Private finance initiative (or public private partnership) implementation processes and perception of value for money

The aim of this study is to examine the relationships among perceptions of implementation processes, implementation difficulties and value for money (VFM) in UK school private finance initiative (PFI) or public private partnership (PPP) contracts. The results suggest that implementation factors, such as effective PFI ‘consultation’, ‘contractual’, ‘monitoring and review’ processes have a significantly positive influence on perception of VFM. The results also suggest that difficulties involved in actually implementing PFI processes, such as ‘lack of transparency’, ‘performance measurement difficulties’, ‘cultural differences’ and ‘lack of authority’ have a significant and negative influence on perception of VFM. These implementation difficulties were also found to be inversely related with perception of the PFI implementation processes but the extent of these relationships varied

Why private finance initiatives are so addictive - and yet offer such poor value for money

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Agroecology accounting: biodiversity and sustainable livelihoods from the margins

Purpose: The study provides a socio-ecological counter account of the role that agroecology plays in supporting the sustainable livelihoods of a co-operative of smallholder coffee farmers, where very little value is created at their end of the coffee commodity chain. Agroecology may be defined as the science that provides the ecological principles and concepts for the design and management of productive agricultural ecosystems that conserve natural resources. Design/methodology/approach: This study uses a case study design of a coffee producing co-operative in India using data collected from participant observation, focus groups and unstructured interviews with indigenous smallholder farmers. It combines the science of agroecology with the labour theory of value as a theoretical framework. Findings: An agroecological approach supports agricultural biodiversity, while promoting sustainable livelihoods since members of the co-operative are able to reduce their use of external inputs. However, an agroecological transformation is curtailed by the continued dependence on corporate value chains. A framework using the labour theory of value is used to explain the extraction of surplus value from the labour of both the smallholder farmers as well as nature. This study provides evidence of the role of government policy and practice in perpetuating the status quo by not promoting either research on agroecology or direct consumer to producer value chains while providing subsidies for the inputs of industrial agriculture. Originality/value: There have been very few studies that have provided an account of smallholder farmers of the limited value generated in agricultural commodity chains due to the need to purchase the inputs of industrial agriculture supported by government subsidies. This study extends the field of accounting for biodiversity into agriculture using the science of agroecology to explain the role played by biodiversity in increasing the amount of value generated by smallholder farmers. By utilizing the labour theory of value, we have introduced the notion of the labour power of nature as represented by the environmental services that nature provides

A framework for examining accountability and value for money in the UK's private finance initiative

This paper seeks to develop a system for evaluating the implications of accountability and value-for-money (VFM) decisions in private finance initiative (PFI) projects from initiation through set-up, implementation and internal and external monitoring. By reviewing the extant literature on accountability and VFM, a model is developed for evaluating the implications of various types of accountability and VFM decisions on PFI projects. Most previous studies have considered either the accountability or VFM at the projects' initial stages; little attention has been paid to the interrelationship between accountability and VFM issues in the evaluation of various PFI processes. This paper addresses these lacunae in the literature

The governmentality and accountability of UK national museums and art galleries

This study furthers our understanding of the role of governmentality mechanisms in relation to other-forming and self-forming accounts of art organisations, by using empirical data collected from interviews with senior managers of UK national museums and art galleries (MAGs) and from secondary published sources. The findings highlight how governmentality mechanisms had power-effects through the creation of knowledge about MAGs and the resistance strategies of MAGs. Whilst the governmentality mechanisms were expected to ensure the automatic functioning of disciplinary power, in some instances the government directly intervened to over-ride decisions taken by senior managers when these conflicted with political imperatives

Predictors of in-hospital mortality and complications in very elderly patients undergoing emergency surgery

INTRODUCTION: With the increasing aging population demographics and life expectancies the number of very elderly patients (age ≥ 80) undergoing emergency surgery is expected to rise. This investigation examines the outcomes in very elderly patients undergoing emergency general surgery, including predictors of in-hospital mortality and morbidity. METHODS: A retrospective study of patients aged 80 and above undergoing emergency surgery between 2008 and 2010 at a tertiary care facility in Canada was conducted. Demographics, comorbidities, surgical indications, and perioperative risk assessment data were collected. Outcomes included length of hospitalization, discharge destination, and in-hospital mortality and morbidity. Multivariable logistic regression was used to identify predictors of in-hospital mortality and complications. RESULTS: Of the 170 patient admissions, the mean age was 84 years and the in-hospital mortality rate was 14.7%. Comorbidities were present in 91% of this older patient population. Over 60% of the patients required further services or alternate level of care on discharge. American Society of Anesthesiologist Physical Status (ASA) Classification (OR 5.30, 95% CI 1.774-15.817, p = 0.003) and the development of an in-hospital complications (OR 2.51, 95% CI 1.210-5.187, p = 0.013) were independent predictors of postoperative mortality. Chronological age or number of comorbidities was not predictive of surgical outcome. CONCLUSIONS: Mortality, complication rates and post-discharge care requirements were high in very elderly patients undergoing emergency general surgery. Advanced age and medical comorbidities alone should not be the limiting factors for surgical referral or treatment. This study illustrates the importance of preventing an in-hospital complication in this very vulnerable population. ASA class is a robust tool which is predictive of mortality in the very elderly population and can be used to guide patient and family counseling in the emergency setting

