Supply structure: The pendulum in action

Using an in-depth longitudinal case study based on an “historical retrospective”, this article focuses on how some factors (“drivers”) set into motion the pendulum of change in supply structures, a research theme neglected in the supply field. It examines, over a 20-year period, the changes made to the supply structure of a well-known organization. The data comes mainly from: (a) semi-structured interviews with 21 managers and professionals within eight operating units, and (b) documentary analyses of the archives. This article shows how to map structural changes of the supply function, while explaining the nature and the causes of these changes. Understanding the pendulum movement from one supply structure to another can be very valuable, as well for academics as for managers.     

Property rights imperfections and asset allocation: Co-ownership in Bulgaria

This paper analyzes how imperfections of property rights affect households’ allocation of assets using micro-survey data from Bulgaria. Co-ownership of assets is widespread in many countries due to inheritance. Central and Eastern Europe offers an interesting natural experiment to assess the effects of this type of property rights imperfection because of the asset restitution process in the 1990s. In Bulgaria, where co-ownership is very prominent and land is strongly fragmented, the land reform and inheritance legislation allows identifying the impact of co-ownership by taking advantage of a discontinuity created by a minimum plot size law. We find that land in co-ownership is more likely to be used by less efficient farm organizations or to be left abandoned, and that it is related to significant welfare losses. The paper hence provides evidence of sub-optimal land allocation following a privatization that established formal but imperfect property rights.     

An investigation of issues relating to where energy should enter the production function

This paper examines the impact of imposing different separability assumptions in the specifications of the standard hierarchical KLEM production function in a computable general equilibrium (CGE) model. The appropriate means of introducing energy to production functions has been a source of debate for a number of years. However, while modellers often subject results to parametric sensitivy analysis regarding the values associated with elasticities of substitution between inputs, it is rarely the case that the structure of the production function is subjected to testing. However, the chosen structure reflects the modeller's view about elasticity between different inputs and will have implications for model results wherever there are changes in relative prices. We illustrate our argument by introducing a simple demand shock to a CGE model of the Scottish economy (targeted at the energy supply sector) under different assumptions regarding the structure of the KLEM production function and separability assumptions therein.     

The CNO/CFO partnership: navigating the changing landscape

With increasing pressure to cut costs, both real and immediate, and those forecasted and anticipated, the partnership and collaboration between nursing and finance will continue to take on new challenges. This partnership has historically been strained and does not always come easy due to differences in focus, different priorities, and inadequate communication, listening, and hearing. That needs to change and a strong CNO-CFO partnership is needed. Nursing leaders need to understand and appreciate the financial constraints and balance them with expected outcomes, and financial leaders need to understand and appreciate the core clinical business and what gaps in care mean to the financial viability of the organization and to patient outcomes. One health system developed a platform for change and is dedicated to the hard work involved in continuously working on those partnerships so when it comes to patient quality, safety, and financial performance, nursing and finance leaders are well positioned for future health care challenges.     

Comparative effectiveness of standard endotracheal tubes vs. endotracheal tubes with continuous subglottic suctioning on ventilator-associated pneumonia rates

Ventilator-associated pneumonia (VAP) accounts for the majority of nosocomial pneumonias, which may increase intensive care and prolonged hospital stays. Endotracheal tubes allowing continuous subglottic suctioning may reduce VAP; however, they are more expensive than standard endotracheal tubes not allowing continuous suctioning. he objective of this study was to measure the comparative costs associated with continuous subglottic suctioning endotracheal tubes (CSS-ETT) versus standard endotracheal tubes (S-ETT) among intubated patients and whether cost differential is offset by the occurrence of VAP in patients receiving either type of intubation. A retrospective chart review was conducted for 154 intubated adult patients (77 = S-ETT; 77 = CSS-ETT). The S-ETT group had one case of VAP; the CSS-ETT group had none. The mean total hospital charges were higher for the S-ETT group ($103,600; CSS-ETT= $88,500) (p = 0.3). Although the average number of intubation days and ICU days were greater for the CSS-ETT group, there were no cases of VAP compared to the S-ETT group. ased upon the one S-ETT VAP case and the VAP attributable costs, it is cost effective to use the CSS-ETT.     

Contribution of low-level flammable vapor concentrations to dust explosion output

As a result of extensive dust explosion research, additional areas of hazards have arisen. The potential of combining small percentages of flammable vapors (below the lower explosion limit) introduces additional dust explosion hazards.     

