Search results

Millions of people die of chronic diseases within inpatient settings annually in the United States, despite patient preferences for dying at home. This medicalization of dying has received social and economic critiques for decades. This chapter offers a further analysis to these critiques by examining the ecological impacts of inpatient end-of-life care on the natural environment and occupational and public health.

We compare the ecological health outcomes of medical care in three inpatient units (conventional cancer unit, palliative care ward, and hospice facility) using ethnographic observations, semi-structured interviews, and institutional records on medical supply use, waste generation, and pharmaceutical administration and disposal.

Care provided on all three medical units had significant socioecological impacts. Cumulative impacts were greatest on the conventional unit, followed by palliative care, and lowest on the hospice unit. Variations in impacts mirrored differences in dependence on material interventions, which arose from variations in patient needs, institutional policies, and nursing cultures between the three units.

Social and economic concerns have been major drivers in reforming end-of-life medical care, and our analysis shows that ecological concerns must also be considered. Transitioning terminal patients to less materially intensive modes of care when appropriate could mitigate ecological health impacts while honoring patient preferences.

This chapter describes how the medicalization of dying has converged with institutional policies, practices, and actors to increase the negative consequences of medical care, and recognizes that the far-reaching impacts of clinical decisions make the provision of medical care a socioecological act.

This paper seeks to provide an overview of the concept of “localization” of human resources in Qatar. Relative to the rest of the Gulf Cooperation Council countries (GCCCs), economic development began late in Qatar due to political and economic factors such as the influx of an immigrant labour force and changes in the education system. Now, with one of the fastest growing economies in the world, and the highest per capita income, Qatar has vigorously embraced rapid economic expansion. However, in a small country awash with natural resources, and with a population engulfed by expatriates, the issue of “localization” is a pressing economic and social issue.

This paper reviews the national human resource situation in this atypical context, and seeks to determine the factors that impact on “localization” in this small, yet important Gulf nation.

There are some common barriers to “localization” throughout the GCCCs. These can be summarized as: an inefficient quota system; a culture that is focused more on prestige than performance; strict cultural practices concerning women in the workforce; education systems that are not market driven; and an inequitable social contract and distribution of oil and natural gas wealth in the GCCCs.

While much attention has been directed to the concept of “localization” in developing countries, “Qatarization” has received no attention in the scholarly literature, despite the resounding political and economic role that Qatar has in the GCCCs.

Since the early 1980s, breakaway training has been synonymous with many prevention and management of violence and aggression (PMVA) training programmes in social care and NHS settings. However, for almost three decades, this community has continued to accept a training approach that has been largely unsupported by a robust underpinning methodology or evidence base. The validity of this historical training approach will be examined in context with the available literature, and will seek to identify the fundamental flaws that have been inherent in the traditional system. This paper will conclude by making some practical suggestions on how the efficacy of personal protective training may be improved, based on the emerging findings from other scientific fields.

This paper aims to examine the nature and prevalence of violence in a medium secure unit and to evaluate a personal defence training programme for staff working with mentally disordered offenders.

The paper identifies an existing training gap associated with traditional breakaway techniques and describes a process of piloting a new educational module known as the spontaneous protection enabling accelerated response (SPEAR) system. Structured questionnaires were used to collect demographic data and analyse staff confidence and perceptions of the training module. Clinician confidence in coping with patient aggression was measured before, immediately after and at three months following participation in the new programme.

A significant change in staff confidence was observed at two time scales after the training had been administered when compared with the pre‐test baseline total scores. Over 90 per cent of staff either agreed or strongly agreed that training in the new personal defence module provided a credible defence against sudden episodes of high‐risk violence.

The paper describes a proposed module of training that may provide a credible tertiary strategy for those frontline clinicians currently exposed to the risk of sudden, spontaneous episodes of close proximity violence where traditional breakaway techniques are likely to be ineffective. This paper would interest managers, trainers and specialist practitioners that are involved in the preparation and delivery of violence reduction initiatives aimed at promoting safer and therapeutic services.

After Hurricane Katrina hit the coast of Louisiana on August 29, 2005, Wal-Mart initiated emergency operations that not only protected and reopened its stores, but also helped its employees and others in the community cope with the disaster's personal impact. This response was part of a wider effort by the company under CEO Lee Scott to improve its public image. Wal-Mart's efforts were widely regarded as the most successful of all corporations in the aftermath of the disaster and set the standard for future corporate disaster relief programs.

