Re-examining the deployment of market orientation in the public leisure sector

Author Posting © Westburn Publishers Ltd, 2012. This is a post-peer-review, pre-copy-edit version of an article which has been published in its definitive form in the Journal of Marketing Management, and has been posted by permission of Westburn Publishers Ltd for personal use, not for redistribution. The article was published in Journal of Marketing Management, 28, 2012,11-12, pp. 1249-1269, doi: 10.1080/0267257X.2011.645857, http://dx.doi.org/10.1080/0267257X.2011.645857This paper examines the moderating effects of market orientation's intelligence generation and dissemination components on the response-performance relationship. We offer valuable insight into the application of, and subsequent returns to, market orientation in the public leisure sector, thereby helping to broaden the appeal, relevance, and usefulness of this important marketing theory to other contexts. The research involved a national survey questionnaire to 1060 public leisure managers of local government leisure facilities in England. Empirical testing through structural equation modelling revealed two important findings. First, intelligence generation efforts of the organisation can in part affect the performance returns to an organisation from its responsiveness to market intelligence. Second, intelligence generation coupled with organisation-wide dissemination of intelligence can have a destructive impact on the response-performance relationship, demonstrated by a negative significant moderating impact on this relationship. This paper provides an alternative explanation to the deployment of market orientation as a means to create value and an explanation that transcends its current linear portrayal in public-service delivery. © 2012 Copyright 2012 Westburn Publishers Ltd

Predicting at-risk opioid use three months after ed visit for trauma: Results from the AURORA study

OBJECTIVE: Whether short-term, low-potency opioid prescriptions for acute pain lead to future at-risk opioid use remains controversial and inadequately characterized. Our objective was to measure the association between emergency department (ED) opioid analgesic exposure after a physical, trauma-related event and subsequent opioid use. We hypothesized ED opioid analgesic exposure is associated with subsequent at-risk opioid use. METHODS: Participants were enrolled in AURORA, a prospective cohort study of adult patients in 29 U.S., urban EDs receiving care for a traumatic event. Exclusion criteria were hospital admission, persons reporting any non-medical opioid use (e.g., opioids without prescription or taking more than prescribed for euphoria) in the 30 days before enrollment, and missing or incomplete data regarding opioid exposure or pain. We used multivariable logistic regression to assess the relationship between ED opioid exposure and at-risk opioid use, defined as any self-reported non-medical opioid use after initial ED encounter or prescription opioid use at 3-months. RESULTS: Of 1441 subjects completing 3-month follow-up, 872 participants were included for analysis. At-risk opioid use occurred within 3 months in 33/620 (5.3%, CI: 3.7,7.4) participants without ED opioid analgesic exposure; 4/16 (25.0%, CI: 8.3, 52.6) with ED opioid prescription only; 17/146 (11.6%, CI: 7.1, 18.3) with ED opioid administration only; 12/90 (13.3%, CI: 7.4, 22.5) with both. Controlling for clinical factors, adjusted odds ratios (aORs) for at-risk opioid use after ED opioid exposure were: ED prescription only: 4.9 (95% CI 1.4, 17.4); ED administration for analgesia only: 2.0 (CI 1.0, 3.8); both: 2.8 (CI 1.2, 6.5). CONCLUSIONS: ED opioids were associated with subsequent at-risk opioid use within three months in a geographically diverse cohort of adult trauma patients. This supports need for prospective studies focused on the long-term consequences of ED opioid analgesic exposure to estimate individual risk and guide therapeutic decision-making

Post-traumatic stress and future substance use outcomes: leveraging antecedent factors to stratify risk

