Interorganisational collaboration in the public sector

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.The research applies the contextual context, content, and process (CCP) framework to explore the contextual and processual factors that are associated with implementing interorganisational collaborative arrangements in the public sector. Collaborative arrangements in the public sector are found to be complex, difficult to implement, and liable to failure when not fully explored and recognised. Background theory reveals the absence of a multilevel lens that can embrace the multifaceted nature of interorganisational collaborations, the multiple contextual levels, the process stages and micro-actions, and the interplay between the process and the context. By identifying the need to explore contextual and processual factors, the background theory informs the focal theory which proposes an extended CCP framework as a useful multilevel lens to elucidate the research problem. The framework is developed and validated through multidisciplinary literature synthesisation, the pilot stage, and the main fieldwork which applies qualitative methods based on multiple case studies from the public sector in Oman as data sources’ techniques. The originality of this study stemming from developing and validating a novel multilevel contextual framework. The emerged multifaceted CCP framework, used to explore contextual and processual factors when implementing collaborative arrangements in the public sector, is found to be an applicable, feasible, and useful analysis tool. It can help public policy-makers, public management, academics, change agents, and collaborating organisations in identifying the inhibitive, supportive prerequisites, and in general influencing contextual factors. It helps also in elucidating and minimising uncertainty about the nature and micro-actions of the processual stages

Assessment of Groundwater Resources in Selected Areas of Al Ain in the U.A.E.

The sustainable development of any region depends on the availability of water resources. In arid and semi-arid regions, the shortage in freshwater resources constitutes the major constraint against the expansion in agricultural and industrial activities. Therefore, every possible effort should be made to assess, develop and sustain the limited freshwater water resource in such regions. The United Arab Emirates (UAE) is located in an arid region, where the climate is harsh and the renewable freshwater resources are very limited. Despite the severe shortage in water resources, water is misused and sometimes wasted. The per capita daily consumption in the UAE is estimated at 700 l/d which is among the highest consumptions in the world including those countries with excess water resources. On the other hand, the country has experienced a rapid development over the last three decades. Vast areas have been cultivated and green belts have been created around cities and along the highways. Many new industries were established in the different Emirates. As a result, the water demands to meet the rapid development in the different sectors have increased considerably during the same period. This increase in demand was partially covered by the expansion in the development of desalination water. Nevertheless, the groundwater resources have been overexploited for agricultural purpose. Many private farms were developed and hundreds of pumping wells were constructed. Records indicate that groundwater resources are currently under the risk of possible depletion not only because of the excessive pumping but also due to the limited recharge from rainfall. This study presents a comprehensive analysis of the groundwater resources in some selected areas in Al Ain. The study area included Al Hayer, Gummed, Nahil and part of Al Khadar. Previous reports, information and data were critically reviewed and discussed. The hydrogeological setting and main hydrogeological parameters for the study area were reviewed. Available records for the groundwater levels were analyzed and contour maps were developed for the equipotential lines depth to groundwater and drawdown in the different years. These maps were compared to provide a better understanding for the groundwater system and the flow pattern in the study area. As compared to the records of 1991, the maximum drawdown in the groundwater levels was about 17 m at the central part of the study area. On the other hand, contour maps were developed to assess the change in the water quality over the last two decades. It is concluded that the change in the groundwater quality is limited and it can be used for unrestricted irrigation purposes. A two-dimensional finite-element model (SUTRA) was employed to simulate the groundwater condition is the study domain. Argus-One was used as pre-processor and post-processor for SUTRA. The model was calibrated for the groundwater measurements of the year 2001 and was then used to predict the groundwater levels for the year 2010 assuming the same pumping rates. The expected decline in the groundwater levels within the study domain varied between 5 m near the boundaries and 9.5 m at the central part. Due to the limited availability of data, the results of the model should be regarded as qualitative rather than quantitative. Finally, recommendations were proposed to protect and sustain the groundwater resources

Antiplatelet Agent Use After Stroke due to Intracerebral Hemorrhage

This focused update about antiplatelet agents to reduce the high risk of major adverse cardiovascular events after stroke due to spontaneous (nontraumatic) intracerebral hemorrhage (ICH) complements earlier updates about blood pressure-lowering, lipid-lowering, and oral anticoagulation or left atrial appendage occlusion for atrial fibrillation after ICH. When used for secondary prevention in people without ICH, antiplatelet agents reduce the risk of major adverse cardiovascular event (rate ratio, 0.81 [95% CI, 0.75-0.87]) and might increase the risk of ICH (rate ratio, 1.67 [95% CI, 0.97-2.90]). Before 2019, guidance for clinical decisions about antiplatelet agent use after ICH has focused on estimating patients' predicted absolute risks and severities of ischemic and hemorrhagic major adverse cardiovascular event and applying the known effects of these drugs in people without ICH to estimate whether individual ICH survivors in clinical practice might be helped or harmed by antiplatelet agents. In 2019, the main results of the RESTART (Restart or Stop Antithrombotics Randomized Trial) randomized controlled trial including 537 survivors of ICH associated with antithrombotic drug use showed, counterintuitively, that antiplatelet agents might not increase the risk of recurrent ICH compared to antiplatelet agent avoidance over 2 years of follow-up (12/268 [4%] versus 23/268 [9%]; adjusted hazard ratio, 0.51 [95% CI, 0.25-1.03]; P=0.060). Guidelines in the United States, Canada, China, and the United Kingdom and Ireland have classified the level of evidence as B and indicated that antiplatelet agents may be considered/reasonable after ICH associated with antithrombotic agent use. Three subsequent clinical trials have recruited another 174 participants with ICH, but they will not be sufficient to determine the effects of antiplatelet therapy on all major adverse cardiovascular events reliably when pooled with RESTART. Therefore, ASPIRING (Antiplatelet Secondary Prevention International Randomized Study After Intracerebral Hemorrhage) aims to recruit 4148 ICH survivors to determine the effects of antiplatelet agents after ICH definitively overall and in subgroups. </p

