An exploration of pharmacy-specific reasons for non-adherence to prescribed medicines in a socioeconomically deprived, ethnically diverse UK cohort

Methods - Ethical approval for the study was granted by both the local National Health Service (NHS) Research Ethics Committee (REC) and Aston University’s REC. Seven focus groups were conducted between October and December 2011 in medical or community settings within inner-city Birmingham (UK). Discussions were guided by a theme plan which was developed from key themes identified by a literature review and piloted via a Patient Consultation Group. Each focus group had between 3 and 7 participants. The groups were digitally recorded and subsequently transcribed verbatim. The transcriptions were then subjected to thematic analysis via constant comparison in order to identify emerging themes. Results - Participants recognised the pharmacist as an expert source of advice about prescribed medicines, a source they frequently felt a need to consult as a result of the inadequate supply of medicines information from the prescriber. However, an emerging theme was a perception that pharmacists had an oblique profit motive relating to the supply of generic medicines with frequent changes to the ‘brand’ of generic supplied being attributed to profit-seeking by pharmacists. Such changes had a negative impact on the patient’s perceived efficacy of the therapy which may make non-adherence more likely. Conclusions - Whilst pharmacists were recognised as medicines experts, trust in the pharmacist was undermined by frequent changes to generic medicines. Such changes have the potential to adversely impact adherence levels. Further, quantitative research is recommended to examine if such views are generalisable to the wider population of Birmingham and to establish if such views impact on adherence levels.

Patient experiences of serious adverse drug reactions and their attitudes to medicines:a qualitative study of survivors of Stevens-Johnson syndrome and toxic epidermal necrolysis in the UK

Background: Adverse drug reactions (ADRs) cause significant morbidity and mortality and account for around 6.5% of hospital admissions. Patient experiences of serious ADRs and their long-term impact on patients' lives, including their influence on current attitudes towards medicines, have not been previously explored. Objective: The aim of the study was to explore the experiences, beliefs, and attitudes of survivors of serious ADRs, using drug-induced Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) as a paradigm. Methods: A retrospective, qualitative study was undertaken using detailed semi-structured interviews. Fourteen adult survivors of SJS and TEN, admitted to two teaching hospitals in the UK, one the location of a tertiary burns centre, were interviewed. Interview transcripts were independently analysed by three different researchers and themes emerging from the text identified. Results: All 14 patients were aware that their condition was drug induced, and all but one knew the specific drug(s) implicated. Several expressed surprise at the perceived lack of awareness of the ADR amongst healthcare professionals, and described how the ADR was mistaken for another condition. Survivors believed that causes of the ADR included (i) being given too high a dose of the drug; (ii) medical staff ignoring existing allergies; and (iii) failure to monitor blood tests. Only two believed that the reaction was unavoidable. Those who believed that the condition could have been avoided had less trust in healthcare professionals. The ADR had a persisting impact on their current lives physically and psychologically. Many now avoided medicines altogether and were fearful of becoming ill enough to need them. © 2011 Adis Data Information BV. All rights reserved. Conclusions: Life-threatening ADRs continued to affect patients’ lives long after the event. Patients’ beliefs regarding the cause of the ADR differed, and may have influenced their trust in healthcare professionals and medicines. We propose that clear communication during the acute phase of a serious ADR may therefore be important.

Uneasy lies the head that bears the trust:the effects of feeling trusted on emotional exhaustion

The construct of feeling trusted reflects the perception that another party is willing to accept vulnerability to one's actions. Although this construct has received far less attention than trusting, the consensus is that believing their supervisors trust them has benefits for employees' job performance. Our study challenges that consensus by arguing that feeling trusted can be exhausting for employees. Drawing on Stevan Hobfoll's conservation of resources theory, we develop a model in which feeling trusted fills an employee with pride a benefit for exhaustion and performance while also increasing perceived workload and concerns about reputation maintenance burdens for exhaustion and performance. We test our model in a field study using a sample of public transit bus drivers in London, England. Our results suggest that feeling trusted is a double-edged sword for job performance, bringing with it both benefits and burdens. Given that recommendations for managers generally encourage placing trust in employees, these results have important practical implications.

