Understanding change in the public sector:a local authority case study

Increasingly managers in the public sector are being required to manage change, but many of the models of change which are available to them have been developed from private sector experience. There is a need to understand more about how the change process unfolds in the public sector. A case study of change in one local authority over the period 1974-87 is provided. The events surrounding housing decentralisation and the introduction of community development are considered in detail. To understand these events a twofold model of change is proposed: a short wave model which explains a change project or event; and a long wave model which considers how these projects or events might be linked together to provide a picture of an organisation over a longer period. The short wave model identifies multiple triggers of change and signals the importance of mediators in recognising these triggers. The extent to which new ideas are implemented and the pace of their adoption is influenced by the balance of power within the organisation and the political tactics which are used. Broad phases in the change process can be identified, but there is not a simple linear passage through these. The long wave model considers the way in which continuity and change feed off one another. It suggests that periods of relative stability may be interspersed with more radical transformations as the dominant paradigm guiding the organisation shifts. However, such paradigmatic shifts in local government may be less obvious than in the private sector due to the diverse nature of the former.

Are lipid ratios less susceptible to change with systemic inflammation than individual lipid components in patients with rheumatoid arthritis?

Rheumatoid arthritis (RA) associates with excess cardiovascular risk and there is a need to assess that risk. However, individual lipid levels may be influenced by disease activity and drug use, whereas lipid ratios may be more robust. A cross-sectional cohort of 400 consecutive patients was used to establish factors that influenced individual lipid levels and lipid ratios in RA, using multiple regression models. A further longitudinal cohort of 550 patients with RA was used to confirm these findings, using generalized estimating equations. Cross-sectionally, higher C-reactive protein (CRP) levels correlated with lower levels of total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), and high-density lipoprotein-cholesterol ([HDL-C] P = .015), whereas lipid ratios did not correlate with CRP. The findings were broadly replicated in the longitudinal data. In summary, the effects of inflammation on individual lipid levels may underestimate lipid-associated cardiovascular disease (CVD) risk in RA, thus lipid ratios may be more appropriate for CVD risk stratification in RA.

"Ignorance was bliss, now I'm ignorant and that is far more difficult":transdisciplinary learning and reflexivity in responsible management education

Purpose – The collapse of world economic systems brought the interconnectedness between business and global events sharply into focus. As Starkey points out: “leading business schools need to overcome their fascination with a particular form of finance and economics […] to broaden their intellectual horizons […] (and to) look at the lessons of history and other disciplines”. The purpose of this paper is to provide evidence from three years of research on the Aston MBA suggesting that an emphasis on developing capabilities within a far broader, connected and reflexive business curriculum is what business students and practitioners now recognise as an essential way forward for responsible management education. Design/methodology/approach – This research paper examines the reflective accounts of 300 MBA students undertaking a transdisciplinary Business Ethics, Responsibility and Sustainability core module. Findings – As Klein argues, transdisciplinarity is simultaneously an attitude and a form of action. The student reflections provide powerful discourses of individual learning and report a range of outcomes from finding “the vocabulary or the confidence” to raise issues to acting as “change agents” in the workplace. Originality/value – As responsibility and sustainability requires learners, researchers and educators to engage with real world complexity, uncertainty and risk, conventional disciplinary study, especially within business, often proves inadequate and partial. This paper demonstrates that creative and exploratory frames need to be developed to facilitate the development of more connected knowledge – informed by multiple stakeholders, able to contribute heterogeneous skills, perspectives and expertise.

Large scale organisational intervention to improve patient safety in four UK hospitals:mixed method evaluation

Objectives: To conduct an independent evaluation of the first phase of the Health Foundation's Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design: Mixed method evaluation involving five substudies, before and after design. Setting: NHS hospitals in United Kingdom. Participants: Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention: The SPI1 was a compound (multicomponent) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results: Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration - monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items) - there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for "difference in difference" 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from17%(63) to13%(49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening.

