Personal Costs Research Articles

Russian Immigrant Families’ Child Care Selection in the United States

AbstractResearch on immigrant populations shows that child care choices are dependent on the population’s region of origin. While the Russian immigrant population in the United States comprises the largest group of immigrants from Eastern Europe and is likely to increase in the future, there is virtually no research on Russian immigrant families’ child care search and selection criteria. This qualitative study applies the theoretical model of Pungello and Kurtz-Costes (1999), which illustrates how factors such as parental demographic characteristics, environmental context, child characteristics, and parental beliefs play into families’ child care selection. The study draws from semi-structured interviews with 11 Russian immigrant families residing in the Mid-Atlantic region of the United States to examine their child care search processes and selection criteria. Results revealed that most parents found child care through friends’ recommendations, Internet search, and online reviews. Nine themes describing child care criteria valued by Russian immigrant families emerged from the analysis. Specifically, parents mentioned culture and personal beliefs, child characteristics, convenience, cost and subsidy, education and learning, program features, facilities and environment, teacher characteristics, and rating and reputation as the major factors in selecting child care. Understanding Russian immigrant parents’ child care information sources and selection criteria will allow for early care and education (ECE) providers to accommodate the needs of Russian immigrant population and for policymakers to facilitate access to ECE programs for these families.

Social Power May Enhance Workplace Initiative: An Experimental Investigation Among Two Samples.

Organizational citizenship behavior (OCB) refers to voluntary actions members take to benefit organizational function. However, the benefits of OCB for organizations are sometimes countered by detriments for employees who exhibit them, resulting in threats to organizational members' psychological wellbeing. The present research examined whether social power-the perceived ability to control allocations and outcomes in a social hierarchy-could increase OCB endorsement while buffering against negative personal costs. Indeed, manipulated social power enhanced OCB endorsement. This effect was mediated by increased positive affect and goal seeking among participants assigned to a high-power condition relative to participants assigned to a low-power condition. Further, participants assigned to a high-power (vs. low-power) condition did not report increased occupational burden despite their greater OCB endorsement. Patterns of results were similar among a sample of community members (N = 149; Mage = 37 years) and a sample of university students (N = 129; Mage = 20 years). Organizations might empower members by employing procedural justice principles that facilitate members' meaningful contributions to workplace operations.

Level 4 seizure monitoring unit admissions are associated with reduced long-term health care costs.

This study was undertaken to determine whether admission to dedicated seizure monitoring units (SMUs) result in reduced health care use (HCU). This was a retrospective open cohort study covering the years 2010-2018 of patients residing in Alberta, Canada, who were referred to the Calgary Comprehensive Epilepsy Program and admitted to a level 4 SMU. Patients were required to have ≥3 years pre- and postadmission follow-up. The outcome was the change in trajectory of composite HCU (primary care, specialist outpatient visits, emergency department visits, and hospitalizations) for the 3 years prior to and 3 years following SMU admission using the point of admission as the "index date." Secondary outcomes were HCU limited to specific settings. We excluded the first 30 days following the point of admission to mitigate the confounding admission would have on the postadmission HCU trajectory. We used adjusted restricted maximum likelihood linear and nonlinear effects models to determine trajectories expressed as Canadian dollars. A total of 315 of 600 (53%) patients met eligibility criteria. Mean age was 40 years (SD = 17.4), 176 (56%) were female, 220 (70%) had focal epilepsy, and 60 (19%) had functional seizures or physiologic seizure mimics without epilepsy as adjudicated by the attending physician at the point of discharge. Mean per person health care costs increased by CAD$341.28 (95% confidence interval [CI] = -25.17 to 707.74) for each successive 6-month interval prior to SMU admission (p = .07). Following admission, mean per person costs decreased by CAD$802.34 (95% CI = 699.62-905.06, p < .001) for each successive 6-month interval up to 3 years postdischarge. Similar trends were noted for primary and specialist care, emergency department, admitted care, and when nonlinear models were applied. Admission to an SMU is associated with significant and enduring declines in HCU. Each 6-months following discharge overall HCU declined by a mean of CAD$802.34 and acute inpatient, emergency department, and outpatient physician interactions declined by 25%, 26%, and 18% respectively. Comprehensive epilepsy care not only reduces morbidity and mortality but also reduces cost.

