Effect of patient age on management decisions in breast cancer: consensus from a national consultation

This qualitative study investigated the attitudes, perceptions, and practices of breast cancer specialists with reference to the effect of patient age on management decisions in breast cancer, and attempted to identify national consensus on this issue. One hundred thirty-three relevant specialists, including 75 surgeons and 43 oncologists, participated in a virtual consultation using e-mailed questionnaires and open-ended discussion documents, culminating in the development of proposed consensus statements sent to participants for validation. A strong consensus was seen in favor of incorporating minimum standards of diagnostic services, treatment, and care for older patients with breast cancer into relevant national guidance, endorsed by professional bodies. Similarly, an overwhelming majority of participants agreed that simple, evidence-based protocols or guidelines on standardizing assessment of biological and chronological age should be produced by the National Institute for Health and Clinical Excellence and the Scottish Medicines Consortium, developed in collaboration with specialist oncogeriatricians, and endorsed by professional bodies. A further recommendation that all breast cancer patient treatment and diagnostic procedures be undertaken in light of up-to-date, relevant scientific data met with majority support. This study was successful in gauging national specialist opinion regarding the effect of patient age on management decisions in breast cancer in the U.K.

The use of public participation and economic appraisal for public involvement in large-scale hydropower projects: Case study of the Nam Theun 2 Hydropower Project

Gaining public acceptance is one of the main issues with large-scale low-carbon projects such as hydropower development. It has been recommended by the World Commission on Dams that to gain public acceptance, publicinvolvement is necessary in the decision-making process (WCD, 2000). As financially-significant actors in the planning and implementation of large-scale hydropowerprojects in developing country contexts, the paper examines the ways in which publicinvolvement may be influenced by international financial institutions. Using the casestudy of the NamTheun2HydropowerProject in Laos, the paper analyses how publicinvolvement facilitated by the Asian Development Bank had a bearing on procedural and distributional justice. The paper analyses the extent of publicparticipation and the assessment of full social and environmental costs of the project in the Cost-Benefit Analysis conducted during the projectappraisal stage. It is argued that while efforts were made to involve the public, there were several factors that influenced procedural and distributional justice: the late contribution of the Asian Development Bank in the projectappraisal stage; and the issue of non-market values and discount rate to calculate the full social and environmental costs.

Multiple-project discount rates for cost-benefit analysis in construction projects: A formal risk model for microgeneration renewable energy technologies

The traditional economic approach for appraising the costs and benefits of construction project Net Present Values involves the calculation of net returns for each investment option under different discount rates. An alternative approach consists of multiple-project discount rates based on risk modelling. The example of a portfolio of microgeneration renewable energy technology (MRET) is presented to demonstrate that risks and future available budget for re-investment can be taken into account when setting discount rates for construction project specifications in presence of uncertainty. A formal demonstration is carried out through a reversed intertemporal approach of applied general equilibrium. It is demonstrated that risk and the estimated available budget for future re-investment can be included in the simultaneous assessment of the costs and benefits of multiple projects.

Contested institutions? Traditional leaders and land access and control in communal areas of Eastern Cape Province, South Africa

The South African government has endeavoured to strengthen property rights in communal areas and develop civil society institutions for community-led development and natural resource management. However, the effectiveness of this remains unclear as the emergence and operation of civil society institutions in these areas is potentially constrained by the persistence of traditional authorities. Focusing on the former Transkei region of Eastern Cape Province, three case study communities are used examine the extent to which local institutions overlap in issues of land access and control. Within these communities, traditional leaders (chiefs and headmen) continue to exercise complete and sole authority over land allocation and use this to entrench their own positions. However, in the absence of effective state support, traditional authorities have only limited power over how land is used and in enforcing land rights, particularly over communal resources such as rangeland. This diminishes their local legitimacy and encourages some groups to contest their authority by cutting fences, ignoring collective grazing decisions and refusing to pay ‘fees’ levied on them. They are encouraged in such activities by the presence of democratically elected local civil society institutions such as ward councillors and farmers’ organisations, which have broad appeal and are increasingly responsible for much of the agrarian development that takes place, despite having no direct mandate over land. Where it occurs at all, interaction between these different institutions is generally restricted to approval being required from traditional leaders for land allocated to development projects. On this basis it is argued that a more radical approach to land reform in communal areas is required, which transfers all powers over land to elected and accountable local institutions and integrates land allocation, land management and agrarian development more effectively.

