The impact of a shift in organizational role on ethical perceptions: A comparative study

This study investigates ethical decision-making by considering the differences in ethical judgments between undergraduate business and MBA students on selected ethical issues facing employees and managers of today's businesses. The study further investigates differences in ethical judgments between undergraduates and MBAs in terms of a perceived position as an employee or as a manager. The findings indicate that undergraduate students tend to be more ethical than MBA students and that both groups tend to be more ethical when they perceive themselves as managers rather than employees. The authors discuss the implications for both business practitioners and educators.Shohreh A. Kaynama is Associate Professor of Marketing in the School of Business and Economics at Towson State University in Baltimore, Maryland. She earned a Ph.D. in Marketing and the Decision Sciences. Dr. Kaynama has published extensively in numerous National and International proceedings. Her area of research is strategic marketing, consumer behavior, applications of computers and decision sciences in marketing and global marketing. Louise W. Smith is Professor of Marketing in the School of Business and Economics at Towson State University in Baltimore, Maryland. Dr. Smith's main professional interest is consumer behavior. Dr. Smith's articles have appeared in the Journal of Public Policy & Marketing, Journal of Health Care Marketing, Journal of Marketing Education, Journal of Services Marketing, and Journal of Consumer Marketing among others. Algin B. King is Professor of Marketing in the School of Business and Economics at Towson State University in Baltimore, Maryland. He has served on the Faculties of seven universities, publishing numerous articles in National Professional Meetings Proceedings and scholarly journals including Journal of Euro-Marketing, Atlantic Economic Journal. In addition he has served as a business consultant to numerous business firms.     

A review and validation of overall survival extrapolation in health technology assessments of cancer immunotherapy by the National Institute for Health and Care Excellence: how did the initial best estimate compare to trial data subsequently made available?

Background: Validation of overall survival (OS) extrapolations of immune-checkpoint inhibitors (ICIs) during the National Institute for Health and Care Excellence (NICE) Single Technology Assessment (STA) process is limited due to data still maturing at the time of submission. Inaccurate extrapolation may lead to inappropriate decision-making. The availability of more mature trial data facilitates a retrospective analysis of the plausibility and validity of initial extrapolations. This study compares these extrapolations to subsequently available longer-term data.

Methods: A systematic search of completed NICE appraisals of ICIs from March 2000 to December 2017 was performed. A targeted search was also undertaken to procure published OS data from the pivotal clinical trials for each identified STA made available post-submission to NICE. Initial Kaplan-Meier curves and associated extrapolations from NICE documentation were extracted to compare the accuracy of OS projections versus the most mature data.

Results: The review identified 11 STAs, of which 10 provided OS data upon submission to NICE. The extrapolations undertaken considered parametric or piecewise survival models. Additional data cut-offs provided a mean of 18 months of OS beyond the end of the original data. Initial extrapolations typically under-estimated OS from the most mature data cut-off by 0.4–2.7%, depending on the choice of assessment method and use of the manufacturer- or ERG-preferred extrapolation.

Conclusion: Long-term extrapolation of OS is required for NICE STAs based on initial immature OS data. The results of this study demonstrate that the initial OS extrapolations employed by manufacturers and ERGs generally predicted OS reasonably well when compared to more mature data (when available), although on average they appeared to underestimate OS. This review and validation shows that, while the choice of OS extrapolation is uncertain, the methods adopted are generally aligned with later-published follow-up data and appear appropriate for informing HTA decisions.     

Annual Reporting Mechanisms of National Health Service Trusts

This article investigates the role of the annual report and the annual general meeting (AGM) in the context of NHS trusts. The authors report the results of a questionnaire survey of every NHS trust in the UK. Significant variation in the approach taken within a common framework of accountability was found. In general, there seems to be little public demand for trusts' annual reports and attendance at their AGMs was low. The research indicates possibilities of extending annual reporting in the public sector beyond the annual report and AGM and discloses innovative ways that trusts have attempted to overcome the limited interest of stakeholders produced by the traditional reporting mechanisms.     

