Better lives for all? : prospects for empowerment through marine wildlife tourism in Gansbaai, South Africa : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Development Studies at Massey University, Manawatū, Aotearoa New Zealand

Little is known about the consequences of burgeoning commercial marine wildlife tourism (MWT) for communities in the Global South. Gansbaai, the location for this research, has a concentration of twelve MWT operators; it also faces the triple challenge of unemployment, poverty, and inequality. Given their privileged access to marine common resources, empowerment and tourism policies position MWT permit holders as key agents of development. This research examines how MWT contributes to development for less advantaged residents of Gansbaai. Here, development means better lives and sustained empowerment for residents and rebalanced power relationships between social actors. A novel Tourism-Empowerment Framework guided observation and analysis of empowerment interfaces, expressions of power, and empowerment processes and outcomes in MWT. A mixed methods approach drew on administrative data, participant observation, and interviews with civil society, private sector, and government actors. Crucially, the results revealed government actions, persistent societal power imbalances, and structural constraints circumscribed prospects for empowerment through MWT operators. Therefore, the ability of private firms to advance empowerment was restricted. Nevertheless, the results show how business processes advanced empowerment in several dimensions for most residents linked to operators. Substantial investment in human and local economic development by some MWT operators meant benefits extended beyond business owners and employees. Empowerment manifested as strengthened ability and agency to attain personal goals through decent work, increased household resources, enhanced skills and self-confidence, expanded social capital, strengthened collective power, and greater influence over decisions that affect their lives. Further, most less advantaged residents of Gansbaai were marginalised from the multidimensional benefits of MWT, and some people experienced disempowerment. Many interventions were operator-defined, charity-based, prioritised business benefits, and maintained power imbalances. Altogether, the findings suggest unequal empowerment, uneven impact on the six dimensions of empowerment, simultaneous empowerment and disempowerment, and a muted effect on structural transformation. In the final analysis, while MWT appears to have progressed multi-dimensional empowerment for some residents, claiming that MWT has led to rebalanced power relations and better lives for all less advantaged residents of Gansbaai would be disingenuous

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London