An investigation of management accounting control systems in the palm oil industry:a sociomaterial approach to practice change

The primary aim of this research is to understand what constitutes management accounting and control (MACs) practice and how these control processes are implicated in the day to day work practices and operations of the organisation. It also examines the changes that happen in MACs practices over time as multiple actors within organisational settings interact with each other. I adopt a distinctive practice theory approach (i.e. sociomateriality) and the concept of imbrication in this research to show that MACs practices emerge from the entanglement between human/social agency and material/technological agency within an organisation. Changes in the pattern of MACs practices happens in imbrication processes which are produced as the two agencies entangle. The theoretical approach employed in this research offers an interesting and valuable lens which seeks to reveal the depth of these interactions and uncover the way in which the social and material imbricate. The theoretical framework helps to reveal how these constructions impact on and produce modifications of MACs practices. The exploration of the control practices at different hierarchical levels (i.e. from the operational to middle management and senior level management) using the concept of imbrication process also maps the dynamic flow of controls from operational to top management and vice versa in the organisation. The empirical data which is the focus of this research has been gathered from a case study of an organisation involved in a large vertically integrated palm oil industry company in Malaysia specifically the refinery sector. The palm oil industry is a significant industry in Malaysia as it contributed an average of 4.5% of Malaysian Gross Domestic Product, over the period 1990 -2010. The Malaysian palm oil industry also has a significant presence in global food oil supply where it contributed 26% of the total oils and fats global trade in 2010. The case organisation is a significant contributor to the Malaysian palm oil industry. The research access has provided an interesting opportunity to explore the interactions between different groups of people and material/technology in a relatively heavy process food industry setting. My research examines how these interactions shape and are shaped by control practices in a dynamic cycle of imbrications over both short and medium time periods.

The 'law of requisite variety' may assist climate change negotiations:a review of the Kyoto and Durban meetings

Ashby wrote about cybernetics, during which discourse he described a Law that attempts to resolve difficulties arising in complex situations – he suggested using variety to combat complexity. In this paper, we note that the delegates to the UN Framework Convention on Climate Change (UNFCCC) meeting in Kyoto, 1997, were offered a ‘simplifying solution’ to cope with the complexity of discussing multiple pollutants allegedly contributing to ‘climate change’. We assert that the adoption of CO2eq has resulted in imprecise thinking regarding the ‘carbon footprint’ – that is, ‘CO2’ – to the exclusion of other pollutants. We propose, as Ashby might have done, that the CO2eq and other factors within the ‘climate change’ negotiations be disaggregated to allow careful and specific individual solutions to be agreed on each factor. We propose a new permanent and transparent ‘action group’ be in charge of agenda setting and to manage the messy annual meetings. This body would be responsible for achieving accords at these annual meetings, rather than forcing this task on national hosts. We acknowledge the task is daunting and we recommend moving on from Ashby's Law to Beer's Viable Systems approach.

