Carvedilol reduces the costs of medical care in severe heart failure: An economic analysis of the COPERNICUS study applied to the United Kingdom

Background: The aim of this study was to determine the effects of carvedilol on the costs related to the treatment of severe chronic heart failure (CHF). Methods: Costs for the treatment for heart failure within the National Health Service (NHS) in the United Kingdom (UK) were applied to resource utilisation data prospectively collected in all patients randomized into the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) Study. Unit-specific, per them (hospital bed day) costs were used to calculate expenditures due to hospitalizations. We also included costs of carvedilol treatment, general practitioner surgery/office visits, hospital out-patient clinic visits and nursing home care based on estimates derived from validated patterns of clinical practice in the UK. Results: The estimated cost of carvedilol therapy and related ambulatory care for the 1156 patients assigned to active treatment was 530,771 pound (44.89 pound per patient/month of follow-up). However, patients assigned to carvedilol were hospitalised less often and accumulated fewer and less expensive days of admission. Consequently, the total estimated cost of hospital care was 3.49 pound million in the carvedilol group compared with 4.24 pound million for the 1133 patients in the placebo arm. The cost of post-discharge care was also less in the carvedilol than in the placebo group (479,200 pound vs. 548,300) pound. Overall, the cost per patient treated in the carvedilol group was 3948 pound compared to 4279 pound in the placebo group. This equated to a cost of 385.98 pound vs. 434.18 pound, respectively, per patient/month of follow-up: an 11.1% reduction in health care costs in favour of carvedilol. Conclusions: These findings suggest that not only can carvedilol treatment increase survival and reduce hospital admissions in patients with severe CHF but that it can also cut costs in the process.

Models of psychological service provision under Australia's better outcomes in mental health care program

The Access to Allied Psychological Services component of Australia's Better Outcomes in Mental Health Care program enables eligible general practitioners to refer consumers to allied health professionals for affordable, evidence-based mental health care, via 108 projects conducted by Divisions of General Practice. The current study profiled the models of service delivery across these projects, and examined whether particular models were associated with differential levels of access to services. We found: 76% of projects were retaining their allied health professionals under contract, 28% via direct employment, and 7% some other way; Allied health professionals were providing services from GPs' rooms in 63% of projects, from their own rooms in 63%, from a third location in 42%; and The referral mechanism of choice was direct referral in 51% of projects, a voucher system in 27%, a brokerage system in 24%, and a register system in 25%. Many of these models were being used in combination. No model was predictive of differential levels of access, suggesting that the approach of adapting models to the local context is proving successful.

Superstring: A scalable service discovery protocol for the wide-area pervasive environment

Arguably, the world has become one large pervasive computing environment. Our planet is growing a digital skin of a wide array of sensors, hand-held computers, mobile phones, laptops, web services and publicly accessible web-cams. Often, these devices and services are deployed in groups, forming small communities of interacting devices. Service discovery protocols allow processes executing on each device to discover services offered by other devices within the community. These communities can be linked together to form a wide-area pervasive environment, allowing processes in one p u p tu interact with services in another. However, the costs of communication and the protocols by which this communication is mediated in the wide-area differ from those of intra-group, or local-area, communication. Communication is an expensive operation for small, battery powered devices, but it is less expensive for servem and workstations, which have a constant power supply and 81'e connected to high bandwidth networks. This paper introduces Superstring, a peer to-peer service discovery protocol optimised fur use in the wide-area. Its goals are to minimise computation and memory overhead in the face of large numbers of resources. It achieves this memory and computation scalability by distributing the storage cost of service descriptions and the computation cost of queries over multiple resolvers.

An investigation into the antecedents of goal congruence in retail-service settings

The authors report the results of two studies that model the antecedents of goal congruence in retail-service settings. They draw the antecedents from extant research and propose that goal congruence is related to employees' perceptions of morale, leadership support, fairness in reward allocation, and empowerment. They hypothesize and test direct and indirect relationships between these constructs and goal congruence. Results of structural equations modeling suggest an important mediating role for morale and interesting areas of variation across retail and service settings.

