Private finance for the delivery of school projects in England

This paper analyses the use of the private finance initiative (PFI) approach to deliver school projects in England. The findings are based on case-study research in the Building Schools for the Future scheme (BSF), the largest single capital investment in SO years to rebuild and renew all of England's secondary schools. Up to half of the school infrastructure is to be procured by PFI contracts. A major concern has been the high cost associated with PFI procurement and any subsequent changes to scope. Furthermore, in some cases PFI-funded schools have been closed soon after completion; at great cost to the public sector. The aim of this research was therefore to understand the underlying reasons for these problems. The main conclusion is that the difficulties in BSF arise from not sorting out strategic issues and instituting appropriate organisational frameworks before engaging the private sector. The result of this is a lack of clarity about the long-term needs and end user aspirations. A brief outline of current programme management methods is given and it is suggested that this might be integral to the successful delivery of schools using private finance. A clear strategic vision that cascades into projects via programmes will ensure that the school infrastructure is appropriate for the anticipated strategic benefits and is aligned to the overall service delivery ambitions

Understanding Afghan healthcare providers: a qualitative study of the culture of care in a Kabul maternity hospital.

To analyse the culture of a Kabul maternity hospital to understand the perspectives of healthcare providers on their roles, experiences, values and motivations and the impact of these determinants on the care of perinatal women and their babies

The Application of a Geographically Weighted Principal Component Analysis for Exploring Twenty-three Years of Goat Population Change across Mongolia

The dzud are extreme weather events in Mongolia of deep snow, severe cold, or other conditions that render forage unavailable or inaccessible, which in turn results in extensive livestock deaths. Mongolia is economically vulnerable to extreme events due to an increase in nonprofessional herders and the livestock population, brought about by a deregularized industry. Thus, it is hugely informative to try to understand the spatial and temporal trends of livestock population change. To this end, annual livestock census data are exploited and a geographically weighted principal component analysis (GWPCA) is applied to goat data recorded from 1990 to 2012 in 341 regions. This application of GWPCA to temporal data is novel and is able to account for both temporal and spatial patterns in goat population change. Furthermore, the GWPCA methodology is extended to simultaneously optimize the number of components to retain and the kernel bandwidth. In doing so, this study not only advances the GWPCA method but provides a useful insight into the spatiotemporal variations of the Mongolian goat population

Globalization intentions in tension: The case of Singapore

10.1177/0020872810371202International Social Work535671-68

Cost overruns – helping to define what they really mean

Civil engineers are often in the firing line for alleged cost overruns, particularly on major publicly funded infrastructure projects. This usually occurs when the final cost of a project is simply compared with the original estimate, even though this was published a long time ago, in different circumstances and for a quite different project to the one carried out. This paper proposes a systematic approach to ensure that cost overruns, should they occur, are more accurately defined in terms of when the initial and end costs are assessed, from which point of view, at which project stage, and including scope changes and financial assumptions. The paper refers to the UK’s £163 billion nuclear decommissioning programme

Just transitions for a Climate-Resilient Development in Africa – Transforming Dialogue into Action

CCDA-X1, hosted by the Government of Namibia, convened on the theme: “Just transitions for a Climate-Resilient Development in Africa – Transforming Dialogue into Action” in collaboration with Africa’s civil society organisations, academia, development partners, regional and international organisations and the private sector. The conference resulted in the following key messages to be taken forward to COP27 by Namibia

A systematic evaluation of payback of publicly funded health and health services research in Hong Kong

<p>Abstract</p> <p>Background</p> <p>The Health and Health Services Research Fund (HHSRF) is dedicated to support research related to all aspects of health and health services in Hong Kong. We evaluated the fund's outcomes and explored factors associated with the translation of research findings to changes in health policy and provider behaviour.</p> <p>Methods</p> <p>A locally suitable questionnaire was developed based on the "payback" evaluation framework and was sent to principal investigators of the completed research projects supported by the fund since 1993. Research "payback" in six outcome areas was surveyed, namely knowledge production, use of research in the research system, use of research project findings in health system policy/decision making, application of the research findings through changed behaviour, factors influencing the utilization of research, and health/health service/economic benefits.</p> <p>Results</p> <p>Principal investigators of 178 of 205 (87%) completed research projects returned the questionnaire. Investigators reported research publications in 86.5% (mean = 5.4 publications per project), career advancement 34.3%, acquisition of higher qualifications 38.2%, use of results in policy making 35.4%, changed behaviour in light of findings 49.4%, evidence of health service benefit 42.1% and generated subsequent research in 44.9% of the projects. Payback outcomes were positively associated with the amount of funding awarded. Multivariate analysis found participation of investigators in policy committees and liaison with potential users were significantly associated with reported health service benefit (odds ratio [OR]_{participation}= 2.86, 95% confidence interval [CI] 1.28–6.40; OR_liaison= 2.03, 95% CI 1.05–3.91), policy and decision-making (OR_{participation}= 10.53, 95% CI 4.13–26.81; OR_liaison= 2.52, 95% CI 1.20–5.28), and change in behavior (OR_{participation}= 3.67, 95% CI 1.53–8.81).</p> <p>Conclusion</p> <p>The HHSRF has produced substantial outcomes and compared favourably with similar health research funds in other developed economies. Further studies are needed to better understand the factors and pathways associated with the translation of research findings into practice.</p

