On the nature of problems in consulting practice

OR consultants who wish to help clients with complex policy issues need to find ways of taking account of personal and illegitimate features of a client's understanding of his situation, as well as the technical features which are usually considered. This paper is an attempt to discuss the practice of operational research in ways which reflect its political complexity, rather than the techniques, which are more commonly described in the published papers and texts. The discussion leads to the suggestion that practitioners could usefully devote some energy to reflecting upon the processes used in effective problem solving.     

Out of the shadows: Classifying economies by the extent and nature of employment in the informal economy

Given the prevalence of informality, this article proposes a typology for classifying countries by the extent and nature of employment in the informal economy, rather than by the composition of their formal economies. The author analyses ILO data on employment in the informal economy in 36 developing countries, and shows that there is a significant correlation between cross‐national variations in the degree and intensity of informalization and cross‐national variations in social and economic indicators such as levels of GNP per capita, corruption, poverty, taxation and social contributions. The article concludes by discussing implications for theory and policy.     

Subgroup analyses of clinical effectiveness to support health technology assessments

Subgroup analysis is an integral part of access and reimbursement dossiers, in particular health technology assessment (HTA), and their HTA recommendations are often limited to subpopulations. HTA recommendations for subpopulations are not always clear and without controversies. In this paper, we review several HTA guidelines regarding subgroup analyses. We describe good statistical principles for subgroup analyses of clinical effectiveness to support HTAs and include case examples where HTA recommendations were given to subpopulations only. Unlike regulatory submissions, pharmaceutical statisticians in most companies have had limited involvement in the planning, design and preparation of HTA/payers submissions. We hope to change this by highlighting how pharmaceutical statisticians should contribute to payers' submissions. This includes early engagement in reimbursement strategy discussions to influence the design, analysis and interpretation of phase III randomized clinical trials as well as meta-analyses/network meta-analyses. The focus on this paper is on subgroup analyses relating to clinical effectiveness as we believe this is the first key step of statistical involvement and influence in the preparation of HTA and reimbursement submissions.     

Bare Bodies: Nudity,Gender, and the Looking Glass Body1

This article examines the role of nude embodiment as it affects sexuality, intimacy, and pleasure when people seek to align their nude body with cultural values. This research, based on open‐ended and closed‐ended data from 184 young heterosexual adults attending a large Midwestern university, finds the experience of nude embodiment and its effects to be strongly gendered. For example, among both men and women, comfort with one’s nude body is associated with a sexually expansive point of view, but it is only found to be associated with sexual behavior and pleasure among the women. For women, too, feelings of objectification in nude embodiment are shown to be mitigated through positive relationships with their male partner. Throughout we emphasize the “lived experience” of the body, especially as experienced in the body techniques used in the pursuit of sexual intimacy and pleasure. Discussion relates these results to objectification theory and how wider social changes may impinge on sexual embodiment in general.     

Punitive benefit sanctions,welfare conditionality,and the social abuse of unemployed people in Britain: Transforming claimants into offenders?

A defining feature of U.K. welfare reform since 2010 has been the concerted move towards greater compulsion and sanctioning, which has been interpreted by some social policy scholars as punitive and cruel. In this article, we borrow concepts from criminology and sociology to develop new interpretations of welfare conditionality. Based on data from a major Economic and Social Research Council-funded qualitative longitudinal study (2014–2019), we document the suffering that unemployed claimants experienced because of harsh conditionality. We find that punitive welfare conditionality often caused symbolic and material suffering and sometimes had life-threatening effects. We argue that a wide range of suffering induced by welfare conditionality can be understood as ‘social abuse’, including the demoralisation of the futile job-search treadwheel and the self-administered surveillance of the Universal Jobmatch panopticon. We identify a range of active claimant responses to state perpetrated harm, including acquiescence, adaptation, resistance, and disengagement. We conclude that punitive post-2010 unemployment correction can be seen as a reinvention of failed historic forms of punishment for offenders.     

The need to bring an end to the era of eligibility policies for a person-centred,financially sustainable future

Attention within the social care sector in England is moving away from consumerist notions of choice towards good professional practice as the route to personalisation. This demands a new focus on how to make practice that is person-centred the norm. The following sets out that this is unlikely to happen until the use of eligibility policies is ended. The lessons are relevant not only to England, but to other countries who may be looking to the United Kingdom as pioneering in the personalisation agenda.     

Outcomes from a homegrown HIV prevention program for extremely high-risk,substance-using men who have sex with men with multiple health disparities

ABSTRACT

From February 2010 through December 2014, 585 substance-using men who have sex with men (MSM) were enrolled into a “homegrown” risk reduction intervention. Participants evidenced significant iterative factor reductions in the odds of substance use including alcohol (AOR = 0.79) and marijuana (AOR = 0.78; both p ≤ 0.05) and marginally significant reductions in the odds of methamphetamine use (AOR = 0.83; p ≤ 0.07). Participants also evidenced significant reductions in sexual risks including the odds of reporting drug/alcohol use before or during sex (AOR = 0.80) and of condomless anal intercourse (AOR = 0.72; all significant at p ≤ 0.05). Results demonstrate that the homegrown intervention was effective at reducing HIV risk behaviors among high-risk MSM.