Pensions and procrastination : how can employers help their employees save for the future?

In this paper I show that employees tend to procrastinate when they are expected to decide whether or not they would like to save using the defined contribution pension scheme offered by their employer. By auto-enrolling the employees or asking them to decide before a given deadline, employers can mitigate some of the problems caused by employee procrastination. However both of these mechanisms present their own problems, caused by default stickiness and other issues, so I discuss how employers can decide which is the right mechanism to use depending on the characteristics of their employees, and how to minimize the problems these mechanisms can cause.

Leverage and beliefs: Personal experience and risk taking in margin lending

What determines risk-bearing capacity and the amount of leverage in financial markets? Thispaper uses unique micro-data on collateralized lending contracts during a period of financialdistress to address this question. An investor syndicate speculating in English stocks wentbankrupt in 1772. Using hand-collected information from Dutch notarial archives, we examinechanges in lenders' behavior following exposure to potential (but not actual) losses. Before thedistress episode, financiers that lent to the ill-fated syndicate were indistinguishable from therest. Afterwards, they behaved differently: they lent with much higher haircuts. Only lendersexposed to the failed syndicate altered their behavior. The differential change is remarkable sincethe distress was public knowledge, and because none of the lenders suffered actual losses ? allfinanciers were repaid in full. Interest rates were also unaffected; the market balanced solelythrough changes in collateral requirements. Our findings are consistent with a heterogeneousbeliefs-interpretation of leverage. They also suggest that individual experience can modify thelevel of leverage in a market quickly.

Experience and endocrine stress responses in neonatal and pediatric critical care nurses and physicians.

OBJECTIVE: Critical care is a working environment with frequent exposure to stressful events. High levels of psychological stress have been associated with increased prevalence of burnout. Psychological distress acts as a potent trigger of cortisol secretions. We attempted to objectify endocrine stress reactivity. DESIGN: Observational cohort study during two 12-day periods in successive years. SETTING: A tertiary multidisciplinary neonatal and pediatric intensive care unit (33 beds). SUBJECTS: One hundred and twelve nurses and 27 physicians (94% accrual rate). INTERVENTIONS AND MEASUREMENTS: Cortisol determined from salivary samples collected every 2 hrs and after stressful events. Participants recorded the subjective perception of stress with every sample. Endocrine reactions were defined as transient surges in cortisol of >50% and 2.5 nmol/L over the baseline. MAIN RESULTS: During 7,145 working hours, we observed 474 (12.5%) endocrine reactions from 3,781 samples. The mean cortisol increase amounted to 10.6 nmol/L (219%). The mean occurrence rate of endocrine reactions per subject and sample was 0.159 (range, 0-0.43). Although the mean raw cortisol levels were lower in experienced team members (>3 yrs of intensive care vs. <3 yrs, 4.1 vs. 4.95 nmol/L, p < .001), professional experience failed to attenuate the frequency and magnitude of endocrine reactions, except for the subgroup of nurses and physicians with >8 yrs of intensive care experience. A high proportion (71.3%) of endocrine reactions occurred without conscious perception of stress. Unawareness of stress was higher in intensive care nurses (75.1%) than in intermediate care nurses (51.8%, p < .01). CONCLUSIONS: Stress-related cortisol surges occur frequently in neonatal and pediatric critical care staff. Cortisol increases are independent of subjective stress perception. Professional experience does not abate the endocrine stress reactivity.

Adult native septic arthritis: a review of 10 years of experience and lessons for empirical antibiotic therapy.

Objectives To review the epidemiology of native septic arthritis to establish local guidelines for empirical antibiotic therapy as part of an antibiotic stewardship programme. Methods We conducted a 10 year retrospective study based on positive synovial fluid cultures and discharge diagnosis of septic arthritis in adult patients. Microbiology results and medical records were reviewed. Results Between 1999 and 2008, we identified 233 episodes of septic arthritis. The predominant causative pathogens were methicillin-susceptible Staphylococcus aureus (MSSA) and streptococci (respectively, 44.6% and 14.2% of cases). Only 11 cases (4.7%) of methicillin-resistant S. aureus (MRSA) arthritis were diagnosed, among which 5 (45.5%) occurred in known carriers. For large-joint infections, amoxicillin/clavulanate or cefuroxime would have been appropriate in 84.5% of cases. MRSA and Mycobacterium tuberculosis would have been the most frequent pathogens that would not have been covered. In contrast, amoxicillin/clavulanate would have been appropriate for only 75.3% of small-joint infections (82.6% if diabetics are excluded). MRSA and Pseudomonas aeruginosa would have been the main pathogens not covered. Piperacillin/tazobactam would have been appropriate in 93.8% of cases (P < 0.01 versus amoxicillin/clavulanate). This statistically significant advantage is lost after exclusion of diabetics (P = 0.19). Conclusions Amoxicillin/clavulanate or cefuroxime would be adequate for empirical coverage of large-joint septic arthritis in our area. A broad-spectrum antibiotic would be significantly superior for small-joint infections in diabetics. Systematic coverage of MRSA is not justified, but should be considered for known carriers. These recommendations are applicable to our local setting. They might also apply to hospitals sharing the same epidemiology.

