Science and proven experience: a Swedish variety of evidence-based medicine and a way to better risk analysis?

A key question for evidence-based medicine (EBM) is how best to model the way in which EBM should ‘[integrate] individual clinical expertise and the best external evidence’. We argue that the formulations and models available in the literature today are modest variations on a common theme and face very similar problems when it comes to risk analysis, which is here understood as a decision procedure comprising a factual assessment of risk, the risk assessment, and the decision what to do based on this assessment, the risk management. Both the early and updated models of evidence-based clinical decisions presented in the writings of Haynes, Devereaux and Guyatt assume that EBM consists of, among other things, evidence from clinical research together with information about patients’ values and clinical expertise. On this A-view, EBM describes all that goes on in a specific justifiable medical decision. There is, however, an alternative interpretation of EBM, the B-view, in which EBM describes just one component of the decision situation (a component usually based on evidence from clinical research) and in which, together with other types of evidence, EBM leads to a justifiable clincial decision but does not describe the decision itself. This B-view is inspired by a 100-years older version of EBM, a Swedish standard requiring medical decision-making, professional risk-taking and practice to be in accordance with ‘science and proven experience’ (VBE). In the paper, we outline how the Swedish concept leads to an improved understanding of the way in which scientific evidence and clinical experience can and cannot be integrated in light of EBM. How scientific evidence and clinical experience is integrated influences both the way we do risk assessment and risk management. In addition, the paper sketches the as yet unexplored historical background to VBE and EBM.     

Perspectives of children with disabilities and their guardians on factors affecting inclusion in education in rural Nepal: “I feel sad that I can’t go to school”

Globally, children with disabilities are significantly less likely to attend school compared to their peers without disabilities and, even if they do attend, have poorer educational outcomes. In order to understand why these inequalities persist, this study explores the barriers and enablers to accessing education. We focus on the perspectives of guardians and children with disabilities – voices that have thus far been underrepresented – complemented by perspectives from local and national level stakeholders. Data was collected in three rural districts in Nepal, using semi-structured interviews; data was analysed thematically. Overall, the research found that challenges to inclusion are complex, involving a mixture of individual, family, school, community and policy level factors. Notable barriers were attitudes towards education for children with disabilities, the low capacity of schools to provide an inclusive education, as well as the interplay of additional ‘push factors’ such as poor health and poverty.     

Imperfect Information and Consumer Inflation Expectations: Evidence from Microdata

This paper explores which factors trigger an adjustment in consumers’ inflation expectations and looks at the implications regarding forecast errors. We find support for imperfect information models, as inflation volatility and news trigger an adjustment in expectations. Furthermore, we document that individual expectations become more accurate if they have been adjusted.     

The Energy Paradox Revisited: Analyzing the Role of Individual Differences and Framing Effects in Information Perception

In the ongoing debate about the “energy paradox”, a recent stream of literature highlights the importance of behavioural anomalies such as bounded rationality and self-control problems. However, the role of individual-level factors in explaining the energy paradox is still not fully understood. Combining literature on behavioural anomalies and consumer heterogeneity, the current paper analyses how individual differences influence the perception of energy-related information and susceptibility to choice-framing effects. A choice-based conjoint experiment about energy-saving home improvements was conducted with 363 homeowners in Switzerland. Results show that numeracy and energy literacy have no influence on how much attention individuals pay to energy cost savings. However, impulsivity and risk aversion are found to significantly impact homeowners’ weighting of future energy cost savings. Further, it is found that impulsive homeowners are significantly more susceptible to energy cost-framing effects. A key implication for consumer policy is that general educational programs targeted at enhancing citizens’ knowledge and cognitive abilities are unlikely to increase energy conservation investments. The findings further suggest that consumer policies and business models aimed at reducing impulsiveness and influencing risk perception might foster the uptake of energy-saving measures in the residential housing sector.     

