Cost-effectiveness of dedicated dietitians for hyperphosphatemia management among hemodialysis patients in Lebanon: results from the Nutrition Education for Management of Osteodystrophy trial

Aim: To assess the cost-effectiveness of nutrition education by dedicated dietitians (DD) for hyperphosphatemia management among hemodialysis patients.

Materials and methods: This was a trial-based economic evaluation in 12 Lebanese hospital-based units. In total, 545 prevalent patients were cluster randomized to DD, trained hospital dietitian (THD), and existing practice (EP) groups. During Phase I (6 months), DD (n?=?116) received intensive education by DD trained on renal nutrition, THD (n?=?299) received care from trained hospital dietitians, and EP (n?=?130) received usual care from untrained hospital dietitians. Patients were followed-up during Phase II (6 months).

Results: At baseline, EP had the lowest weekly hemodialysis time, and DD had the highest serum phosphorus and malnutrition-inflammation score. The additional costs of the intervention were low compared with the societal costs (DD: $76.7, $21,007.7; EP: $4.6, $18,675.4; THD: $17.4, $20,078.6, respectively). Between Phases I and II, DD showed the greatest decline in services use and societal costs (DD: –$2,364.0; EP: –$1,727.7; THD: –$1,105.7). At endline, DD experienced the highest decrease in adjusted serum phosphorus (DD: –0.32; EP: +0.16; THD: +0.04?mg/dL), no difference in quality-adjusted life-years (QALY), and the highest societal costs. DD had a cost-effectiveness ratio of $7,853.6 per 1?mg decrease in phosphorus, compared with EP; and was dominated by THD. Regarding QALY, DD was dominated by EP and THD. The results were sensitive to changes in key parameters.

Limitations: The analysis depended on numerous assumptions. Interpreting the results is limited by the significant baseline differences in key parameters, suggestive of higher baseline societal costs in DD.

Conclusions: DD yielded the greatest effectiveness and decrease in societal costs, but did not affect QALY. Regarding serum phosphorus, DD was likely to be cost-effective compared with EP, but had a low cost-effectiveness probability compared with THD. Regarding QALY, DD was not likely to be cost-effective. Assessing the long-term cost-effectiveness of DD, on similar groups, is recommended.     

Consumer adoption of Internet banking in Jordan: Examining the role of hedonic motivation,habit, self-efficacy and trust

Despite the rapid growth of Internet banking (IB), customers in developing countries still hesitate to adopt this technology and its use in the Middle East remains low. This study aims to identify and examine the factors that predict behavioural intention and adoption of IB in Jordan. Four factors – hedonic motivation, habit, self-efficacy and trust – are proposed in a conceptual model. Data was collected by means of a survey with bank customers in Jordan. Structural equation modelling (SEM) was used to analyse the data. The results strongly supported the conceptual model. Further, hedonic motivation, habit, self-efficacy and trust were all confirmed to have a significant influence on behavioural intention. Trust was found to be strongly predicted by both hedonic motivation and self-efficacy. This study provides both academics and practitioners with an insight into the factors that can be used to encourage customer adoption of IB specifically in a Middle East context.     

The role of destination personality fit in destination branding: Antecedents and outcomes

Drawing from fit research in strategic management, this study develops and investigates a model predicting destination attitude and (re)visit intention. The study introduces the concept of destination personality fit on the basis of how well consumer perceptions of a tourist destination's brand personality fits that of what the destination brand manager wishes to convey. A model incorporating destination advertising awareness as an antecedent of destination personality and consumer‐manager destination personality fit is tested on international consumers with the destination personality of Switzerland as the study setting. Structural equation modeling results reveal that destination advertising awareness does indeed relate positively to both stronger perceived destination personality and destination personality fit in consumers’ minds. Interestingly, the subsequent destination personality–destination attitude relationship is moderated by consumer–manager destination personality fit in such a way that the link grows stronger in cases where fit is high. The results have important implications for destination brand managers in that they reinforce the importance of strong and distinct destination personalities. The findings also show the importance of actively communicating the destination brand to consumers since the positive outcomes of a strong destination personality increase in magnitude when successfully communicated, and the vision of the destination brand manager has been adopted by the consumer.     

