Neuropsychiatric risk in children with intellectual disability of genetic origin: IMAGINE - The UK National Cohort Study

Background: Children with intellectual disability (ID) frequently have multiple co-morbid neuropsychiatric conditions and poor physical health. Genomic testing is increasingly recommended as a first-line investigation for these children. We aimed to determine the impact of genomics, inheritance and socioeconomic deprivation on neuropsychiatric risk in children with intellectual disability of genetic origin as compared to the general population. Methods: IMAGINE is a prospective study using online mental health and medical assessments in a cohort of 2770 children with ID and pathogenic genomic variants, identified by the UK’s National Health Service. Outcomes: Assessments completed on 2397 young people with ID (4-19 years, M 9·2, SD 3·9) with a rare pathogenic genomic variant. 1339 (55·9%) were male. 1771 (73·9%) of participants had a pathogenic copy number variant (CNV), 626 (26·1%) a pathogenic single nucleotide variant (SNV). Participants were representative of the socioeconomic spectrum of the UK general population. The relative risk of co-occurring neuropsychiatric diagnoses, compared with the UK national population, was high: Autism Spectrum Disorder 29·2 (95% CI 23·9 to 36·5), Attention Deficit Hyperactivity Disorder 13·5 (95% CI 11·1 to 16·3). In children with a CNV, those with a familial variant tended to live in more socioeconomically deprived areas. Both inheritance and socioeconomic deprivation contributed to neuropsychiatric risk in those with a CNV. Interpretation: Children with genomic variants and ID are at a greatly enhanced risk of neuropsychiatric difficulties. CNV variant inheritance and socioeconomic deprivation also contribute to the risk

Neuropsychiatric risk in children with intellectual disability of genetic origin: IMAGINE, a UK national cohort study

Background Children with intellectual disability frequently have multiple co-morbid neuropsychiatric conditions and poor physical health. Genomic testing is increasingly recommended as a first-line investigation for these children. We aim to determine the effect of genomics, inheritance, and socioeconomic deprivation on neuropsychiatric risk in children with intellectual disability of genetic origin as compared with the general population. Methods IMAGINE is a prospective cohort study using online mental health and medical assessments in a cohort of 3407 UK participants with intellectual disability and pathogenic genomic variants as identified by the UK's National Health Service (NHS). Our study is on a subset of these participants, including all children aged 4–19 years. We collected diagnostic genomic reports from NHS records and asked primary caregivers to provide an assessment of their child using the Development and Well-Being Assessment (DAWBA), the Strengths and Difficulties Questionnaire (SDQ), the Adaptive Behaviour Assessment System 3 (ABAS-3), and a medical history questionnaire. Each child was assigned a rank based on their postcode using the index of multiple deprivation (IMD). We compared the IMAGINE cohort with the 2017 National Survey of Children's Mental Health in England. The main outcomes of interest were mental health and neurodevelopment according to the DAWBA and SDQ. Findings We recruited 2770 children from the IMAGINE study between Oct 1, 2014 and June 30, 2019, of whom 2397 (86·5%) had a basic assessment of their mental health completed by their families and 1277 (46·1%) completed a medical history questionnaire. The mean age of participants was 9·2 years (SD 3·9); 1339 (55·9%) were boys and 1058 (44·1%) were girls. 355 (27·8%) of 1277 reported a seizure disorder and 814 (63·7%) reported movement or co-ordination problems. 1771 (73·9%) of 2397 participants had a pathogenic copy number variant (CNV) and 626 (26·1%) had a pathogenic single nucleotide variant (SNV). Participants were representative of the socioeconomic spectrum of the UK general population. The relative risk (RR) of co-occurring neuropsychiatric diagnoses, compared with the English national population, was high: autism spectrum disorder RR 29·2 (95% CI 23·9–36·5), ADHD RR 13·5 (95% CI 11·1–16·3). In children with a CNV, those with a familial variant tended to live in more socioeconomically deprived areas than those with a de novo variant. Both inheritance and socioeconomic deprivation contributed to neuropsychiatric risk in those with a CNV. Interpretation Children with genomic variants and intellectual disability are at an increased risk of neuropsychiatric difficulties. CNV variant inheritance and socioeconomic deprivation also contribute to the risk. Early genomic investigations of children with intellectual disability could facilitate the identification of the most vulnerable children. Additionally, harnessing parental expertise using online DAWBA assessments could rapidly identify children with exceptional needs to child mental health services