Avoidance of altruistic punishment: Testing with a situation-selective third-party punishment game

Third-party punishment games have consistently shown that people are willing to bear personal costs to punish others who act selfishly, even as uninvolved observers. However, the traditional third-party punishment game places participants in contrived situations that mandate direct punishment decisions, potentially inflating the prevalence of such actions compared to those observed in more naturalistic settings. In light of this obligatory nature, one might speculate that if given the autonomy to step aside, people could be inclined to forgo punishment rather than penalize unfairness. The present study developed the Situation-Selective Third-Party Punishment Game (SS-TPPG), an experimental paradigm, to investigate whether avoidance of witnessing unfairness stems from a reluctance to make punitive decisions or a desire to avoid observing unfairness altogether. Three studies (total N = 810) consistently revealed that avoidance was driven by both a reluctance to witness unfair treatment and an aversion to administering punishments. Notably, participants who typically avoided observing unfair treatment were inclined to punish when forced to observe it. Furthermore, when given the opportunity to punish indirectly, participants were less likely to avoid observing unfair distributions. These results suggest that the elevated instances of direct punishment noted in the traditional third-party punishment game might be reflective of the game's structure, which constrains participants' ability to avoid witnessing unfair distributions.

DETERMINANTS OF INTENTION TO DO WHISTLEBLOWING IN BANK PEREKONOMIAN RAKYAT

Whistleblowing is when someone speaks up to expose wrongdoing within an organization, with the goal of protecting it from illegal or unethical behavior. The act of whistleblowing is driven by a deep personal motivation to protect an organization from engaging in illegal activities. This intention can arise due to several factors. This research seeks to analyze on how organizational dedication, individual sacrifices, and ethical thinking impact an individual's decision to report misconduct. This study was conducted at 21 Head Offices of PT Bank Perekonomian Rakyat throughout Denpasar City. A survey was conducted by distributing a questionnaire directly to the participants for collecting data Respondents were selected from employees in the compliance, accounting, teller, credit, and internal auditor divisions, so that the total was 105 respondents. Of the 105 questionnaires distributed, only 92 respondents' answers met the requirements for further analysis using multiple linear regression. The findings of this research reveal that being committed to an organization can increase the likelihood of whistleblowing, while bearing personal costs can also increase the likelihood of whistleblowing. Additionally, moral reasoning does not seem to have an impact on the whistleblowing intention.

Social dynamics of luxury customization: The unique impact of name personalization

AbstractAs customized luxury becomes increasingly mainstream, adhering to a uniform treatment of all types of customization falls short of the nuanced insight needed. Our research focuses on the effects of a prevalent form of customization—name personalization—on the perceived “social cost” associated with luxury items from a potential buyer's point of view. Despite most luxury brands offering consumers the option to imprint their names on products for a personalized touch, concerns arise about being perceived to be “showing off.” Our four experimental studies demonstrate that adding one's name to luxury goods heightens apprehensions about the social cost, specifically diminishing metaperceptions of warmth due to impression management (Study 1). This phenomenon applies to both the imprinting of one's full first name, and only their initials (Study 2). However, luxury consumers with a lower social‐adjustive (i.e., less driven by the desire for social approval) show an elevated concern over the social cost of name personalization (Studies 3 and 4). As the trend of customizing luxury items rises, our findings emphasize the significance of luxury researchers and practitioners to discern both the positive and negative outcomes associated with various forms of luxury customization.

Results of a randomized controlled superiority trial of the effect of modified collaborative assessment vs. standard assessment on patients’ readiness for psychotherapy (CO-ASSM-RCT)

BackgroundAvoidant personality disorder (AvPD) and social phobia (SP) are associated with high personal and societal costs. While psychotherapy can be efficient, many patients drop out during treatment. Little is known about what can be done to increase a patient’s readiness for psychotherapy. However, research highlights the fields of collaborative and therapeutic assessment as a possible means to enhance readiness for psychotherapy.MethodsWe conducted a randomized controlled feasibility and superiority trial on patients with SP or AvPD who were to initiate psychotherapeutic treatment in outpatient mental health services. Patients were randomized 1:1 to either assessment as usual or modified collaborative assessment (MCA), provided as a pre-treatment intervention before psychotherapy initiation. MCA included the collaborative administration of a battery of psychological tests designed to assess the patient’s psychopathology more systematically. The tests were administered in collaboration with the patient, and detailed oral and written feedback was provided. We investigated the feasibility of the MCA intervention regarding acceptability, patient satisfaction, and adherence. We also investigated MCA’s effect on readiness for psychotherapy, as assessed with the University of Rhode Island Change Assessment Scale (URICA), and outcomes relating to symptomatology and dropout rates.ResultsAll three prespecified feasibility outcomes were met. At the end of treatment, no significant difference was observed in any other outcome, except client satisfaction, which favored MCA (− 7.42 (95% CI − 11.75; − 3.09; p = 0.002)).DiscussionWe found that MCA was feasible, and patients were highly satisfied with the intervention. It is relevant to investigate another implementation of MCA.Trial registrationClinicalTrials.gov NCT05018312. Registered on August 24, 2021.