Background: Post-traumatic stress disorder (PTSD) and substance use (tobacco, alcohol, and cannabis) are highly comorbid. Many factors affect this relationship, including sociodemographic and psychosocial characteristics, other prior traumas, and physical health. However, few prior studies have investigated this prospectively, examining new substance use and the extent to which a wide range of factors may modify the relationship to PTSD. Methods: The Advancing Understanding of RecOvery afteR traumA (AURORA) study is a prospective cohort of adults presenting at emergency departments (N = 2,943). Participants self-reported PTSD symptoms and the frequency and quantity of tobacco, alcohol, and cannabis use at six total timepoints. We assessed the associations of PTSD and future substance use, lagged by one timepoint, using the Poisson generalized estimating equations. We also stratified by incident and prevalent substance use and generated causal forests to identify the most important effect modifiers of this relationship out of 128 potential variables. Results: At baseline, 37.3% (N = 1,099) of participants reported likely PTSD. PTSD was associated with tobacco frequency (incidence rate ratio (IRR): 1.003, 95% CI: 1.00, 1.01, p = 0.02) and quantity (IRR: 1.01, 95% CI: 1.001, 1.01, p = 0.01), and alcohol frequency (IRR: 1.002, 95% CI: 1.00, 1.004, p = 0.03) and quantity (IRR: 1.003, 95% CI: 1.001, 1.01, p = 0.001), but not with cannabis use. There were slight differences in incident compared to prevalent tobacco frequency and quantity of use; prevalent tobacco frequency and quantity were associated with PTSD symptoms, while incident tobacco frequency and quantity were not. Using causal forests, lifetime worst use of cigarettes, overall self-rated physical health, and prior childhood trauma were major moderators of the relationship between PTSD symptoms and the three substances investigated. Conclusion: PTSD symptoms were highly associated with tobacco and alcohol use, while the association with prospective cannabis use is not clear. Findings suggest that understanding the different risk stratification that occurs can aid in tailoring interventions to populations at greatest risk to best mitigate the comorbidity between PTSD symptoms and future substance use outcomes. We demonstrate that this is particularly salient for tobacco use and, to some extent, alcohol use, while cannabis is less likely to be impacted by PTSD symptoms across the strata

The AURORA Study: a longitudinal, multimodal library of brain biology and function after traumatic stress exposure

Adverse posttraumatic neuropsychiatric sequelae (APNS) are common among civilian trauma survivors and military veterans. These APNS, as traditionally classified, include posttraumatic stress, postconcussion syndrome, depression, and regional or widespread pain. Traditional classifications have come to hamper scientific progress because they artificially fragment APNS into siloed, syndromic diagnoses unmoored to discrete components of brain functioning and studied in isolation. These limitations in classification and ontology slow the discovery of pathophysiologic mechanisms, biobehavioral markers, risk prediction tools, and preventive/treatment interventions. Progress in overcoming these limitations has been challenging because such progress would require studies that both evaluate a broad spectrum of posttraumatic sequelae (to overcome fragmentation) and also perform in-depth biobehavioral evaluation (to index sequelae to domains of brain function). This article summarizes the methods of the Advancing Understanding of RecOvery afteR traumA (AURORA) Study. AURORA conducts a large-scale (n = 5000 target sample) in-depth assessment of APNS development using a state-of-the-art battery of self-report, neurocognitive, physiologic, digital phenotyping, psychophysical, neuroimaging, and genomic assessments, beginning in the early aftermath of trauma and continuing for 1 year. The goals of AURORA are to achieve improved phenotypes, prediction tools, and understanding of molecular mechanisms to inform the future development and testing of preventive and treatment interventions

Linear indices in nonlinear structural equation models: best fitting proper indices and other composites

Best fitting proper indices, Generalized canonical variables, Partial least squares, Latent factor scores, Indices, Interaction, Flat maximum,

On insensitivity of the chi-square model test to nonlinear misspecification in structural equation models

In this paper, we show that for some structural equation models (SEM), the classical chi-square goodness-of-fit test is unable to detect the presence of nonlinear terms in the model. As an example, we consider a regression model with latent variables and interactions terms. Not only the model test has zero power against that type of misspecifications, but even the theoretical (chi-square) distribution of the test is not distorted when severe interaction term misspecification is present in the postulated model. We explain this phenomenon by exploiting results on asymptotic robustness in structural equation models. The importance of this paper is to warn against the conclusion that if a proposed linear model fits the data well according to the chi-quare goodness-of-fit test, then the underlying model is linear indeed; it will be shown that the underlying model may, in fact, be severely nonlinear. In addition, the present paper shows that such insensitivity to nonlinear terms is only a particular instance of a more general problem, namely, the incapacity of the classical chi-square goodness-of-fit test to detect deviations from zero correlation among exogenous regressors (either being them observable, or latent) when the structural part of the model is just saturated.Research of the second author is supported by the grants SEJ2006-13537 and PR2007-0221 from the Spanish Ministry of Science and Technology

Causality as validity: some implications for the social sciences

Causality, Validity, Temporal asymmetry, Simultaneous relations, Non-directional causality, Causal models, Social sciences,