Organisational Effectiveness: Debates behind measurement issues in the Public Health Sector

This paper presents a discussion and exploration of influences into the development of performance measurements in the public sector. Such measures are subject to individual (rational decision-makers), managerial (goal congruent) and organisational (political philosophy) variations A case study (PHARMAC) is used by way of example to describe one organisation’s response to the complex relationships that exist within the public health sector. However, this paper does not attempt to describe or prescribe how public sector entities should behave. Rather, it is hoped to enable those responsible for developing public sector performance measures through an informed presentation of the influences on such actions.UnpublishedAbernethy, Margaret A. and Johannes U. Stoelwinder (1990), "Physicians and Resource Management in Hospitals: An Empirical Investigation," in Financial Accountability and Management, Vol. 6, No. 1, Spring, pp. 17-31. Abernethy, Margaret A. and Johannes U. Stoelwinder (1995), "The Role of Professional Control in the Management of Complex Organizations," in Accounting, Organizations and Society, Vol. 20, No. 1, pp. 1-17. Annual Report for the year ended 30 June 2003, Pharmaceutical Management Agency, available through http://www.pharmac.govt.nz/pdf/ARep03.pdf Annual Review 2003, Pharmaceutical Management Agency, available through http://www.pharmac.govt.nz/pdf/AR03.pdf Anthony, Robert N. and David W. Young (1994), Management Control in Nonprofit Organizations, 5th edition, Irwin, Illinois. Ashton, Toni, Donald Besley, Pat Alley and Gary Taylor (1991), “Reforming the New Zealand Health System: Lessons from Other Countries,” Report of a study tour sponsored by Health Boards New Zealand. Birkett, Donald J., Andrew S. Mitchell and Peter McManus (2001), “A Cost-Effectiveness Approach to Drug Subsidy and Pricing in Australia,” in Health Affairs, Vol. 20, No. 3, pp. 104-115. Boston, Jonathan, John Martin, June Pallot and Pat Walsh (1996), Public Management: The New Zealand Model, Oxford University Press, South Melbourne. Bourn, Michael and Mahmoud Ezzamel (1986), "Organisational Culture in Hospitals in the National Health Service," in Financial Accountability and Management, Vol. 2, No. 3, Autumn, pp. 203-225. Burton, Stephan L., Lauren Randel, Karen Titlow and Ezekiel J. Emmanuel (2001), “The Ethics of Pharmaceutical Benefit Management,” in Health Affairs, Vol. 20, No. 5, pp. 150-164. Chua, Wai Fong (1995), "Experts, Networks and Inscriptions in the Fabrication of Accounting Images: A Story of the Representation of Three Public Hospitals," in Accounting, Organizations and Society, Vol. 20, No. 2/3, pp. 111-145. Coombs, R.W. (1987), "Accounting for the Control of Doctors: Management Information Systems in Hospitals," in Accounting, Organizations and Society, Vol. 12, No. 4, pp. 389-404. Coupe, Mike (1991), "Medical Involvement in Management: A Natural Corollary of the Budget Reforms?" in New Zealand Medical Journal, Vol. 104, No. 922, 23 October, pp. 450-452. Di Tommaso, Marco R. and Stuart O. Schweitzer (2001), “The Health Industry: More than Just Containing Costs,” The Background Paper for The Ferrara Health Industry Policy Forum, Institute for Industrial Development. Geare, A.J., R. Turner, R.J. Moore, G.R. Elkin, T.W. Batley and M.T. Fay (1987), The Principles and Practice of Management, Pitman New Zealand, Wellington. Hofstede, Geert (1981), "Management Control of Public and Not-for-Profit Activities," in Accounting, Organizations and Society, Vol. 6, No. 3, pp. 193-211. Hughes, Owen E. (1994), Public Management & Administration: An Introduction, St. Martin’s Press, New York. Laughlin, Richard (1995), “Methodological Themes – Empirical Research in Accounting: Alternative Approaches and a Case or ‘Middle-Range’ Thinking,” in Accounting, Auditing and