'They did not have a word': the parental quest to locate a 'true sex' for their intersex children

Given the paucity of research in this area, the primary aim of this study was to explore how parents of infants with unclear sex at birth made sense of 'intersex'. Qualitative methods were, used (semi-structured interviews, interpretative phenomenological analysis) with 10 parents to generate pertinent themes and provide ideas for further research. Our analysis highlights the fundamental shock engendered by the uncertain sex status of children, and documents parental struggles to negotiate a coherent sex identity for their children. Findings are discussed in light of the rigid two-sex system which pervades medicine and everyday life, and we argue that greater understanding of the complexity of sex and gender is required in order to facilitate better service provision and, ultimately, greater informed consent and parental participation regarding decisions about their children's status.

Managing multiple markets: big firms and PFI contracts

The Private Finance Initiative (PFI) is frequently portrayed as a vehicle for change for the UK construction sector. Significant change in the working practices of construction companies is predicted as new business models based on whole-life value creation emerge. This paper shifts the focus of discussion from projected ideals and possible developments to the current situation. More specifically, it focuses on the challenges that large firms participating in both PFI and traditional markets face. The analysis focuses on the relations between business units and on day-to-day challenges to greater long-term commitment, through life-service provision and increased integration between construction and service provision. The paper offers insights into the effects of PFI on construction practice and their implications for theorizing on organizational and strategic change. It suggests abandoning a simplistic model of the centralized, homogenous firm and instead capturing the dynamics of decentralized, large firms working in multiple markets on a variety of projects. This would assist in the provision of more realistic and fruitful models of how to realize the PFI vision.

Contracts and incentives in the construction sector

The aim of this chapter is to examine what the construction sector brings to our understanding of the procurement of complex performance. The chapter is divided into the following parts: fi rst, an overview of the various matters that contribute to the complexity of construction procurement is provided. Second, the most important contractual incentive schemes found in construction contracts are discussed, and this is followed by, third, an examination of the changes associated with the shift towards procuring complex performance (PCP) (service provision). Fourth, the main findings of the authors’ recent research on PCP contracts are summarised, followed by the conclusion. It should be noted that the procurement of services is referred to as ‘PCP’ in this chapter.

Assessment of projected changes in upland environments using simple climatic indices

Climate controls upland habitats, soils and their associated ecosystem services; therefore, understanding possible changes in upland climatic conditions can provide a rapid assessment of climatic vulnerability over the next century. We used 3 different climatic indices that were optimised to fit the upland area classified by the EU as a Severely Disadvantaged Area (SDA) 1961–1990. Upland areas within the SDA covered all altitudinal ranges, whereas the maximum altitude of lowland areas outside of the SDA was ca. 300 m. In general, the climatic index based on the ratio between annual accumulated temperature (as a measure of growing season length) and annual precipitation predicted 96% of the SDA mapped area, which was slightly better than those indices based on annual or seasonal water deficit. Overall, all climatic indices showed that upland environments were exposed to some degree of change by 2071–2100 under UKCIP02 climate projections for high and low emissions scenarios. The projected area declined by 13 to 51% across 3 indices for the low emissions scenario and by 24 to 84% for the high emissions scenario. Mean altitude of the upland area increased by +11 to +86 m for the low scenario and +21 to +178 m for the high scenario. Low altitude areas in eastern and southern Great Britain were most vulnerable to change. These projected climatic changes are likely to affect upland habitat composition, long-term soil carbon storage and wider ecosystem service provision, although it is not yet possible to determine the rate at which this might occur.

Local management and landscape drivers of pollination and biological control services in a Kenyan agro-ecosystem

Arthropods that have a direct impact on crop production (i.e. pests, natural enemies and pollinators) can be influenced by both local farm management and the context within which the fields occur in the wider landscape. However, the contributions and spatial scales at which these drivers operate and interact are not fully understood, particularly in the developing world. The impact of both local management and landscape context on insect pollinators and natural enemy communities and on their capacity to deliver related ecosystem services to an economically important tropical crop, pigeonpea was investigated. The study was conducted in nine paired farms across a gradient of increasing distance to semi-native vegetation in Kibwezi, Kenya. Results show that proximity of fields to semi-native habitats negatively affected pollinator and chewing insect abundance. Within fields, pesticide use was a key negative predictor of pollinator, pest and foliar active predator abundance. On the contrary, fertilizer application significantly enhanced pollinator and both chewing and sucking insect pest abundance. At a 1 km spatial scale of fields, there were significant negative effects of the number of semi-native habitat patches within fields dominated by mass flowering pigeonpea on pollinators abundance. For service provision, a significant decline in fruit set when insects were excluded from flowers was recorded. This study reveals the interconnections of pollinators, predators and pests with pigeonpea crop. For sustainable yields and to conserve high densities of both pollinators and predators of pests within pigeonpea landscapes, it is crucial to target the adoption of less disruptive farm management practices such as reducing pesticide and fertilizer inputs.