Modeling the Total Allowable Area for Coastal Reclamation : a case study of Xiamen, China

Author Posting. © The Author(s), 2013. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Ocean & Coastal Management 76 (2013):38-44, doi:10.1016/j.ocecoaman.2013.02.015.This paper presents an analytical framework to estimate the Total Allowable Area for Coastal Reclamation (TAACR) to provide scientific support for the implementation of a coastal reclamation restriction mechanism. The logic of the framework is to maximize the net benefits of coastal reclamation subject to a set of constraints. Various benefits and costs, including the ecological and environmental costs of coastal reclamation, are systematically quantified in the framework. Model simulations are developed using data from Tongan Bay of Xiamen. The results suggest that the TAACR in Tongan Bay is 5.67 km2, and the area of the Bay should be maintained at least at 87.52 km2.The study was funded by the National Oceanic Public Welfare Projects (No. 201105006) and the Fujian Natural Science Foundation (No. 2010J01360

Legal Empowerment and Horizontal Inequalities after Conflict

This article explores whether legal empowerment can address horizontal inequalities in post-conflict settings, and, if so, how. It argues that legal empowerment has modest potential to reduce these inequalities. Nevertheless, there are risks that legal empowerment might contribute to a strengthening of group identities, reduction of social cohesion, and, in the worst case, triggering of conflict. It looks at how two legal empowerment programmes in Liberia navigated the tensions between equity and peace

Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people: systematic review and economic evaluation

Background: Psoriasis is a chronic inflammatory disease that predominantly affects the skin. Adalimumab (HUMIRA®, AbbVie, Maidenhead, UK), etanercept (Enbrel®, Pfizer, New York, NY, USA) and ustekinumab (STELARA®, Janssen Biotech, Inc., Titusville, NJ, USA) are the three biological treatments currently licensed for psoriasis in children. Objective: To determine the clinical effectiveness and cost-effectiveness of adalimumab, etanercept and ustekinumab within their respective licensed indications for the treatment of plaque psoriasis in children and young people. Data sources: Searches of the literature and regulatory sources, contact with European psoriasis registries, company submissions and clinical study reports from manufacturers, and previous National Institute for Health and Care Excellence (NICE) technology appraisal documentation. Review methods: Included studies were summarised and subjected to detailed critical appraisal. A network meta-analysis incorporating adult data was developed to connect the effectiveness data in children and young people and populate a de novo decision-analytic model. The model estimated the cost-effectiveness of adalimumab, etanercept and ustekinumab compared with each other and with either methotrexate or best supportive care (BSC), depending on the position of the intervention in the management pathway. Results: Of the 2386 non-duplicate records identified, nine studies (one randomised controlled trial for each drug plus six observational studies) were included in the review of clinical effectiveness and safety. Etanercept and ustekinumab resulted in significantly greater improvements in psoriasis symptoms than placebo at 12 weeks’ follow-up. The magnitude and persistence of the effects beyond 12 weeks is less certain. Adalimumab resulted in significantly greater improvements in psoriasis symptoms than methotrexate for some but not all measures at 16 weeks. Quality-of-life benefits were inconsistent across different measures. There was limited evidence of excess short-term adverse events; however, the possibility of rare events cannot be excluded. The majority of the incremental cost-effectiveness ratios for the use of biologics in children and young people exceeded NICE’s usual threshold for cost-effectiveness and were reduced significantly only when combined assumptions that align with those made in the management of psoriasis in adults were adopted. Limitations: The clinical evidence base for short- and long-term outcomes was limited in terms of total participant numbers, length of follow-up and the absence of young children. Conclusions: The paucity of clinical and economic evidence to inform the cost-effectiveness of biological treatments in children and young people imposed a number of strong assumptions and uncertainties. Health-related quality-of-life (HRQoL) gains associated with treatment and the number of hospitalisations in children and young people are areas of considerable uncertainty. The findings suggest that biological treatments may not be cost-effective for the management of psoriasis in children and young people at a willingness-to-pay threshold of £30,000 per quality-adjusted life-year, unless a number of strong assumptions about HRQoL and the costs of BSC are combined. Registry data on biological treatments would help determine safety, patterns of treatment switching, impact on comorbidities and long-term withdrawal rates. Further research is also needed into the resource use and costs associated with BSC. Adequately powered randomised controlled trials (including comparisons against placebo) could substantially reduce the uncertainty surrounding the effectiveness of biological treatments in biologic-experienced populations of children and young people, particularly in younger children. Such trials should establish the impact of biological therapies on HRQoL in this population, ideally by collecting direct estimates of EuroQol-5 Dimensions for Youth (EQ-5D-Y) utilities. Study registration: This study is registered as PROSPERO CRD42016039494. Funding: The National Institute for Health Research Health Technology Assessment programme