Accountability Journal, Vol. 8, No. 1, pp. 63-87. Lawrence, Stewart, Manzurul Alam and Tony Lowe (1994), “The Great Experiment: Financial Management Reform in the NZ Health Sector,” in Accounting, Auditing & Accountability Journal, Vol. 7, No. 3, pp. 68-95. Lawrence, S., M. Alam, D. Northcott and T. Lowe (1997), “Accounting Systems and Systems of Accountability in the New Zealand Health Sector,” in Accounting, Auditing & Accountability Journal, Vol. 10, No. 5, pp. 665-683. Locke, Edwin A. and Gary P. Latham (1990), A Theory of Goal Setting & Task Performance, Prentice Hall, Englewood Cliffs. Lodh, Sudhim C., and Michael J.R. Gaffikin (1997), “Critical Studies in Accounting Research, Rationality and Habermas: A Methodological Reflection,” in Critical Perspectives on Accounting, Vol. 8, pp. 433-474. Llewellyn, Sue, Ron Eden and Colin Lay (1999), “Financial and Professional Incentives in Health Care: comparing the U.K. and Canadian experiences,” in International Journal of Public Sector Management, Vol. 12, No. 1, pp. 6-16. Lofgren, Hans and Rebecca de Boer (2004), “Pharmaceuticals in Australia: Developments in Regulation and Governance,” in Social Science & Medicine, Vol. 58, No. 12, pp. 2397-2407. Lowry, John F. (1990), "Management Accounting and Service Industries: An Exploratory Account of Historical and Current Economic Contexts," in Abacus, Vol. 26, No. 2, pp. 159-184. Ministry of Health website: http://www.moh.govt.nz/publichospitals Monks, R. and N. Minow (1995), “Shareholders: Ownership” in Corporate Governance, Ch. 2, Blackwell Publishers, Oxford. New Zealand Public Health and Disability Act 2000, available through http://rangi.knowledge-basket.co.nz/gpacts/actlists.html Norris, Gweneth and Brendan O’Dwyer (2004), “Motivating Socially Responsive Decision-Making: the Operation of Management Controls in a Socially Responsive Organisation,” in British Accounting Review, Vol. 36, pp. 173-196. Operating Policies and Procedures of the Pharmaceutical Management Agency (2001), second edition, January, available through http://www.pharmac.govt.nz/pdf/opps.pdf Ouchi, William G. (1979), "A Conceptual Framework for the Design of Organizational Control Mechanisms," in Management Science, Vol. 25, No. 9, September, pp. 833-848. Phillips, Ceri and Guy Thompson (1998), “What is a QALY?,” Hayward Medical Communictions, available through www.evidence-based-medicine.co.uk Popkin, Richard H. and Avrum Stroll (1993), Philosophy, 3rd edition, Made Simple Books, Oxford. Public Finance Act 1989, available through http://rangi.knowledge-basket.co.nz/gpacts /public/text/1989/an/044.html Roberts, Trevor (1992), "The Ethics and Politics of Health Care Delivery: Where to Now?" in New Zealand Health and Hospital, Jan.-Feb., pp. 21-24. Scott, Graham (2001), Public Management in New Zealand, Centre for Law and Economics, Australian National University. Sculpher, M.J. and M. Price (2003), “Measuring Costs and Consequences in Economic Evaluation in Asthma,” in Respiratory Medicine, Vol. 97, pp. 508-520. Simon, Herbert A. (1978), “Rationality as Process and as Product of Thought,” Richard T. Ely Lecture, in American Economic Association, Vol. 68, No. 2, pp. 1-16. Stiglitz, Joseph E. (2000), Economics of the Public Sector, 3rd ed., W.W. Norton & Company, New York. Van Peursem, K.A., M.J. Pratt and S.R. Lawrence (1995), “Health Management Performance; a review of measures and indicators,” in Accounting, Auditing and Accountability Journal, Vol. 8, No. 5, pp. 34-70. Willcocks, Stephen George (2002), “Adopting a Multi-Perspective Approach to the Study of Public Sector Managerial Effectiveness,” in International Journal of Public Sector Management, Vol. 15, No. 4, pp. 262-280. Wright, Edmond (2005), “Perceiving Socially and Morally: The Question of Triangulation,” in Philosphy, Vol. 80, pp. 53-75

Organisational Effectiveness: Debates behind measurement issues in the Public Health Sector