The association between perceived sensitivity to medicines, reported side effects and personal characteristics: A secondary analysis of an RCT.

A patient's perceived sensitivity to medicines (PSM) might influence the reported side effects of a treatment. The experience of side effects can result in personal and structural costs (such as nonadherence). Research on nocebo mechanisms and the workings of side effect reporting has been disproportionally smaller compared to the emerging evidence of the individual and clinical impact of the matter. In this study, we explored and re-examined the association between PSM and reported side effects within a specific population (chronic low back pain patients receiving acupuncture treatment), including possible mediating variables (i.e., gender, medical and nonmedical care utilization, optimism, pessimism, anxiety, depression and treatment expectation). We conducted a secondary analysis of a randomized controlled trial that examined the influence of treatment outcome expectations in chronic low back pain (CLBP) patients. All measures in the analysis were self-assessments. We explored the association between PSM, reported side effects and personal characteristics using correlational and regression analyses. Our sample consisted of 152 CLBP patients (65.8% female), the mean age was 39.5 years (SD = 12.5). We found positive correlations between PSM and reported side effects (r = 0.24; p < 0.01) and between PSM and anxiety (r = 0.21; p < 0.05). However, the subsequent regression analyses did not confirm a mediating or moderating effect of anxiety between PSM and reported side effects. We confirmed and extended earlier research on PSM. Our study involved a specific pain population receiving a nonpharmacological intervention. Our results highlight the importance of targeting PSM and anxiety within a treatment to take measures to mitigate the prevalence of side effects.

The role of personality traits and emotional intelligence in the evaluation of the benefits and costs of social distancing during a pandemic outbreak

The analysis of the benefits and costs of social distancing is a crucial aspect for understanding how individual and community actions can mitigate and manage the costs of a pandemic. In this study, we aimed to investigate the extent to which personality factors and emotional intelligence (EI) contributed to the subjective assessment of the benefits and costs of social distancing behaviors during the COVID-19 pandemic. We also aimed at determining whether EI served as a mediator in the relationship between personality traits and the evaluation of social distancing consequences. Data was collected via online surveys from a sample of 223 Italian-speaking participants (age: 30.78 ± 9.97; 86.1% females) between March and April 2021. Findings indicate that the tendency to prioritize the benefits of social distancing over personal costs was positively associated with emotional stability and emotion regulation, but negatively associated with extroversion. The following mediational analyses revealed that the emotion regulation facet of EI mediated the associations between personality dimensions (emotional stability and extroversion) and the evaluation of the costs and benefits of social distancing. These findings provide useful indications and implications for developing appropriate communication strategies aimed at reaching the general population and suggest that, during health-related crises, emphasis should be placed on offering courses and programs to improve and develop individuals’ EI.

Consumer Data Collection Strategies in Two-Sided Platforms: The Role of Data Ownership Assignment and Privacy Concerns

Recognizing data as the new oil of the digital economy, two-sided platforms have invested heavily in collecting consumer data. However, issues surround privacy concerns and conflicts over data ownership. More importantly, should consumers retain ownership of their personal data? This paper models a two-sided platform under different data ownership structures and explores the effect of data ownership assignment, consumer privacy concerns, and network externalities on Consumer Data Collection (CDC) strategies. Game theoretic results suggest that, with a low data collection compensation, leaving data ownership with consumers increases the platform's inclination toward investing in CDC strategies when the cost of personal data protection is low and the loss of consumer data ownership is high. However, in cases with high data collection compensation, this inclination diminishes, indicating a decreased desire for CDC investment. Interestingly, when data ownership is assigned to consumers, heightened consumer privacy concerns lead to consumers providing less personal data, but the platform may be more incentivized to invest in CDC. Further, allowing consumers to hold on to data does not always increase consumer surplus, as the latter depends on the trade-off between the costs of data ownership shift (i.e., both personal data protection costs and data collection compensation) and the benefits attached to the data. When data collection compensation is relatively low, conflicting views on data ownership may arise between the platform and consumers.

