An innovative role for nurse practitioners in managing chronic disease

Under the current care delivery model, persons with chronic illnesses, such as diabetes, are not receiving all recommended interventions and failing to meet targeted outcomes. The Chronic Care Model provides a framework for new approaches and roles for many members of the multidisciplinary team. Using the Chronic Care Model as a guide, a group of hospital-based clinics in an academic system incorporated nurse practitioners into the care model for patients with diabetes. Through use of planned visits, a patient registry, drug intensification protocols, and collaboration with other members of the team, the pilot sample improved processes of care and clinical outcomes. Use of nurse practitioners in this model of care for chronically ill patient populations has economic implications, as the payers begin to pay for performance.     

Paths into the economy: structural barriers and the job hunt for skilled PRC migrants in Canada

Well-educated and trained Chinese professionals immigrating to Canada face barriers in finding jobs. To understand this wastage of human capital, we see entry to the professions as mediated by frameworks. The social construction of careers influences the demand for labour. Human capital is a social construct defined by certification procedures in Canada and by the way Canadian employers perceive appropriate matches of jobs and job applicants. Their demand for people with 'Canadian experience' blocks entry into higher-level jobs. The study interviewed thirty-two couples in 1999-2001 using qualitative methods to learn about their experiences finding jobs in Toronto.     

Voluntary tipping and the selective attraction and retention of service workers in the USA: an application of the ASA model

Gratuities paid by consumers are widely used to compensate workers in the service industry despite the fact that this practice permits and even encourages a variety of negative practices – from customer–employee collusion against the interests of the firm to service discrimination against consumers thought to be poor tippers. Such negative effects of tipping raise a question about why it exists – what benefits (if any) do firms receive from tipping to justify this practice? One common explanation for tipping is that it is the most efficient way to provide service workers with performance-contingent rewards and to motivate them to deliver good service. In this paper, we draw upon the attraction–selection–attrition model to describe and test another benefit to firms of this practice, namely that it helps to selectively attract and retain better service workers. Data from a survey of restaurant servers support this selection effect. Concluding discussion calls for more research on this interesting and understudied form of employee compensation.     

Examination of economies of scale in credit unions: a New Zealand study

Recent government pressure and aspirations within the industry itself to improve financial stability, have seen credit unions pursue economies of scale to achieve this objective. This presented an opportunity to test the validity of this strategy. However, this study is uncommon, as it utilized the credit union population as the unit of analysis, rather than a sample, prevalent in other research. As a consequence this overcomes difficulties associated with multiple testings, and other statistical problems present in some other previous studies. By drawing upon two measures of operational efficiency, viz. operating costs to income and operating costs to total assets, inconclusive evidence of scale economies was found. While clear efficiency improvement occurred in moving from small to medium sized organisations, less compelling was the evidence of economies of scale in larger credit unions. Although the article followed a conventional cross-sectional methodology by examining performance at a moment in time, the study also adopted a longitudinal case study approach, by examining over time the efficiency of a large credit union. Finally, the measure used, inclusion or exclusion of outliers, and the operational efficiency ratio chosen, all effect the outcome, and either showed evidence of economies or diseconomies, of scale.     

Cost-effectiveness of axicabtagene ciloleucel for adult patients with relapsed or refractory large B-cell lymphoma in the United States

Abstract

Purpose: Axicabtagene ciloleucel (axi-cel) was recently approved for treatment of relapsed or refractory (R/R) large B-cell lymphoma (LBCL) following two or more prior therapies. As the first CAR T-cell therapy available for adults in the US, there are important questions about clinical and economic value. The objective of this study was to assess the cost-effectiveness of axi-cel compared to salvage chemotherapy using a decision model and a US payer perspective.

Materials and methods: A decision model was developed to estimate life years (LYs), quality-adjusted life years (QALYs), and lifetime cost for adult patients with R/R LBCL treated with axi-cel vs salvage chemotherapy (R-DHAP). Patient-level analyses of the ZUMA-1 and SCHOLAR-1 studies were used to inform the model and to estimate the proportion achieving long-term survival. Drug and procedure costs were derived from US average sales prices and Medicare reimbursement schedules. Future healthcare costs in long-term remission was derived from per capita Medicare spending. Utility values were derived from patient-level data from ZUMA-1 and external literature. One-way and probabilistic sensitivity analyses evaluated uncertainty. Outcomes were calculated over a lifetime horizon and were discounted at 3% per year.