The growing importance of inter-company collaboration

Guest editorial: This special issue has been drawn from papers that were published as part of the Second European Conference on Management of Technology (EuroMOT) which was held at Aston Business School (Birmingham, UK) 10-12 September 2006. This was the official European conference for the International Association for Management of Technology (IAMOT); the overall theme of the conference was “Technology and global integration.” There were many high-calibre papers submitted to the conference and published in the associated proceedings (Bennett et al., 2006). The streams of interest that emerged from these submissions were the importance of: technology strategy, innovation, process technologies, managing change, national policies and systems, research and development, supply chain technology, service and operational technology, education and training, small company incubation, technology transfer, virtual operations, technology in developing countries, partnership and alliance, and financing and investment. This special issue focuses upon the streams of interest that accentuate the importance of collaboration between different organisations. Such organisations vary greatly in character; for instance, they may be large or small, publicly or privately owned, and operate in manufacturing or service sectors. Despite these varying characteristics they all have something in common; they all stress the importance of inter-organisational collaboration as a critical success factor for their organisation. In today's global economy it is essential that organisations decide what their core competencies are what those of complementing organisations are. Core competences should be developed to become a bases of differentiation, leverage and competitive advantage, whilst those that are less mature should be outsourced to other organisations that can claim to have had more recognition and success in that particular core competence (Porter, 2001). This strategic trend can be observed throughout advanced economies and is growing strongly. If a posteriori reasoning is applied here it follows that organisations could continue to become more specialised in fewer areas whilst simultaneously becoming more dependent upon other organisations for critical parts of their operations. Such actions seem to fly in the face of rational business strategy and so the question must be asked: why are organisations developing this way? The answer could lie in the recent changes in endogenous and exogenous factors of the organisation; the former emphasising resource-based issues in the short-term, and strategic positioning in the long-term whilst the later emphasises transaction costs in the short-term and acquisition of new skills and knowledge in the long-term. For a harmonious balance of these forces to prevail requires organisations to firstly declare a shared meta-strategy, then to put some cross-organisational processes into place which have their routine operations automated as far as possible. A rolling business plan would review, assess and reposition each organisation within this meta-strategy according to how well they have contributed (Binder and Clegg, 2006). The important common issue here is that an increasing number of businesses today are gaining direct benefit from increasing their levels of inter-organisational collaboration. Such collaboration has largely been possible due to recent technological advances which can make organisational structures more agile (e.g. the extended or the virtual enterprise), organisational infra-structure more connected, and the sharing of real-time information an operational reality. This special issue consists of research papers that have explored the above phenomenon in some way. For instance, the role of government intervention, the use of internet-based technologies, the role of research and development organisations, the changing relationships between start-ups and established firms, the importance of cross-company communities of practice, the practice of networking, the front-loading of large-scale projects, innovation and the probabilistic uncertainties that organisations experience are explored in these papers. The cases cited in these papers are limited as they have a Eurocentric focus. However, it is hoped that readers of this special issue will gain a valuable insight into the increasing importance of collaborative practices via these studies.

The UK productivity gap in the service sector: do management practices matter?

Purpose – This paper aims to contribute to the debate on the drivers of the productivity gap that exists between the UK and its major international competitors. Design/methodology/approach – From the macro perspective the paper explores the quantitative evidence on the productivity differentials and how they are measured. From the micro perspective, the article explores the quantitative evidence on the role of management practices claimed to be a key determinant in promoting firm competitiveness and in bridging the UK gap. Findings – This study suggests that management practices are an ambiguous driver of firm productivity and higher firm performance. On the methodological side, qualitative and subjective measures of either management practices or firm performance are often used. This makes the results not comparable across studies, across firms or even within firms over time. Productivity and profitability are often and erroneously interchangeably used while productivity is only one element of firm performance. On the other hand, management practices are multi-dimensional constructs that generally do not demonstrate a straightforward relationship with productivity variables. To assume that they are the only driver of higher productivity may be misleading. Moreover, there is evidence of an inverse causal relationship between management practices and firm performance. This calls into question most empirical results of the extant literature based on the unidirectional assumption of direct causality between management practices and firm performance. Research limitations/implications – These and other issues suggest that more research is needed to deepen the understanding of the UK productivity gap and more quantitative evidence should be provided on the way in which management practices contribute to the UK competitiveness. Their impact is not easily measurable due to their complexity and their complementary nature and this is a fertile ground for further research. Originality/value – This paper brings together the evidence on the UK productivity gap and its main drivers, provided by the economics, management and performance measurement literature. This issue scores very highly in the agenda of policy makers and academics and has important implications for practitioners interested in evaluating the impact of managerial best practices.

Intra-industry foreign direct investment, uneven development and globalization:the legacy of Stephen Hymer

This paper revisits the issue of intra-industry foreign direct investment (FDI). This issue was considered in Stephen Hymer's early work, but was not subsequently developed, and was largely ignored in the literature for some time. Using the example of the UK, this paper traces the patterns of intra-industry FDI, both across countries and industries, for both the manufacturing and service sectors. Despite the undoubted increase in the integration of goods and factor markets since the time of Hymer's writing, the analysis presented here shows that the pattern has changed little in the last 40 years. The paper then goes on to discuss the motives for intra-industry FDI, relating it to technology flows and factor cost differentials. Finally, we present some analysis relating intra-industry FDI to uneven development, both between developed and developing countries, and between regions of a developed country. It is clear that intra-industry FDI is still very much a developed country phenomenon, as Hymer suggested, with both developing countries and poorer regions of developed countries unlikely to reap any of the benefits. In this context, one-way and two-way FDI must be seen as different phenomena within the debate on globalisation. © The Author 2005. Published by Oxford University Press on behalf of the Cambridge Political Economy Society. All rights reserved.

