Redesigning an Effective Pathway to Consumer Loyalty for Sustainable Competitive Advantage

The qualitative case study aimed to study the impact of leadership behaviors on delivering hospitality frontline employee services to customers to sustain consumer loyalty and gain a sustainable competitive advantage in the South Florida hospitality and tourism industry. The flexible design allowed the researcher to develop specific research questions while focusing on the problem statement, which addressed the potential inability of U.S. business leaders in service-related industries to gain customer loyalty, resulting in the possible loss of competitive advantage for the organizations. The researcher selected a highly successful South Florida luxury hotel resort, and twenty-nine professionally diversified participants were interviewed in person during this study. Each participant was asked eight semi-structured interview questions about their experiences at the resort or previous hospitality experiences. The qualitative concepts of bracketing and triangulation used in data collection enabled the researcher to develop an increase of objectivity about the participants. Through this case study, the researcher discovered that hospitality leadership must ensure employees are engaged with their jobs; such actions should help reduce employee turnover and develop a strong culture of employer-employee commitment (Figure 1). Furthermore, this qualitative research discovered the five new critical themes of 1) ensuring proper training, 2) teamwork, 3) leadership engagement with staff, 4) delivering high-quality services, and 5) developing and maintaining a caring organizational culture. Furthermore, this case study proved to fill the gaps in research knowledge on redesigning a practical pathway to customer loyalty for sustainable competitive advantage

IS PSYCHOLOGICAL FLEXIBILITY A TRANS-THEORETICAL PROCESS OF THERAPEUTIC CHANGE?

Introduction Psychological flexibility has been considered to be an important ingredient of good psychological health for the last five decades or so. It has been suggested that psychological flexibility predominantly refers to a number of dynamic processes which determine a person’s interactions with their environment. For the purpose of this research, the model of psychological flexibility associated with Acceptance and Commitment Therapy (ACT) has been adopted. From an ACT perspective, psychological flexibility consists of six interlinked processes: present moment awareness, acceptance, cognitive defusion, self-as-context, committed action and values. ACT founders argue that psychological flexibility is a change process in ACT. The evidence suggests that psychological flexibility is a trans-diagnostic process, meaning that an increase in psychological flexibility is associated with a decrease of distress across a range of diagnoses. It is less clear, however, whether psychological flexibility is also trans-theoretical, meaning that it is unclear whether other successful therapies also operate through the process of psychological flexibility. Aims The primary aims of this study were (1) to examine whether psychological flexibility processes can be detected in client talk during therapy that does not overtly target psychological flexibility as a change process and (2) to examine whether changes in detected levels of psychological flexibility are related to clinical outcomes. Method A secondary data analysis was conducted in this study. The second, fourth and last sessions of Cognitive Behavioural Therapy (CBT) recordings from three participants were analysed in order to examine whether psychological flexibility could be identified in their speech. Additionally, a panel of judges (blinded to the actual clinical outcomes of the participants) made predictions about the therapy outcomes based on the analysed data. Results The results showed that the psychological flexibility process can be reliably identified in the talk of participants who engage in CBT. It is unclear, however, whether accurate outcome predictions can be made based on the identified patterns of psychological flexibility. Discussion There is a large body of research supporting the notion that a number of well-established psychological treatments produce similar outcomes across different presentations and populations, which have led some authors to conclude that some therapeutic processes contributing to achieving therapeutic change are common across all psychological treatments. It has been argued that psychological flexibility is an important process of psychotherapeutic change, and the results of this study show that its components can be identified in CBT which does not explicitly target psychological flexibility. This finding provides a platform for future research into the role of psychological flexibility in facilitating psychotherapeutic change. However, whether accurate outcome predictions can be made based on the identified patterns of psychological flexibility remains unclear. Given that there are many similarities between ACT and CBT, it would be valuable to examine whether psychological flexibility can be also detected in therapies which do not have cognitive and behavioural roots, such as psychodynamic therapy. Additionally, further research should analyse the talk of participants whose clinical outcomes are more varied in order to examine the relationship between patterns of psychological flexibility identified in text and participants’ clinical outcomes