The rising number of “beanpole” families in UK: A qualitative insight into the parent-adolescent relationship

Objective: Nearly half of British families are classified as single-child families, showing a gradual but steady increase in this family type from the 1990s onwards. Despite this, research on relationships of only-children in the UK is scant. The aim of this paper was to explore parent-adolescent relationships in single-child families. Design: This study used qualitative semi-structured interviews to explore both parents’ and only-children’s perceptions of the parent-adolescent relationship. Methods: 15 families with an only child and 15 families with multiple children were interviewed when children were aged 11-14 years. Families were recruited using advertising, convenience and snowballing sampling. Interviews were analysed using thematic analysis. Results: Analysis of data from parents and adolescents of both groups revealed several common themes: the experience of a positive parent-child relationship, parental support and the impact of early adolescence on parent-child relationships. Closeness in parent-child relationship was also identified as a common theme amongst adolescents in both groups. However this theme differed in the views of parents: parents of an only-child reported a very close relationship with their child including a strong emotional connection in the form of parent-child bonding, while parents with multiple children reported less closeness. Parent gender seemed to influence the relationship. Adolescents in both groups felt closer to their mothers than fathers. However, this difference was much more prominent in single-child families. Some themes were specific to each family type. Adolescent only-children reported a strong emotional connection only with their mothers. They also reported positive differences in parent-child relationships from being an only-child. Adolescents with siblings mostly reported little differentiation in terms of how they perceived their relationship with each parent. Conclusion: This study revealed that adolescent only children share as positive a relationship with their parents as adolescents with siblings. More importantly, only-children seem to be at an advantage compared to non-only children with positive differences in parent-child relationship from both parents’ and adolescents’ perspectives. Gaining a first insight into the nature of parent-child relationship in single-child families and identifying specific aspects of the parent-child relationship which are unique to this family type has valuable implications in light of the growing number of single-child families

Parenting in single-child families in UK

Objective: Nearly half of British families are classified as single-child families showing a gradual but steady increase in this family type from the 1990s onwards. Despite this, research on only children/single-child families is scant. The aim of this paper is to explore parenting in single-child families in depth through qualitative interviews. Design: This study used qualitative semi-structured interviews to explore both parents’ and only-children’s perceptions of the parent-adolescent relationship. Methods: Fifteen families with an only child and 15 families with multiple children were interviewed, where the children were aged 11–14 years. Families were recruited using advertising, convenience and snowballing sampling. Interviews were analyzed using thematic analysis. Results: The two family types were similar on many of the themes reported such as practising authoritative parenting, levels of child-centeredness, parental behavioural control and the absence of parental overindulgence. However, whilst parents of an only-child reported high one-on-one parental involvement with their child, parents with multiple children reported less so. Overprotective parenting was also more prevalent in single-child families. Moreover, mothers and fathers of only-children reported using different parenting approaches from each other, while their counterparts reported using mostly a similar parenting approach to each other. Some family-type specific themes were also identified. It was found that single-child families engaged in permissive parenting and pampering of the child as well as pushy parenting. By contrast, a parental perception of parent-child conflict was a theme identified only in multiple-children families. Conclusion: This study concludes that parenting in single-child families is similar to parenting in multiple-children families on many dimensions but those differences do exist. On a positive side, only children seem to be more at an advantage than nononly children as they benefit from higher parental involvement. Nevertheless, only children are also the ones who are more likely to experience overprotection and permissiveness from their parents. Findings suggest that there are both similarities and differences in the parenting of only-children in China, Brazil and those in UK. Insight in parenting of single-child families has valuable implications in light of the growing number of single-child families

Gastrointestinal dysfunction in the critically ill: can we measure it?

Gastrointestinal dysfunction is an intuitively important, yet descriptively elusive component of the multiple organ dysfunction syndrome. Reintam and colleagues have attempted to quantify this dimension using a combination of intolerance of enteral feeding, and the development of intra-abdominal hypertension. While they show that both parameters are associated with an increased risk of death (and therefore that, in combination, the risk of death is even greater), they fall short in developing a novel descriptor of gastrointestinal dysfunction. Nonetheless, and even with its shortcomings, their effort is a welcome contribution to the surprisingly complex process of describing the morbidity of critical illness