Age as double‐edged sword among victims of customer mistreatment: A self‐esteem threat perspective

Service workers are expected to maintain high‐quality service delivery despite customer mistreatment—the poor‐quality treatment of service workers by customers—which can be demeaning and threatening to self‐esteem. Although service work is increasingly delivered by middle‐aged and older workers, very little is known about how employees across the age range navigate abuse from customers on the job. Does advancing age help or hinder service performance in reaction to customer mistreatment? Drawing on strength and vulnerability integration theory, we proposed that age paradoxically both helps and hinders performance after customer mistreatment, albeit at different stages. We tested our proposed model in a two‐sample field investigation of service workers and their supervisors using a time‐lagged, dyadic design. Results showed that age heightens the experience of self‐esteem threat but, nevertheless, dampens reactions to self‐esteem threat, leading to divergent effects on performance at different stages. Implications for age and service work, as well as aging and the sense of self, are discussed.     

Cost comparison of continued anticoagulation with rivaroxaban versus placebo based on the 1-year EINSTEIN-Extension trial efficacy and safety results

Aims: The EINSTEIN-Extension trial (EINSTEIN-EXT) found that continued treatment with rivaroxaban for an additional 6 or 12 months (vs placebo) after 6–12 months of initial anticoagulation significantly reduced the risk of recurrent venous thromboembolism (VTE) with a small non-significant increased risk of major bleeding (none fatal or in critical site). This study aimed to compare total healthcare cost between rivaroxaban and placebo, based on the EINSTEIN-EXT event rates.

Methods: Total healthcare cost was calculated as the sum of treatment and clinical event costs from a US managed care perspective. Treatment duration and event rates were obtained from the EINSTEIN-EXT study. Adjustment on treatment duration was made by assuming a 10% non-adherence rate. Drug costs were based on wholesale acquisition costs. Cost estimates for clinical events (i.e. recurrent deep vein thrombosis [DVT], recurrent pulmonary embolism, major bleeding, clinically relevant non-major bleeding) were determined from the literature. Results were examined over a ±20% range of each cost component and over 95% confidence intervals (CIs) of event rate differences in deterministic (one-way) and probabilistic sensitivity analyses (PSA).

Results: Total healthcare cost was $1,454 lower for rivaroxaban-treated (vs placebo-treated) patients in the base-case, with a lower clinical event cost fully offsetting drug cost. The cost savings of recurrent DVT alone (–$3,102) was greater than drug cost ($2,723). Total healthcare cost remained lower for rivaroxaban in the majority (73%) of PSA (cost difference [95% CI]?=?–$1,454 [–$2,396, $1,231]).

Limitations: This study was conducted over the 1-year observation period of the EINSTEIN-EXT trial, which limited “real-world” applicability and examination of long-term economic impact. Assumptions on drug and clinical event costs were US-based and, thus, not applicable to other healthcare systems.

Conclusions: Total healthcare costs were estimated to be lower for patients continuing rivaroxaban therapy compared to those receiving placebo in VTE patients who had completed 6–12 months of VTE treatment.     

Health state utilities associated with caring for an individual with cutaneous T-cell lymphoma (CTCL)

Abstract

Aim

Cutaneous T-cell Lymphoma (CTCL) is a rare form of non-Hodgkin lymphoma characterized by skin lesions, which can negatively impact the quality of life of both patients and their caregivers. The Decision Support Unit (DSU) at the National Institute for Health and Care Excellence (NICE) in the UK recently outlined a rationale for the inclusion of caregiver burden in economic evaluations. This study aimed to estimate utilities for health states associated with being a caregiver for an individual with CTCL at different stages of treatment.     

Le Pont de Londres: Interactions between monetary and prudential policies in cross‐border lending

Using two unique confidential datasets summarizing the cross‐border lending of banks in France and the UK, we examine whether recipient‐country prudential policies can help to reduce the spillover effects of euro‐area (EA) monetary policy. We address this question from a novel angle, focused on the role of international financial centres, by considering differences in bank size and location (lending from French headquarters vs. from French affiliates located in the UK). For small French banks that lack a presence in international financial centres, the response of direct cross‐border lending from France to EA monetary policy is partially offset by recipient‐country prudential policy. For larger banks, however, the offsetting effect applies only to lending that passes through foreign affiliates located in London. This suggests the existence of a “London Bridge”: banks adapt their flows to the UK conditional on EA monetary policy and global prudential policies; and from their UK affiliates to third‐party countries in a manner that depends on local prudential settings.     