Bizalom és kockázat a kapcsolatokban – egy kísérlet eredményei = Relationship between trust and risk - results of an experiment

Műhelytanulmányunkban a diadikus kapcsolatokat állítjuk az elemzés középpontjába. A Budapesti Corvinus Egyetem másodéves, gazdálkodástudományi alapszakjaira járó hallgatóiból véletlenszerűen alakított kétoldalú kapcsolatokban a felek egymás iránt érzett bizalmi szintje és különböző szintű kockázat melletti konkrét cselekvése közötti kapcsolatot vizsgáltuk. Előzetes várakozásaink szerint a felek egymás iránt érzett bizalmi szintje befolyásolja, hogy különböző kockázati szintek mellett hogyan fognak a kapcsolatban szereplő egyének viselkedni. Empirikus elemzésünk során a közgazdaságtanban is elfogadott kísérlet eszközét választottuk, s konkrét adatainkat, megfigyeléseinket e módszertannal gyűjtöttük össze. Az így kapott mintát a Magyarországon a gazdálkodás-, illetve közgazdaságtudományban tudomásunk szerint eddig még nem használt diadikus adatelemzés speciális statisztikai módszertanát alkalmazva vizsgáltuk. Műhelytanulmányunk célja volt ezért az is, hogy ennek a hálózati gazdaság építőkövének, a kapcsolatnak a vizsgálatára alkalmas elemzési módszertannak az ismertetését is megtegyük. _______ In the working paper we have focused on the analysis of trust in dyadic relationships. We have assumed that trust is a kind of coordinating mechanism in these relationships, the existence of which influences interaction between dyadic partners. We carried out an experiment with the help of bachelor students studying at the Budapest Corvinus University. Our hypothesis was that medium and high level of trust will influence the willingness to take more risky decisions. These experiments have been realized in concrete personal dyads; therefore the applied statistical analysis was the dyadic analysis that is a new analytical method developed for analyzing such dyadic problem settings.

Law Enforcement Actions in Urban Spaces Governed by Violent Non-State Entities: Lessons from Latin America

In response to a crime epidemic afflicting Latin America since the early 1990s, several countries in the region have resorted to using heavy-force police or military units to physically retake territories de facto controlled by non-State criminal or insurgent groups. After a period of territory control, the heavy forces hand law enforcement functions in the retaken territories to regular police officers, with the hope that the territories and their populations will remain under the control of the state. To a varying degree, intensity, and consistency, Brazil, Colombia, Mexico, and Jamaica have adopted such policies since the mid-1990s. During such operations, governments need to pursue two interrelated objectives: to better establish the state’s physical presence and to realign the allegiance of the population in those areas toward the state and away from the non-State criminal entities. From the perspective of law enforcement, such operations entail several critical decisions and junctions, such as: Whether or not to announce the force insertion in advance. The decision trades off the element of surprise and the ability to capture key leaders of the criminal organizations against the ability to minimize civilian casualties and force levels. The latter, however, may allow criminals to go to ground and escape capture. Governments thus must decide whether they merely seek to displace criminal groups to other areas or maximize their decapitation capacity. Intelligence flows rarely come from the population. Often, rival criminal groups are the best source of intelligence. However, cooperation between the State and such groups that goes beyond using vetted intelligence provided by the groups, such as a State tolerance for militias, compromises the rule-of-law integrity of the State and ultimately can eviscerate even public safety gains. Sustaining security after initial clearing operations is at times even more challenging than conducting the initial operations. Although unlike the heavy forces, traditional police forces, especially if designed as community police, have the capacity to develop trust of the community and ultimately focus on crime prevention, developing such trust often takes a long time. To develop the community’s trust, regular police forces need to conduct frequent on-foot patrols with intensive nonthreatening interactions with the population and minimize the use of force. Moreover, sufficiently robust patrol units need to be placed in designated beats for substantial amount of time, often at least over a year. Establishing oversight mechanisms, including joint police-citizens’ boards, further facilities building trust in the police among the community. After disruption of the established criminal order, street crime often significantly rises and both the heavy-force and community-police units often struggle to contain it. The increase in street crime alienates the population of the retaken territory from the State. Thus developing a capacity to address street crime is critical. Moreover, the community police units tend to be vulnerable (especially initially) to efforts by displaced criminals to reoccupy the cleared territories. Losing a cleared territory back to criminal groups is extremely costly in terms of losing any established trust and being able to recover it. Rather than operating on a priori determined handover schedule, a careful assessment of the relative strength of regular police and criminal groups post-clearing operations is likely to be a better guide for timing the handover from heavy forces to regular police units. Cleared territories often experience not only a peace dividend, but also a peace deficit – in the rise new serious crime (in addition to street crime). Newly – valuable land and other previously-inaccessible resources can lead to land speculation and forced displacement; various other forms of new crime can also significantly rise. Community police forces often struggle to cope with such crime, especially as it is frequently linked to legal business. Such new crime often receives little to no attention in the design of the operations to retake territories from criminal groups. But without developing an effective response to such new crime, the public safety gains of the clearing operations can be altogether lost.