From dialysis to transplantation, illness experience and patients' concerns about future: A longitudinal qualitative study

Background: Transplantation is the treatment of choice when compared to dialysis. Long-term evolution of patients is rarely comprehensively described. Thirty end-stage renal disease patient's experience of illness was explored from registration for transplantation until twenty-four months after transplantation. Methods: Longitudinal semi-structured interviews were conducted, and qualitative discourse analysis performed. Findings: Before transplantation loss of quality of life (QOL), emotional fragility related to dialysis constraints were reported, and increased with waiting-time. Six months after transplantation, recovered freedom was described but acute rejection, and life-dependency to immunosuppressants generated concerns. After twelve months, long-term survival of the graft, and possible return-to-dialysis were mentioned. After twenty months graft's dysfunction, co-morbidities, immunosuppressants side effects rose concerns even though QOL persisted. Most patients report positive transformations after transplantation, which are related to graft survival and limited co-morbidities. Discussion: As time passes, patients deal with changing illness constraints, and contemplate with anxiety possible new return to dialysis and/or transplantation.

The importance of sonographer experience and machine quality with regards to the role of musculoskeletal ultrasound in routine care of rheumatoid arthritis patients.

OBJECTIVES: Regarding recent progress, musculoskeletal ultrasound (US) will probably soon be integrated in standard care of patient with rheumatoid arthritis (RA). However, in daily care, quality of US machines and level of experience of sonographers are varied. We conducted a study to assess reproducibility and feasibility of an US scoring for RA, including US devices of different quality and rheumatologist with various levels of expertise in US as it would be in daily care. METHODS: The Swiss Sonography in Arthritis and Rheumatism (SONAR) group has developed a semi-quantitative score using OMERACT criteria for synovitis and erosion in RA. The score was taught to 108 rheumatologists trained in US. One year after the last workshop, 19 rheumatologists participated in the study. Scans were performed on 6 US machines ranging from low to high quality, each with a different patient. Weighted kappa was calculated for each pair of readers. RESULTS: Overall, the agreement was fair to moderate. Quality of device, experience of the sonographers and practice of the score before the study improved substantially the agreement. Agreement assessed on higher quality machine, among sonographers with good experience in US increased to substantial (median kappa for B-mode and Doppler: 0.64 and 0.41 for erosion). CONCLUSIONS: This study demonstrated feasibility and reproducibility of the Swiss US SONAR score for RA. Our results confirmed importance of the quality of US machine and the training of sonographers for the implementation of US scoring in the routine daily care of RA.

Longitudinal study of informed consent in innovative therapy research: experience and provisional recommendations from a multicenter trial of intracerebral grafting.

BACKGROUND: There is an urgent need to assess and improve the consent process in clinical trials of innovative therapies for neurodegenerative disorders. METHODS: We performed a longitudinal study of the consent of Huntington's disease patients during the Multicenter Fetal Cell Intracerebral Grafting Trial in Huntington's Disease (MIG-HD) in France and Belgium. Patients and their proxies completed a consent questionnaire at inclusion, before signing the consent form and after one year of follow-up, before randomization and transplantation. The questionnaire explored understanding of the protocol, satisfaction with the information delivered, reasons for participating in the trial and expectations regarding the transplant. Forty-six Huntington's disease patients and 27 proxies completed the questionnaire at inclusion, and 27 Huntington's disease patients and 16 proxies one year later. RESULTS: The comprehension score was high and similar for Huntington's disease patients and proxies at inclusion (72.6% vs 77.8%; P > 0.1) but only decreased in HD patients after one year. The information satisfaction score was high (73.5% vs 66.5%; P > 0.1) and correlated with understanding in both patients and proxies. The motivation and expectation profiles were similar in patients and proxies and remained unchanged after one year. CONCLUSIONS: Cognitively impaired patients with Huntington's disease were capable of consenting to participation in this trial. This consent procedure has presumably strengthened their understanding and should be proposed before signing the consent form in future gene or cell therapy trials for neurodegenerative disorders. Because of the potential cognitive decline, proxies should be designated as provisional surrogate decision-makers, even in competent patients.

