Economic modelling of costs associated with outcomes reported for type 2 diabetes mellitus (T2DM) patients in the CANVAS and EMPA-REG cardiovascular outcomes trials

Aims: To model direct medical costs associated with reductions in cardiovascular disease (CVD) events in T2DM patients reported in the CANVAS and EMPA-REG trials, which assessed the cardiovascular safety of canagliflozin and empagliflozin, respectively.

Materials and methods: Costs were modeled from a US managed care organization (MCO) perspective for the CVD outcomes included in both trials: three-point major adverse cardiovascular event (MACE) and its components (cardiovascular-related death, nonfatal myocardial infarction, nonfatal stroke), as well as heart failure requiring hospitalization. The rate of CVD events averted (difference between study drug and placebo) was projected to the portion of an MCO T2DM population matching the respective trial’s inclusion criteria. A targeted literature search for paid amounts directly associated with each CVD event provided the unit costs, which were applied to the projected number of events averted, to calculate costs avoided per member per year (PMPY). One-way sensitivity analyses were performed on events averted, unit costs, and percentages of trial-applicable patients.

Results: Based on three-point MACE events averted, costs avoided PMPY of $6.17 (range: $1.27–$10.94) for CANVAS and $2.75 ($0.19–$4.83) for EMPA-REG were estimated. Costs avoided for individual components of MACE ranged from $0.77 to $3.84 PMPY for CANVAS and from -$0.97 (additional costs) to $1.54 for EMPA-REG. PMPY costs avoided for heart failure were $2.72 for CANVAS and $1.32 for EMPA-REG.

Limitations and conclusions: Models assumed independent, non-recurrent outcomes and were restricted to medical costs directly associated with the trial-reported events. The reductions in CVD events in T2DM patients reported for both CANVAS and EMPA-REG project to a positive cost avoidance for these events in an MCO population. The analysis did not include an assessment of the impact on total cost, as the costs associated with adverse events, drug utilization or other clinical outcomes were not examined.     

The effect of entrepreneurship education in schools on entrepreneurial outcomes: a systematic review

Management Review Quarterly - This study systematically reviewed 21 quantitative and qualitative articles on the effect of entrepreneurship education in schools. We reviewed short-term effects,...     

Working towards sincere encounters in volunteer tourism: an ethnographic examination of key management issues at a Nordic eco-village

This article explores host–guest dynamics at Sólheimar eco-village, Iceland to contribute to the conceptualization of transformative learning in volunteer tourism. At the eco-village, the host and volunteers come together to share similar goals and meaningful experiences. This interaction gets complicated, however: the eco-village exists within the global capitalist system and must operate using market norms. The idealist and educational expectations of the volunteers often clash with the practical short-term goals of the community: there are also cultural and experiential differences between the parties. This clash is used to discuss the importance of sincerity in volunteer tourism at the eco-village. Data were collected through fieldwork, primarily including participant observations and interviews, to help interpret the patterns of behaviors and perceptions of both parties in relation to the aim. Ultimately, the experience that binds host and guests cannot solely be about learning to do things alternatively and sustainably; it requires sincerity, using Taylor's 2001 sincerity concept, to tackle the difficulties in working alternatively and sustainably to attain this experience. It is argued that transformative learning during the volunteer experience in alternative spaces should be conceptualized to include the promotion of sincere encounters, and adjusted to concern both the host and its guests.     

ON‐THE‐JOB SEARCH,PRODUCTIVITY SHOCKS,AND THE INDIVIDUAL EARNINGS PROCESS*

Individual labor earnings observed in worker panel data have complex, highly persistent dynamics. We investigate the capacity of a structural job search model with on‐the‐job search, wage renegotiation by mutual consent, and i.i.d. productivity shocks to replicate salient properties of these dynamics, such as the covariance structure of earnings, the evolution of individual earnings mean, and variance with the duration of uninterrupted employment, or the distribution of year‐to‐year earnings changes. Structural estimation of our model on a 12‐year panel of highly educated British workers shows that our simple framework produces a dynamic earnings structure that is remarkably consistent with the data.     