Move beyond the operational dimensions of disaster response and appreciate how disaster response is connected to the company's strategy and its position in the market place. Understand how disasters are different than other types of reputational crises and are subject to different expectation from the public. Understand how a company can do well by doing good: how it can do the right thing and benefit its business at the same time. Discuss the changing expectations of companies to act in the public interest.

Total quality management (TQM) has received considerable attention as a way to increase both the effectiveness and the efficiency of corporations (Bounds et. al., 1994; Grant, Shani and Krisnan 1994; Olian and Rynes 1991; Powell 1995; Ross 1993). Concerned primarily with the delivery of customer satisfaction, the proponents of quality and/or TQM (Deming 1986; Juran 1992; and Crosby 1979) have developed principles and procedures for achieving total quality and meeting multiple corporate goals. Empirical evidence regarding outcomes is mixed; success and failure case studies abound, statistical methodologies are questioned, and more rigorous empirical studies present some positive findings (Powell 1995). Some maintain that the reasons for the failure of TQM systems is incompatibility between existing Western management thought which is grounded in economic models, and the TQM paradigm, which evolved from statistical theory, and has its own set of assumptions (Grant, Shani and Krisnan 1994). Despite such mixed empirical results, TQM continues to be promoted and implemented. This is the beginning point for our examination of TQM. The TQ management paradigm is practiced in economically and culturally diverse environments, including those which embrace an economic perspective, complete with maximisation of shareholder wealth, self‐interest, rational decision makers, separation of ownership, and agency costs (Grant, Shani and Krishnan 1994).

An analysis of the way the bureaucratic management system responded to the Tsunami disaster of December 26, 2004 was repeated in handling of the aftermath of Hurricane Katrina in the USA at the end of 2005. This research note aims to follow up on the original paper “Bureaucracy meet catastrophe: analysis of the Tsunami disaster relief efforts and their implications for global emergency governance”, to be published in early 2006. It again highlights the severe shortcomings of the bureaucratic model as a paradigm for responding to situations in which the magnitude of the system's task is overwhelmingly complex and the timing process is bounded by urgency.

Evidence of the findings for this research is driven by primary references, namely news reports and web site information provided in the aftermath of the fall 2005 hurricane.

Like in the Tsunami disaster, the reports from Hurricane Katrina highlight the key problems of bureaucratic management including slow decision making, inability to absorb and process outside information, and escalation of commitment to failed courses of action.

Suggestions for future research are provided.

It is this very requirement (absorbing and processing outside information and escalation of commitment to failed initial courses of action) which may undermine all relief efforts when such a high magnitude event occurs.

The tragic irony of this analysis is that most emergency relief organizations of the proper size and complexity to effectively deal with “shocking” events must work within the bureaucratic systems created by large federal relief organizations (such as FEMA) as the “price” for staying in operation.

In October we begin our librarianship studies, if we are still students, and never in library history have so many facilities, in whole and in part‐time schools, been available. It still remains for all library authorities to accept the idea that it is a natural and proper thing for every entrant into library work to come into it, either by way of a library school, or with the intention (and the opportunity) of attending a library school, with aid equivalent to that given in the training of the teacher. In October, too, we note that eight meetings of librarians, three of them week‐end conferences, have been arranged. This is indeed activity and we hope that attendances in all cases justify their organizers. At a more general level, the Election of the Library Association Council occurs this month. Here is a real obligation upon librarians—to elect a Council representative of every library interest, general and special, public and otherwise. Next year, the Centenary Year of public libraries, is a great one for them; we want the best Council for it. We want, however, non‐public librarians to participate in its celebrations.

Under this heading are published regularly abstracts of all Reports and Memoranda of the Aeronautical Research Council, Reports and Technical Notes of the United States National Advisory Committee for Aeronautics and publications of other similar Research Bodies as issued

Acquisition of products and services from contractors consumes about a quarter of discretionary spending governmentwide and is a key function in many federal agencies. In fiscal year 2005 alone, federal government contracting involved over $388 billion. The work of the government is increasingly being performed by contractors, including in emergency and large-scale logistics operations such as hurricane response and recovery and the war in Iraq. Many agencies rely extensively on contractors to carry out their basic missions. The magnitude of the government's spending and dependence on contractors make it imperative that this function be performed as efficiently and effectively as possible. Yet, acquisition issues are heavily represented on GAO's list of government highrisk areas. In the 21st century, the government needs to reexamine and evaluate its strategic and tactical approaches to acquisition. To identify and discuss the key issues confronting the federal acquisition community, the Comptroller General hosted a forum in July 2006 that brought together acquisition experts from inside and outside the government. Participants shared their insights on challenges and opportunities for improving federal acquisition in an environment of increasing reliance on contractors and severe fiscal constraint.