Importance-performance analysis of UK and US bank customer perceptions of service delivery technologies

Importance-performance analysis is utilised to compare the perceptions held by bank customers regarding selected service delivery technologies (SDTs) such as automated teller machines (ATMs), telephone banking and internet banking. Bank patrons in the United Kingdom and the United States are surveyed to examine which service delivery factors they consider to be most important toward assessing the performance of SDTs offered by banking institutions. Customer views are plotted onto importance-performance grids which offer banking strategists a straightforward, graphic illustration of service factors that patrons consider to be salient and well-addressed by current installations of bank SDTs in each respective nation. The grids also offer heuristic decision guides for translating customer perceptions into strategic allocations of organisational investments toward SDT

Prednisolone improves the response to primary endocrine treatment for advanced breast cancer.

Two hundred and twenty patients with progressive advanced breast cancer were given primary endocrine treatment (PET) according to menstrual status. Pre-menopausal patients received ovarian irradiation (O) and post-menopausal tamoxifen 10 mg bd (T). Patients were randomised to receive either no additional treatment or prednisolone 5 mg bd (P). Similar results were observed in each menstrual subgroup. In 194 evaluable patients, the response to PET + P was 49% and to PET alone 30% (P less than 0.01). P increased the median duration of response from 9 to 14 months (P less than 0.002) and the median time to disease progression from 5 to 9 months (P less than 0.001). Response to P after O or T alone occurred in only 2/62 (3%). Median survival in patients randomised to receive P at the outset of PET was prolonged by 4 months (P less than 0.05). The addition of P significantly improves the response to O or T in the treatment of advanced breast cancer

Performing the high-school prom in the UK: Locating authenticity through practice

The purpose of this study was threefold: to develop an understanding of the appropriation of the US High School Prom in the UK and more importantly to generate an insight into the producers and consumers of such an event; to establish if the performance of the prom is hyper-real or if there is an awareness of the authentic or inauthentic elements of this ritual and finally to ascertain local interpretation of authenticity and glocal practice. The method used here was a qualitative approach employing 24 in-depth interviews with young adults (18-20 years) who had attended a prom in the UK in the last three years. The findings illustrated that the role and the social network of the individual was key to engagement with the High School Prom and also indicated a possible symbiosis of the strands of theory associated with authenticity. Diverse localised meanings of the prom performance were also identified. As the school prom is a growth market in the UK businesses should be aware of adolescents’ desire for ownership of this event and should tailor their marketing accordingly

Consumer vulnerability and the transformative potential of Internet shopping: An exploratory case study

Ten million individuals in the UK who suffer from long-term illness, impairments or disability can be considered as vulnerable consumers (Office for Disability Issues, 2010). Despite this, there are few studies on the use of the Internet for grocery shopping by the disabled and none which offers an understanding of the multiple facets of consumer vulnerability. The purpose of this study is to contextualise the use of the Internet for grocery shopping using an exploratory case to provide fresh insights into the 'actual' vulnerability of "Danni" – a disabled housewife and mother. The consumer focussed methods used here were combined multiple complementary approaches. The findings illustrate that whilst the use of the Internet reduces the impracticalities of shopping in-store, the normalcy afforded to Danni through shopping in-store (including her sense of self) was not met by the technological offerings. The paradoxes associated with using online provision and the strategies adopted to manage these by Danni demonstrate engagement/disengagement and assimilation/isolation. Policy implications and insights for retailers are provided

Exploring Appropriation of Global Cultural Rituals

Adolescents, as a consequence of identification with popular culture, have been described as having homogenous consumption patterns. More recently, however, it has been recognised that ‘glocalisation’ (global practices reworked to fit local contexts) affords an opportunity for differentiation. This paper considers a recent UK phenomenon, namely that of the US high school prom, and seeks to explore the ways in which this ritual has been adopted or adapted as part of youth culture. The method employed here was mixed methods and included in-depth interviews with those who attended a prom in the last three years as well as a questionnaire distributed amongst high school pupils who were anticipating a high school prom. The findings illustrate that the high school prom in the UK is becoming increasingly integrated into the fabric of youth culture although, depending on the agentic abilities employed by the emerging adults in the sample, there is differing appropriation of this ritual event particularly in relation to attitudes towards and motivations for attending the prom. A typology of prom attendees is posited. This paper contributes to our understanding of this practice in a local context

Forms of fettering : application forms and the exercise of discretion in the welfare state

Application forms are often the compulsory interface between citizens and their social rights. Applicants for support must navigate the questions, checklists and blank spaces in often long, detailed documents to assert their social entitlements. Given their ubiquity and the central role they play in the administration of the welfare state, it is perhaps surprising that they have been neglected in favour of a focus on other documentation, principally policy and guidance. This paper argues that the non-fettering ground of review – a principle whose jurisprudence is tied to the design and use of policy – also engages application forms. Through an analysis of 271 application forms used to administer the localised Discretionary Housing Payment scheme in England, three examples of their fettering potential are provided: the imposition of exhaustive criteria; requiring the applicant to self-classify or disclose irrelevant considerations; and constraining responses through tied evidential requirements. By arguing that the non-fettering ground should not limit itself to one kind of document (policy) when administrators are so reliant on another (application forms), the paper’s broader agenda is to argue that principles of good administration should apply to all documentation used to administer social entitlement

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes