Investigating the Quitting Decision of Nurses: Panel Data Evidence from the British National Health Service

There is currently a worldwide shortage of registered nurses, driven by large shifts in both the demand for and supply of nurses. Consequently, various policies to increase the recruitment and retention of nurses are under discussion, in particular, the role that wage increases might have in promoting nurse labour supply. In this paper we provide the first detailed empirical investigation into the quitting behaviour of nurses in the British National Health Service (NHS), using a newly constructed longitudinal survey. We fit both single and competing-risks duration models that enable us to establish the characteristics of those nurses who leave the NHS, distinguish the importance of pay in this decision and document the destinations that nurses move to. Contrary to expectations, we find that the hourly wage received by nurses outside of the NHS is around 20% lower than in the NHS, and that hours of work are about the same. However, there is a clear movement away from shift work. Age, seniority, job and employer characteristics are all found to be important predictors of nurses leaving the NHS. However, whilst the effect of wages is found to be statistically significant, the predicted impact of an increase in nurses' pay on retention rates is small. Our main conclusion, therefore, is that the current nurse shortages in the NHS will not be eliminated through substantially increased pay. Rather employers need to identify and address other aspects of the job which are driving nurses' decisions to quit the NHS.nurses, panel data, wages, hours, quitting, NHS

To Teach or not to Teach? Panel Data Evidence on the Quitting Decision

The question we address in this paper is which factors influence the quitting decision of public sector teachers in England and Wales, using a nationally representative panel data set over 1997-2003. We document the outcomes of former teachers, fit single and competing-risks duration models and examine the influence of relative pay on retention. Surprisingly, we find that teachers who move to outside employment earn 22% less pay, work longer hours, in largely nonprofessional occupations and mainly stay within the public sector. We estimate that a 10% increase in teachers’ relative pay would reduce annual quitting rates by less than 1%.Teachers, Panel Data, Wages, Quitting

Testing for Employee Discrimination in Britain using Matched Employer-Employee Data.

We use recent matched employer-employee data to directly test if white workers have a taste for racial discrimination in Britain. We formally introduce individual and firm heterogeneity into the discrimination model used by Becker (1957, 1971) which we extend to generate predictions consistent with an employee taste for discrimination. We argue firstly that white employees with a taste for discrimination should report lower levels of job satisfaction the larger the proportion of ethnic minorities at their workplace. Secondly, white employees would have to be compensated by higher wages if required to work alongside ethnic minority co-workers. Both hypotheses are clearly supported for white males in our data, after comprehensively controlling for individual, job, and workplace characteristics. The white male wage premium for working amongst only ethnic minority co-workers, as compared to working only with whites, is about 12%. Importantly, it appears that neither of these effects operates via realised racial prejudice at the workplace or white employees' feelings concerning their job security.Matched employer-employee data, discrimination, job satisfaction, compensating wage differentials

TESTING FOR EMPLOYEE DISCRIMINATION USING MATCHED EMPLOYER-EMPLOYEE DATA: THEORY AND EVIDENCE

We use recent matched employer-employee data to directly investigate if white workers have a taste for racial discrimination in Britain. Based on a new structural model with individual and firm heterogeneity, we develop and test two predictions. Firstly, white employees with a taste for discrimination should report lower levels of job satisfaction the larger the proportion of ethnic minorities at their workplace. Secondly, white employees would have to be compensated by higher wages if required to work alongside ethnic minority co-workers. Both hypotheses are clearly supported for white males in our data, after comprehensively controlling for individual, job, and workplace characteristics. However, the evidence is weaker for females. The white male wage premium for working amongst only ethnic minority co-workers, as compared to working only with whites, is about 12%. Importantly, it appears that neither of these effects operates via realised racial prejudice at the workplace or white employees’ feelings concerning their job security.Employee Discrimination, Compensating Differentials, StructuralEstimation, Wages, Job Satisfaction

To Teach or Not to Teach? : Panel Data Evidence on the Quitting Decision

The question we address in this paper is which factors influence the quitting decision of public sector teachers in England and Wales, using a nationally representative panel data set over 1997-2003. We document the outcomes of former teachers, fit single and competingrisks duration models and examine the influence of relative pay on retention. Surprisingly, we find that teachers who move to outside employment earn 22% less pay, work longer hours, in largely nonprofessional occupations and mainly stay within the public sector. We estimate that a 10% increase in teachers? relative pay would reduce annual quitting rates by less than 1%

Immigrant Job Search in the UK: Evidence from Panel Data

Most immigrant groups experience higher rates of unemployment than the host countries native population, but it is as yet unclear whether differences in job search behaviour, or its success, can help explain this gap. In this paper, we investigate how the job search methods of unemployed immigrants compare with those of the native born, using panel data from the UK Quarterly Labour Force Survey. We explore the relative effectiveness of different job search methods, between the main native born and immigrant groups, in terms of their impact on the duration of unemployment. Our main finding is that immigrant job search in the UK is less successful than that of UK born whites. However their relative failure to exit unemployment cannot generally be explained by differences in the choice of main job search method or in observable characteristics. We find no support for a policy that would constrain immigrants to use verifiable job search methods