The relationship between risk experience and risk response: a study of farmers and climate change

Within the existing literature, the role of experience of risk on attitudinal and behavioural risk response has been relatively neglected. Recent research that draws on the psychological distance of climate change as a concept notes the importance of local, significant experience as a driver for encouraging appropriate response. The experience of flooding was used as the stimulus in this paper, and emphasis placed on whether direct and/or indirect experience of flood risk is associated with different responses to climate change risk. In order to explore the relationship between climate change risk experience and response in the form of on-farm mitigation and adaptation, this paper draws on a case study of farmers in England, many of whom have experienced flooding. Results from a quantitative survey undertaken with 200 farmers in Gloucestershire, England are discussed. Statistical analysis found experience of flooding to be significantly associated with a heightened concern for climate change. Although also finding an association between experience and behavioural response, the sample were most likely to be taking adaptive behaviour as part of normal practice, with factors such as lack of overall concern for climate change risk and absence of information and advice likely to be the main barriers to action. Risk communication needs to further emphasise the connection between climate change and extreme weather events to allow for farmers to perceive climate change as a relevant and locally salient phenomenon, and subsequent tailored information and advice should be offered to clearly illustrate the best means of on-farm response. Where possible, emphasis must be placed on actions that also enable adaptation to other, more immediate risks which farmers in this study more readily exhibited concern for, such as market volatility.     

Nursing home choice,family bargaining,and optimal policy in a Hotelling economy

We develop a model of family bargaining to study the impact of the distribution of bargaining power within the family on the choice of nursing homes by families, and on the locations and prices chosen by nursing homes in a Hotelling economy. In the baseline (static) model, where the dependent parent cares only about the location of the nursing home, the markup of nursing homes is increasing in the bargaining power of the dependent parent, and nursing homes are located at the extreme periphery. We compare the laissez‐faire with the social optimum (which involves more central locations of nursing homes), and examine its decentralization in first‐best and second‐best settings. We explore the robustness of our results to introducing a bequest motive in a dynamic overlapping generations model, which allows us to study the joint dynamics of wealth accumulation and nursing home prices. If the bequest motive is strong, the markup is decreasing in the bargaining power of the dependent. However, wealth accumulation, by reducing interest rates, raises markup rates and nursing homes prices.     

Nontraditional student withdrawal from undergraduate accounting programmes: a holistic perspective

A collaborative project of several Quebec universities, this study investigates nontraditional student withdrawal from undergraduate accounting programmes. A nontraditional student is older than 24, or is a commuter or a part-time student, or combines some of these characteristics. Univariate and multivariate analyses of student dropout factors were performed. A logistic regression for full-time students indicates several significant determinants of student withdrawal: returning to school after working for some time, enrolment in a non-first choice programme, dissatisfaction with programme choice and courses, and low grade point average (GPA). For part-time students, low GPA is the main explanatory factor for student withdrawal. Other factors appear to be instrumental in withdrawal decisions, such as management of external resources (time and family responsibilities) for women. The results suggest that students would benefit from university support services to acquire learning strategies that improve perseverance. Lastly, in-class learning activities that help bolster grades could decrease student withdrawal rates.     

"Quicker and sicker" under Medicare's prospective payment system for hospitals: new evidence on an old issue from a national longitudinal survey

Medicare's prospective payment system for hospitals (PPS), introduced in the USA in 1983, replaced cost reimbursement with a system of fixed rates which created incentives for hospitals to control costs. Previous studies found that elderly patients were discharged from hospital "quicker and sicker" under PPS and concluded that families were coping at home. We analyse a national longitudinal survey, the first National Health and Nutrition Examination Survey and its Epidemiologic Followup Study, which includes data on more outcomes over a longer period than earlier studies. We find that the rate of admission to nursing homes from the community in the first weeks after a hospital discharge more than tripled under PPS, suggesting that families were not always able to cope. As another response to sicker patients, discharges directly to nursing homes from hospitals, which jumped initially under PPS, may have risen further when payment rates were tightened in the early 1990s. Hospital readmissions fell after the first few years. Our findings are strengthened by the fact that we control for patients' health using health information collected independently of hospital admission.