This paper proposes a new conceptualization of business model (BM) that rigorously exploits the important insights this notion offers and links them to related views developed in economics and business studies. We develop the foundations of a BM concept consistent with the principles of generalized Darwinism (GD) and with contributions already developed within this framework. Thus, we demonstrate the relevance of GD as a unifying framework for developing the evolutionary theory of firm and industry. We suggest analysing BM as a generative replicator hosted by the firm, which structures interactions between the members of this organization and the social entities of its industrial environment. We argue that GD allows us to clarify the nature and boundaries of the BM concept and to specify its relationships to other key evolutionary concepts, such as organizational routines.

Retirees' encounter with time has long interested social scientists, especially the negotiation of such an open-ended status. Pursuing theoretical suggestions that daily activities anchor a narrative of self-identity, this project examined the coherence of retirees' representations of their time use. Information is drawn from interviews with 30 retirees in the Midwestern United States of America who were invited to discuss their daily lives and activities. The retirees valued time sovereignty and accounted for their time use by describing schedules of activities in some detail. Daily time was not presented as improvised but rather as structured into routines. Recurring behaviours flowed from situations and structures in which people were implicated, such as body care and living with others. Even in replies to a specific question about the preceding day, people slipped into language about what they typically do. Retirees' ready narratives about routines were also accounts of who they are not. Our findings suggest, first, that daily routines are instrumental for retirees in economising thought and behaviour. Second, the assertion of a routine is an assurance that one's life is ordered and proceeds with purpose, thus solving the task of time. Third, routines can be a means to signal conformity with ideals of active ageing.

This paper discusses the project of an archaeology of capitalism through a case study situated in the southern Scottish Highlands. It is argued that archaeology as a discipline has a significant contribution to make to discussions of the emergence and development of the social relations of capitalism. This is because archaeology has as one of its main concerns mundane social practice or routine. Changes in everyday routine and the associated material environment made the ideological aspects of capitalism, focusing on the individual and private property, conceivable for some. These changes to the everyday environment were instigated by the landlords, inspired by enlightenment thought, in order to secure their ownership of certain estates as private property, which had been in dispute under the clan system. Response of the rural population to Improvement was varied and their continuing relationship with their landlord evolved with reference to certain key structuring dispositions. The essential issue for the farming population was land rights. The major conclusion of this paper as concerns archaeologies of capitalism is that we must distinguish between capitalism (an ideology of the individual made knowable in routine practice) and capitalist societies (those societies where capitalism is widespread but not necessarily universal). This allows consideration of varied experience of and interaction with capitalism in the past.

Objectives: Pre-admission clinics are traditionally run jointly by nurses and doctors. Within an adult ENT pre-admission clinic, we wished to assess what doctors added tonurses’ pre-clerking, to determine whether doctors were actually needed in the clinic.

Methods: Prospective study,looking at how often doctors, seeing patients after ward-based nurses, changed or added to clerking or tests as organized by nurses.

Results: Out of 184 patients, doctors changed or added to nurses’ clerking or planned investigations in 47 patients (26 per cent), making 64 different changes. The commonest reasonsfor changes were ordering blood tests (22 changes), chest X-rays (eight), cancelling due to hypertension (seven), altering drug history (five) and requesting electrocardiograms (five changes).

Conclusion: Most changes made by doctors could be eliminated by designing a pre-admission clinic protocol that could easily be used by nurses. We recommend that all ENT departments consider implementing nurse-led pre-admission clinics.

Little is known about the value patients, physicians, and payers place on intangible attributes of care. Differences in valuations among these groups and misperceptions of value of intangible attributes to other groups can contribute to conflicts about treatment recommendations or coverage decisions. We surveyed patients, physicians, and managed care executives to assess their willingness to pay (WTP) for diagnostic certainty for peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD). To determine if patients, physicians, and payers accurately perceive each other's valuations of diagnostic certainty, participants were also asked to estimate the WTP of each of the other types of respondents. Patients were most likely, and executives least likely, to value diagnostic certainty. For PUD, 84% of patients, 61% of physicians, and 43% of executives expressed a positive WTP. Median WTP was low for all three groups ($1–9 for patients and physicians; $0 for payers). Physicians and executives both correctly predicted patient WTP. For GERD, 87% of patients, 52% of physicians, and 29% of executives expressed a positive WTP. Executives underestimated patient WTP. For both diseases, physicians' WTP was overestimated by patients and underestimated by executives. The inconsistency in the value that patients, physicians, and managed care executives place on diagnostic certainty indicates the potential for conflict over practice guidelines or access to services. WTP surveys can provide information to aid in anticipating and addressing areas of disagreement.

A prospective multicentre pilot study was undertaken in 20 Italian hospitals to assess the influence of a routine pre-operative chest radiograph on anaesthetic management and to characterise which patients might benefit from it. A total of 6111 patients undergoing elective surgery and submitted for routine pre-operative chest radiograph were enrolled. Abnormal pre-operative chest radiographs were reported in 1116 patients (18.3%). Pre-operative chest radiograph altered the anaesthetic management (i.e. useful pre-operative chest radiograph) in 313 patients (5.1%). Male sex, age >60 years, ASA classes ≥3, respiratory diseases, and the presence of two or more co-existing diseases were significantly related to the probability of a useful pre-operative chest radiograph using multivariate analysis (P<0.01). The classification of the surgical intervention and, of the co-existing diseases, the presence of cardiac disease had a very low influence when determining the probability that a pre-operative chest radiograph would be useful. A simple equation includes the effects of all the variables studied and allows calculation of the probability of a useful pre-operative chest radiograph. This study indicates that in healthy, female, ≤60-year-old patients, submitted for standard surgery, the probability of a useful pre-operative chest radiograph ranges from 0.2% to 3.5% according to the hospital. The probability increases in male or elderly subjects, or in the presence of co-existing respiratory diseases, or in ASA classes ≥3, but there is a wide variation between hospitals.

Estimation of haemoglobin is still undertaken routinely before ENT surgery in many centres despite evidence that it is unnecessary, traumatic and expensive. The haemoglobin was estimated of all 372 children about to undergo ENT surgery in a busy district general hospital over a one year period. No child was noted to be clinically anacmic, and no child had a haemoglobin of less than 9 g/dl. Of 18 children with a haemoglobin level of 10.5 or less, 10 had their operations postponed and eight did not. There were no complications in the latter group. We can find no published evidence that operating on children with mild anaemia is unsafe. Ceasing routine pre-operative haemoglobin estimation would safely save an estimated £9000 per year in our unit.