A comparison of the equity-supportiveness of organizational cultures of (public) NHS organizations and (private) Social Enterprise (SE) providers

Title: A Comparison of the Equity-supportiveness of Organizational Cultures of (Public) NHS Organizations and (Private) Social Enterprise (SE) Providers Theory: New Public Management (NPM) has been the most influential paradigm in public administration in the last three decades. NPM-driven ideas such as provider competition, privatisation and patient choice have resulted in increased interest from recent UK governments in Social Enterprises (SEs) for delivering public health services. NPM-based changes have been criticized for creating inequitable provision of healthcare and increasing unjust health inequalities. It is worth asking whether equity for patients is promoted equally effectively by public (NHS) organizations and SE providers. Research Aims and Methodology: A mixed methods approach was employed. The quantitative strand used a survey to compare the equity-supportiveness of NHS and SE organizational cultures [124 respondents (68 NHS and 56 SE staff) from 21 organizations (12 NHS and 9 SEs)]. The qualitative strand used semi-structured interviews with 27 SE staff members to examine organizational changes in SEs and the impact of these changes on equity in service provision. Findings: By achieving better alignment with organizational values, reducing bureaucracy, speeding up decision-making, giving staff more autonomy and responsibility, encouraging initiative, risk-taking and innovation, involving staff more actively in strategic decision-making, and making better use of technology, Social Enterprises are promoting equity to an equal or greater degree than public (NHS) organizations. Implications: However, the SE model (currently limited to community healthcare services) remains unclear and problematic, suggesting caution in its use by larger NHS acute Trusts. More research is needed before a policy to support the adoption of the SE model in public service delivery is mainstreamed

Rourkela steel plant automation:A case study

n order to improve product quality, reduce cost, increase customer satisfaction and to sustain the global competition, automation in the existing infrastructure of the steel industry is essential. After liberalization started in the steel sector in India, a large number of steel plants have come up with most advanced technology. In this paper automation process in Integrated material management system (IMMS), Electronic Procurement system (EPS), Product Planning and Control System (PPCS) are discussed and possibility of implementation of ERP and GPS based transportation system is discussed for automation

An optimization program based on the method of feasible directions: Theory and users guide

The theory and user instructions for an optimization code based on the method of feasible directions are presented. The code was written for wide distribution and ease of attachment to other simulation software. Although the theory of the method of feasible direction was developed in the 1960's, many considerations are involved in its actual implementation as a computer code. Included in the code are a number of features to improve robustness in optimization. The search direction is obtained by solving a quadratic program using an interior method based on Karmarkar's algorithm. The theory is discussed focusing on the important and often overlooked role played by the various parameters guiding the iterations within the program. Also discussed is a robust approach for handling infeasible starting points. The code was validated by solving a variety of structural optimization test problems that have known solutions obtained by other optimization codes. It has been observed that this code is robust: it has solved a variety of problems from different starting points. However, the code is inefficient in that it takes considerable CPU time as compared with certain other available codes. Further work is required to improve its efficiency while retaining its robustness

Therapeutic plasma exchange in acute fatty liver of pregnancy: a case report and literature review

Acute fatty liver of pregnancy(AFLP) is characterised by acute liver failure that occurs most commonly in the third trimester of pregnancy. Emergent delivery of the foetus reverses liver failure in most cases. Rarely, termination of pregnancy may not reverse liver failure, and adjunct interventions may be required. Therapeutic plasma exchange (TPE) has been described in AFLP in very few reports. We describe a patient in whom liver failure and extrahepatic organ failure persisted four days after delivery. She underwent TPE for persistent liver failure which resulted in prompt clinical improvement. We propose that TPE be considered as a measure to salvage AFLP patients with liver failure that does not reverse after termination of pregnancy

Relational approaches to poverty in rural India: social, ecological and technical dynamics

Poverty is now widely recognised as multidimensional, with indicators including healthcare, housing and sanitation. Yet, relational approaches that foreground political-cultural processes remain marginalised in policy discourses. Focusing on India, we review a wide range of relational approaches to rural poverty. Beginning with early approaches that focus on structural reproduction of class, caste and to a lesser extent gender inequality, we examine new relational approaches developed in the last two decades. The new approaches examine diverse ways in which poverty is experienced and shapes mobilisations against deprivation. They draw attention to poor people’s own articulations of deprivation and alternate conceptions of well-being. They also show how intersecting inequalities of class, caste and gender shape governance practices and political movements. Despite these important contributions, the new relational approaches pay limited attention to technologies and ecologies in shaping the experience of poverty. Reviewing studies on the Green Revolution and wider agrarian transformations in India, we then sketch the outlines of a hybrid relational approach to poverty that combines socio-technical and -ecological dynamics. We argue that such an approach is crucial to challenge narrow economising discourses on poverty and to bridge the policy silos of poverty alleviation and (environmentally) sustainable development

Subarachnoid hemorrhage in pituitary tumor

Subarachnoid hemorrhage (SAH) is the bleeding into the subarachnoid space containing cerebrospinal fluid. The most common cause of SAH is trauma. Rupture of aneurysms, vascular anomalies, tumor bleeds and hypertension are other important etiologies. SAH in the setting of pituitary tumor can result from various causes. It can be due to intrinsic tumor related pathology, injury to surrounding the vessel during the operative procedure or due to an associated aneurysm. We discuss the pathological mechanisms and review relevant literature related to this interesting phenomenon. Early and accurate diagnosis of the cause of the SAH in pituitary tumors is important, as this influences the management

Role of gamma knife radiosurgery in craniopharyngioma

Craniopharyngiomas continue to be a challenge to manage, due to difficulty in complete excision and frequent recurrences. The management protocol remains controversial. They have a tendency to invade the normal brain tissues around them and due to their position in suprasellar region in close relationship with vital structures like optic apparatus, pituitary-hypothalamic axis, complete removal is often not feasible without causing serious morbidity and mortality. In this scenario, sub-total excision seems to be a better alternative, which is plagued by early and frequent recurrences. Radiotherapy has been used for increasing the progression free survival and to improve the overall quality of life. Recently Gamma knife radiosurgery has evolved as a promising technique of radiating the residual or recurrent tumor in a single session with great accuracy and precision. This helps in maximizing the radiation dose to the tumor with steep dose fall off to the surrounding tissue, and hence there is better control of the tumor and minimal radiation exposure to surrounding normal, vital brain tissues. We discuss the current strategies of Gamma knife treatment for craniopharyngioma and review the literature

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