Whistleblowing intentions by public accountants in a non-Western society: The case of Japanese accountants

This study addresses a gap in the literature by exploring whistleblowing intentions in a society where social harmony, respectfulness, and conformity to rules and norms are perceived as important. A survey of Japanese public accountants indicates attitudes, independence commitment, perceived behavioral control, personal cost of reporting, and personal responsibility for reporting significantly influence internal whistleblowing intentions. Contrary to previous studies, we found personal cost of reporting has significant positive relationship with internal whistleblowing intention, which is a reflection of the unique Japanese work culture. Furthermore, perceived organizational support has a significant positive relationship with internal whistleblowing, signifying that Japanese public accountants feel comfortable to blow the whistle internally when there is high support from the organization. However, the interactive results reveal a significant negative relationship between perceived organizational support and internal whistleblowing, suggesting that despite organizational values that support internal whistleblowing, there is less room for accountants to decide and act independently when faced with an ethical dilemma. For external whistleblowing, both personal factors and interactive results are not significant as accountants perceived it as a betrayal or rebellious act, and feared potential lawsuits. Overall, our results imply that the Japanese unique work culture mitigates the consistency between individual intentions and actual behavior.

Baseline characteristics of parents enrolled in ACCL20N1CD: Financial distress during treatment for pediatric acute lymphoblastic leukemia (ALL) in the US.

220 Background: Personal costs of childhood cancer can contribute to disparities in health outcomes. The purpose of ACCL20N1CD is to examine trajectories of parental costs and the associated financial distress, cost coping behaviors, and household material hardships (HMH) during treatment for pediatric ALL. Objective is to report baseline characteristics of the parents and their households. Methods: The study used a prospective cohort design with repeated measures. Setting was Children’s Oncology Group (COG) practices at National Cancer Institute Community Oncology Research Program (NCORP) institutions. Parents who use English or Spanish, and have children newly diagnosed with ALL treated at COG NCORP practices were eligible. Parents were asked to complete surveys at 3 time points, including baseline (T1; during induction and &lt;7 days after planned induction remission evaluation). Surveys included items about (a) parent socio‐economic status, financial distress measured by 8-item Personal Wellness Scale (PFWS), and cost coping behaviors, and (b) HMH. Factors related to high PFWS scores were evaluated by logistic regression. Results: Of 104 evaluable parents, most were female (83.7%), white (65.4%), non-Hispanic (48.1%), partnered (79.8%), &gt; high school diploma (93.3%), used English (84.6%), worked full (48.1%) or part (5.8%) time, and paid for their child’s care with public insurance (57.7%). Median household income=$50,000 (Inter-Quartile Range/IQR 20,000-100,000) for 4 (IQR 4-5) people. Not including wages lost due to caregiving, out of pocket payments for medical care + other ALL-related costs in the prior month &gt;15% of monthly income for 51.9% of households, which is considered financially catastrophic. 24.0% of households lacked food stability; 21% had housing insecurity. Conclusions: At baseline, sizeable proportions of parents exhibit high out of pocket costs, high financial distress level, and multiple cost coping behaviors with implications for future health and individual and household quality of life.

Physiotherapy-led care versus physician-led care for persons with low back pain: A systematic review

Objective To summarise the evidence on the effect of physiotherapy-led versus physician-led care on clinical outcomes, healthcare use, and costs in persons with low back pain. Data sources PubMed, Web of Science, CINAHL, Embase, and PEDro were systematically searched with the latest search performed in July 2024. Reference lists of articles were hand-searched. Review methods Studies comparing clinical outcomes, healthcare use, or costs between adults with low back pain first consulting a physiotherapist and those first consulting a physician were included. Methodological quality was assessed with the Newcastle-Ottawa Scale. Study design, clinical setting, patient characteristics, and group effects were extracted. Findings on outcomes assessed in two or more studies were synthesised narratively. Certainty of evidence was determined using the GRADE approach. Results Eighteen studies comprising 1,481,980 persons with low back pain were included. Most studies were non-randomised retrospective or prospective cohort studies. In primary care (15 studies), consistent evidence, though of mostly very low certainty, indicated that physiotherapy-led care leads to higher patient satisfaction, less use of medication, injections and imaging, fewer physician's visits, lower total healthcare costs, and less sick leave compared to physician-led care, without increased harm. In emergency care (three studies), evidence of very low certainty showed that physiotherapy-led care leads to shorter waiting and treatment times, and fewer hospital admissions. Conclusion Physiotherapy-led care is a clinically, time- and cost-effective care pathway for low back pain, although the certainty of evidence was overall very low. Further high-quality research with a greater focus on clinical outcomes is warranted.