Accounting for the economic risk, caused by variation in disease severity, in fungicide dose decisions: exemplified for Mycosphaerella graminicola on winter wheat

A method is presented to calculate economic optimum fungicide doses accounting for the risk-aversion of growers responding to variability in disease severity between crops. Simple dose-response and disease-yield loss functions are used to estimate net disease-related costs (fungicide cost, plus disease-induced yield loss) as a function of dose and untreated severity. With fairly general assumptions about the shapes of the probability distribution of disease severity and the other functions involved, we show that a choice of fungicide dose which minimises net costs on average across seasons results in occasional large net costs caused by inadequate control in high disease seasons. This may be unacceptable to a grower with limited capital. A risk-averse grower can choose to reduce the size and frequency of such losses by applying a higher dose as insurance. For example, a grower may decide to accept ‘high loss’ years one year in ten or one year in twenty (i.e. specifying a proportion of years in which disease severity and net costs will be above a specified level). Our analysis shows that taking into account disease severity variation and risk-aversion will usually increase the dose applied by an economically rational grower. The analysis is illustrated with data on septoria tritici leaf blotch of wheat caused by Mycosphaerella graminicola. Observations from untreated field plots at sites across England over three years were used to estimate the probability distribution of disease severities at mid-grain filling. In the absence of a fully reliable disease forecasting scheme, reducing the frequency of ‘high loss’ years requires substantially higher doses to be applied to all crops. Disease resistant cultivars reduce both the optimal dose at all levels of risk and the disease-related costs at all doses.

From projects into operations: lessons for data handover

Data from civil engineering projects can inform the operation of built infrastructure. This paper captures lessons for such data handover, from projects into operations, through interviews with leading clients and their supply chain. Clients are found to value receiving accurate and complete data. They recognise opportunities to use high quality information in decision-making about capital and operational expenditure; as well as in ensuring compliance with regulatory requirements. Providing this value to clients is a motivation for information management in projects. However, data handover is difficult as key people leave before project completion; and different data formats and structures are used in project delivery and operations. Lessons learnt from leading practice include defining data requirements at the outset, getting operations teams involved early, shaping the evolution of interoperable systems and standards, developing handover processes to check data rather than documentation, and fostering skills to use and update project data in operations

Public values and community energy: lessons from the US and UK

This paper examines some of the normative aspects of community energy programmes — defined here as decentralized forms of energy production and distributed energy technologies where production decisions are made as close as possible to sources of consumption. Such projects might also display a degree of separation from the formal political process. The development of a community energy system often generates a great deal of debate about both the degree of public support for such programmes and the values around which programmes ought to be organized. Community energy programmes also raise important issues regarding the energy choice problem, including questions of process, that is, by whom a project is developed and the influence of both community and exogenous actors, as well as certain outcome issues regarding the spatial and social distribution of energy. The case studies, drawn from community energy programmes in both the United States and the United Kingdom, allow for a careful examination of all of these factors, considering in particular the complex interplay and juxtaposition between the ideas of 'public value' and 'public values'.

Exploring socioeconomic impacts of forest based mitigation projects: Lessons from Brazil and Bolivia

This paper aims to contribute new insights globally and regionally on how carbon forest mitigation contributes to sustainable development in South America. Carbon finance has emerged as a potential policy option to tackling global climate change, degradation of forests, and social development in poor countries. This paper focuses on evaluating the socioeconomic impacts of a set of forest based mitigation pilot projects that emerged under the United Nations Framework Convention on Climate Change. The paper reviews research conducted in 2001–2002, drawing from empirical data from four pilot projects, derived from qualitative stakeholder interviews, and complemented by policy documents and literature. Of the four projects studied three are located in frontier areas, where there are considerable pressures for conversion of standing forest to agriculture. In this sense, forest mitigation projects have a substantial role to play in the region. Findings suggest however, that all four projects have experienced cumbersome implementation processes specifically, due to weak social objectives, poor communication, as well as time constraints. In three out of four cases, stakeholders highlighted limited local acceptance at the implementation stages. In the light of these findings, we discuss opportunities for implementation of future forest based mitigation projects in the land use sector.