Customers acting badly: Evidence from the hospitality industry

The activities of misbehaving customers represent a significant problem for organizations across diverse sectors and industries. Customer misbehavior signifies behavior within the exchange setting that deliberately violates the generally accepted norms of conduct in such situations. The core aim of this study is to advance understanding of the antecedents to past customer misbehavior and examine the relationship between past misbehavior and future misbehavior intentions. Although prior studies offer insights into individual events or types of customer misbehavior, to date, empirical evidence of the antecedents to past misbehaviors and future behavioral intentions is lacking. Synthesizing literature from varied theoretical backgrounds, this study puts forth five personality-based variables (consumer alienation, Machiavellianism, sensation seeking, aggressiveness, and self-esteem) and four demographic variables (gender, income, age, and education) as antecedents to past customer misbehavior. In turn, this study reveals an association between past customer misbehavior and future misbehavior intent. Structural equation modeling procedures using a sample of 380 respondents reveals support for eight of the nine specified hypotheses. The article concludes with a discussion of the study's implications for theory and practice.     

Poor relief in Elizabethan English communities: an analysis of Collectors' accounts

This article analyses 30 accounts of income and expenditure left by Collectors for the Poor in Elizabethan England, before the period known as the old poor law. Collectors were appointed by parishes and incorporated boroughs in accordance with the poor laws of 1552 and 1563, but few of their fragile records survive. The accounts examined here document early use of compulsory rates to provide income, but several features of the distribution of relief differ from patterns common in the seventeenth and eighteenth centuries. Adult male recipients outnumbered women in many of the parishes; children were frequently helped directly; and cities and towns assisted a smaller fraction of their total populations than did villages but awarded larger per capita payments. Accounts from the 10 villages and small towns analysed most fully show that Elizabethan Collectors were moving away from the late medieval practice of providing only occasional aid; increasingly they awarded regular payments to a selected subset of the local poor. Comparison with the early seventeenth century suggests that the poor laws of 1598 and 1601 contributed to a transition that was already underway but did not create a new system of relief.     

Making compassion count: equal recognition and authentic involvement in mental health care

Compassionate care within mental health services is often taken for granted as something that can be made visible and authentic. However, recent government reports and policy suggest that we are far from providing compassionate care and may be more focused upon risk and surveillance. This paper will discuss the visibility of compassionate care and explore outcomes that consumers and practitioners could measure in practice. Separating the fact from fiction within compassionate care will make authentic involvement practices more visible and open to discussion around consumer collaboration. In a qualitative analysis of a small study with mental health consumers, compassion was found to be a major factor in whether consumers became more involved in their own health care. Demonstrating compassionate care may therefore also demonstrate consumer participation and engagement. This paper will argue that compassionate care can be observed in the relationships between practitioners and consumers that are collaborative and use presence and persistence as methods of practice. Emancipatory practices can be made more visible in mental health care in order to make compassion measurable and to encourage consumer participation and engagement.     

Length of stay and economic consequences with rivaroxaban vs enoxaparin/vitamin K antagonist in patients with DVT and PE: findings from the North American EINSTEIN clinical trial program

Objective:

Venous thromboembolism (VTE) (deep vein thrombosis [DVT] and pulmonary embolism [(PE]) represents a substantial economic burden to the healthcare system. Using data from the randomized EINSTEIN DVT and PE trials, this North American sub-group analysis investigated the potential of rivaroxaban to reduce the length of initial hospitalization in patients with acute symptomatic DVT or PE.

Methods:

A post-hoc analysis of hospitalization and length-of-stay (LOS) data was conducted in the North American sub-set of patients from the randomized, open-label EINSTEIN trial program. Patients received either rivaroxaban (15?mg twice daily for 3 weeks followed by 20?mg once daily; n?=?405) or dose-adjusted subcutaneous enoxaparin overlapping with (guideline-recommended ‘bridging’ therapy) and followed by a vitamin K antagonist (VKA) (international normalized ratio?=?2.0–3.0; n?=?401). The open-label study design allowed for the comparison of LOS between treatment arms under conditions reflecting normal clinical practice. LOS was evaluated using investigator records of dates of admission and discharge. Analyses were carried out in the intention-to-treat population using parametric tests. Costs were applied to the LOS based on weighted mean cost per day for DVT and PE diagnoses obtained from the Healthcare Cost and Utilization Project dataset.

Results:

Of 382 patients hospitalized, 321 (84%), had acute symptomatic PE; few DVT patients required hospitalization. Similar rates of VTE patients were hospitalized in the rivaroxaban and enoxaparin/VKA treatment groups, 189/405 (47%) and 193/401 (48%), respectively. In hospitalized VTE patients, rivaroxaban treatment produced a 1.6-day mean reduction in LOS (median?=?1 day) compared with enoxaparin/VKA (mean?=?4.5 vs 6.1; median?=?3 vs 4), translating to total costs that were $3419 lower in rivaroxaban-treated patients.

Conclusion:

In hospitalized North American patients with VTE, treatment with rivaroxaban produced a statistically significant reduction in LOS. When treating DVT and PE patients, clinicians should consider newer anti-coagulants with less complex treatment regimens.     

Amalgamations of universities:are there economics of scale or scope?

This paper estimates a multiple-output cost function for Australian universities. The estimates are used to evaluate the cost savings arising from the amalgamation of two or more institutions. These cost savings in turn are decomposed into those due to economics of scale and those due to economics of scope, using a new measure of economics of scope associated with the amalgamation of two institutions.