Municipal accountability: Should regulations similar to the Sarbanes -Oxley Act apply to the local sector?

As America moved into the 2lst century financial scandals associated with large publicly traded corporations brought widespread concern about the reliability of financial reporting. In response the U.S. Congress adopted the Sarbanes-Oxley Act of 2002 (SOX). Undergirding SOX was the belief that improvements in the reliability of an organization's financial disclosures would lead to increased trust in the issuing organization. While SOX is aimed at publicly traded private sector organizations, the value of adopting SOX-like practices in the public and the nonprofit sectors have been recognized. Although SOX-like auditing practices have not at the time of this research become part of the auditing regime for municipalities, the results of this research provide a baseline "read" of municipal finance officers' perceptions of the value and obstacles associated with adoption of two major components of SOX: Principal Officer(s) Certification (POC) and the Independent Audit Committee (IAC) requirements. The author mailed surveys to all finance officers of municipalities in Florida and Ohio with populations of 10,000 or greater which did not contract out the operation of their finance departments. Post-survey "elite" interviews were conducted in an effort to obtain a deeper understanding of revealed issues and contradictions found in the analysis of the results of the mails survey. The findings suggest municipal finance officers are willing to adopt POC but have reservations about implementing IAC. With both POC and IAC the respondents appeared to consider intangible, non-pecuniary consequences as much or more than tangible, pecuniary consequences. Consistent with prior research, attitudes regarding POC and IAC were found to be unrelated to prior adoptive behavior, or personal and organizational demographic variables. Although accounting and auditing are inexorably intertwined, views of the recently implemented GASB 34 reporting model were found to be unrelated to the willingness to adopt POC or IAC. Findings dovetail with current discourse in public sector accounting suggesting local finance professionals may see benefits—both tangible and intangible—to some but not all accounting practices adopted in the private sector. This is consistent with the commonly accepted belief that public sector accounting maintains fundamental differences from its private counterpart.

Intuition and its component parts in the heuristic processing of deception detection: Hunch, *evidence, and reliance on intuitive efficacy

Rated trust in intuitive efficacy (measured as trust, belief, use, accuracy and weighting of intuition) was investigated as a predictor of self-designated use of intuitive (hunch and hunch plus evidential belief) vs. deliberative (evidential belief and evidential belief plus hunch) deception detection judgments and actual accuracy. Twenty-nine student participants were filmed as they made true and deceptive statements about their everyday activities on a given evening (last Friday night), and college students (N=238) judged 20 (10=true, 10=deceptive) of these filmed statements as truthful or deceptive. Participants provided ratings of reliance on hunches vs. evidential belief, confidence in film judgments, intuitive efficacy, accuracy in deception detection, reliance on cues to deception, and experiences with intuition. Generalized estimated equation modeling using binary logistics demonstrated accuracy in identifying true vs. deceptive statements was predicted by film number, hunch-evidence ratings, weighting of intuition, and total cues cited. Weighting of intuition was predictive of accuracy across participants, with higher weighting predictive of higher accuracy in general. Participants who cited evidential belief plus hunch and moderate to high weighting incorrectly reversed their true vs. deceptive judgments. Accuracy for true statements was higher for hunches and hunch plus evidential belief, whereas accuracy for deceptive statements was higher for evidential belief Accuracy for participants who relied on evidential belief plus hunch was at chance. Subjective experiences underlying judgments differed by participant and type of film viewed (true vs. deceptive) and were predicted by hunch-evidence ratings, trust, use, intuitive accuracy, and total cues cited. Trust predicted increases in judging films to be true, whereas use and accuracy predicted increases in judging films as deceptive; none were predictive of accuracy. Increased number of cues cited predicted judgments of deception, whereas decreased number of cues cited predicted truth. The study concluded that participants have the capacity to self-define their judgments as subjectively vs. deliberately based, provide subjective assessments of the influence of intuitive vs. objective information on their judgments, and can apply this self-knowledge, through effective weighting of intuition vs. other types of information, in making accurate judgments of true and deceptive everyday statements.

