831 resultados para Private hospitals


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The technique of linear responsibility analysis is used for a retrospective case study of a private industrial development consisting of an extension to existing buildings to provide a warehouse, services block and packing line. The organizational structure adopted on the project is analysed using concepts from systems theory which are included in Walker's theoretical model of the structure of building project organizations (Walker, 1981). This model proposes that the process of building provision can be viewed as systems and subsystems which are differentiated from each other at decision points. Further to this, the subsystems can be viewed as the interaction of managing system and operating system. Using Walker's model, a systematic analysis of the relationships between the contributors gives a quantitative assessment of the efficacy of the organizational structure used. The causes of the client's dissatisfaction with the outcome of the project were lack of integration and complexity of the managing system. However, there was a high level of satisfaction with the completed project and this is reflected by the way in which the organization structure corresponded to the model's propositions.

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This paper describes the results of field research to dissect how social interactions differ between two reserves in Paraguay having very different styles of governance. The two reserves were Mbaracayu Natural Forest Reserve (Reserva Natural del Bosque de Mbaracayti, RNBM) and San Rafael Managed Resource Reserve (Reserva de Recursos Manejados San Rafael, RRMSR). RNBM is a private reserve owned by a non-governmental organisation. while RRNISR is a publicly-managed reserve, albeit with a substantial degree of private land ownership. Both reserves are intended to protect Atlantic Forest, one of the five world biodiversity 'hotspots', and also one of the most highly threatened. Each reserve and its buffer zone comprises a set of stakeholders, including indigenous communities and farmers, and the paper explores the interactions between these and the management regime. Indeed, while the management regimes of the two reserves are different, one being highly top-down (RNBM) and the other more socially inclusive (RRMSR), the issues that they have to deal with are much the same. However, while both management regimes will readily acknowledge the need to address poverty, inequality appears to be a far more sensitive issue. Whereas this may be expected for the privately-owned RNBM it is perhaps more surprising in RRNISR even when allowing for the fact that much of the land in the latter is in private hands. It is argued that the origins of this sensitivity rest within the broader features of Paraguayan society, and the prevalence of private land ownership. Yet ironically, it is the inequality in land ownership that is perhaps the most significant threat to conservation in both reserves. Therefore, while reserve-level analyses can provide some insight into the driving forces at play in the interaction between conservation and sustainable management, larger scales may be necessary to gain a fuller appreciation of the dynamics operating at site level. Even in a society with a history of centralised control these dynamics may be surprising. (c) 2005 Elsevier Ltd. All rights reserved.

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The private sector, after shifting fortunes in development theory and practice over the years, is now widely recognised as the key to economic growth, which itself is indispensable for poverty reduction. The Development Studies Association (DSA) Annual Conference in 2006 brought together academics, private sector actors, NGOs and policy makers to share insights and experiences on how this vital contribution to growth, development and poverty reduction can be realised. This paper summarises the main themes and discussions of the conference and introduces the papers selected for inclusion in this conference issue.

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The paper examines how European retailers are using private standards for food safety and,quality as risk management and competitive tools and the strategic responses of leading Kenyan and other developing country supplier/exporters to such standards. Despite measures to harmonize a 'single market', the European fresh produce market is very diverse in terms of consumer preferences, structural dynamics and attention to and enforcement of food safety and other standards. Leading Kenyan fresh produce suppliers have re-positioned themselves at the high end, including 'high care', segments of the market - precisely those that are most demanding in terms of quality assurance and food safety systems. An array of factors have influenced this strategic positioning, including relatively high international freight costs, the emergence of more effective competition in mainstream product lines, relatively low labor costs for produce preparation, and strong market relationships with selected retail chains. To succeed in this demanding market segment, the industry has had to invest substantially in improved production and procurement systems, upgraded pack house facilities, and quality assurance/food safety management systems. (C) 2005 Elsevier Ltd. All rights reserved.