High life in the sky? Mortality by floor of residence in Switzerland

Living in high-rise buildings could influence the health of residents. Previous studies focused on structural features of high-rise buildings or characteristics of their neighbourhoods, ignoring differences within buildings in socio-economic position or health outcomes. We examined mortality by floor of residence in the Swiss National Cohort, a longitudinal study based on the linkage of December 2000 census with mortality and emigration records 2001-2008. Analyses were based on 1.5 million people living in buildings with four or more floors and 142,390 deaths recorded during 11.4 million person-years of follow-up. Cox models were adjusted for age, sex, civil status, nationality, language, religion, education, professional status, type of household and crowding. The rent per m2 increased with higher floors and the number of persons per room decreased. Mortality rates decreased with increasing floors: hazard ratios comparing the ground floor with the eighth floor and above were 1.22 [95% confidence interval (CI) 1.15-1.28] for all causes, 1.40 (95% CI 1.11-1.77) for respiratory diseases, 1.35 (95% CI 1.22-1.49) for cardiovascular diseases and 1.22 (95% CI 0.99-1.50) for lung cancer, but 0.41 (95% CI 0.17-0.98) for suicide by jumping from a high place. There was no association with suicide by any means (hazard ratio 0.81; 95% CI 0.57-1.15). We conclude that in Switzerland all-cause and cause-specific mortality varies across floors of residence among people living in high-rise buildings. Gradients in mortality suggest that floor of residence captures residual socioeconomic stratification and is likely to be mediated by behavioural (e.g. physical activity), and environmental exposures, and access to a method of suicid

The Swiss neighbourhood index of socioeconomic position: update and re-validation.

BACKGROUND The widely used Swiss neighbourhood index of socioeconomic position (Swiss-SEP 1) was based on data from the 2000 national census on rent, household head education and occupation, and crowding. It may now be out of date. METHODS We created a new index (Swiss-SEP 2) based on the 2012-2015 yearly micro censuses that have replaced the decennial house-to-house census in Switzerland since 2010. We used principal component analysis on neighbourhood-aggregated variables and standardised the index. We also created a hybrid version (Swiss-SEP 3), with updated values for neighbourhoods centred on buildings constructed after the year 2000 and original values for the remaining neighbourhoods. RESULTS A total of 1.54 million neighbourhoods were included. With all three indices, the mean yearly equivalised household income increased from around 52,000 to 90,000 CHF from the lowest to the highest index decile. Analyses of mortality were based on 33.6 million person-years of follow-up. The age- and sex-adjusted hazard ratios of all-cause mortality comparing areas in the lowest Swiss-SEP decile with areas of the highest decile were 1.39 (95% confidence interval [CI] 1.36-1.41), 1.31 (1.29-1.33) and 1.34 (1.32-1.37) using the old, new and hybrid indices, respectively. DISCUSSION The Swiss-SEP indices capture area-based SEP at a high resolution and allow the study of SEP when individual-level SEP data are missing or area-level effects are of interest. The hybrid version (Swiss-SEP 3) maintains high spatial resolution while adding information on new neighbourhoods. The index will continue to be useful for Switzerland's epidemiological and public health research

Dying among Older Adults in Switzerland: Who Dies in Hospital, Who Dies in a Nursing Home?

Background: Institutional deaths (hospitals and nursing homes) are an important issue because they are often at odds with patient preference and associated with high healthcare costs. The aim of this study was to examine deaths in institutions and the role of individual, regional, and healthcare supply characteristics in explaining variation across Swiss Hospital Service Areas (HSAs). Methods: Retrospective study of individuals ≥66 years old who died in a Swiss institution (hospital or nursing homes) in 2010. Using a two-level logistic regression analysis we examined the amount of variation across HSAs adjusting for individual, regional and healthcare supply measures. The outcome was place of death, defined as death in hospital or nursing homes