Small-scale forest carbon projects: Adapting CDM to low-income communities

Given the decision to include small-scale sinks projects implemented by low-income communities in the clean development mechanism of the Kyoto Protocol, the paper explores some of the basic governance conditions that such carbon forestry projects will have to meet if they are to be successfully put in practice. To date there are no validated small-scale sinks projects and investors have shown little interest in financing such projects, possibly to due to the risks and uncertainties associated with sinks projects. Some suggest however, that carbon has the potential to become a serious commodity on the world market, thus governance over ownership, rights and responsibilities merit discussion. Drawing on the interdisciplinary development, as well as from the literature on livelihoods and democratic decentralization in forestry, the paper explores how to adapt forest carbon projects to the realities encountered in the local context. It also highlights the importance of capitalizing on synergies with other rural development strategies, ensuring stakeholder participation by working with accountable, representative local organizations, and creating flexible and adaptive project designs.

The influence of environmental policy on the decisions of managers to adopt G-SCM practices

This article explores the reasons that affect the decisions of managers of firms to adopt management practices in order to green their supply chain management. Under the context of environmental policy, the relationship between policy instruments (‘command and control’, market-based, and self-regulated) and the decisions of managers to adopt green supply chain management (G-SCM) practices is examined. The results show that in some cases the environmental legislation, market-based instruments and self-regulated incentives could play a critical role in the decisions of managers to adopt some specific G-SCM practices, while in other cases environmental policy instruments have not seemed to affect the decisions of managers regarding some other G-SCM practices.

Best practice in the training, appointment and remuneration of members of dispute boards for large infrastructure projects

This paper reports part of a qualitative study into evolving practice in the implementation of the Dispute Adjudication Board (DAB) construction dispute resolution technique, a variant of the Dispute Review Board (DRB) concept used in the US and Canada. Data was collected through a focus group interview of 20 highly experienced dispute resolution practitioners from engineering and the law. The group was assembled from members of FIDIC-NET with direct experience of project DABs. The part reported here concerns practice and procedure for establishing DABs. The main findings are that: constitution of the DABs is often delayed because of either project owners' ignorance of the DAB process or deterrence by the cost of the DABs; such owners also tend to insist on appointing DAB members from local engineers and lawyers without sufficient understanding of the DAB process; rates of remuneration of DAB members vary widely; the training provision for DAB membership and advocacy skills is inadequate; the process of selecting candidates for DAB membership and negotiating the tripartite agreement between each member and the contractual parties needs to be navigated with great care to avoid raising ethical problems. The research contribution is threefold. First, it highlights the importance of realistic fees for DAB members within a standard framework in achieving timely establishment of a board that works well as a team. Second, it illustrates the use of qualitative focus group interview to study the impact of new contract terms from multiple stakeholder perspectives. Finally, it identifies areas where further research is needed.

Insiders, outsiders, and the role of local enforcement in forest management: an example from Tanzania

In low-income countries, both nearby local villagers, “insiders”, and non-locals, “outsiders”, extract products from protected forests even though their actions are illegal. Forest managers typically combine enforcement and livelihood projects offered to nearby communities to reduce this illegal activity, but with limited budgets cannot deter all extraction. We develop a game theoretic model of a forest manager's decision interacting with the extraction decisions of insiders and outsiders. Our analysis suggests that, depending on the relative ecological damage caused by each group, budget-constrained forest managers may reduce total forest degradation by legalizing “insider” extraction in return for local villagers' involvement in enforcement activities against outsiders.

The mediating effect of environmental and ethical behaviour on supply chain partnership decisions and management appreciation of supplier partnership risks

Green supply chain management and environmental and ethical behaviour (EEB), a major component of corporate responsibility (CR), are rapidly developing fields in research and practice. The influence and effect of EEB at the functional level, however, is under-researched. Similarly, the management of risk in the supply chain has become a practical concern for many firms. It is important that managers have a good understanding of the risks associated with supplier partnerships. This paper examines the effect of firms’ investment in EEB as part of corporate social responsibility in mediating the relationship between supply chain partnership (SCP) and management appreciation of the risk of partnering. We hypothesise that simply entering into a SCP does not facilitate an appreciation of the risk of partnering and may even hamper such awareness. However, such an appreciation of the risk is facilitated through CR’s environmental and stakeholder management ethos. The study contributes further by separating risk into distinct relational and performance components. The results of a firm-level survey confirm the mediation effect, highlighting the value to supply chain strategy and design of investing in EEB on three fronts: building internal awareness, monitoring and sharing best practice.