This paper presents a discussion and exploration of influences into the development of performance measurements in the public sector. Such measures are subject to individual (rational decision-makers), managerial (goal congruent) and organisational (political philosophy) variations A case study (PHARMAC) is used by way of example to describe one organisation’s response to the complex relationships that exist within the public health sector. However, this paper does not attempt to describe or prescribe how public sector entities should behave. Rather, it is hoped to enable those responsible for developing public sector performance measures through an informed presentation of the influences on such actions.UnpublishedAbernethy, Margaret A. and Johannes U. Stoelwinder (1990), "Physicians and Resource Management in Hospitals: An Empirical Investigation," in Financial Accountability and Management, Vol. 6, No. 1, Spring, pp. 17-31. Abernethy, Margaret A. and Johannes U. Stoelwinder (1995), "The Role of Professional Control in the Management of Complex Organizations," in Accounting, Organizations and Society, Vol. 20, No. 1, pp. 1-17. Annual Report for the year ended 30 June 2003, Pharmaceutical Management Agency, available through http://www.pharmac.govt.nz/pdf/ARep03.pdf Annual Review 2003, Pharmaceutical Management Agency, available through http://www.pharmac.govt.nz/pdf/AR03.pdf Anthony, Robert N. and David W. Young (1994), Management Control in Nonprofit Organizations, 5th edition, Irwin, Illinois. Ashton, Toni, Donald Besley, Pat Alley and Gary Taylor (1991), “Reforming the New Zealand Health System: Lessons from Other Countries,” Report of a study tour sponsored by Health Boards New Zealand. Birkett, Donald J., Andrew S. Mitchell and Peter McManus (2001), “A Cost-Effectiveness Approach to Drug Subsidy and Pricing in Australia,” in Health Affairs, Vol. 20, No. 3, pp. 104-115. Boston, Jonathan, John Martin, June Pallot and Pat Walsh (1996), Public Management: The New Zealand Model, Oxford University Press, South Melbourne. Bourn, Michael and Mahmoud Ezzamel (1986), "Organisational Culture in Hospitals in the National Health Service," in Financial Accountability and Management, Vol. 2, No. 3, Autumn, pp. 203-225. Burton, Stephan L., Lauren Randel, Karen Titlow and Ezekiel J. Emmanuel (2001), “The Ethics of Pharmaceutical Benefit Management,” in Health Affairs, Vol. 20, No. 5, pp. 150-164. Chua, Wai Fong (1995), "Experts, Networks and Inscriptions in the Fabrication of Accounting Images: A Story of the Representation of Three Public Hospitals," in Accounting, Organizations and Society, Vol. 20, No. 2/3, pp. 111-145. Coombs, R.W. (1987), "Accounting for the Control of Doctors: Management Information Systems in Hospitals," in Accounting, Organizations and Society, Vol. 12, No. 4, pp. 389-404. Coupe, Mike (1991), "Medical Involvement in Management: A Natural Corollary of the Budget Reforms?" in New Zealand Medical Journal, Vol. 104, No. 922, 23 October, pp. 450-452. Di Tommaso, Marco R. and Stuart O. Schweitzer (2001), “The Health Industry: More than Just Containing Costs,” The Background Paper for The Ferrara Health Industry Policy Forum, Institute for Industrial Development. Geare, A.J., R. Turner, R.J. Moore, G.R. Elkin, T.W. Batley and M.T. Fay (1987), The Principles and Practice of Management, Pitman New Zealand, Wellington. Hofstede, Geert (1981), "Management Control of Public and Not-for-Profit Activities," in Accounting, Organizations and Society, Vol. 6, No. 3, pp. 193-211. Hughes, Owen E. (1994), Public Management & Administration: An Introduction, St. Martin’s Press, New York. Laughlin, Richard (1995), “Methodological Themes – Empirical Research in Accounting: Alternative Approaches and a Case or ‘Middle-Range’ Thinking,” in Accounting, Auditing and