Seeing history: a visual assessment of the historic-grounding of Old Western tourist towns

Despite the significant role that the visual plays in the experience of tourism, few studies have specifically examined the visual appearances of heritage tourist destinations. This study sought to analyze how historically grounded the visual appearances were of two heritage tourist towns in the state of Arizona: Tombstone and Jerome. These towns were both mining towns that experienced historic booms during the days of the American Old West and survive today as tourist destinations. This study utilized a detailed visual comparison of historic and contemporary town photographs in order to assess the relative historic-grounding of building exteriors and streets. It also incorporated the findings of interviews with tourists and town residents regarding their perceptions of visual historic-grounding. Study findings offered a means to assess and compare visual historic-grounding. Additionally, they suggested that while visual historic-grounding was important to visitors, it was one of several factors influencing their perceptions of the town's historic appearance: visual appeal, personal reflections, engaging activities, and previous visitor expectations of the American Old West (often grounded in filmic-representations) worked together to visually communicate a general impression of history within each town.     

When we are onstage,we smile: The effects of emotional labor on employee work outcomes

A growing body of literature has confirmed the deleterious effects of emotional labor on service employees. The study adds to it by investigating two hypothesized antecedents to emotional labor; affectivity and empathy which is conceptualized as a two-dimensional construct composed of emotional contagion and empathic concern. It also examines the impact of emotional labor on job satisfaction and exhaustion. The results confirmed a two-dimensional structure of emotional labor, emotive dissonance, and emotive effort. Hospitality employees with higher positive affect tend to experience less emotive dissonance while individuals with higher negative affect exert more effort to enact emotional labor. A positive relationship was found between emotional contagion and emotive dissonance, and emotive effort and job satisfaction. The results also suggested a negative relationship between emotive effort and emotional exhaustion. An unexpected negative relationship was found between emotional dissonance and emotional exhaustion. Managerial implications discuss training and acting techniques to more effectively manage employee emotional labor.     

Crowding standards at Petra Archaeological Park: a comparative study of McKercher's five types of heritage tourists

To achieve sustainability in heritage tourism, tourists should be placed at the heart of the management and planning processes. Indicators and standards-based frameworks were developed in the field of outdoor recreation management to manage and measure crowding and other problematic issues in parks and related areas. Using normative theory and visual research methods, this article aims to examine crowding standards of tourists at Petra Archaeological Park, and compare these standards between the types of heritage tourists suggested by a model developed by Bob McKercher. Results showed that tourists’ acceptability levels go down with an increasing number of tourists, and tourists who are highly motivated to visit heritage sites (i.e. purposeful and sightseeing heritage tourists) had the most restrictive acceptable number of tourists at the park. The normative standards formulated in this article provided a guidance to manage crowding at Petra.     

Major bleeding risk and healthcare economic outcomes of non-valvular atrial fibrillation patients newly-initiated with oral anticoagulant therapy in the real-world setting

Aims: This study compared the risk for major bleeding (MB) and healthcare economic outcomes of patients with non-valvular atrial fibrillation (NVAF) after initiating treatment with apixaban vs rivaroxaban, dabigatran, or warfarin.

Methods: NVAF patients who initiated apixaban, rivaroxaban, dabigatran, or warfarin were identified from the IMS Pharmetrics Plus database (January 1, 2013–September 30, 2015). Propensity score matching (PSM) was used to balance differences in patient characteristics between study cohorts: patients treated with apixaban vs rivaroxaban, apixaban vs dabigatran, and apixaban vs warfarin. Risk of hospitalization and healthcare costs (all-cause and MB-related) were compared between matched cohorts during the follow-up.

Results: During the follow-up, risks for all-cause (hazard ratio [HR]?=?1.44, 95% confidence interval [CI]?=?1.2–1.7) and MB-related (HR?=?1.57, 95% CI?=?1.0–2.4) hospitalizations were significantly greater for patients treated with rivaroxaban vs apixaban. Adjusted total all-cause healthcare costs were significantly lower for patients treated with apixaban vs rivaroxaban ($3,950 vs $4,333 per patient per month [PPPM], p?=?.002) and MB-related medical costs were not statistically significantly different ($100 vs $233 PPPM, p?=?.096). Risk for all-cause hospitalization (HR?=?1.98, 95% CI?=?1.6–2.4) was significantly greater for patients treated with dabigatran vs apixaban, although total all-cause healthcare costs were not statistically different. Risks for all-cause (HR?=?2.22, 95% CI?=?1.9–2.5) and MB-related (HR?=?2.05, 95% CI?=?1.4–3.0) hospitalizations were significantly greater for patients treated with warfarin vs apixaban. Total all-cause healthcare costs ($3,919 vs $4,177 PPPM, p?=?.025) and MB-related medical costs ($96 vs $212 PPPM, p?=?.026) were significantly lower for patients treated with apixaban vs warfarin.

Limitations: This retrospective database analysis does not establish causation.

Conclusions: In the real-world setting, compared with rivaroxaban and warfarin, apixaban is associated with reduced risk of hospitalization and lower healthcare costs. Compared with dabigatran, apixaban is associated with lower risk of hospitalizations.     