Role of quality management capabilities in developing market-based organisational learning capabilities: Case study evidence from four Indian business process outsourcing firms

Business-to-business marketing literature acknowledges the value firms, including business process outsourcing firms, realise through their supplier networks. Such value realisation is often possible through a dynamic exchange of complementary organisational capabilities between a firm and its network partners. However, little is known about how outsourcing firms develop these capabilities and thus realise value. This paper addresses an unexplored theoretical gap of developing market-based organisational learning capabilities in business process outsourcing firms. Using a capabilities lens, this study assesses the impact of quality management capabilities in developing market-based organisational learning capability. Findings from a case study of four business process outsourcing firms in India suggest that effective knowledge transfer, diffusion and the development of market-based organisational learning capabilities are contingent upon the strength of a firm's quality management capabilities. Implications for theory and practice are discussed.     

Optimal trade policy with quality-differentiated goods

In this article we apply the model of vertically differentiated products to international trade. A foreign firm competes with a domestic firm in the latter's market, producing products of varying quality. We examine the nature of the equilibrium in this case, assuming the firms compete in prices. Contrary to the popular belief, we show that a protectionist policy of imposing a tariff on the foreign firm raises overall welfare in the domestic economy, as well as induces the domestic firm to upgrade the quality of its product, if it produces the lower quality product. Furthermore, if minimum quality standards are imposed on the foreign firm, the domestic firm upgrades quality, and overall welfare in the domestic economy is higher.     

Fair welfare maximization

We consider the general problem of finding fair constrained resource allocations. As a criterion for fairness we propose an inequality index, termed “fairness ratio,” the maximization of which produces Lorenz-undominated, Pareto-optimal allocations. The fairness ratio does not depend on the choice of any particular social welfare function, and hence it can be used for an a priori evaluation of any given feasible resource allocation. The fairness ratio for an allocation provides a bound on the discrepancy between this allocation and any other feasible allocation with respect to a large class of social welfare functions. We provide a simple representation of the fairness ratio as well as a general method that can be used to directly determine optimal fair allocations. For general convex environments, we provide a fundamental lower bound for the optimal fairness ratio and show that as the population size increases, the optimal fairness ratio decreases at most logarithmically in what we call the “inhomogeneity” of the problem. Our method yields a unique and “balanced” fair optimum for an important class of problems with linear budget constraints.     

The risky business of hiring stars

With the battle for the best and brightest people heating up again, you're most likely out there looking for first-rate talent in the ranks of your competitors. Chances are, you're sold on the idea of recruiting from outside your organization, since developing people within the firm takes time and money. But the authors, who have tracked the careers of high-flying CEOs, researchers, software developers, and leading professionals, argue that top performers quickly fade after leaving one company for another. To study this phenomenon in greater detail, the authors analyzed the ups and downs of more than 1,000 star stock analysts, a well-defined group for which there are abundant data. The results were striking. After a star moves, not only does her performance plunge, but so does the effectiveness of the group she joins--and the market value of her new company. Moreover, transplanted stars don't stay with their new organizations for long, despite the astronomical salaries firms pay to lure them from rivals. Most companies that hire stars overlook the fact that an executive's performance is not entirely transferable because his personal competencies inevitably include company-specific skills. When the star leaves the old company for the new, he cannot take with him many of the resources that contributed to his achievements. As a result, he is unable to repeat his performance in another company--at least not until he learns to work the new system, which could take years. The authors conclude that companies cannot gain a competitive advantage or successfully grow by hiring stars from outside. Instead, they should focus on cultivating talent from within and do everything possible to retain the stars they create. Firms shouldn't fight the star wars, because winning could be the worst thing that happens to them.     

The effect of multi-purpose shopping on pricing and location strategy for grocery stores

Though it is a well-accepted fact that consumers indulge in multi-purpose shopping, most previous models of store choice assume that grocery shopping trips are single-purpose trips. This paper provides the first empirical analysis of multi-purpose shopping using data on actual shopping trips. A latent class factor analytic logit model is proposed, which provides a representation of the market structure of grocery store competition, while integrating; multi-purpose shopping, retail pricing format and location strategy. We conclude that incorporating multi-purpose shopping trips provides a better understanding of the competitive market structure, and discuss the managerial implications for the selection of marketing strategies.     

On someE-optimal block designs

Summary TheE-optimality of block designs is the concern of this paper. Bounds for the smallest positive eigenvalue of theC-matrix of block designs are obtained in some general classes of connected designs with equal or unequal block sizes. Use of these bounds is made to obtainE-optimal block designs in various classes.