Ownership and financing of infrastructure : historical perspective

The authors summarize the rich and varied experiences of private and public provision of urban services in France, Great Britain, and the United States over the past 100 years. Their main focus is on experiences in the United States and on shifts back and forth between the public and private sectors. A few of their observations: (i) The values of politically important actors as well as the working of government, political, and legal institutions have shaped decisions about infrastructure development, the sorts of public goods demanded, and the roles played by private firms. (ii) The range of choices that has historically been made with respect to the ownership, financing, and operation of different infrastructures has been far too varied to be encompassed by simple distinctions between"public"and"private."(iii) Throughout the world, many infrastructures owned and operated by governments have been built by private firms. (iv) In the United States, private firms and property-owners associations of various sorts have owned outright both toll roads and residential streets. Private firms have also collected solid wastes and provided urban transport under a range of franchise, contracting, and regulatory arrangements. The situation with mass transit has been similar in Great Britain. Although water works facilities in France are predominantly government-owned, private firms operate and manage most systems under an array of contracting and leasing arrangements. (v) Even when facilities have been owned by private firms, direct competition has been of limited importance in the provision of many kinds of infrastructure. But market discipline can arise from other sources. (vi) Privatization can get government bureaucracies out of the business of performing entrepreneurial activities for which they may be poorly suited. When market forces are weak, however, and important public interests are at stake, strengthening government institutions may be a prerequisite for successful privatization. (vii) In the electric utility industry, private firms played a far greater role in U.S. electric utilities than in Great Britain, in part because of different views about appropriate roles for government in providing essential services. For similar reasons, the state played a much larger role in furnishing telecommunications services in France than in the United States. (viii) Beliefs about the"publicness"of different goods and services have helped shape the character of regulatory franchise, and contracting arrangements. When a good is seen as mainly private, it is easier for private service providers to be compensated mainly by user fees and for most decisions about price, output, and quality, no matter what the role played by private firms in actually providing services. (ix) Goods defined as"public"have often been provided free to users, even though it would have been easy to exclude nonpayers. Examples in the United States include interstate highway systems, public parks, public libraries, and police and fire protection. Free services have been provided because it is believed that in these domains market relationships should not apply - and that denying nonpayers the public services would be a denial of rights. (x) In Great Britain and the United States, the contracting out of public services has been both supported and opposed because of its potential to break the power of public sector unions and to cut workers'pay. In the United States, privatization has also come under attack on the grounds that opportunities for minority employment may be reduced.Regional Governance,Public Sector Economics&Finance,Decentralization,Public Sector Management and Reform,Urban Governance and Management,Public Sector Management and Reform,Urban Governance and Management,Regional Governance,Town Water Supply and Sanitation,Public Sector Economics&Finance

Academic Performance in Middle School: Friendship Influences

The results of the Peer/Performance Relationship Study build on previous research findings demonstrating relational significance of peer influences to academic performance during adolescence. Whereas family, teachers, and friends play a significant role in a student’s academic career, extant literature about the relational dynamics between peers and academic achievement remains scarce. This study evaluated social support and negative interchanges in relation to self-reported grades in reading, mathematics, social studies, and science. Additionally, students’ gender, race, and perception of a friend’s level of school interest were measured. The sample consisted of 321 participants in the 6th, 7th, and 8th grade from three medium-sized suburban, public middle schools in the Midwest. Social support and negative interchanges were measured by scales of the Network of Relationships Inventory. Academic performance was measured as a grade point average of the scores for the four academic subjects. Results support the hypothesis that adolescents’ relationships with peers influence academic performance. Specifically, the study’s outcome demonstrates that social support was significantly and positively related to academic performance. Negative interchanges were not significantly related to academic performance. A positive correlation was found between level of school interest and academic performance. Furthermore, gender differences were found among social support, negative interchanges, and academic performance. There were no statistical differences for race. Altogether, these results are consistent with previous research findings and provide evidence for the importance of adolescent friendships and their impact on academic performance

Managing Dyslipidemia in Chronic Kidney Disease

The incidence of chronic kidney disease (CKD) in the U.S. continues to increase, and now over 10% of the U.S. population has some form of CKD. Although some patients with CKD will ultimately develop renal failure, most patients with CKD will die of cardiovascular disease before dialysis becomes necessary. Patients with CKD have major proatherogenic lipid abnormalities that are treatable with readily available therapies. The severe derangements seen in lipoprotein metabolism in patients with CKD typically results in high triglycerides and low high-density lipoprotein (HDL) cholesterol. Because of the prevalence of triglyceride disorders in patients with CKD, after treating patients to a low-density lipoprotein goal, non-HDL should be calculated and used as the secondary goal of treatment. A review of the evidence from subgroup analysis of several landmark lipid-lowering trials supports treating dyslipidemia in mild to moderate CKD patients with HMG-CoA reductase inhibitors. The evidence to support treating dyslipidemia in hemodialysis patients, however, has been mixed, with several outcome trials pending. Patients with CKD frequently have mixed dyslipidemia and often require treatment with multiple lipid-lowering drugs. Although statins are the cornerstone of therapy for most patients with CKD, differences in their pharmacokinetic properties give some statins a safety advantage in patients with advanced CKD. Although most other lipid-lowering agents can be used safely with statins in combination therapy in patients with CKD, the fibrates are renally metabolized and require both adjustments in dose and very careful monitoring due to the increased risk of rhabdomyolysis. After reviewing the safety and dose alterations required in managing dyslipidemia in patients with CKD, a practical treatment algorithm is proposed

Academic Performance in Middle School: Friendship Influences

The results of the Peer/Performance Relationship Study build on previous research findings demonstrating relational significance of peer influences to academic performance during adolescence. Whereas family, teachers, and friends play a significant role in a student’s academic career, extant literature about the relational dynamics between peers and academic achievement remains scarce. This study evaluated social support and negative interchanges in relation to self-reported grades in reading, mathematics, social studies, and science. Additionally, students’ gender, race, and perception of a friend’s level of school interest were measured. The sample consisted of 321 participants in the 6th, 7th, and 8th grade from three medium-sized suburban, public middle schools in the Midwest. Social support and negative interchanges were measured by scales of the Network of Relationships Inventory. Academic performance was measured as a grade point average of the scores for the four academic subjects. Results support the hypothesis that adolescents’ relationships with peers influence academic performance. Specifically, the study’s outcome demonstrates that social support was significantly and positively related to academic performance. Negative interchanges were not significantly related to academic performance. A positive correlation was found between level of school interest and academic performance. Furthermore, gender differences were found among social support, negative interchanges, and academic performance. There were no statistical differences for race. Altogether, these results are consistent with previous research findings and provide evidence for the importance of adolescent friendships and their impact on academic performance

Evaluation of the Wellspring Model for Improving Nursing Home Quality

Examines how successfully the Wellspring model improved the quality of care for residents of eleven nonprofit nursing homes in Wisconsin. Looks at staff turnover, and evaluates the impact on facilities, employees, residents, and cost