Defining response to anti-VEGF therapies in neovascular AMD

The introduction of anti-vascular endothelial growth factor (anti-VEGF) has made significant impact on the reduction of the visual loss due to neovascular age-related macular degeneration (n-AMD). There are significant inter-individual differences in response to an anti-VEGF agent, made more complex by the availability of multiple anti-VEGF agents with different molecular configurations. The response to anti-VEGF therapy have been found to be dependent on a variety of factors including patient’s age, lesion characteristics, lesion duration, baseline visual acuity (VA) and the presence of particular genotype risk alleles. Furthermore, a proportion of eyes with n-AMD show a decline in acuity or morphology, despite therapy or require very frequent re-treatment. There is currently no consensus as to how to classify optimal response, or lack of it, with these therapies. There is, in particular, confusion over terms such as ‘responder status’ after treatment for n-AMD, ‘tachyphylaxis’ and ‘recalcitrant’ n-AMD. This document aims to provide a consensus on definition/categorisation of the response of n-AMD to anti-VEGF therapies and on the time points at which response to treatment should be determined. Primary response is best determined at 1 month following the last initiation dose, while maintained treatment (secondary) response is determined any time after the 4th visit. In a particular eye, secondary responses do not mirror and cannot be predicted from that in the primary phase. Morphological and functional responses to anti-VEGF treatments, do not necessarily correlate, and may be dissociated in an individual eye. Furthermore, there is a ceiling effect that can negate the currently used functional metrics such as >5 letters improvement when the baseline VA is good (ETDRS>70 letters). It is therefore important to use a combination of both the parameters in determining the response.The following are proposed definitions: optimal (good) response is defined as when there is resolution of fluid (intraretinal fluid; IRF, subretinal fluid; SRF and retinal thickening), and/or improvement of >5 letters, subject to the ceiling effect of good starting VA. Poor response is defined as <25% reduction from the baseline in the central retinal thickness (CRT), with persistent or new IRF, SRF or minimal or change in VA (that is, change in VA of 0+4 letters). Non-response is defined as an increase in fluid (IRF, SRF and CRT), or increasing haemorrhage compared with the baseline and/or loss of >5 letters compared with the baseline or best corrected vision subsequently. Poor or non-response to anti-VEGF may be due to clinical factors including suboptimal dosing than that required by a particular patient, increased dosing intervals, treatment initiation when disease is already at an advanced or chronic stage), cellular mechanisms, lesion type, genetic variation and potential tachyphylaxis); non-clinical factors including poor access to clinics or delayed appointments may also result in poor treatment outcomes. In eyes classified as good responders, treatment should be continued with the same agent when disease activity is present or reactivation occurs following temporary dose holding. In eyes that show partial response, treatment may be continued, although re-evaluation with further imaging may be required to exclude confounding factors. Where there is persistent, unchanging accumulated fluid following three consecutive injections at monthly intervals, treatment may be withheld temporarily, but recommenced with the same or alternative anti-VEGF if the fluid subsequently increases (lesion considered active). Poor or non-response to anti-VEGF treatments requires re-evaluation of diagnosis and if necessary switch to alternative therapies including other anti-VEGF agents and/or with photodynamic therapy (PDT). Idiopathic polypoidal choroidopathy may require treatment with PDT monotherapy or combination with anti-VEGF. A committee comprised of retinal specialists with experience of managing patients with n-AMD similar to that which developed the Royal College of Ophthalmologists Guidelines to Ranibizumab was assembled. Individual aspects of the guidelines were proposed by the committee lead (WMA) based on relevant reference to published evidence base following a search of Medline and circulated to all committee members for discussion before approval or modification. Each draft was modified according to feedback from committee members until unanimous approval was obtained in the final draft. A system for categorising the range of responsiveness of n-AMD lesions to anti-VEGF therapy is proposed. The proposal is based primarily on morphological criteria but functional criteria have been included. Recommendations have been made on when to consider discontinuation of therapy either because of success or futility. These guidelines should help clinical decision-making and may prevent over and/or undertreatment with anti-VEGF therapy.

Plasma membrane abundance of human aquaporin 5 is dynamically regulated by multiple pathways

Aquaporin membrane protein channels mediate cellular water flow. Human aquaporin 5 (AQP5) is highly expressed in the respiratory system and secretory glands where it facilitates the osmotically-driven generation of pulmonary secretions, saliva, sweat and tears. Dysfunctional trafficking of AQP5 has been implicated in several human disease states, including Sjögren’s syndrome, bronchitis and cystic fibrosis. In order to investigate how the plasma membrane expression levels of AQP5 are regulated, we studied real-time translocation of GFP-tagged AQP5 in HEK293 cells. We show that AQP5 plasma membrane abundance in transfected HEK293 cells is rapidly and reversibly regulated by at least three independent mechanisms involving phosphorylation at Ser156, protein kinase A activity and extracellular tonicity. The crystal structure of a Ser156 phosphomimetic mutant indicates that its involvement in regulating AQP5 membrane abundance is not mediated by a conformational change of the carboxy-terminus. We suggest that together these pathways regulate cellular water flow.