"You Can't Let Go" - A Black Community Leader's Perspective on Engagement and Advocacy.

Lanre Tunji-Ajayi is president and CEO of the Sickle Cell Awareness Group of Ontario (SCAGO). This charitable organization focuses on ameliorating the lives of those living with sickle cell disease by providing evidence-based support to patients and supporting clinical and psychosocial research, health promotion and the development of best practice guidelines. Lanre's passion for this work is personal. Following the death of her brother Sunday Afolabi from preventable and treatable complications of sickle cell disease, Lanre immersed herself in advocacy for community health and quality patient care. In this oral history narrative, Lanre reflects on her decades-long journey advocating for those living with sickle cell disease - a disease which disproportionately affects Black people. Her reflections focus acutely on the challenges she has faced in raising awareness and visibility, including through formal public engagement policy processes. Lanre also speaks to the personal costs she has encountered engaging in this advocacy work and the subtle and institutionalized forms of anti-Black racism that have punctuated this already difficult effort to bring about change.

On resisting the seduction of theory

Theory carries a heavy workload in the academic enterprise, offering access to Truth or Understanding of an external world. But theory has proven to be a capricious guide amidst the actual practice of academic theory production, in which the unending cycle of theoretical fashionability vanquishes hope for access to an enduring Truth and the obdurate complexity of the world poses impediments to Understanding at least as severe as those inhibiting the quest for Truth. The route of escape from the seduction of theory is to give up the idea that the problem lies in choosing the right representational lens through which to know or understand the world and, instead, to engage in a dialogical effort to build the world we collectively wish to inhabit. Successful transition from knowing to doing rests on overcoming the conceptual, institutional, personal and psychic costs imposed by relinquishing aspirations to Truth or Understanding in the present and accepting the collective – and far more challenging – task of imagining and creating a better future.

The price of fairness: Experimental evidence on the limits to demand for redistribution

How far are people willing to go to reduce inequality and enact what they perceive as a fair distribution of income? We address this question in South Africa, one of the most unequal countries in the world, where questions of fairness and redistribution are part of everyday considerations. We carry out an experiment where a third-party stakeholder is paired with two “workers” and makes a series of redistributive decisions over their earnings. These redistributive decisions carry varying personal costs to the stakeholder, and the inequality in worker payout is also varied. Additionally, we randomly vary the source of inequality: luck or merit. We show that stakeholders’ willingness to redistribute increases with initial pay inequality and decreases with personal cost to redistribute. The source of inequality also makes a difference, with higher redistribution in the luck treatment. The source matters less at higher levels of inequality, suggesting a degree of aversion to extreme disparities, even when payouts are seen as rightfully earned. On the other hand, the effect of stakeholders’ personal cost does not interact with the source of inequality, indicating a robust self-interest motivation. The interplay of these effects can result in significantly different levels of post-redistribution inequality. We suggest that substantial redistribution might be acceptable to most as a tool for reducing high inequality - such as that observed in South Africa - especially when income allocation is deemed unfair. However, self-interest may be a significant limiting factor.

Estimating the societal cost of heroin dependence in an Australian population engaged in treatment or harm reduction services

IntroductionHeroin dependence is a public health concern in Australia. High mortality rates, increased risk of physical/mental health comorbidities and increased risk of social issues contribute to a high personal and societal cost. The aim of this paper is to understand the societal cost of heroin dependence in an Australian population. MethodsA longitudinal cohort study of 600 people with heroin dependence were interviewed at five timepoints. Resource use was determined from interviews and was multiplied by unit costs to estimate the annual healthcare, productivity, crime and other costs (homelessness, heroin drug and prison costs). The monetary value of premature mortality was calculated using the value of a statistical life year method. ResultsThe annual mean societal cost of heroin dependence in Australia was A$120,599/person. This included healthcare costs (A$10,055), lost productivity costs (A$63,158), crime costs (A$7204) and other costs (A$40,182). Healthcare costs, lost productivity costs, crime costs and other costs trended downwards over the five waves. Lost productivity was the highest cost contributor (52 %), followed by heroin drug (25 %). The estimated number of life years lost due to heroin over the 11-year study period was 2703 years, which approximates to a monetary value of premature death of $213 million. Discussion and conclusionsThe significant societal cost emphasises the importance of providing resources to heroin dependence. The cost of lost productivity, crime and heroin contributed to over 80 % of the total costs, which highlights the illicit nature and reduced capacity to work contributes to the high costs to society.

How to establish a new medical school? A scoping review of the key considerations.