The development and impact of the Livestock Guru: meeting the knowledge needs of poor livestock keepers in Tamil Nadu, India

Livestock keepers comprise 2/3rds of the 2.8 billion households living on less than two dollars per day. However, as a group they tend to be marginalised and excluded from formal service provision, particularly in relation to animal health. Therefore, the following paper describes the development of the Livestock Guru, a multi-media learning programme created to meet the knowledge needs of poor livestock keepers in Tamil Nadu, India. The findings from the study illustrate the importance of both appropriate visuals, voice-overs but also the need for addressing issues in the environment in which learning will take place.

Are the debates on water privatization missing the point? Experiences from Africa, Asia and Latin America

This paper has two principal aims: first, to unravel some of the arguments mobilized in the controversial privatization debate, and second, to review the scale and nature of private sector provision of water and sanitation in Africa, Asia and Latin America. Despite being vigorously promoted in the policy arena and having been implemented in several countries in the South in the 1990s, privatization has achieved neither the scale nor benefits anticipated. In particular, the paper is pessimistic about the role that privatization can play in achieving the Millennium Development Goals of halving the number of people without access to water and sanitation by 2015. This is not because of some inherent contradiction between private profits and the public good, but because neither publicly nor privately operated utilities are well suited to serving the majority of low-income households with inadequate water and sanitation, and because many of the barriers to service provision in poor settlements can persist whether water and sanitation utilities are publicly or privately operated. This is not to say that well-governed localities should not choose to involve private companies in water and sanitation provision, but it does imply that there is no justification for international agencies and agreements to actively promote greater private sector participation on the grounds that it can significantly reduce deficiencies in water and sanitation services in the South.

The domestic garden: its contribution to urban green infrastructure

Domestic gardens provide a significant component of urban green infrastructure but their relative contribution to eco-system service provision remains largely un-quantified. ‘Green infrastructure’ itself is often ill-defined, posing problems for planners to ascertain what types of green infrastructure provide greatest benefit and under what circumstances. Within this context the relative merits of gardens are unclear; however, at a time of greater urbanization where private gardens are increasingly seen as a ‘luxury’, it is important to define their role precisely. Hence, the nature of this review is to interpret existing information pertaining to gardens /gardening per se, identify where they may have a unique role to play and to highlight where further research is warranted. The review suggests that there are significant differences in both form and management of domestic gardens which radically influence the benefits. Nevertheless, gardens can play a strong role in improving the environmental impact of the domestic curtilage, e.g. by insulating houses against temperature extremes they can reduce domestic energy use. Gardens also improve localized air cooling, help mitigate flooding and provide a haven for wildlife. Less favourable aspects include contributions of gardens and gardening to greenhouse gas emissions, misuse of fertilizers and pesticides, and introduction of alien plant species. Due to the close proximity to the home and hence accessibility for many, possibly the greatest benefit of the domestic garden is on human health and well-being, but further work is required to define this clearly within the wider context of green infrastructure.

Species distribution models for crop pollination: a modelling framework applied to Great Britain