Large-scale data for multiple-view stereopsis

The seminal multiple-view stereo benchmark evaluations from Middlebury and by Strecha et al. have played a major role in propelling the development of multi-view stereopsis (MVS) methodology. The somewhat small size and variability of these data sets, however, limit their scope and the conclusions that can be derived from them. To facilitate further development within MVS, we here present a new and varied data set consisting of 80 scenes, seen from 49 or 64 accurate camera positions. This is accompanied by accurate structured light scans for reference and evaluation. In addition all images are taken under seven different lighting conditions. As a benchmark and to validate the use of our data set for obtaining reasonable and statistically significant findings about MVS, we have applied the three state-of-the-art MVS algorithms by Campbell et al., Furukawa et al., and Tola et al. to the data set. To do this we have extended the evaluation protocol from the Middlebury evaluation, necessitated by the more complex geometry of some of our scenes. The data set and accompanying evaluation framework are made freely available online. Based on this evaluation, we are able to observe several characteristics of state-of-the-art MVS, e.g. that there is a tradeoff between the quality of the reconstructed 3D points (accuracy) and how much of an object’s surface is captured (completeness). Also, several issues that we hypothesized would challenge MVS, such as specularities and changing lighting conditions did not pose serious problems. Our study finds that the two most pressing issues for MVS are lack of texture and meshing (forming 3D points into closed triangulated surfaces).

Price of unsustainability. Economic impacts of climate change

Global problems, rapid and massive regional changes in the 21st century call for genuine long-term, awareness, planning and well focused actions from both national governments and international organizations. This book wishes to contribute to building an innovative path of strategic views in handling the diverse challenges, and more emphatically, the economic impacts of climate change. Although the contributors of this volume represent several approaches, they all rely on some common grounds such as the costbenefit analysis of mitigation and adaptation, and on the need to present an in-depth theoretical and practical dimension. The research accounted for in this book tried to integrate and confront various types of economics approaches and methods, as well as knowledge from game theory to country surveys, from agricultural adaptation to weather bonds, from green tax to historical experience of human adaptation. The various themes and points of views do deserve the attention of the serious academic reader interested in the economics of climate change. We hope to enhance the spread of good solutions resulting from world wide disputes and tested strategic decisions. WAKE UP! It is not just the polar bears' habitat that is endangered, but the entire human form of life.

Mitigation and adaptation to climate change

Climate change produces significant social and economic impacts in most parts of the world, thus global action is needed to address climate change. In this chapter, the different possibilities of mitigation are explored from different points of view, and analyse the possibilities of adaptation to climate change. First, substantial reduction of GHG emission is needed, on the other hand adaptation action must deal with the inevitable impacts. According to the assessment of the chapter, it is essential that coordinated actions be taken at an EU level. In our argumentation, a macroeconomic model is used for the cost- benefit analysis of GHG gas emissions reduction. The GHG emission structure is analysed on European and global level. Even in the case of a successful mitigation strategy there rest the long-term effects of climate change which will need a coherent adaptation strategy to be dealt with. Although certain adaptation measures already have been taken, these initiatives are still very modest, and insufficient to deal with the economic effects of climate change properly.

Analysis of climate change scenarios based on modelling of the seasonal dynamics of a Danubian copepod species

Climate change is one of the most crucial ecological problems of our age with great influence. Seasonal dynamics of aquatic communities are — among others — regulated by the climate, especially by temperature. In this case study we attempted the simulation modelling of the seasonal dynamics of a copepod species, Cyclops vicinus, which ranks among the zooplankton community, based on a quantitative database containing ten years of data from the Danube’s Göd area. We set up a simulation model predicting the abundance of Cyclops vicinus by considering only temperature as it affects the abundance of population. The model was adapted to eight years of daily temperature data observed between 1981 and 1994 and was tested successfully with the additional data of two further years. The model was run with the data series of climate change scenarios specified for the period around 2070- 2100. On the other hand we looked for the geographically analogous areas with the Göd region which are mostly similar to the future climate of the Göd area. By means of the above-mentioned points we can get a view how the climate of the region will change by the end of the 21st century, and the way the seasonal dynamics of a chosen planktonic crustacean species may follow this change. According to our results the area of Göd will be similar to the northern region of Greece. The maximum abundance of the examined species occurs a month to one and a half months earlier, moreover larger variances are expected between years in respect of the abundance. The deviations are expected in the direction of smaller or significantly larger abundance not observed earlier.