Results: In the base case, LYs, QALYs, and lifetime costs were 9.5, 7.7, and $552,921 for axi-cel vs 2.6, 1.1, and $172,737 for salvage chemotherapy, respectively. The axi-cel cost per QALY gained was $58,146. Cost-effectiveness was most sensitive to the fraction achieving long-term remission, discount rate, and axi-cel price. The likelihood that axi-cel is cost-effective was 95% at a willingness to pay of $100,000 per QALY.

Conclusion: Axi-cel is a potentially cost-effective alternative to salvage chemotherapy for adults with R/R LBCL. Long-term follow-up is necessary to reduce uncertainties about health outcomes.     

Discrimination by Black Males Revisited:

ABSTRACT In an earlier article on faculty salary discrimination at a Southern, historically black, public university (SHBU), the authors presented evidence of salary discrimination by black males against other race-sex groups (Riggs and Dwyer 1995). The authors now contrast SHBU's salary model with the model of Riggs and Dwyer and apply the latter to new data to determine whether SHBU eliminated race and sex discrimination in faculty salaries. After equity adjustments, the evidence suggests that SHBU has eliminated the salary discrimination found by Riggs and Dwyer in their earlier study.     

Stimulus generalization in classical conditioning: An initial investigation and extension

Conditioning as a mechanism for attitude change has received much attention over the past 10 years. This research examines stimulus generalization, the extent to which a response conditioned to one stimulus transfers to similar stimuli. Stimulus generalization relates to both brand extension and private‐label imitations of national brands. Two studies collectively provide evidence that attitudes which are conditioned to a particular brand can be transferred to a product with a similar name in the same category, as well as a product with the same name in a different category. Study Two suggests that stimulus generalization effects may be relatively transitory. © 2000 John Wiley & Sons, Inc.     

An Olympic legacy for all? The non-infrastructural outcomes of the Olympic Games for socially excluded groups (Atlanta 1996-Beijing 2008)

The use of mega sporting events to achieve social goals for socially excluded groups is heavily contested. Comparative evidence regarding the effects of the Olympic Games for these groups is scarce, and there is an even greater dearth of studies focusing on non-infrastructural programmes (such as sport participation initiatives, volunteering opportunities, training and employment schemes). This study identifies planning principles that allow for the development of such non-infrastructural benefits for socially excluded groups in host cities, and reviews their application in recent Olympic Games.This study examines data from 7 Olympic cities (Atlanta, Nagano, Sydney, Salt Lake City, Athens, Turin and Beijing). It shows that the Olympic Games generally bring few benefits for socially excluded groups, although these benefits are often important justifications in the bidding stage. The study highlights the growing importance placed by the International Olympic Committee on environmental sustainability, and proposes a similar emphasis on social sustainability.     

How Do Playful People Play? Gendered and Racial Leisure Perspectives,Motives, and Preferences of College Students

Playfulness is an aspect of personality that predisposes individuals to reframe boring situations into more amusing ones for themselves. This study extends knowledge about the playfulness construct by contrasting college students who were high or low in playfulness relative to the activity preferences they make, the motives they have, and their perspectives on their leisure time. Significant differences were found in perspectives and motives but not in activity preferences, leading to the conclusion that playfulness relates more to how individuals view their leisure and what they seek than in what they do. Only minor differences due to gender or race were observed.     

Boredom in Free Time: Relationships with Personality,Affect, and Motivation for Different Gender,Racial and Ethnic Student Groups

The propensity to experience boredom in free time was investigated by exploring relationships with the individual's demographic characteristics, personality, motivational orientation, and affective style assessed through group-administered questionnaires to 999 university students. The self-as-entertainment personality attribute consistently predicted the likelihood that students would be bored, and inverse relationships with extraversion and intrinsic motivational orientation were found for all student groups. Multiple regression analyses revealed that race, ethnicity, and gender were the only significant demographic predictors of the likelihood an individual would be bored in free time. Group similarities and differences in depicting students who were prone to experience boredom in free time are described.