Tiedon jakaminen ja organisaation oppiminen

Tutkielman tavoite: Tutkielman tavoitteena oli selvittää sitä, miten tiedon jakaminen vaikuttaa organisaation oppimiseen. Tutkielman teoriaosassa tarkastellaan niitä käsitteitä ja lainalaisuuksia, jotka liittyvät oppimiseen yleensä sekä yksilö- että organisaatiotasolla, oppivaan organisaatioon, tietoon ja sen syntymiseen, virtaukseen, hallintaan, merkitykseen ja johtamiseen. Näiden lisäksi työssä tarkastellaan yksilön motivaatioon vaikuttavia seikkoja, yrityksen arvoja ja kulttuuria. Näiden pohjalta rakentui tutkielman viitekehys. Tutkielman empiriaosassa tarkastellaan viitekehyksen soveltuvuutta käytäntöön analysoimalla Casa-yrityksen toimintaa. Tutkimusaineisto ja tutkimusmenetelmät: Tutkimuksen teoriaosa perustuu suurelta osin sekä oppivaa että älykästä organisaatiota käsittelevään kirjallisuuteen, artikkeleihin ja aikaisempiin tutkimustöihin. Tämän lisäksi teoriaosuudessa perehdytään tiedon johtamiseen ja tiedon jakamiseen sekä tähän kiinteästi liittyvään motivaatioon ja sitoutumiseen. Empiirinen tutkimus toteutettiin kvalitatiivisella puolistrukturoidulla haastattelulla. Haastatteluja oli seitsemän ja kaikki haastateltavat olivat johtavissa tehtävissä. Tutkimuksen tulokset: Empiirisen osan tulokset mukailevat teoreettisin osan tuloksia. Organisaatiossa ei voi tapahtua oppimista ilman tiedon jakamista. Organisaation oppimisen suurimpana esteenä on se, ettei tietoa ja osaamista jaeta organisaation jäsenten kesken. Usein tällaiselta organisaatiolta puuttuvat myös yhteiset tavoitteet, siellä vallitsevat epämääräiset toimintatavat, puutteelliset vuorovaikutustaidot ja huonot henkilöstösuhteet. Organisaation oppimiskykyä heikentävät jäykät ja aikaa vievät rutiinit, kokemuksista ja virheistä ei osata oppia, hitaita muutoksia ei havaita ja kokemustieto unohdetaan. Työntekijän täytyy olla motivoitunut ja organisaatiossa turvallinen henkinen ilmapiiri, jotta tiedon jakamista tapahtuisi. Tieto on valtaa vain jaettuna, koska silloin siitä on mahdollisuus muodostua kilpailuetua yritykselle.

A model of gender prejudice, power, and discrimination: How hierarchy-enhancing factors predominate over hierarchy-attenuating factors

Gender inequalities remain an issue in our society and particularly in the workplace. Several factors can explain this gender difference in top-level managerial positions such as career ambitions but also biases against women. In our chapter, we propose a model explaining why gender inequalities and particularly discrimination against women is still present in our societies despite social norms and existing legislation on gender equality. To this purpose, we review research on discrimination through two different approaches, (a) a prejudice approach through the justification-suppression model developed by Crandall and Eshleman (2003) and (b) a power approach through the social dominance theory (Pratto, Sidanius, Stallworth, & Malle, 1994; Sidanius & Pratto, 1999). In our work, we integrate these two approaches and propose a model of gender prejudice, power and discrimination. The integration of these two approaches contributes to a better understanding of how discrimination against women is formed and maintained over time.