Institutional Persistence in Eastern Europe: Economic and Political Legacies of Empires and Communism

This dissertation seeks to advance our understanding of the roles that institutions play in economic development. How do institutions evolve? What mechanisms are responsible for their persistence? What effects do they have on economic development?

I address these questions using historical and contemporary data from Eastern Europe and Russia. This area is relatively understudied by development economists. It also has a very interesting history. For one thing, for several centuries it was divided between different empires. For another, it experienced wars and socialism in the 20th century. I use some of these exogenous shocks as quasi-natural social experiments to study the institutional transformations and its effects on economic development both in the short and long run.

This first chapter explores whether economic, social, and political institutions vary in their resistance to policies designed to remove them. The empirical context for the analysis is Romania from 1690 to the 2000s. Romania represents an excellent laboratory for studying the persistence of different types of historical institutional legacies. In the 18th and 19th centuries, Romania was split between the Habsburg and Ottoman Empires, where political and economic institutions differed. The Habsburgs imposed less extractive institutions relative to the Ottomans: stronger rule of law, a more stable and predictable state, a more developed civil society, and less corruption. In the 20th century, the Romanian Communist regime tried deliberately to homogenize the country along all relevant dimensions. It was only partially successful. Using a regression discontinuity design, I document the persistence of economic outcomes, social capital, and political attitudes. First, I document remarkable convergence in urbanization, education, unemployment, and income between the two former empires. Second, regarding social capital, no significant differences in organizational membership, trust in bureaucracy, and corruption persist today. Finally, even though the Communists tried to change all political attitudes, significant discontinuities exist in current voting behavior at the former Habsburg-Ottoman border. Using data from the parliamentary elections of 1996-2008, I find that former Habsburg rule decreases by around 6 percentage points the vote share of the major post-Communist left party and increases by around 2 and 5 percentage points the vote shares of the main anti-Communist and liberal parties, respectively.

The second chapter investigates the effects of Stalin’s mass deportations on distrust in central authority. Four deported ethnic groups were not rehabilitated after Stalin’s death; they remained in permanent exile until the disintegration of the Soviet Union. This allows one to distinguish between the effects of the groups that returned to their homelands and those of the groups that were not allowed to return. Using regional data from the 1991 referendum on the future of the Soviet Union, I find that deportations have a negative interim effect on trust in central authority in both the regions of destination and those of origin. The effect is stronger for ethnic groups that remained in permanent exile in the destination regions. Using data from the Life in Transition Survey, the chapter also documents a long-term effect of deportations in the destination regions.

The third chapter studies the short-term effect of Russian colonization of Central Asia on economic development. I use data on the regions of origin of Russian settlers and push factors to construct an instrument for Russian migration to Central Asia. This instrument allows me to interpret the outcomes causally. The main finding is that the massive influx of Russians into the region during the 1897-1926 period had a significant positive effect on indigenous literacy. The effect is stronger for men and in rural areas. Evidently, interactions between natives and Russians through the paid labor market was an important mechanism of human capital transmission in the context of colonization.

The findings of these chapters provide additional evidence that history and institutions do matter for economic development. Moreover, the dissertation also illuminates the relative persistence of institutions. In particular, political and social capital legacies of institutions might outlast economic legacies. I find that most economic differences between the former empires in Romania have disappeared. By the same token, there are significant discontinuities in political outcomes. People in former Habsburg Romania provide greater support for liberalization, privatization, and market economy, whereas voters in Ottoman Romania vote more for redistribution and government control over the economy.

In the former Soviet Union, Stalin’s deportations during World War II have a long-term negative effect on social capital. Today’s residents of the destination regions of deportations show significantly lower levels of trust in central authority. This is despite the fact that the Communist regime tried to eliminate any source of opposition and used propaganda to homogenize people’s political and social attitudes towards the authorities. In Central Asia, the influx of Russian settlers had a positive short-term effect on human capital of indigenous population by the 1920s, which also might have persisted over time.