The epidemiology of brain arteriovenous malformations in adults

Arteriovenous malformations (AVMs) of the brain are part of the spectrum of intracranial vascular malformations (IVMs). They are the leading cause of intracerebral haemorrhage in young adults, they account for ~10% of non-traumatic subarachnoid haemorrhage, and they also cause epilepsy. Not only are affected individuals subject to the initial consequences of these events, but there are substantial risks of recurrent haemorrhage and epilepsy, and long-term disability. For a disorder discovered as long ago as the mid-nineteenth century, surprisingly little is known about it. In this thesis, I begin by systematically reviewing the sizeable medical literature about brain AVM frequency, presentation, clinical course and prognosis. I did not find a single prospective, truly population-based study, which is why I set up the Scottish Intracranial Vascular Malformation Study (SIVMS) with the multidisciplinary collaboration of the four clinical neuroscience centres in Scotland. SIVMS aspires to meet the standards of the ideal study of frequency and prognosis, by using multiple, overlapping sources of case ascertainment to prospectively recruit a population based inception cohort of adults, with explicit diagnostic criteria and outcome definitions for events which are validated by independent review. During 1999-2000, 96 adults (of whom 92 were definite) were detected with a first-in-a-lifetime diagnosis of a brain AVM in Scotland. Quality of baseline demographic, clinical and basic morphological data was excellent, although detailed variables about angioarchitecture were less complete, partly because only three-quarters of patients underwent catheter angiography. The cohort was distributed in proportion to the dispersion of the Scottish population, and standardised incidence ratios were not significantly different between healthboards. The sensitivity of ICD-10 coding of brain AVMs in hospital discharge data was 72% (95%CI 61% to 80%), and its positive predictive value was 46% (95%CI 38% to 55%). Reliance on hospital discharge data for case ascertainment or a requirement for catheter angiography to make the diagnosis would have biased the cohort. Furthermore, I found that expert neuroradiologists’ assessment of AVM angioarchitecture on catheter angiography was characterised by greater intra-observer than inter-observer agreement (which ranged from less than chance for e.g. ‘angiogenesis’ to almost perfect for e.g. nidus size). In a survey with multiple, overlapping sources of ascertainment confined to the Lothian healthboard region of Scotland, using capture-recapture analysis, I found the point prevalence of brain AVMs to be 18 (95%CI 16 to 24) per 100,000 adults. In SIVMS, the crude incidence of brain AVMs in Scotland in 1999 and 2000 was 1.1 (95%CI 0.9 to 1.4) per 100,000 adults per year. Of the incident adults, 53% were male and their median age at presentation was 45 years (range 16 to 81); one fifth were incidental discoveries and four fifths were symptomatic (presentation was with intracranial haemorrhage in 59%, one or more seizure(s) in 34%, and focal neurological deficits in 7%). 9% of cases were pure arteriovenous fistulae, 75% were lobar in location, 53% were superficial, and 22% had associated aneurysms. There appeared to be significant differences between SIVMS and well-established hospital-based cohorts. Having established brain AVM prevalence, incidence and the characteristics of presenting adults, the next stage for this work is to describe prognosis for this enlarging population-based cohort. The data are being collected, the hurdles of ethical approval have been negotiated, although the direction in which privacy legislation and confidentiality guidance are heading will make this a challenging task

Interorganisational collaboration in the public sector

The research applies the contextual context, content, and process (CCP) framework to explore the contextual and processual factors that are associated with implementing interorganisational collaborative arrangements in the public sector. Collaborative arrangements in the public sector are found to be complex, difficult to implement, and liable to failure when not fully explored and recognised. Background theory reveals the absence of a multilevel lens that can embrace the multifaceted nature of interorganisational collaborations, the multiple contextual levels, the process stages and micro-actions, and the interplay between the process and the context. By identifying the need to explore contextual and processual factors, the background theory informs the focal theory which proposes an extended CCP framework as a useful multilevel lens to elucidate the research problem. The framework is developed and validated through multidisciplinary literature synthesisation, the pilot stage, and the main fieldwork which applies qualitative methods based on multiple case studies from the public sector in Oman as data sources’ techniques. The originality of this study stemming from developing and validating a novel multilevel contextual framework. The emerged multifaceted CCP framework, used to explore contextual and processual factors when implementing collaborative arrangements in the public sector, is found to be an applicable, feasible, and useful analysis tool. It can help public policy-makers, public management, academics, change agents, and collaborating organisations in identifying the inhibitive, supportive prerequisites, and in general influencing contextual factors. It helps also in elucidating and minimising uncertainty about the nature and micro-actions of the processual stages.EThOS - Electronic Theses Online ServiceGBUnited Kingdo