent of the adverse events were rated as having more than a 50% probability of preventability; 1.4% of all patients experienced an adverse event related death. Eight of the 45 factors significantly associated with adverse events formed a single factor model predictive of adverse events. Six two-factor interactions and the absence of one factor were also predictive of the occurrence of adverse events. Five of the 12 critical indicators significantly related to adverse events, as well as 7 critical indicator combinations formed models that reliably located about two-thirds of patients who had, and almost all patients who had not, experienced an adverse event. This study suggests that a significant number of home care patients experience adverse events, two-thirds of which are preventable. Use of adverse event sensitive factors as a screening tool for patients that may benefit from enhanced case management and clinical vigilance, and those unlikely to be placed at increased adverse event risk by maintaining current levels of vigilance, presents an opportunity to improve patient safety. Retrospective critical indicator models identifying home care patients who have experienced an adverse event can be used to estimate adverse event incidence rates and changes in rates over time.