Accountability Journal, Vol. 8, No. 1, pp. 63-87. Lawrence, Stewart, Manzurul Alam and Tony Lowe (1994), “The Great Experiment: Financial Management Reform in the NZ Health Sector,” in Accounting, Auditing & Accountability Journal, Vol. 7, No. 3, pp. 68-95. Lawrence, S., M. Alam, D. Northcott and T. Lowe (1997), “Accounting Systems and Systems of Accountability in the New Zealand Health Sector,” in Accounting, Auditing & Accountability Journal, Vol. 10, No. 5, pp. 665-683. Locke, Edwin A. and Gary P. Latham (1990), A Theory of Goal Setting & Task Performance, Prentice Hall, Englewood Cliffs. Lodh, Sudhim C., and Michael J.R. Gaffikin (1997), “Critical Studies in Accounting Research, Rationality and Habermas: A Methodological Reflection,” in Critical Perspectives on Accounting, Vol. 8, pp. 433-474. Llewellyn, Sue, Ron Eden and Colin Lay (1999), “Financial and Professional Incentives in Health Care: comparing the U.K. and Canadian experiences,” in International Journal of Public Sector Management, Vol. 12, No. 1, pp. 6-16. Lofgren, Hans and Rebecca de Boer (2004), “Pharmaceuticals in Australia: Developments in Regulation and Governance,” in Social Science & Medicine, Vol. 58, No. 12, pp. 2397-2407. Lowry, John F. (1990), "Management Accounting and Service Industries: An Exploratory Account of Historical and Current Economic Contexts," in Abacus, Vol. 26, No. 2, pp. 159-184. Ministry of Health website: http://www.moh.govt.nz/publichospitals Monks, R. and N. Minow (1995), “Shareholders: Ownership” in Corporate Governance, Ch. 2, Blackwell Publishers, Oxford. New Zealand Public Health and Disability Act 2000, available through http://rangi.knowledge-basket.co.nz/gpacts/actlists.html Norris, Gweneth and Brendan O’Dwyer (2004), “Motivating Socially Responsive Decision-Making: the Operation of Management Controls in a Socially Responsive Organisation,” in British Accounting Review, Vol. 36, pp. 173-196. Operating Policies and Procedures of the Pharmaceutical Management Agency (2001), second edition, January, available through http://www.pharmac.govt.nz/pdf/opps.pdf Ouchi, William G. (1979), "A Conceptual Framework for the Design of Organizational Control Mechanisms," in Management Science, Vol. 25, No. 9, September, pp. 833-848. Phillips, Ceri and Guy Thompson (1998), “What is a QALY?,” Hayward Medical Communictions, available through www.evidence-based-medicine.co.uk Popkin, Richard H. and Avrum Stroll (1993), Philosophy, 3rd edition, Made Simple Books, Oxford. Public Finance Act 1989, available through http://rangi.knowledge-basket.co.nz/gpacts /public/text/1989/an/044.html Roberts, Trevor (1992), "The Ethics and Politics of Health Care Delivery: Where to Now?" in New Zealand Health and Hospital, Jan.-Feb., pp. 21-24. Scott, Graham (2001), Public Management in New Zealand, Centre for Law and Economics, Australian National University. Sculpher, M.J. and M. Price (2003), “Measuring Costs and Consequences in Economic Evaluation in Asthma,” in Respiratory Medicine, Vol. 97, pp. 508-520. Simon, Herbert A. (1978), “Rationality as Process and as Product of Thought,” Richard T. Ely Lecture, in American Economic Association, Vol. 68, No. 2, pp. 1-16. Stiglitz, Joseph E. (2000), Economics of the Public Sector, 3rd ed., W.W. Norton & Company, New York. Van Peursem, K.A., M.J. Pratt and S.R. Lawrence (1995), “Health Management Performance; a review of measures and indicators,” in Accounting, Auditing and Accountability Journal, Vol. 8, No. 5, pp. 34-70. Willcocks, Stephen George (2002), “Adopting a Multi-Perspective Approach to the Study of Public Sector Managerial Effectiveness,” in International Journal of Public Sector Management, Vol. 15, No. 4, pp. 262-280. Wright, Edmond (2005), “Perceiving Socially and Morally: The Question of Triangulation,” in Philosphy, Vol. 80, pp. 53-75