Automating Thermal Analysis with Thermal Desktop™

Thermal analysis is typically executed with multiple tools in a series of separate steps for performing radiation analysis, generating conduction and capacitance data, and for solv-ing temperatures. This multitude of programs often leads to many user files that become unmanageable with their mul-titude, and the user often looses track as to which files go with which cases. In addition to combining the output from multiple programs, current processes often involve the user inputting various hand calculations into the math model to account for MLI/Insulation and contact conductance between entities. These calculations are not only tedious to make, but users often forget to update them when the geometry is changed. Several new features of Thermal Desktop are designed to automate some of the tedious tasks that thermal engineers now practice. To start with, Thermal Desktop is a single program that does radiation analysis, generates conduc-tion/capacitance data and automates the building of a SINDA/FLUINT model to solve for temperatures. Some of these new features of Thermal Desktop are Radiation Anal

What does your neighbourhood say about you? : a study of life expectancy in 1.3 million Swiss neighbourhoods

BACKGROUND: Switzerland had the highest life expectancy at 82.8 years among the Organisation for Economic Co-operation and Development (OECD) countries in 2011. Geographical variation of life expectancy and its relation to the socioeconomic position of neighbourhoods are, however, not well understood. METHODS: We analysed the Swiss National Cohort, which linked the 2000 census with mortality records 2000-2008 to estimate life expectancy across neighbourhoods. A neighbourhood index of socioeconomic position (SEP) based on the median rent, education and occupation of household heads and crowding was calculated for 1.3 million overlapping neighbourhoods of 50 households. We used skew-normal regression models, including the index and additionally marital status, education, nationality, religion and occupation to calculate crude and adjusted estimates of life expectancy at age 30 years. RESULTS: Based on over 4.5 million individuals and over 400,000 deaths, estimates of life expectancy at age 30 in neighbourhoods ranged from 46.9 to 54.2 years in men and from 53.5 to 57.2 years in women. The correlation between life expectancy and neighbourhood SEP was strong (r=0.95 in men and r=0.94 women, both p values <0.0001). In a comparison of the lowest with the highest percentile of neighbourhood SEP, the crude difference in life expectancy from skew-normal regression was 4.5 years in men and 2.5 years in women. The corresponding adjusted differences were 2.8 and 1.9 years, respectively (all p values <0.0001). CONCLUSIONS: Although life expectancy is high in Switzerland, there is substantial geographical variation and life expectancy is strongly associated with the social standing of neighbourhoods

Large regional variation in cardiac closure procedures to prevent ischemic stroke in Switzerland a population-based small area analysis.

BACKGROUND Percutaneous closure of a patent foramen ovale (PFO) or the left atrial appendage (LAA) are controversial procedures to prevent stroke but often used in clinical practice. We assessed the regional variation of these interventions and explored potential determinants of such a variation. METHODS We conducted a population-based analysis using patient discharge data from all Swiss hospitals from 2013-2018. We derived hospital service areas (HSAs) using patient flows for PFO and LAA closure. We calculated age-standardized mean procedure rates and variation indices (extremal quotient [EQ] and systematic component of variation [SCV]). SCV values >5.4 indicate a high and >10 a very high variation. Because the evidence on the efficacy of PFO closure may differ in patients aged <60 years and ≥60 years, age-stratified analyses were performed. We assessed the influence of potential determinants of variation using multilevel regression models with incremental adjustment for demographics, cultural/socioeconomic, health, and supply factors. RESULTS Overall, 2574 PFO and 2081 LAA closures from 10 HSAs were analyzed. The fully adjusted PFO and LAA closure rates varied from 3 to 8 and from 1 to 9 procedures per 100,000 persons per year across HSAs, respectively. The regional variation was high with respect to overall PFO closures (EQ 3.0, SCV 8.3) and very high in patients aged ≥60 years (EQ 4.0, SCV 12.3). The variation in LAA closures was very high (EQ 16.2, SCV 32.1). In multivariate analysis, women had a 28% lower PFO and a 59% lower LAA closure rate than men. French/Italian language areas had a 63% lower LAA closure rate than Swiss German speaking regions and areas with a higher proportion of privately insured patients had a 86% higher LAA closure rate. After full adjustment, 44.2% of the variance in PFO closure and 30.3% in LAA closure remained unexplained. CONCLUSIONS We found a high to very high regional variation in PFO closure and LAA closure rates within Switzerland. Several factors, including sex, language area, and insurance status, were associated with procedure rates. Overall, 30-45% of the regional procedure variation remained unexplained and most probably represents differing physician practices