Insect pollination benefits over three quarters of the world's major crops. There is growing concern that observed declines in pollinators may impact on production and revenues from animal pollinated crops. Knowing the distribution of pollinators is therefore crucial for estimating their availability to pollinate crops; however, in general, we have an incomplete knowledge of where these pollinators occur. We propose a method to predict geographical patterns of pollination service to crops, novel in two elements: the use of pollinator records rather than expert knowledge to predict pollinator occurrence, and the inclusion of the managed pollinator supply. We integrated a maximum entropy species distribution model (SDM) with an existing pollination service model (PSM) to derive the availability of pollinators for crop pollination. We used nation-wide records of wild and managed pollinators (honey bees) as well as agricultural data from Great Britain. We first calibrated the SDM on a representative sample of bee and hoverfly crop pollinator species, evaluating the effects of different settings on model performance and on its capacity to identify the most important predictors. The importance of the different predictors was better resolved by SDM derived from simpler functions, with consistent results for bees and hoverflies. We then used the species distributions from the calibrated model to predict pollination service of wild and managed pollinators, using field beans as a test case. The PSM allowed us to spatially characterize the contribution of wild and managed pollinators and also identify areas potentially vulnerable to low pollination service provision, which can help direct local scale interventions. This approach can be extended to investigate geographical mismatches between crop pollination demand and the availability of pollinators, resulting from environmental change or policy scenarios.

Roles of the non-medical prescribing leads within organisations across a Strategic Health Authority: perceived functions and factors supporting the role

Objectives Extending the roles of nurses, pharmacists and allied health professionals to include prescribing has been identified as one way of improving service provision. In the UK, over 50 000 non-medical healthcare professionals are now qualified to prescribe. Implementation of non-medical prescribing ( NMP) is crucial to realise the potential return on investment. The UK Department of Health recommends a NMP lead to be responsible for the implementation of NMP within organisations. The aim of this study was to explore the role of NMP leads in organisations across one Strategic Health Authority (SHA) and to inform future planning with regards to the criteria for those adopting this role, the scope of the role and factors enabling the successful execution of the role. Methods Thirty-nine NMP leads across one SHA were approached. Semi-structured telephone interviews were conducted. Issues explored included the perceived role of the NMP lead, safety and clinical governance procedures and facilitators to the role. Transcribed audiotapes were coded and analysed using thematic analytical techniques. Key findings In total, 27/39 (69.2%) NMP leads were interviewed. The findings highlight the key role that the NMP lead plays with regards to the support and development of NMP within National Health Service trusts. Processes used to appoint NMP leads lacked clarity and varied between trusts. Only two NMP leads had designated or protected time for their role. Strategic influence, operational management and clinical governance were identified as key functions. Factors that supported the role included organisational support, level of influence and dedicated time. Conclusion The NMP lead plays a significant role in the development and implementation of NMP. Clear national guidance is needed with regards to the functions of this role, the necessary attributes for individuals recruited into this post and the time that should be designated to it. This is important as prescribing is extended to include other groups of non-medical healthcare professionals.

A comparative value of electricity storage within GB market mechanisms

This paper investigates the value of a generic storage system within two GB market mechanisms and one ancillary service provision: the wholesale power market, the Balancing Mechanism and Firm Frequency Response (FFR). Three models are evaluated under perfect foresight and fixed horizon which is subsequently extended to explore the impact of a longer foresight on market revenues. The results show that comparatively, the balancing mechanism represents the highest source of potential revenues followed by the wholesale power market and Firm Frequency Response respectively. Longer horizons show diminishing returns, with the 1 day horizon providing the vast majority of total revenues. However storage power capacity utilization benefits from such long horizons. These results could imply that short horizons are very effective in capturing revenues in both the wholesale market and balancing mechanism whereas sizing of a storage system should take into consideration horizon foresight and accuracy for greater benefit.

Resources, staff beliefs and organizational culture: factors in the use of information and communication technology for adults with intellectual disabilities

Background  Access to, and the use of, information and communication technology (ICT) is increasingly becoming a vital component of mainstream life. First-order (e.g. time and money) and second-order factors (e.g. beliefs of staff members) affect the use of ICT in different contexts. It is timely to investigate what these factors may be in the context of service provision for adults with intellectual disabilities given the role ICT could play in facilitating communication and access to information and opportunities as suggested in Valuing People. Method  Taking a qualitative approach, nine day service sites within one organization were visited over a period of 6 months to observe ICT-related practice and seek the views of staff members working with adults with intellectual disabilities. All day services were equipped with modern ICT equipment including computers, digital cameras, Internet connections and related peripherals. Results  Staff members reported time, training and budget as significant first-order factors. Organizational culture and beliefs about the suitability of technology for older or less able service users were the striking second-order factors mentioned. Despite similar levels of equipment, support and training, ICT use had developed in very different ways across sites. Conclusion  The provision of ICT equipment and training is not sufficient to ensure their use; the beliefs of staff members and organizational culture of sites play a substantial role in how ICT is used with and by service users. Activity theory provides a useful framework for considering how first- and second-order factors are related. Staff members need to be given clear information about the broader purpose of activities in day services, especially in relation to the lifelong learning agenda, in order to see the relevance and usefulness of ICT resources for all service users.

