Confrontations and concessions: an everyday politics of tourism in three ethnic minority villages,Guizhou Province,China

As a state-promoted livelihood diversification approach for ethnic minority communities in rural China, tourism development influences household and community assets in diverse ways. Focusing on three case study villages in Qiandongnan Hmong and Dong Autonomous Prefecture, Guizhou Province, we compare the livelihoods of one village without tourism to date (but slated for tourism development in the near future), one with a ‘medium’ level of tourism, and another where tourism is in full force. Our analysis of the transitional characteristics of these communities focuses on agriculture, income-related activities, cultural norms, and social relationships to shed light on the everyday politics of ethnic minority households under different stresses and demands from local government and state-controlled tourism businesses. We find that confrontations have arisen due to tourism expansion and state tourism planning directives among a wide range of stakeholders: Zhailao elites, core and peripheral tourism communities, country-level governments, local residents, and tourists. In turn, local residents have made broad concessions ranging from resignation to unwelcome changes in their livelihoods and new income inequalities, to acceptance of certain tourism-based changes and reallocation of resources. In sum, we find that villagers’ everyday politics involves coping with or challenging new tensions in diverse ways, yet at times marginalisation remains.     

Rural-Urban Differences in the Unemployment-Crime Relationship: The Case of Pennsylvania

This study analyzes the unemployment-crime (U-C) relationship in urban and rural Pennsylvania counties using a balanced panel data set over the period from 1990 to 2009. A two-way fixed effects model is estimated to account for unobserved county-specific and time-specific heterogeneity. The criminal opportunity and criminal motivation effects of unemployment on crime advanced by Cantor and Land are tested. The results suggest that there are rural-urban differences in the impacts of the covariates. Specifically, both statistically significant criminal opportunity and criminal motivation effects are present in urban counties. In contrast, rural counties fail to conform to U-C predictions. Oaxaca decomposition reveals that the unexplained portion of the rural-urban difference in the crime rate is 12%. The results provide support for addressing labor market conditions to complement traditional crime-fighting measures in urban settings.     

Dropouts,Defaulters, and Continuing Borrowers: Client Exit from Microfinance

High dropout rates are a problem faced by many microfinance institutions, with borrowers exiting after a few loans. The curiosity of dropouts is that, unlike defaulters, they repay their loans. To understand this I investigate differences across borrowers using data from Zimbabwe. I find that negative shocks are a significant predictor of dropout, but not of default, and that social networks are the most important correlate of on‐time repayment. The results show the importance of social networks in determining credit relationships.     

Bendamustine-rituximab: a cost-utility analysis in first-line treatment of indolent non-Hodgkin’s lymphoma in England and Wales

Objective:

To evaluate the cost-effectiveness of bendamustine-rituximab (B-R) compared with CHOP-R (cyclophosphamide, doxorubicin, vincristine, prednisone, rituximab) and CVP-R (cyclophosphamide, vincristine, prednisone, rituximab) as first-line treatment for patients with advanced indolent non-Hodgkin’s lymphoma (NHL).

Methods:

A patient-level simulation was adapted from the model used by the University of Sheffield School of Health and Related Research (ScHARR) in a health technology appraisal of rituximab for first-line treatment of follicular lymphoma. This approach allowed modelling of the complex treatment pathways in indolent NHL. Data from a Phase 3 randomized, open-label trial were used to compare B-R with CHOP-R. The relative efficacy of CHOP-R and CVP-R was estimated using an indirect treatment comparison similar to the original ScHARR approach. The analysis was conducted from the perspective of the National Health Service in England and Wales, using a lifetime time horizon. A number of one-way sensitivity and scenario analyses were conducted, including one using recently published data comparing CVP-R with CHOP-R.

Results:

The deterministic incremental cost-effectiveness ratio (ICER) was £5249 per quality adjusted life year (QALY) for B-R vs CHOP-R, and £8092 per QALY for B-R vs CVP-R. The alternative scenario using direct data comparing CVP-R with CHOP-R approximately halved the ICER for B-R vs CVP-R to £4733. Owing to its better toxicity profile, B-R reduced the cost of treating adverse events by over £1000 per patient vs CHOP-R.

Limitations:

The main limitations were: immaturity of overall survival data from the Phase 3 trial; reliance on quality-of-life data from previous health technology appraisals (as this was not collected in the trial); and a lack of direct evidence or a network of connected evidence comparing B-R with CVP-R.

Conclusions:

The ICERs for B-R vs CHOP-R and CVP-R were considerably below the thresholds normally regarded as cost-effective in England and Wales (£20,000–30,000 per QALY).     

Quantifying the defensive medicine contribution to primary care costs

Background:

Defensive medicine represents one cause of economic losses in healthcare. Studies that measured its cost have produced conflicting results.