Organisational Effectiveness: Debates behind measurement issues in the Public Health Sector

This paper presents a discussion and exploration of influences into the development of performance measurements in the public sector. Such measures are subject to individual (rational decision-makers), managerial (goal congruent) and organisational (political philosophy) variations A case study (PHARMAC) is used by way of example to describe one organisation’s response to the complex relationships that exist within the public health sector. However, this paper does not attempt to describe or prescribe how public sector entities should behave. Rather, it is hoped to enable those responsible for developing public sector performance measures through an informed presentation of the influences on such actions.UnpublishedAbernethy, Margaret A. and Johannes U. Stoelwinder (1990), "Physicians and Resource Management in Hospitals: An Empirical Investigation," in Financial Accountability and Management, Vol. 6, No. 1, Spring, pp. 17-31. Abernethy, Margaret A. and Johannes U. Stoelwinder (1995), "The Role of Professional Control in the Management of Complex Organizations," in Accounting, Organizations and Society, Vol. 20, No. 1, pp. 1-17. Annual Report for the year ended 30 June 2003, Pharmaceutical Management Agency, available through http://www.pharmac.govt.nz/pdf/ARep03.pdf Annual Review 2003, Pharmaceutical Management Agency, available through http://www.pharmac.govt.nz/pdf/AR03.pdf Anthony, Robert N. and David W. Young (1994), Management Control in Nonprofit Organizations, 5th edition, Irwin, Illinois. Ashton, Toni, Donald Besley, Pat Alley and Gary Taylor (1991), “Reforming the New Zealand Health System: Lessons from Other Countries,” Report of a study tour sponsored by Health Boards New Zealand. Birkett, Donald J., Andrew S. Mitchell and Peter McManus (2001), “A Cost-Effectiveness Approach to Drug Subsidy and Pricing in Australia,” in Health Affairs, Vol. 20, No. 3, pp. 104-115. Boston, Jonathan, John Martin, June Pallot and Pat Walsh (1996), Public Management: The New Zealand Model, Oxford University Press, South Melbourne. Bourn, Michael and Mahmoud Ezzamel (1986), "Organisational Culture in Hospitals in the National Health Service," in Financial Accountability and Management, Vol. 2, No. 3, Autumn, pp. 203-225. Burton, Stephan L., Lauren Randel, Karen Titlow and Ezekiel J. Emmanuel (2001), “The Ethics of Pharmaceutical Benefit Management,” in Health Affairs, Vol. 20, No. 5, pp. 150-164. Chua, Wai Fong (1995), "Experts, Networks and Inscriptions in the Fabrication of Accounting Images: A Story of the Representation of Three Public Hospitals," in Accounting, Organizations and Society, Vol. 20, No. 2/3, pp. 111-145. Coombs, R.W. (1987), "Accounting for the Control of Doctors: Management Information Systems in Hospitals," in Accounting, Organizations and Society, Vol. 12, No. 4, pp. 389-404. Coupe, Mike (1991), "Medical Involvement in Management: A Natural Corollary of the Budget Reforms?" in New Zealand Medical Journal, Vol. 104, No. 922, 23 October, pp. 450-452. Di Tommaso, Marco R. and Stuart O. Schweitzer (2001), “The Health Industry: More than Just Containing Costs,” The Background Paper for The Ferrara Health Industry Policy Forum, Institute for Industrial Development. Geare, A.J., R. Turner, R.J. Moore, G.R. Elkin, T.W. Batley and M.T. Fay (1987), The Principles and Practice of Management, Pitman New Zealand, Wellington. Hofstede, Geert (1981), "Management Control of Public and Not-for-Profit Activities," in Accounting, Organizations and Society, Vol. 6, No. 3, pp. 193-211. Hughes, Owen E. (1994), Public Management & Administration: An Introduction, St. Martin’s Press, New York. Laughlin, Richard (1995), “Methodological Themes – Empirical Research in Accounting: Alternative Approaches and a Case or ‘Middle-Range’ Thinking,” in Accounting, Auditing and Accountability Journal, Vol. 8, No. 1, pp. 63-87. Lawrence, Stewart, Manzurul Alam and Tony Lowe (1994), “The Great Experiment: Financial Management Reform in the NZ Health Sector,” in Accounting, Auditing & Accountability Journal, Vol. 7, No. 3, pp. 68-95. Lawrence, S., M. Alam, D. Northcott and T. Lowe (1997), “Accounting Systems and Systems of Accountability in the New Zealand Health Sector,” in Accounting, Auditing & Accountability Journal, Vol. 10, No. 5, pp. 665-683. Locke, Edwin A. and Gary P. Latham (1990), A Theory of Goal Setting & Task Performance, Prentice Hall, Englewood Cliffs. Lodh, Sudhim C., and Michael J.R. Gaffikin (1997), “Critical Studies in Accounting Research, Rationality and Habermas: A Methodological Reflection,” in Critical Perspectives on Accounting, Vol. 8, pp. 433-474. Llewellyn, Sue, Ron Eden and Colin Lay (1999), “Financial and Professional Incentives in Health Care: comparing the U.K. and Canadian experiences,” in International Journal of Public Sector Management, Vol. 12, No. 1, pp. 6-16. Lofgren, Hans and Rebecca de Boer (2004), “Pharmaceuticals in Australia: Developments in Regulation and Governance,” in Social Science & Medicine, Vol. 58, No. 12, pp. 2397-2407. Lowry, John F. (1990), "Management Accounting and Service Industries: An Exploratory Account of Historical and Current Economic Contexts," in Abacus, Vol. 26, No. 2, pp. 159-184. Ministry of Health website: http://www.moh.govt.nz/publichospitals Monks, R. and N. Minow (1995), “Shareholders: Ownership” in Corporate Governance, Ch. 2, Blackwell Publishers, Oxford. New Zealand Public Health and Disability Act 2000, available through http://rangi.knowledge-basket.co.nz/gpacts/actlists.html Norris, Gweneth and Brendan O’Dwyer (2004), “Motivating Socially Responsive Decision-Making: the Operation of Management Controls in a Socially Responsive Organisation,” in British Accounting Review, Vol. 36, pp. 173-196. Operating Policies and Procedures of the Pharmaceutical Management Agency (2001), second edition, January, available through http://www.pharmac.govt.nz/pdf/opps.pdf Ouchi, William G. (1979), "A Conceptual Framework for the Design of Organizational Control Mechanisms," in Management Science, Vol. 25, No. 9, September, pp. 833-848. Phillips, Ceri and Guy Thompson (1998), “What is a QALY?,” Hayward Medical Communictions, available through www.evidence-based-medicine.co.uk Popkin, Richard H. and Avrum Stroll (1993), Philosophy, 3rd edition, Made Simple Books, Oxford. Public Finance Act 1989, available through http://rangi.knowledge-basket.co.nz/gpacts /public/text/1989/an/044.html Roberts, Trevor (1992), "The Ethics and Politics of Health Care Delivery: Where to Now?" in New Zealand Health and Hospital, Jan.-Feb., pp. 21-24. Scott, Graham (2001), Public Management in New Zealand, Centre for Law and Economics, Australian National University. Sculpher, M.J. and M. Price (2003), “Measuring Costs and Consequences in Economic Evaluation in Asthma,” in Respiratory Medicine, Vol. 97, pp. 508-520. Simon, Herbert A. (1978), “Rationality as Process and as Product of Thought,” Richard T. Ely Lecture, in American Economic Association, Vol. 68, No. 2, pp. 1-16. Stiglitz, Joseph E. (2000), Economics of the Public Sector, 3rd ed., W.W. Norton & Company, New York. Van Peursem, K.A., M.J. Pratt and S.R. Lawrence (1995), “Health Management Performance; a review of measures and indicators,” in Accounting, Auditing and Accountability Journal, Vol. 8, No. 5, pp. 34-70. Willcocks, Stephen George (2002), “Adopting a Multi-Perspective Approach to the Study of Public Sector Managerial Effectiveness,” in International Journal of Public Sector Management, Vol. 15, No. 4, pp. 262-280. Wright, Edmond (2005), “Perceiving Socially and Morally: The Question of Triangulation,” in Philosphy, Vol. 80, pp. 53-75