The multiple dimensions of political trust in democratic Argentina

Why do Argentines continue to support democracy despite distrusting political institutions and politicians? Support for democracy is high even though performance of the regime is poor. One would suspect that poor economic and political performance would open the door for military intervention given the history of Argentina. What changed? What explains variance across the multiple dimensions of political trust, such as trust in the regime, trust in political institutions, and trust in politicians? This dissertation is a case study of political culture through public opinion exploring the multiple dimensions of political trust in Argentina during the 1990s. ^ Variance across the different dimensions of political trust may be an indicator of the rise of a new type of citizens called "critical citizens." Critical citizens are citizens who criticize the regime to obtain democratic reforms but support the ideals of democracy. In established democracies, the rise of critical citizens is explained by a shift in individuals' value priorities towards postmaterialism. Postmaterialism is a cultural change in the direction of values that emphasize self-realization and individual well-being. Postmaterialism influences various social and political attitudes. ^ Because Argentina is experiencing a cultural change and a rise of critical citizens similar to more advanced societies, the theory of postmaterialism generated the main hypothesis to explain the multiple dimensions of political trust. This dissertation also tested an alternative explanation: the multiple dimensions of political trust responded instead to citizens' evaluations of performance. Ultimately, postmaterialism explained trust in the political regime and trust in the political institutions. Contrary to expectations, postmaterialism did not explain trust in the political elites or politicians. Trust in politicians was better explained by the alternative hypothesis, performance. ^ The main method of research was the statistical method supplemented with the comparative method when data were available. Two main databases were used: the World Values Surveys and the Latinobarometer. ^

Examining the process of regime change in the North Atlantic Treaty Organization: The divide between rhetoric and reality

The North Atlantic Treaty Organization (NATO) is a product of the Cold War through which its members organized their military forces for the purpose of collective defense against the common threat of Soviet-backed aggression. Employing the terminology of regime theory, the creation of NATO can be viewed as the introduction of an international security regime. Throughout the Cold War, NATO member states preserved their commitment to mutual defense while increasingly engaging in activities aimed at overcoming the division of Europe and promoting regional stability. The end of the Cold War has served as the catalyst for a new period of regime change as the Alliance introduced elements of a collective security regime by expanding its mandate to address new security challenges and reorganizing both its political and military organizational structures. ^ This research involves an interpretive analysis of NATO's evolution applying ideal theoretical constructs associated with distinct approaches to regime analysis. The process of regime change is investigated over several periods throughout the history of the Alliance in an effort to understand the Alliance's changing commitment to collective security. This research involves a review of regime theory literature, consisting of an examination of primary source documentation, including official documents and treaties, as well as a review of numerous secondary sources. This review is organized around a typology of power-based, organization-based, and norm-based approaches to regime analysis. This dissertation argues that the process of regime change within NATO is best understood by examining factors associated with multiple theoretical constructs. Relevant factors provide insights into the practice of collective security among NATO member states within Europe, while accounting for the inability of the NATO allies to build on the experience gained within Europe to play a more central role in operations outside of this region. This research contributes to a greater understanding of the nature of international regimes and the process of regime change, while offering recommendations aimed at increasing NATO's viability as a source of greater security and more meaningful international cooperation.^

Climate Change and Regions at Risk: A Look at Central America

Climate change has been a security issue for mankind since Homo sapiens first emerged on the planet, driving him to find new and better food, water, shelter, and basic resources for survival and the advancement of civilization. Only recently, however, has the rate of climate change coupled with man’s knowledge of his own role in that change accelerated, perhaps profoundly, changing the security paradigm. If we take a ―decades‖ look at the security issue, we see competition for natural resources giving way to Cold War ideological containment and deterrence, itself giving way to non-state terrorism and extremism. While we continue to defend against these threats, we are faced with even greater security challenges that inextricably tie economic, food and human security together and where the flash points may not provide clearly discernable causes, as they will be intrinsically tied to climate change. Several scientific reports have revealed that the modest development gains that can be realized by some regions could be reversed by climate change. This means that climate change is not just a long-term environmental threat as was widely believed, but an economic and developmental disaster that is unfolding. As such, addressing climate change has become central to the development and poverty reduction by the World Bank and other financial institutions. In Latin America, poorer countries and communities, such as those found in Central America, will suffer the hardest because of weaker resilience and greater reliance on climatesensitive sectors such as agriculture. The US should attempt to deliver capability to assist these states to deal with the effects of climate change.