Establishing new medical schools in medically under-served regions is suggested as part of the solution to the problem of doctor shortages and maldistributions. Establishing a new medical school is, however, a complex undertaking with high financial and political stakes. Critically, the evidence-base for this significant activity has not previously been elucidated. This paper presents the first scoping review on this vitally important, yet under-researched aspect of medical education and health workforce planning. To better understand the process of new medical school establishment, this review posed two research questions: (1) What is the nature of the available literature on establishing a new medical school?; (2) What are the key factors to be considered when establishing a new medical school? Five databases and grey literature were searched in 2015 and 2021 for English-language articles, using search terms related to new medical schools and their establishment. Inclusion and exclusion criteria were based on relevance and suitability in answering the research questions. Seventy-eight articles were analysed both structurally and thematically to understand the nature of the literature and the key considerations involved. Structurally, most articles were descriptive pieces outlining personal and institutional experiences and did not make use of research methodologies nor theory. Thematically, thirteen key considerations were identified including reasons for establishment; location choices; leadership and governance; costs and funding; partnerships; staffing; student numbers; student recruitment; curriculum design and implementation; clinical training sites; buildings and facilities; information and technology resources; and accreditation. Significant gaps in the literature included how to obtain the initial permission from governing authorities and the personal costs and burnout experienced by founding leaders and staff. Although, the literature on new medical school establishment is empirically and theoretically under-developed, it is still useful and reveals a number of important considerations that could assist founding leaders and teams to maximise the outcomes and impact of their establishment efforts. Critically, the evidence-base underpinning this complex undertaking needs to be better informed by theory and research.

One-year budget impact of InTandem™: a novel neurorehabilitation system for individuals with chronic stroke walking impairment.

Aim: Chronic stroke walking impairment is associated with high healthcare resource utilization (HCRU) costs. InTandem™ is a neurorehabilitation system that autonomously delivers a rhythmic auditory stimulation (RAS)-based intervention for the at-home rehabilitation of walking impairment in adults in the chronic phase of stroke recovery. This study was conducted to estimate the budget impact of InTandem in comparison with currently available intervention strategies for improvement of gait/ambulation in individuals with chronic stroke walking impairment. Methods & materials: A budget impact analysis (BIA) for InTandem was conducted based on a 1-million-member US third-party payer perspective over a 1-year time horizon. Key inputs for the budget impact model were: costs for each intervention strategy (InTandem, physical therapy, self-directed walking and no treatment), HCRU costs for persons with chronic stroke and anticipated HCRU cost offsets due to improvements in gait/ambulatory status as measured by self-selected comfortable walking speed (based on functional ability). In addition to the reference case analysis, a sensitivity analysis was conducted. Results: Based on the reference case, introduction of InTandem was projected to result in overall cost savings of $439,954 in one year. Reduction of HCRU costs (-$2,411,778) resulting from improved walking speeds with InTandem offset an increase in intervention costs (+$1,971,824). Demonstrations of cost savings associated with InTandem were robust and were consistently evident in nearly all scenarios evaluated in the sensitivity analysis (e.g., with increased/decreased patient shares, increased HCRU costor increased InTandem rental duration). Conclusion: The InTandem system is demonstrated to improve walking and ambulation in adults in the chronic phase of stroke recovery after a five-week intervention period. The BIA predicts that introduction of InTandem will be associated with overall cost savings to the payer.

The email conservation task: Testing the validity of an online measure of direct pro-environmental behavior

There is a need for valid measures of pro-environmental behavior, in particular ones measuring actual behavior. In response, a number of such measures have been introduced recently, however each faces limitations such as high costs, practical use and/or only measure indirect environmental behavior, limiting their scope, accessibility and inclusivity. In response, this study introduces the easily administered and low-cost Email Conservation Task (ECT), which measures direct pro-environmental behaviour (in this case, email use). Here, participants chose between personal costs (time spent on trivial tasks) or environmental costs (receiving unnecessary emails leading to CO2 emissions) across multiple trials. In a pre-registered study testing the validity of the ECT, it was found (as hypothesized) that participants scored higher on the ECT (incurred more personal costs rather than receiving unnecessary emails) when personal costs to them were lower, and scored higher when the environmental costs of receiving unnecessary emails were higher. Finally, total scores on the ECT significantly correlated with scores on three self-reported indicators of pro-environmentalism. Overall, the results of this study support all three hypotheses, indicating that the ECT is a valid measure of pro-environmental behavior that can be implemented across a diverse range of research areas.