Evaluation of medical costs associated with use of new oral anticoagulants compared with standard therapy among venous thromboembolism patients

Objective:

This study evaluated differences in medical costs associated with clinical end-points from randomized clinical trials that compared the new oral anticoagulants (NOACs), dabigatran, rivaroxaban, apixaban, and edoxaban, to standard therapy for treatment of patients with venous thromboembolism (VTE).

Research design and methods:

Event rates of efficacy and safety end-points from the clinical trials (RE-COVER, RE-COVER II, EINSTEIN-Pooled, AMPLIFY, Hokusai-VTE trial) were obtained from published literature. Incremental annual medical costs among patients with clinical events from a US payer perspective were obtained from the literature or healthcare claims databases and inflation adjusted to 2013 costs. Differences in total medical costs associated with clinical end-points for the NOACs vs standard therapy were then estimated. One-way and Monte Carlo sensitivity analyses were carried out.

Results:

A lower rate of major bleedings was associated with use of any of the NOACs vs standard therapy. Except for dabigatran, use of NOACs was also associated with a lower rate of recurrent VTE/death. As a result of the reduction in clinical event rates, the overall medical cost differences were ?$146, ?$482, ?$918, and ?$344 for VTE patients treated with dabigatran, rivaroxaban, apixaban, and edoxaban, respectively, vs patients treated with standard therapy.

Conclusions:

When any of the four NOACs are used instead of standard therapy for acute VTE, treatment medical costs are reduced. Apixaban is associated with the greatest reduction in medical costs, which is driven by medical cost reductions associated with both efficacy and safety end-points. Further evaluation may be needed to validate these results in the real-world setting.     

The economic burden of tuberous sclerosis complex in UK patients with renal manifestations: a retrospective cohort study in the clinical practice research datalink (CPRD)

Background: Tuberous sclerosis complex (TSC) is a multi-system genetic disorder in which renal manifestations occur in ～50% of children and 80% of adults. Since these often present alongside other manifestations, renal TSC is likely to incur significant costs. This study aims to quantify healthcare resource use (HCRU) and costs for renal TSC patients in the UK.

Methods: TSC patients in the Clinical Practice Research Datalink (CPRD) linked to Hospital Episodes Statistics were identified from January 1987–June 2013. Clinical data were extracted over the entire history and costs were reported over the most recent 3-year period. HCRU was compared with a matched comparator cohort. Incremental costs were reported and the key cost drivers by primary manifestation category were identified by regression modeling.

Results: A total of 79 renal TSC patients were identified with manifestations including chronic kidney disease stage 3–5 (with prevalence increasing with age) and renal angiomyolipoma. Renal TSC patients consistently reported greater HCRU than the comparator. Inpatient hospitalizations were more frequent for renal TSC patients (3.2 vs 1.6), but length of stay was comparable; however, 70.9% of renal TSC patients recorded no kidney-related procedures ever and averaged <1 test per year in the 3-year period. Average costs for renal TSC patients were nearly 3-fold greater than the comparator (£15,162 vs £5672). Costs increased with additional manifestation categories (£3600: only renal; £27,531: renal with ≥4 additional manifestation categories [25% of patients]). Additional nervous system and dermatology/psychiatric manifestations significantly (p?Conclusions: Renal TSC patients have greater HCRU than the general CPRD population, likely to result from progression of renal disease and additional manifestations; however, surveillance for disease progression appears to be deficient. Inadequate monitoring may contribute to a lack of co-ordinated care and increased healthcare-associated costs. Efforts should be made to follow the TSC guidelines to effectively monitor and treat patients.     

A TEST OF BAYESIAN LEARNING FROM FARMER TRIALS OF NEW WHEAT VARIETIES*

In this study, elicited estimates of farmers' subjective beliefs about the mean and variance of wheat variety yields were used to test propositions about Bayesian learning developed in the recent literature on innovation adoption. A series of empirical tests of the Bayesian adoption model were conducted using beliefs elicited from farm surveys conducted in 1982, 1983 and 1984. The results of the analysis neither confirm nor reject the Bayesian approach as a model of how farmers revise subjective beliefs, but do raise serious doubts about its realism, and suggest some issues requiring further investigation. Shortcomings in the elicitation techniques are discussed and the assumptions of the Bayesian model are reviewed.     

Case Studies of Ethics Scandals: Effects on Ethical Perceptions of Finance Students

Ethics instructors often use cases to help students understand ethics within a corporate context, but we need to know more about the impact a case-based pedagogy has on students’ ability to make ethical decisions. We used a pre- and post-test methodology to assess the effect of using cases to teach ethics in a finance course. We also wanted to determine whether recent corporate ethics scandals might have impacted students’ perceptions of the importance and prevalence of ethics in business, so we used in-depth case studies of several of the major scandals (e.g., Enron, Tyco, Adelphia). Our results are somewhat surprising since studying ethics scandals positively impacts students’ ethical decision making and their perceptions of the ethics of businesspeople.