From a development perspective, these findings stress the importance of institutions for future paths of development. Even if past institutional differences are not apparent for a certain period of time, as was the case with the former Communist countries, they can polarize society later on, hampering economic development in the long run. Different institutions in the past, which do not exist anymore, can thus contribute to current political instability and animosity.

Work and play in management studies: a Kleinian analysis

This paper takes some of Melanie Klein’s ideas, which Bion (1961/1998) previously used to understand group dynamics, to analyse the discipline of management studies since its ‘birth’ in the United States in the late 19th century. Specifically, it focuses on the idealisation of work and play, and argues that at its inception, for idiosyncratic historical reasons, the discipline was rooted in a ‘paranoid-schizoid’ position in which work was idealised as good and play as bad. The paper maps out the peculiar set of factors and influences that brought this about. It then examines how and if, again following Klein, the discipline has evolved to the ‘depressive’ position, where the idealisations are replaced by a more ambiguous, holistic semantic frame. Seven different relationships between work and play are then described. The paper contends that the originary splitting and idealisation is foundational to the discipline, and provides an enduring basis for analysing management theory and practice. It concludes by using this splitting to map out five potential future trajectories for the discipline.

A voice for change? Trust relationships between ombudsmen, individuals and public service providers

There has been a debate for years about what the role of the ombudsman is. This article examines a key component of the role, to promote trust in public services and government. To be able to do this, however, an ombudsman needs to be perceived as legitimate and be trusted by a range of stakeholders, including the user. This article argues that three key relationships in a person’s complaint journey can build trust in an institution, and must therefore be understood as a system. The restorative justice framework is adapted to conceptualize this trust model as a novel approach to understanding the institution from the perspective of its users. Taking two public sector ombudsmen as examples, the article finds that voice and trust need to be reinforced through the relationships in a consumer journey to manage individual expectations, prevent disengagement, and thereby promote trust in the institution, in public service providers, and in government.

La confianza en la construcción de la realidad social

El artículo analiza el rol que cumple la confianza en la construcción de la realidad social, argumentando que constituye uno de sus componentes esenciales. Lo es porque hace posible el nacimiento, permanencia y reconocimiento colectivo de las instituciones, así como su iteración y organización en subsistemas.

A confiança interorganizacional nas compras

This research is part of the field of organizational studies, focusing on organizational purchase behavior and, specifically, trust interorganizational at the purchases. This topic is current and relevant by addressing the development of good relations between buyer-supplier that increases the exchange of information, increases the length of relationship, reduces the hierarchical controls and improves performance. Furthermore, although there is a vast literature on trust, the scientific work that deal specifically at the trust interorganizational still need further research to synthesize and validate the variables that generate this phenomenon. In this sense, this investigation is to explain the antecedents of trust interorganizational by the relationship between the variable operational performance, organizational characteristics, shared values and interpersonal relationships on purchases by manufacturing industries, in order to develop a robust literature, most consensual, that includes the current sociological and economic, considering the effect of interpersonal relationships in this phenomenon. This proposal is configured in a new vision of the antecedents of interorganizational trust, described as significant quantitative from models Morgan and Hunt (1994), Doney and Cannon (1997), Zhao and Cavusgil (2006) and Nyaga, Whipple, Lynch (2011), as well as qualitative analysis of Tacconi et al. (2011). With regard to methodological aspects, the study assumes the form of a descriptive, survey type, and causal trace theoretical and empirical. As for his nature, the investigation, explicative character, has developed a quantitative approach with the use of exploratory factor analysis and structural equation modeling SEM, with the use of IBM software SPSS Amos 18.0, using the method of maximum verisimilitude, and supported by technical bootstraping. The unit of analysis was the buyer-supplier relationship, in which the object under investigation was the supplier organization in view of the purchasing company. 237 valid questionnaires were collected among key informants, using a simple random sampling developed in manufacturing industries (SIC 10-33), located in the city of Natal and in the region of Natal. The first results of descriptive analysis demonstrate the phenomenon of interorganizational trust, in which purchasing firms believe, feel secure about the supplier. This demonstration showed high levels of intensity, predominantly among the vendors that supply the company with materials that are used directly in the production process. The exploratory and confirmatory factor analysis, performed on each variable alone, generated a set of observable and unobservable variables more consistent, giving rise to a model, that needed to be further specified. This again specify model consists of trajectories was positive, with a good fit, with a composite reliability and variance extracted satisfactory, and demonstrates convergent and discriminant validity, in which the factor loadings are significant and strong explanatory power. Given the findings that reinforce the model again specify data, suggesting a high probability that this model may be more suited for the study population, the results support the explanation that interorganizational trust depends on purchases directly from interpersonal relationships, sharing value and operating performance and indirectly of personal relationships, social networks, organizational characteristics, physical and relational aspect of performance. It is concluded that this trust can be explained by a set of interactions between these three determinants, where the focus is on interpersonal relationships, with the largest path coefficient for the factor under study