TRAINING AND LABOUR MARKET SEGMENTATION

A two period model of the training decision is analysed using a human capital approach. The segmented labour market model where training opportunities distinguish entrants is compared with a competitive structure with homogeneous entrants. The main conclusions in the paper are the clear effects of training wages and the different effects in the two market structures of both wages and employment prospects in the unskilled market on training.     

Economic modeling for the US of the cost-efficiency and associated expanded treatment access of conversion to biosimilar pegfilgrastim-bmez from reference pegfilgrastim

Abstract

Aims: For this economic analysis, we aimed to model: (1) the cost-efficiency of prophylaxis with biosimilar pegfilgrastim-bmez for chemotherapy-induced (febrile) neutropenia (CIN/FN) compared to reference pegfilgrastim, and (2) the expanded access to CIN/FN prophylaxis and anti-neoplastic treatment that could be achieved with biosimilar cost-savings on a budget-neutral basis.

Methods: In a hypothetical panel of 20,000 cancer patients receiving CIN/FN prophylaxis and using the average sales price (ASP) for the second quarter of 2019 for reference pegfilgrastim, we: conducted an ex ante simulation from the payer perspective of the cost-savings of 10–100% conversion from reference to biosimilar pegfilgrastim-bmez using drug price discounting ranging from 10–35%; estimated the budget-neutral expanded access to biosimilar pegfilgrastim-bmez enabled by these cost-savings; and estimated the budget-neutral expanded access to anti-neoplastic treatment with pembrolizumab. The simulations were replicated using fourth quarter 2019 wholesale acquisition cost (WAC) for reference pegfilgrastim and biosimilar pegfilgrastim-bmez in a post facto analysis.

Results: In ASP simulations, cost-savings of using pegfilgrastim-bmez over reference pegfilgrastim in a 20,000 patient panel range from $1.3?M (at 15% price discount) to $3?M (35%) at 10% conversion rate and from $6.4?M to $14.9?M, respectively, at 50% conversion. These savings could provide prophylaxis with pegfilgrastim-bmez to an additional 352 (15% discount) to 1,076 patients (35%) at 10% conversion or 1,764–5,384, respectively, at 50% conversion. Alternatively, savings could be reallocated for anti-neoplastic treatment with pembrolizumab to 3 (15% discount) to 9 (35%) patients at 10% conversion or 19–45, respectively, at 50% conversion. When utilizing WAC, cost-savings range from $4.6?M (10% conversion) to $23.1?M (50%) which could provide pegfilgrastim-bmez to an additional 1,174 (10% conversion) to 5,873 patients (50%).

Conclusions: Prophylaxis with biosimilar pegfilgrastim-bmez increases the value of cancer care by generating significant cost-savings that could be reallocated to provide expanded access to CIN/FN prevention and anti-neoplastic therapy on a budget-neutral basis.     

Visitor centre staffing: Involving volunteers

Volunteer involvement in visitor centres has received little attention by tourism researchers despite the critical role staff play in welcoming tourists to a destination and promoting tourism activities. The community function of visitor centres - of which volunteering is part - has also been underplayed in previous research. Using data from a survey and interviews with visitor centre managers in Australia, this paper investigates the rationales for staffing visitor centres with volunteers and/or paid employees and, related to motivations for volunteering, the factors influencing the attractiveness of visitor centre volunteer programmes. The dominant rationales for involving volunteers are need, community involvement, visitor experience, and the personal qualities and motivations of volunteers. Visitor centre volunteering is attractive because of location and local pride, interactions with tourists and social relationships with other volunteers, and the reputation of the visitor centre and its volunteer programme.     

E-Shopping Patterns of Chinese and US Millennials

A conceptually based taxonomy of 22 distinct forms of e-shopping vehicles is proposed. A modification of the UTAUT and UTAUT2 models is introduced to explain how vehicles are interrelated in regard to consumer reliance upon them for their e-purchasing. A survey of over 1,000 millennial university students, 697 Chinese and 306 US, revealed strong support in both samples for the hypothesized six dimensional pattern underlying consumer vehicular reliance. Further, differences between Chinese and US samples lay not in the nature of the dimensions, but rather in the strength of reliance upon each dimension. Thus, the study demonstrates the utility of the concept/measure of shopper vehicular reliance, VPR (Vehicle Purchasing Reliance) for both practitioners and scientists. In cross-national comparisons, observed differences between samples in strength of reliance supported four of five hypotheses predicated on previously established national distinctions a) in trust and b) in the cultural value of individualism-collectivism.