Once were farmers: Occupation, social mobility, and mortality during industrialization in Saguenay-Lac-Saint-Jean, Quebec 1840–1971

We study men's adult mortality and longevity by socio-occupational status during industrialization in Saguenay-Lac-Saint-Jean, Quebec. Data were extracted from the BALSAC database (Université du Québec à Chicoutimi), which comprehensively traces the demographic history of the region since the beginning of the French Canadian settlement in 1840 up to the early 1970s. Using five occupational classes and controlling for year, age at marriage, urban/rural residence, and literacy, we found no evidence for the emergence of a socioeconomic gradient in mortality. At least until the early 1970s, mortality in the region is the lowest for farmers and appears to be driven by occupational risk rather than fundamental social causes.     

Bargained Equality: The Strengths and Weaknesses of Workplace Gender Equality Agreements and Plans in France

‘Bargained equality’ reflects wider characteristics of French employment relations whereby state‐driven collective bargaining is a major mode of regulation but is based on weak workplace bargaining cultures outside the largest firms. This article focuses on duties on French employers to bargain on gender equality. It presents findings of a project evaluating workplace agreements and plans on gender equality, based on a sample of 186 agreements submitted in 2014–2015, in 10 sectors, and in‐depth interviews in 20 companies. Despite a rise in formal compliance due to stronger enforcement since 2012, our analysis shows that most companies submitting plans or agreements do not systematically address quantitative measurement of pay or other gender gaps. As well as sectoral differences, the analysis also identifies ‘generational effects’: processes of change which occur as collective agreements expire and are replaced are dependent on local dynamics of bargaining. Based on this analysis, we argue that attention should be paid to the resources available to local bargaining actors, in order to promote an equality agenda.     

Confronting sustainable development in two rural heritage valorization models

Many rural areas have reinvented their territorial development through tourism, turning to vernacular heritage to ensure their future. Various models of heritage preservation and valorization are adopted where small-scale agriculture is no longer viable. Among them, ecomuseums and place-based labelization schemes transform rural heritage into an economic resource while remaining grounded in cultural and architectural preservation and identity transmission to future generations. Both face criticisms, including being decried as fostering the museumification and mythification of the rural, effectively holding back rural areas in an imagined and romanticized past rather than providing a vision for a sustainable future. The Association of the Most Beautiful Villages of France and the Ecomusée d'Alsace illustrate the debate. This investigation analyzes how these two initiatives challenge critics. It unveils their respective understandings of the future of rurality and their approach to promoting sustainable communities through tourism. By highlighting responses to tensions between valorizing the past and forward development in the countryside, findings reveal paradigm shifts from traditional habitat preservation to future-oriented architectural pedagogy in one case, while operational exigencies and normative quality principles mitigate opportunities in the other.     

Is power more evenly balanced in poor households?

The structure of intra-household allocation is crucial to know whether a transfer from a rich household to a poor one translates into a transfer from a rich individual to a poor one. If rich households are more unequal than poor ones, then a progressive transfer among households reduces intra-household inequality, hence inequality among individuals. More specifically, two conditions have to be satisfied for extending Generalized Lorenz judgments from household level to individual one. The fraction of the couple's expenditures devoted to goods jointly consumed should decrease at the margin with the couple's income as well as the part of private expenditure devoted to the disadvantaged individual. This double concavity condition is non-parametrically tested on the French Household Expenditure Survey (2000). It is not rejected by the data and supports the view that power is more evenly distributed in poor households.     

Anti-consumption discourses and consumer-resistant identities

This article presents the analysis of two dominant anti-consumption discourses (the voluntary simplicity discourse and the culture jammer discourse) to show the importance of anti-consumption practices in the construction of consumer identities. Specifically, two consumer-resistant identities are presented: a hero identity and a project identity. Each resistant identity is produced by, and produces, overreaching cultural discourses against consumer culture, namely resistance to exploitative consumption and resistance to positional consumption. In addition, each identity expresses resistance either in terms of political consumption for an outer change or in terms of creative consumption directed toward an inner change. By stressing the importance of hero resistant identities and project resistant identities, this article offers the concept of identity formation as central rather than peripheral to the development of consumer resistance.