Methodological challenges in hip fracture registration: the Harstad Injury Registry

The aim of the study was to evaluate a hospital-based injury recording system on hip fracture registration in elderly persons aged?+?65 years from 1994 through 2008, and to examine the agreement between the number of validated fractures and the number of fractures reported to the Norwegian Patient Registry using three different sources: (1) Medical records, (2) Patient administrative system and (3) The hospital's hip fracture record to the Norwegian Patient Registry from 2002 through 2008. The injury recording system included 582 hip fracture events and 535 (92%) were confirmed through the medical records. Reasons for non-verification were different coding failures. Searching the patient administrative system using ICD codes identified 16 hip fractures not included in the fracture registry between 2002 through 2008. The total number was the same as the number of hip fractures reported to the Norwegian Patient Registry using ICD codes alone for identification. The conclusion is that on well-defined diagnosis like hip fractures, local fracture registries may obtain a high degree of reliability if different sources are available for quality control. Well-functioning patient administrative systems may be used to study numbers of hip fractures.     

Making an effort for free – volunteers' roles in destination-based storytelling

Many destinations are dependent on volunteers. Storytelling is one of the areas to which volunteers are increasingly contributing; however, the role of volunteers has been offered only sporadic attention. The aim of this study is to provide insights into volunteer involvement by studying volunteers as destination stakeholders with focus on their roles, influence, and contribution. A cross-case analysis of three Nordic cases is undertaken. A theoretical framework is developed based on volunteer tourism, stakeholder theory, and marketing literature on storytelling. A three-phase model of the storytelling process is developed. Findings show substantial variation. Unsurprisingly, early inclusion of volunteers result in substantial influence on the storytelling concept, however, this does not guarantee volunteer involvement later on. Conversely, late inclusion of volunteers does not necessarily hinder engagement among volunteers in the execution of the stories. All cases demonstrate that developing a strong concept that can tie together the efforts of stakeholders across professional and volunteer divides is a major challenge. The results point at the importance of strategic goals coordinating storytelling activities, volunteer inclusion, and ‘use’ of volunteers' local knowledge and enthusiasm in all phases of the destination-based storytelling process planned along with strategic goals such as ‘selling place’ or ‘building community’.     

Sustainable Branding — mehr als ein neues Schlagwort?!

In der Markenführung l?sst sich derzeitig ein bemerkenswerter Trend zur Nachhaltigkeit beobachten. Im Mittelpunkt der Diskussion stehen Fragen, inwiefern Nachhaltigkeitsaspekte in der Marke verankert werden sollten und ob Sustainable Branding mehr als ein neues Schlagwort darstellt. Nachhaltigkeit war Prof. Dr. Dr. Helmut Sihler als ehemaligem Vorstandsvorsitzenden von Henkel immer ein besonderes Anliegen. Dieser Beitrag sei ihm daher aus Anlass seines 80. Geburtstages gewidmet.     

Distribution and growth reconsidered: empirical results for six OECD countries

We analyse the relationship between functional income distributionand economic growth in Austria, France, Germany, the Netherlands,the UK and the USA from 1960 until 2005. The analysis is basedon a demand-driven distribution and growth model for an openeconomy inspired by Bhaduri and Marglin, which allows for eitherprofit- or wage-led growth. We find that growth in France, Germany,the UK and the USA has been wage-led, whereas Austria and theNetherlands have been profit-led. In the case of Austria a domesticallywage-led economy changes to profit-led when including the effectof distribution on external trade. The Netherlands, however,are already profit-led without external trade. Our results sofar only partially confirm Bhaduri and Marglin's theoreticalconclusion that wage-led growth becomes less feasible when theeffects of distribution on foreign trade are taken into account.     

Revenue management strategies under the lunar–solar calendar: Evidence of Chinese restaurant operations

This paper discusses the lunar–solar calendar-driven festivals that affect Chinese restaurant operations. In-depth interviews and a survey were carried out with 50 catering professionals to provide information that was subsequently used to estimate the change of restaurant turnover due to the identified festivals. Four core common lunar–solar calendar-driven festivals that create more demand for dining out across China were identified. They generated extra revenue, which was nearly 10% of total annual business for restaurants. The study also ascertained 21 measures related to revenue management strategies to cope with these demand variations. In addition, a new restaurant revenue management strategy framework was developed. Recommendations based on this study were suggested to multi-functional restaurants and hotel systems.