Antecedents and consequences of service quality in consumer evaluation of self-service internet technologies

Advances in technology coupled with increasing labour costs have caused service firms to explore self-service delivery options. Although some studies have focused on self-service and use of technology in service delivery, few have explored the role of service quality in consumer evaluation of technology-based self-service options. By integrating and extending the self-service quality framework the service evaluation model and the Technology Acceptance Model the authors address this emerging issue by empirically testing a comprehensive model that captures the antecedents and consequences of perceived service quality to predict continued customer interaction in the technology-based self-service context of Internet banking. Important service evaluation constructs like perceived risk, perceived value and perceived satisfaction are modelled in this framework. The results show that perceived control has the strongest influence on service quality evaluations. Perceived speed of delivery, reliability and enjoyment also have a significant impact on service quality perceptions. The study also found that even though perceived service quality, perceived risk and satisfaction are important predictors of continued interaction, perceived customer value plays a pivotal role in influencing continued interaction.

Au service du marechal?:French documentary under German occupation

Following the fall of France in June 1940 and the installation of the Vichy Regime, government set about establishing its own New Order. A reprogramming of national consciousness was attempted through an emphasis on a return to traditional values which was disseminated in various fora. Despite publications on divers aspects of Vichy's propaganda machine, work on film production of the period has merely touched on mainstream documentary without further analysis. Such a lacuna appears inexplicable in light of the production of 550 or so documentaries between 1940 and 1944, especially in view of a 1948 comment by the film writer Roger Régent that documentary in many ways provided a focal point for the regime's wishes for "moralisation collective". This thesis sets out the first steps of a new evaluation of the role of documentary during the Occupation. After an overview of the changes to the industry and the ideological framework of the Révolution nationale, the thesis discusses theories of propaganda together with direct examples of Vichy propaganda documentary. The 'control' thus established is then applied to an examination of the 'Arts, Sciences, Voyages' series of documentary screenings (1941-43) and the Premier congrès du film documentaire (1943), tracing thematic and ideological consonances and evaluating the use of documentary film of the Occupation in the Service of the Marshal.

The evaluation of information systems in the organisational context of the National Health Service. Available in 2 volumes.

This thesis describes a project which has investigated the evaluation of information systems. The work took place in, and is related to, a specific organisational context, that of the National Health Service (NHS). It aims to increase understanding of the evaluation which takes place in the service and the way in which this is affected by the NHS environment. It also investigates the issues which surround some important types of evaluation and their use in this context. The first stage of the project was a postal survey in which respondents were asked to describe the evaluation which took place in their authorities and to give their opinions about it. This was used to give an overview of the practice of IS evaluation in the NHS and to identify its uses and the problems experienced. Three important types of evaluation were then examined in more detail by means of action research studies. One of these dealt with the selection and purchase of a large hospital information system. The study took the form of an evaluation of the procurement process, and examined the methods used and the influence of organisational factors. The other studies are concerned with post-implementation evaluation, and examine the choice of an evaluation approach as well as its application. One was an evaluation of a community health system which had been operational for some time but was of doubtful value, and suffered from a number of problems. The situation was explored by means of a study of the costs and benefits of the system. The remaining study was the initial review of a system which was used in the administration of a Breast Screening Service. The service itself was also newly operational and the relationship between the service and the system was of interest.

An investigation of the relationships between service quality, customer satisfaction, perceived value and behavioural intentions

Customer satisfaction and service quality are two important concepts in the marketing literature. However, there has been some confusion about the conceptualisation and measurement of these two concepts and the nature of the relationship between them. The primary objective of this research was to develop a more thorough understanding of these concepts, and a model that could help to explain the links between them and their relationships with post-purchase behaviour. A preliminary theoretical model was developed, based on an exhaustive review of the literature. Following exploratory research, the model was revised by incorporating "Perceived Value" and "Perceived Sacrifice" to help explain customer's post-purchase behaviour. A longitudinal survey was conducted in the context of the restaurant industry, and the data were analysed using structural equation modelling. The results provided evidence to support the main research hypotheses. However, the effect of "Normative Expectations" on "Encounter Quality" was insignificant, and "Perceived Value" had a direct effect on "Behavioural Intentions" despite expectations that such an effect would be mediated through "Customer Satisfaction". It was also found that "Normative Expectations" were relatively more stable than "Predictive Expectations". It is argued that the present research significantly contributes to the marketing literature, and in particular the role of perceived value in the formation of customers' post-purchase behaviour. Further research efforts in this area are warranted.