The art of building trust via e-communication channels: Post-acquisition integration as a special context

This study discusses the importance of establishing trust in post-acquisition integration context and how the use of e-channels facilitates or inhibits this process. The objective of this study is to analyze how the use of electronic communication channels influences the post-acquisition integration process in terms of trust establishment and overall integration efficiency, developing a framework as a result. Three sub-objectives are introduced: to find out the building blocks of trust in M&A’s, to analyse how the use of e-channels influence the process of trust establishment in post-acquisition integration context, and to define the consequences trust and use of e-channels have for the process. The theoretical background of the study includes literature and theories relating to trust establishment in post-acquisition integration context and how the use of e-channels influences the process of trust development on a general level. The empirical research is conducted as a single case study, based on key informant interviews. The interview data was collected between October 2015 and January 2016. Altogether nine interviews were realised; six with representatives from the acquiring firm and three with target firm members. Thematic analysis was selected as the main method for analysing and processing the qualitative data. This study finds that trust has an essential role in post-acquisition integration context, facilitating the integration process in various different ways. Hence, identifying the different building blocks of trust is important in order for members of the organisations to be better able establish and maintain trust. In today’s international business, the role of electronic communication channels has also increased in importance significantly and it was confirmed that these pose both challenges and possibilities for the development of interpersonal trust. One of the most important underlying factors influencing the trust levels via e-communication channels is the level of user’s comfort in using the different e-channels. Without sufficient and meaningful training, the communication conducted via these channels in inhibited in a number of ways. Hence, understanding the defining characteristics of e-communication together with the risks and opportunities related to the use of these can have far-reaching consequences for the post-acquisition integration process as a whole. The framework based on the findings and existing theory introduces the most central factors influencing the trust establishment together with the positive and negative consequences these have for the integration process. Moreover, organizational level consistency and the existence of shared guidelines on appropriate selection of communication channels according to the nature of the task at hand are seen as important

Trust, confidence, and equity affect the legitimacy of natural resource governance

Social-ecological systems are often highly complex, making effective governance a considerable challenge. In large, heterogeneous systems, hierarchical institutional regimes may be efficient, but effective management outcomes are dependent on stakeholder support. This support is shaped by perceptions of legitimacy, which risks being undermined where resource users are not engaged in decision-making. Although legitimacy is demonstrably critical for effective governance, less is known about the factors contributing to stakeholders’ perceptions of legitimacy or how these perceptions are socially differentiated. We quantitatively assessed stakeholder perceptions of legitimacy (indicated by support for rules) and their contributory factors among 307 commercial fishers and tourism operators in Australia’s Great Barrier Reef Marine Park. Legitimacy was most strongly associated with trust in information from governing bodies, followed by confidence in institutional performance and the equity of management outcomes. Legitimacy differed both within and among resource user groups, which emphasizes the heterogeneous nature of commonly defined stakeholder groups. Overall, tourism operators perceived higher legitimacy than did commercial fishers, which was associated with higher trust in information from management agencies. For fishers, higher levels of trust were associated with: (1) engagement in fisheries that had high subsector cohesion and positive previous experiences of interactions with governing bodies; (2) location in areas with greater proximity to sources of knowledge, resources, and decision-making; and (3) engagement in a Reef Guardian program. These findings highlight the necessity of strategies and processes to build trust among all user groups in large social-ecological systems such as the Great Barrier Reef Marine Park. Furthermore, the social differentiation of perceptions that were observed within user groups underscores the importance of targeted strategies to engage groups that may not be heard through traditional governance channels.