The Influence of Business Case Studies on Learning Styles: An Empirical Investigation

The use of business case studies has been promoted frequently as a method for providing realistic learning scenarios and for developing accounting graduates who are active and independent learners. This article extends a recent study into the use of case studies (Adler et al. 2004, Accounting Education: an international journal, 13(2), 213-229). In the light of evidence that indicated that exposure alone to business case studies did not lead to balanced learning styles, the researchers replicated the study a year later, with two changes. The survey was administered at a later point in the particular accounting course, and the course itself occurred later in the academic year. This gave the opportunity to test for a longer treatment time, with students who had more experience of university study. The results of the second survey confirm and extend those of the first, namely, that a lack of active involvement in cases results in less balanced learning styles. Further, even when students have experienced the benefits of active participation, the suspension of such involvement also leads to an erosion of learning style balance. That is, not only is it important to consider how case involvement occurs, it is also necessary to maintain business case activity. The result of non-involvement is a stronger tendency to acquire information from theoretical bases rather than from concrete experience. The fact that the present survey occurred later in the management accounting programme had no discernible effect on the results.Case studies, learning styles, learning style inventory, repeated studies, active learning,

Student-led and teacher-led case presentations: empirical evidence about learning styles in an accounting course

Educators and employers alike have made repeated calls for developing graduates who are active, interdependent, and independent learners. While the use of business case studies has been a frequently promoted method for achieving this objective, there is a dearth of information about how best to use the case study method, i.e. should the method be student- or teacher-led? The findings from this study suggest that the choice is far from trivial. Teacher-led cases, which were associated with low levels of student involvement in and responsibility for the case study, resulted in poorly balanced learners. According to learning style theory, these students are less capable of carrying out plans and tasks and show less proclivity for becoming involved in new experiences. Such a finding reinforces Libby's (Issues in Accounting Education 6(2), 193-213, 1991) view that the presence of cases is not the panacea to enhancing generic learning skills. Rather, it is how the case studies are used and the level of student involvement that is of vital importance.case studies, learning styles, learning style inventory, experiential learning, active learning, accounting education,

On Approaches to Learning versus Learning Styles: A Reply to Duff et al.'s Comment

The Comment of Duff, Dobie and Guo (forthcoming) offers variable usefulness. At its best, Duff et al.'s Comment makes an earnest attempt to promote dialogue and debate. For example, their Comment offers new ways to reconceptualize our two papers, and further offers challenges to how the research was motivated and executed. As such, their Comment provides glimpses of the healthy polemics that characterized the accounting discipline during the 1960s and 1970s. We are, therefore, most appreciative of how Duff et al. have attempted to rediscover the art of the polemical argument, and are furthermore grateful that they have chosen to include us in their attempt. What we find regrettable about the Comment of Duff et al. is the frequently misinformed bases from which it operates. This problem could have been partially remedied had the authors accepted our offer to provide them with a copy of the research instrument and data. Reminiscent of Plato's The Allegory of the Cave, instead of observing first hand and writing about the objects themselves, Duff et al. have chosen to observe the objects' shadows and write on these. The ultimate consequence is that we, as the replying authors, and it is also the case that this journals' readers, have regrettably been denied the chance to hear, reflect on, and respond to a more informed, more fully grounded argument. In this Reply, we will respond to the various concerns and challenges raised in the Comment of Duff et al. Mindful of the premium placed on journal space, our Reply aims for directness and succinctness. We do, however, offer all interested readers the opportunity to receive a copy of our research instrument and data to verify the comments we make here and/or to verify, replicate, and/or extend the research findings and conclusions we present in our other two papers (Adler, Whiting and Wynn-Williams, 2004; Wynn-Williams, Whiting and Adler, forthcoming).

Student-led and teacher-led case presentations: further empirical evidence

The use of business case studies has been frequently promoted as a method for developing accounting graduates who are active, interdependent, and independent learners. The debate continues over the best method for using the case study method; should case studies be student- or teacher-led? A recent study (Adler, Whiting and Wynn-Williams, 2004) used Kolb’s Learning-Style Inventory (adapted from Honey and Mumford (1986) and Kolb (1984)) to investigate the use of business case studies and student learning styles in an intermediate-level cost and management accounting course. The findings from that study suggest that it is how the case studies are used and the level of student involvement that is of vital importance. This paper extends the findings of Adler et al (2004) by repeating the survey but with the following potentially important changes: prior to the survey, students had completed an entire semester of intermediate-level courses, including two accounting courses, plus the surveys were administered at a later point in the particular management accounting paper. The results of the second survey confirm and extend those of the first (Adler et al, 2004), namely, that a lack of active involvement in cases results in less balanced learning styles. Further, even when students have experienced the benefits of active participation, a prolonged suspension of such involvement also leads to an exaggerated lack of balance. That is, not only is the how of case involvement important, so is the when. 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