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Many developing countries are currently engaged in designing and implementing plant variety protection systems. Encouraging private investment in plant breeding is the key rationale for extending intellectual property rights to plant varieties. However, the design of plant variety protection systems in developing countries has been dominated by concerns regarding the inequities of a plant variety protection system, especially the imbalance in the reward structure between plant breeders and farmers. The private seed industry, a key stakeholder in plant variety protection, appears to be playing only a peripheral role in the design of the intellectual property rights regime. This paper explores the potential response of the private seed industry in India to plant variety protection legislation based on a survey of major plant breeding companies. The survey finds that the private seed industry in India is generally unenthusiastic about the legislation and plant variety protection is likely to have only a very limited impact on their research profile and expenditures on plant breeding. Measures designed to curb the 'excessive' profits of breeders, farmers' rights provisions and poor prospects for enforcement of rights are seen to be seriously diluting breeders' rights, leaving few incentives for innovation. If the fundamental objective of plant variety protection is to stimulate private investment in plant breeding, then developing countries need to seriously address the question of improving appropriability of returns from investment.

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Accompanying the call for increased evidence-based policy the developed world is implementing more longitudinal panel studies which periodically gather information about the same people over a number of years. Panel studies distinguish between transitory and persistent states (e.g. poverty, unemployment) and facilitate causal explanations of relationships between variables. However, they are complex and costly. A growing number of developing countries are now implementing or considering starting panel studies. The objectives of this paper are to identify challenges that arise in panel studies, and to give examples of how these have been addressed in resource-constrained environments. The main issues considered are: the development of a conceptual framework which links macro and micro contexts; sampling the cohort in a cost-effective way; tracking individuals; ethics and data management and analysis. Panel studies require long term funding, a stable institution and an acceptance that there will be limited value for money in terms of results from early stages, with greater benefits accumulating in the study's mature years. Copyright © 2003 John Wiley & Sons, Ltd.

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OBJECTIVES: To evaluate the evidence for strategies to prevent falls or fractures in residents in care homes and hospital inpatients and to investigate the effect of dementia and cognitive impairment. DESIGN: Systematic review and meta-analyses of studies grouped by intervention and setting (hospital or care home). Meta-regression to investigate the effects of dementia and of study quality and design. DATA SOURCES: Medline, CINAHL, Embase, PsychInfo, Cochrane Database, Clinical Trials Register, and hand searching of references from reviews and guidelines to January 2005. RESULTS: 1207 references were identified, including 115 systematic reviews, expert reviews, or guidelines. Of the 92 full papers inspected, 43 were included. Meta-analysis for multifaceted interventions in hospital (13 studies) showed a rate ratio of 0.82 (95% confidence interval 0.68 to 0.997) for falls but no significant effect on the number of fallers or fractures. For hip protectors in care homes (11 studies) the rate ratio for hip fractures was 0.67 (0.46 to 0.98), but there was no significant effect on falls and not enough studies on fallers. For all other interventions (multifaceted interventions in care homes; removal of physical restraints in either setting; fall alarm devices in either setting; exercise in care homes; calcium/vitamin D in care homes; changes in the physical environment in either setting; medication review in hospital) meta-analysis was either unsuitable because of insufficient studies or showed no significant effect on falls, fallers, or fractures, despite strongly positive results in some individual studies. Meta-regression showed no significant association between effect size and prevalence of dementia or cognitive impairment. CONCLUSION: There is some evidence that multifaceted interventions in hospital reduce the number of falls and that use of hip protectors in care homes prevents hip fractures. There is insufficient evidence, however, for the effectiveness of other single interventions in hospitals or care homes or multifaceted interventions in care homes.

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Since the first PFI hospital was established in 1994, many debates centred on the value for money and risk transfer in PFIs. Little concern is shown with PFI hospitals’ performance in delivering healthcare. Exploratory research was carried out to compare PFI with non‐PFI hospital performance. Five performance indicators were analysed to compare differences between PFI and non‐PFI hospitals, namely the length of waiting, the length of stay, MRSA infection rate, C difficile infection rate and patient experience. Data was collected from various government bodies. The results show that only some indexes measuring patient experience emerge statistically significant. This leads to a conclusion that PFI hospitals may not perform better than non‐PFI hospitals but they are not worse than non‐PFI hospitals in the delivery of services. However, future research needs to pay attention to reliability and validity of data sets currently available to undertake comparison.