Cost-effectiveness of dedicated dietitians for hyperphosphatemia management among hemodialysis patients in Lebanon: results from the Nutrition Education for Management of Osteodystrophy trial

Aim: To assess the cost-effectiveness of nutrition education by dedicated dietitians (DD) for hyperphosphatemia management among hemodialysis patients.

Materials and methods: This was a trial-based economic evaluation in 12 Lebanese hospital-based units. In total, 545 prevalent patients were cluster randomized to DD, trained hospital dietitian (THD), and existing practice (EP) groups. During Phase I (6 months), DD (n?=?116) received intensive education by DD trained on renal nutrition, THD (n?=?299) received care from trained hospital dietitians, and EP (n?=?130) received usual care from untrained hospital dietitians. Patients were followed-up during Phase II (6 months).

Results: At baseline, EP had the lowest weekly hemodialysis time, and DD had the highest serum phosphorus and malnutrition-inflammation score. The additional costs of the intervention were low compared with the societal costs (DD: $76.7, $21,007.7; EP: $4.6, $18,675.4; THD: $17.4, $20,078.6, respectively). Between Phases I and II, DD showed the greatest decline in services use and societal costs (DD: –$2,364.0; EP: –$1,727.7; THD: –$1,105.7). At endline, DD experienced the highest decrease in adjusted serum phosphorus (DD: –0.32; EP: +0.16; THD: +0.04?mg/dL), no difference in quality-adjusted life-years (QALY), and the highest societal costs. DD had a cost-effectiveness ratio of $7,853.6 per 1?mg decrease in phosphorus, compared with EP; and was dominated by THD. Regarding QALY, DD was dominated by EP and THD. The results were sensitive to changes in key parameters.

Limitations: The analysis depended on numerous assumptions. Interpreting the results is limited by the significant baseline differences in key parameters, suggestive of higher baseline societal costs in DD.

Conclusions: DD yielded the greatest effectiveness and decrease in societal costs, but did not affect QALY. Regarding serum phosphorus, DD was likely to be cost-effective compared with EP, but had a low cost-effectiveness probability compared with THD. Regarding QALY, DD was not likely to be cost-effective. Assessing the long-term cost-effectiveness of DD, on similar groups, is recommended.     

Consumer adoption of Internet banking in Jordan: Examining the role of hedonic motivation,habit, self-efficacy and trust

Despite the rapid growth of Internet banking (IB), customers in developing countries still hesitate to adopt this technology and its use in the Middle East remains low. This study aims to identify and examine the factors that predict behavioural intention and adoption of IB in Jordan. Four factors – hedonic motivation, habit, self-efficacy and trust – are proposed in a conceptual model. Data was collected by means of a survey with bank customers in Jordan. Structural equation modelling (SEM) was used to analyse the data. The results strongly supported the conceptual model. Further, hedonic motivation, habit, self-efficacy and trust were all confirmed to have a significant influence on behavioural intention. Trust was found to be strongly predicted by both hedonic motivation and self-efficacy. This study provides both academics and practitioners with an insight into the factors that can be used to encourage customer adoption of IB specifically in a Middle East context.     

Exploring the motives and success factors behind female entrepreneurs in India

Quality & Quantity - Encouraging women as entrepreneurs in the recent scenario are the government initiative over the globe. Some women started these small enterprises to support their living...     

The role of destination personality fit in destination branding: Antecedents and outcomes

Drawing from fit research in strategic management, this study develops and investigates a model predicting destination attitude and (re)visit intention. The study introduces the concept of destination personality fit on the basis of how well consumer perceptions of a tourist destination's brand personality fits that of what the destination brand manager wishes to convey. A model incorporating destination advertising awareness as an antecedent of destination personality and consumer‐manager destination personality fit is tested on international consumers with the destination personality of Switzerland as the study setting. Structural equation modeling results reveal that destination advertising awareness does indeed relate positively to both stronger perceived destination personality and destination personality fit in consumers’ minds. Interestingly, the subsequent destination personality–destination attitude relationship is moderated by consumer–manager destination personality fit in such a way that the link grows stronger in cases where fit is high. The results have important implications for destination brand managers in that they reinforce the importance of strong and distinct destination personalities. The findings also show the importance of actively communicating the destination brand to consumers since the positive outcomes of a strong destination personality increase in magnitude when successfully communicated, and the vision of the destination brand manager has been adopted by the consumer.     

Efficiency of Microfinance Institutions: A Data Envelopment Analysis

This study examines the cost efficiency of 39 microfinance institutions across Africa, Asia and the Latin America using non-parametric data envelopment analysis. Our findings show non-governmental microfinance institutions particularly; under production approach, are the most efficient and this result is consistent with their fulfillment of dual objectives: alleviating poverty and simultaneously achieving financial sustainability. However, bank-microfinance institutions also outperform in the measure of efficiency under intermediation approach. This result reflects that banks are the financial intermediaries and have access to local capital market. It may be possible that bank-microfinance institutions may outperform the non-governmental microfinance institutions in the long run.     

European bank equity risk: 1995–2006

We examine changes in bank equity risk following the formation of the Economic Monetary Union (EMU) in 1999. With the exception of Germany, we observe a decline in bank risk across euro-zone countries. Total risk decreased for 70% of the euro-zone banks in our sample with a statistically significant decrease in total risk observed for 51% of the sample. Similar results are found for idiosyncratic risk and systematic risk. These results are robust to financial crisis effects and test specification. Moreover, we find some evidence of a decrease in bank equity risk for a sample of neighbouring non-euro-zone European countries, consistent with the existence of some spill over effects.     

On a class of correlated queueing problems

This paper deals with a steady state behaviour of a discrete time, single channel, first come first served, finite space queueing problem. It is assumed that the departure probabilities depend on the queue length and that the departure at two consecutive time marks are correlated. The arrivals at two consecutive time marks are statistically independendent. However, the arrival probabilities are assumed to depend on the queue length. A few particular cases have also been discussed.     

Geographic Concentration in Indian Manufacturing and Service Industries: Evidence from 1998 to 2013

This paper uses a comprehensive new data source to document basic facts about geographic concentration among industries in India from 1998 to 2013. Unlike previous studies, our data allow us to accurately measure industrial concentration at the district level and cover manufacturing and services, as well as the formal and informal sectors. Our most striking finding is that average levels of industrial concentration fell dramatically between 1998 and 2013, driven by steep reductions in capital‐intensive manufacturing industries. We provide suggestive evidence that this increasing dispersion may be due to improvements in interregional transportation coupled with inefficient land management policies and limited labor mobility.     

Twenty-five years of business systems research and lessons for international business studies

Since 1992, the national business systems (NBS) approach has been increasingly used to analyse not only firm characteristics, structures and strategies within NBS, but also the nature of international business and its interactions with both national and transnational institutions. In reviewing 25 years of NBS literature, we heed calls in IB journals urging researchers to use NBS notions and findings in IB research. Our systematic review of 96 articles analyses the patterns and contributions of NBS literature, revealing four thematic junctures: (1) comparative business systems, (2) firm internationalisation and the management/organisation inside MNCs, (3) the role of internationalisation in the development of organisational capabilities and innovation and (4) the emergence of transnational communities in and across firms and societies. Themes are described in terms of (a) the research questions (RQ) they focus on, (b) how NBS approach investigates the RQ and what are the major findings, (c) how IB frames and approaches the same RQ, (d) how does the NBS approach extend the perspectives of IB and (e) what are the problems faced by NBS in terms of developing further insights into the RQ. Our review contributes to the recent endeavour of IB research to institutionalism, encouraging a productive dialogue between IB and NBS research.