Quantifying the Cost of Passive Smoking on Child Health: Evidence from Children's Cotinine Samples

Passive smoking is a major public health issue. This paper documents the main risk factors that determine children's exposure to passive smoke, and then uses econometric techniques to provide a new economic quantification of the impact of this exposure on child health. Such information is valuable to policy-makers when deciding upon the amount of resources to direct towards the problem of passive smoking. One of our main contributions is the use of a large nationally representative sample of children drawn from the Health Survey for England, for whom we match parental and household smoking and demographic characteristics. We also utilise an objective measure of children's exposure, namely, the level of cotinine - a metabolite of nicotine - in their saliva. We find that both parental and child carer smoking behaviour, as well as area deprivation, are major risk factors in determining children's exposure to passive smoke. Accounting for the potential measurement error in cotinine in our estimations, we have calculated that for a child who is exposed to a high number of passive smoking risk factors, the shadow price or income-equivalence of such exposure is £16,000 (US$30,000) per year. A further policy-related result is that comprehensively controlling for child passive smoking does not explain the observed gradient between household income and child health

Prevention and Management of Bone Metastases in Lung Cancer: A Review

Abstract:Approximately 30 to 40% of patients with advanced lung cancer will develop bone metastases in the course of their disease, resulting in a significant negative impact on both morbidity and survival. Skeletal complications of bone metastases include pain, pathologic fractures, spinal cord compression, and hypercalcemia. Total medical care costs are greater among patients with bone metastases who develop skeletal complications. A randomized phase III trial of the third generation bisphosphonate zoledronic acid has shown clinical benefit in the management of a subgroup of patients with bone metastases from lung cancer. Zoledronic acid treatment was associated with a reduction in both the risk of, and time to, a skeletal-related event. One of the markers of bone resorption, N-telopeptide, is both prognositic for development of skeletal-related events and predictive for benefit from zoledronic acid. In preclinical models, bisphosphonates have also demonstrated antitumor activity and are therefore currently being evaluated in adjuvant trials. Inhibition of the receptor activator of nuclear factor kappa B ligand-RANK pathway can reduce osteoclast-mediated bone resorption, and trials comparing receptor activator of nuclear factor kappa B ligand inhibitors with bisphosphonates are ongoing, including patients with lung cancer. In this article, we review the management of bone metastases and hypercalcemia as well as potential future directions for bone directed therapies in patients with lung cancer

Employment, wages, and the economic cycle: differences between immigrants and natives

In this paper, we analyse differences in the cyclical pattern of employment and wages of immigrants and natives for two large immigrant receiving countries, Germany and the UK. We show that, despite large differences in their immigrant populations, there are similar and significant differences in cyclical responses between immigrants and natives in both countries, even conditional on education, age, and location. We decompose changes in outcomes into a secular trend and a business cycle component. We find significantly larger unemployment responses to economic shocks for low-skilled workers relative to high-skilled workers and for immigrants relative to natives within the same skill group. There is little evidence for differential wage responses to economic shocks. We offer three explanations for these findings: an equilibrium search model, where immigrants experience higher job separation rates, a model of dual labour markets, and differences in the complementarity of immigrants and natives to capital

Phase II randomized preoperative window-of-opportunity study of the PI3K inhibitor pictilisib plus anastrozole compared with anastrozole alone in patients with estrogen receptor-positive breast cancer

Purpose: Preclinical data support a key role for the PI3K pathway in estrogen receptor-positive breast cancer and suggest that combining PI3K inhibitors with endocrine therapy may overcome resistance. This preoperative window study assessed whether adding the PI3K inhibitor pictilisib (GDC-0941) can increase the antitumor effects of anastrozole in primary breast cancer and aimed to identify the most appropriate patient population for combination therapy. Patients and Methods: In this randomized, open-label phase II trial, postmenopausal women with newly diagnosed operable estrogen receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancers were recruited. Participants were randomly allocated (2:1, favoring the combination) to 2 weeks of preoperative treatment with anastrozole 1 mg once per day (n = 26) or the combination of anastrozole 1 mg with pictilisib 260 mg once per day (n = 49). The primary end point was inhibition of tumor cell proliferation as measured by change in Ki-67 protein expression between tumor samples taken before and at the end of treatment. Results: There was significantly greater geometric mean Ki-67 suppression of 83.8% (one-sided 95% CI, ≥ 79.0%) for the combination and 66.0% (95% CI, ≤ 75.4%) for anastrozole (geometric mean ratio [combination: anastrozole], 0.48; 95% CI, ≤ 0.72; P = .004). PIK3CA mutations were not predictive of response to pictilisib, but there was significant interaction between response to treatment and molecular subtype (P =.03);for patients with luminal B tumors, the combination:anastrozole geometric mean ratio of Ki-67 suppression was 0.37 (95% CI, ≤ 0.67; P = .008), whereas no significant Ki-67 response was observed for pictilisib in luminal A tumors (1.01; P = .98). Multivariable analysis confirmed Ki-67 response to the combination treatment of patients with luminal B tumors irrespective of progesterone receptor status or baseline Ki-67 expression. Conclusion: Adding pictilisib to anastrozole significantly increases suppression of tumor cell proliferation in luminal B primary breast cancer