The use of ICT by adults with learning disabilities in day and residential services

The use of Information and Communication Technology (ICT) by adults with learning disabilities has been positively promoted over the past decade. More recently, policy statements and guidance from the UK government have underlined the importance of ICT for adults with learning disabilities specifically, as well as for the population in general, through the potential it offers for social inclusion. The aim of the present study was to provide a picture of how ICT is currently being used within one organisation providing specialist services for adults with learning disabilities and more specifically to provide a picture of its use in promoting community participation. Nine day and 14 residential services were visited as part of a qualitative study to answer three main questions: What kinds of computer programs are being used? What are they being used for? Does this differ between day and residential services? Computers and digital cameras were used for a wide range of activities and ‘mainstream’ programs were used more widely than those developed for specific user groups. In day services, ICT was often embedded in wider projects and activities, whilst use in houses was based around leisure interests. In both contexts, ICT was being used to facilitate communication, although this was more linked to within-service activities, rather than those external to service provision.

Impact of externalities on sustainable development: evidence from public-private partnerships in Kazakhstan and Russia

Purpose – This paper aims to investigate the influence of public-private partnerships (PPPs) on social and economic conditions in Kazakhstan and Russia from a public economics perspective, namely, through the lens of a market failure and PPPs’ negative externalities. Design/methodology/approach – Drawing on the concept of a market failure and using the externalities perspective, the paper investigates whether partnerships are instrumental in solving market problems, which is illustrated by the evidence from ongoing PPP projects in Kazakhstan and Russia. Findings – Results show that citizens face expansion of monopolistic trends in the service provision and decreased availability of public services. Additionally, the government support to partnerships recreates a negative externality in the form of a higher risk premium on loan interest rates that banks use to finance PPPs. The partnerships’ impact on sustainable development often appears detrimental, as they significantly intensify the struggle between sub-national governments for increased transfers from the national budget. Practical implications – The government agencies must incorporate the appraisal of the PPP externalities and their effects on the society in the decision-making regarding the PPP formation. Originality/value – The authors suggest that, although government is interested in PPPs’ positive externalities, in reality many negative externalities may offset the positive spillover effects. As a result, the partnerships’ contributions to economic and social sustainability remain controversial. Extending the value-for-money concept to incorporate the assessment of PPP externalities might significantly enhance the partnership conceptualisation by more comprehensive and accurate assessment of PPPs’ economic and social value.

Green infrastructure and ecosystem services - is the devil in the detail?

Background - Green infrastructure is a strategic network of green spaces designed to deliver ecosystem services to human communities. Green infrastructure is a convenient concept for urban policy makers, but the term is used too-generically and with limited understanding of the relative values or benefits of different types of green space and how these complement one another. At a finer scale/more practical level– little consideration is given to the composition of the plant-communities, yet this is what ultimately defines extent of service provision. This paper calls for greater attention to be paid to urban plantings with respect to ecosystem service delivery and for plant science to engage more-fully in identifying those plants that promote various services. Scope - Many urban plantings are designed based on aesthetics alone, with limited thought on how plant choice/composition provides other ecosystem services. Research is beginning to demonstrate, however, that landscape plants provide a range of important services, such as helping mitigate floods and alleviating heat islands, but that not all species are equally effective. The paper reviews a number of important services and demonstrates how genotype choice radically affects service delivery. Conclusions – Although research is in its infancy, data is being generated that relates plant traits to specific services; thereby helping identify genotypes that optimise service delivery. The urban environment, however, will become exceedingly bland if future planting is simply restricted to monocultures of a few ‘functional’ genotypes. Therefore, further information is required on how to design plant communities where the plants identified:- a/ provide more than a single benefit (multi-functionality) b/ complement each other in maximising the range of benefits that can be delivered in one location and c/ continue to maintain public acceptance through diversity. The identification/development of functional landscape plants is an exciting and potentially high impact arena for plant science.