Objective:

To directly measure the proportion of primary care costs attributable to defensive medicine.

Research design and methods:

Six-week prospective study of primary care physicians from four outpatient practices. On 3 distinct days, participants were asked to rate each order placed the day before on the extent to which it represented defensive medicine, using a 5-point scale from 0 (not at all defensive) to 4 (entirely defensive).

Main outcome measures:

This study calculated the order defensiveness score for each order (the defensiveness/4) and the physician defensive score (the mean of all orders defensiveness scores). Each order was assigned a weighted cost by multiplying the total cost of that order (based on Medicare reimbursement rates) by the order defensiveness score. The proportion of total cost attributable to defensive medicine was calculated by dividing the weighted cost of defensive orders by the total cost of all orders.

Results:

Of 50 eligible physicians, 23 agreed to participate; 21 returned the surveys and rated 1234 individual orders on 347 patients. Physicians wrote an average of 3.6?±?1.0 orders/visit with an associated total cost of $72.60?±?18.5 per order. Across physicians, the median physician defensive score was 0.018 (IQR?=?[0.008, 0.049]) and the proportion of costs attributable to defensive medicine was 3.1% (IQR?=?[0.5%, 7.2%]). Physicians with defensive scores above vs below the median had a similar number of orders and total costs per visit. Physicians were more likely to place defensive orders if trained in community hospitals vs academic centers (OR?=?4.29; 95% CI?=?1.55–11.86; p?=?0.01).

Conclusions:

This study describes a new method to directly quantify the cost of defensive medicine. Defensive medicine appears to have minimal impact on primary care costs.     

Should They Stay or Should They Go? Attitudes Towards Immigration in Europe

This paper examines the main determinants of individual attitudes towards immigration in Europe. Our results suggest that both economic and non‐economic variables shape attitudes towards immigration, but the relative importance of these factors depends crucially on the race/ethnicity of the arriving immigrants. While fears over labour market competition are more likely to shape attitudes towards the arrival of same race immigrants, more exposure to immigrants reduces opposition towards the arrival of different race immigrants. These findings persist after controlling for socioeconomic characteristics, and after exploiting the data to allow for cohort‐specific effects.     

Adapting a book to make a film: how strategy is adapted through professional practices of marketing middle managers

Abstract

For an organisation to be competitive its strategy must be highly responsive to both environmental challenges and customers continuously shifting demands. Yet many organisations treat strategy making as an exclusively top management concern, even though the top management team is often remote from the daily interactions and communications taking place at the organisation, market, and customer interface. We challenge the assumption that strategy making ‘belongs’ to top managers and argue that marketing middle managers, possessing expert market and customer knowledge and insights, adapt top manager’s strategy to shifting customer demands in a changing environment. We explore this argument by adopting a strategy-as-practice perspective and analysing marketing middle manager’s practices across three case companies operating in a dynamic retail environment. Our research enables two key contributions. Our primary confirmation is to demonstrate that marketers are not passive implementers, but active adapters of top management strategy through three critical practices of sensing, challenging, and transmitting. We use the novel analogy of how adapting a book to make a film involves minor changes to the story line and characters to suit the new medium and to illustrate the strategically relevant and influential role marketing plays in adapting the strategy developed by the top management team for implementation. By demonstrating the value of the strategic practices of functional middle managers we also contribute to the growing debate of the need for greater inclusion and transparency in strategy making.     

Trading incentives to meet the analyst forecast

We examine stock sales as a managerial incentive to help explain the discontinuity around the analyst forecast benchmark. We find that the likelihood of just meeting versus just missing the analyst forecast is strongly associated with subsequent managerial stock sales. Moreover, we provide evidence that managers manage earnings prior to just meeting the threshold and selling their shares. Finally, the relation between just meeting and subsequently selling shares does not hold for non-manager insiders, who arguably cannot affect the earnings outcome, and is weaker in the presence of an independent board, suggesting that good corporate governance mitigates this strategic behavior.

Retirement in the UK

In common with other OECD countries, the UK experienced morethan two decades of declining labour-market activity among oldermen from the 1970s to the early 1990s, a trend that has onlyrecently shown signs of being reversed. Retirement decisionsare heavily shaped by institutional context and in the UK thishas led to there being two distinct groups with very different‘retirement’ experiences. At the top of the wealthdistribution, early retirement has typically been influencedby private, occupational pensions; at the bottom of the wealthdistribution individuals are even more likely to be not workingin their 50s, but do not typically define themselves as retired,and draw on income support, or more usually, disability benefits.Policy-makers keen to increase effective retirement ages willneed to consider the very different circumstances of these twogroups. Footnotes ¹ E-mail addresses: j.banks{at}ifs.org.uk; sarah.smith{at}bristol.ac.uk