Expanding to institutionally different countries. Reasons, Firm International Experience, and Entry Mode Choice

We examine entry mode choice and its consequences when a multinational enterprise (MNE) expands into an institutionally different country. We argue that discussions of entry mode should distinguish between informal (e.g., culture) and formal (e.g., laws) institutions, and should take into account not just the home country of the MNE and its distance to the focal host country, but the MNE's overall footprint and experience across the world in general, especially in countries with an institutional structure that is similar to that of the focal host country. Specifically, we argue that firms with experience in countries with different informal institutions will be more likely to enter via acquisitions than firms without such experience, that such experience will not matter as much in the case of formal institutions, and that such firms will exit more quickly when they enter via equity alliances than through full acquisitions. We also distinguish between balanced and unbalanced alliances and argue that balanced alliances will be more enduring, but only when the host country is culturally (not legally) different from the other countries where the MNE has experience. Our arguments suggest that entry mode should be conditioned on a firm's experience in other markets, and that intercountry differences in formal versus informal institutions have distinct influences on entry mode.

Public Management : Ganzheitliches Know-how zur Sicherstellung eines professionellen Verwaltungsmanagements

Dieses hochwertige Praxishandbuch ermöglicht Personen mit Führungs- und Managementfunktionen in den öffentlichen Verwaltungen des Bundes, der Kantone und der Gemeinden einen raschen Zugang zu allen wichtigen Führungsthemen und enthält praktische Anleitungen zur Bewältigung von Managementproblemen. Über 50 ausgewiesene Fachautoren mit professionellem beruflichen Hintergrund haben die vorliegenden Inhalte entsprechend den heutigen Anforderungen in der öffentlichen Verwaltung erstellt

Immediate Decision-Making and Information Needs in Intensive Care Coordination

The aim of this study was to develop a theoretical model for information integration to support the deci¬sion making of intensive care charge nurses, and physicians in charge – that is, ICU shift leaders. The study focused on the ad hoc decision-making and immediate information needs of shift leaders during the management of an intensive care unit’s (ICU) daily activities. The term ‘ad hoc decision-making’ was defined as critical judgements that are needed for a specific purpose at a precise moment with the goal of ensuring instant and adequate patient care and a fluent flow of ICU activities. Data collection and research analysis methods were tested in the identification of ICU shift leaders’ ad hoc decision-making. Decision-making of ICU charge nurses (n = 12) and physicians in charge (n = 8) was observed using a think-aloud technique in two university-affiliated Finnish ICUs for adults. The ad hoc decisions of ICU shift leaders were identified using an application of protocol analysis. In the next phase, a structured online question¬naire was developed to evaluate the immediate information needs of ICU shift leaders. A national survey was conducted in all Finnish, university-affiliated hospital ICUs for adults (n = 17). The questionnaire was sent to all charge nurses (n = 515) and physicians in charge (n = 223). Altogether, 257 charge nurses (50%) and 96 physicians in charge (43%) responded to the survey. The survey was also tested internationally in 16 Greek ICUs. From Greece, 50 charge nurses out of 240 (21%) responded to the survey. A think-aloud technique and protocol analysis were found to be applicable for the identification of the ad hoc decision-making of ICU shift leaders. During one day shift leaders made over 200 ad hoc decisions. Ad hoc decisions were made horizontally, related to the whole intensive care process, and vertically, concerning single intensive care incidents. Most of the ICU shift leaders’ ad hoc decisions were related to human resources and know-how, patient information and vital signs, and special treatments. Commonly, this ad hoc decision-making involved several multiprofessional decisions that constituted a bundle of immediate decisions and various information needs. Some of these immediate information needs were shared between the charge nurses and the physicians in charge. The majority of which concerned patient admission, the organisation and management of work, and staff allocation. In general, the information needs of charge nurses were more varied than those of physicians. It was found that many ad hoc deci-sions made by the physicians in charge produced several information needs for ICU charge nurses. This meant that before the task at hand was completed, various kinds of information was sought by the charge nurses to support the decision-making process. Most of the immediate information needs of charge nurses were related to the organisation and management of work and human resources, whereas the information needs of the physicians in charge mainly concerned direct patient care. Thus, information needs differ between professionals even if the goal of decision-making is the same. The results of the international survey confirmed these study results for charge nurses. Both in Finland and in Greece the information needs of charge nurses focused on the organisation and management of work and human resources. Many of the most crucial information needs of Finnish and Greek ICU charge nurses were common. In conclusion, it was found that ICU shift leaders make hundreds of ad hoc decisions during the course of a day related to the allocation of resources and organisation of patient care. The ad hoc decision-making of ICU shift leaders is a complex multi-professional process, which requires a lot of immediate information. Real-time support for information related to patient admission, the organisation and man¬agement of work, and allocation of staff resources is especially needed. The preliminary information integration model can be applied when real-time enterprise resource planning systems are developed for intensive care daily management