An investigation into the antecedents of prosocial service behaviours : a travel service context

Frontline employee (FLE) attitudes and behaviours during service encounters influence customers’ perceptions of service quality and customer satisfaction. The identification of variables that influence FLEs service behaviours is, therefore, important. Much remains unknown about the factors affecting prosocial service behaviours (PSBs). This thesis answers the following questions: What are the antecedents of PSBs in a travel service setting? It is argued that managerial strategies indirectly influence PSBs via their direct influence on job attitudes. This thesis represents an attempt towards an increased knowledge about the antecedents of PSBs by seeking answers to the question. A conceptual model was developed from the literature. Briefly stated, the hypothesised model proposed that job attitudes mediate the relationship between managerial strategies and the PSBs. In-depth interviews provided initial support for the conceptual model. Structural equation modelling techniques were then used to test these relationships on data from 179 travel service employees. Partial support for the mediational role of job attitudes was found. More specifically, the relationship between professional development and extra-role customer service is mediated by job satisfaction and organisational commitment, but not in-role customer service and cooperation. The managerial strategies influence PSBs directly. Internal communication influences extra- and in-role customer service behaviours positively. The relationship between professional development and the three PSBs constructs is negative. Empowerment influences in-role customer service and cooperative behaviours positively.

The effects of new technology on employment structures in the service sector

This thesis explores the interrelationships between the labour process, the development of technology and patterns of gender differentiation. The introduction of front office terminals into building society branches forms the focus of the research. Case studies were carried out in nine branches, three each from three building societies. Statistical data for the whole movement and a survey of ten of the top thirty societies provided the context for the studies. In the process of the research it became clear that it was not technology itself but the way that it was used, that was the main factor in determining outcomes. The introduction of new technologies is occurring at a rapid pace, facilitated by continuing high growth rates, although front office technology could seldom be cost justified. There was great variety between societies in their operating philosophies and their reasons for and approach to computerisation, but all societies foresaw an ultimate saving in staff. Computerisation has resulted in the deskilling of the cashiering role and increased control over work at all stages. Some branch managers experienced a decrease in autonomy and an increase in control over their work. Subsequent to this deskilling there has been a greatly increased use of part time staff which has enabled costs to be reduced. There has also been a polarisation between career and non-career staff which, like the use of part time staff, has occurred along gender lines. There is considerable evidence that societies' policies, structures and managerial attitudes continue to directly and indirectly discriminate against women. It is these practices which confine women to lower grades and ensure their dependence on the family and which create the pool of cheap skilled labour that societies so willingly exploit by increasing part time work. Gender strategies enter management strategies throughout the operations of the organisation.

The relative strength of affective commitment in securing loyalty in service relationships

While commitment is an important antecedent to customer retention, a broad consensus has yet to emerge on the impacts of constituent dimensions of commitment on loyalty in service relationships. This study explores the impacts of affective and continuance commitment on attitudinal and behavioral loyalty in a service context. Since affective commitment is more positive and governed by free choice, whereas continuance commitment is more the result of perceived economic and psychological benefits of being in a relationship, the results of this study suggest that emotional bonds with customers provide a more enduring source of loyalty as compared to economic incentives and switching costs.

eHabitat, a multi-purpose Web Processing Service for ecological modeling

The number of interoperable research infrastructures has increased significantly with the growing awareness of the efforts made by the Global Earth Observation System of Systems (GEOSS). One of the Societal Benefit Areas (SBA) that is benefiting most from GEOSS is biodiversity, given the costs of monitoring the environment and managing complex information, from space observations to species records including their genetic characteristics. But GEOSS goes beyond simple data sharing to encourage the publishing and combination of models, an approach which can ease the handling of complex multi-disciplinary questions. It is the purpose of this paper to illustrate these concepts by presenting eHabitat, a basic Web Processing Service (WPS) for computing the likelihood of finding ecosystems with equal properties to those specified by a user. When chained with other services providing data on climate change, eHabitat can be used for ecological forecasting and becomes a useful tool for decision-makers assessing different strategies when selecting new areas to protect. eHabitat can use virtually any kind of thematic data that can be considered as useful when defining ecosystems and their future persistence under different climatic or development scenarios. The paper will present the architecture and illustrate the concepts through case studies which forecast the impact of climate change on protected areas or on the ecological niche of an African bird.