Expenditure on management consultants in public sector organizations is generally seen as contributing to a “hollowing out” of the state through the substitution of internal management capability. ...However, there is little systematic evidence for this view which also ignores how public sector managers may, themselves, drive consulting use. Looking at 125 English public hospitals over 6 years, we explore the relationship between the development and composition of management functions and spending on consultants. Our findings show the absence of a substitution effect and, therefore, challenge the “hollowing out” thesis. Instead, they point to a more active, occupationally varied and political use of consultancy. We find that larger management functions overall are associated with greater reliance on consultants—a complementary relationship. However, where a higher proportion of managers are engaged in internal consulting functions, this results in the lower use of external management consultants, with implications for theory, research and policy.
Abstract We developed a methodology to assess and compare the prediction quality of cardiovascular models for patient-specific simulations calibrated with uncertainty-hampered measurements. The ...methodology was applied in a one-dimensional blood flow model to estimate the impact of measurement uncertainty in wall model parameters on the predictions of pressure and flow in an arterial network. We assessed the prediction quality of three wall models that have been widely used in one-dimensional blood flow simulations. A 37-artery network, previously used in one experimental and several simulation studies, was adapted to patient-specific conditions with a set of three clinically measurable inputs: carotid–femoral wave speed, mean arterial pressure and area in the brachial artery. We quantified the uncertainty of the predicted pressure and flow waves in eight locations in the network and assessed the sensitivity of the model prediction with respect to the measurements of wave speed, pressure and cross-sectional area. Furthermore, we developed novel time-averaged sensitivity indices to assess the contribution of model parameters to the uncertainty of time-varying quantities (e.g., pressure and flow). The results from our patient-specific network model demonstrated that our novel indices allowed for a more accurate sensitivity analysis of time-varying quantities compared to conventional Sobol sensitivity indices.
Was the New Testament written in the early first century CE or at a much later date? Sturdy's work was conceived as a reply to John Robinson's Reading the New Testament, which dated the New Testament ...material very early. Sturdy argued that the Pauline letters are in places interpolated, Colossians, Ephesians and the Pastorals are pseudonymous, and that Luke and Acts are not by the same author. He believed that Matthew was the last Synoptic Gospel to be written, with John assigned to the period 140 CE. Redrawing the Boundaries offers a radical approach to New Testament Studies that stands in a long tradition of scholarship represented by the Tuebingen School in Germany.
The growing use of external management consultancy services by public sector organizations has generated controversy. Some claim that users have become overreliant on, or even addicted to, this ...source of knowledge. However, our understanding of this phenomenon and the precise nature of its risks is underdeveloped. In this article, we address these concerns by focusing on whether using consulting services inflates future demand and on its consequences for efficiency. This is examined in the context of the English National Health Service and the adoption of New Public Management practices such as outsourcing and private finance initiative contracting. Based on an analysis of four years of data, the results suggest that using consulting services is associated with demand inflation and has negative implications for client organizational efficiency. These findings reveal a strong management consultancy effect, emphasizing the risks associated with demand inflation, with implications for both theory and policy.
The concept of knowledge bases originated in artificial intelligence as one side of expert systems-namely, the fundamental body of knowledge available to a domain. KBs are particularly appropriate in ...knowledge-intensive activities like software development. They offer context-based access to complex information, including informal documents and multimedia, as well as a centralized means of storing and preserving digital assets. KBs can help software engineers with many tasks-from project management and design rationale to version control, defect tracking, code reuse, and staff training and development. We recently implemented an open source KB to support the Consortium for Studying Open Source in Public Administrations. COSPA originated in a EU initiative to study the use of open source software to reduce public administrative software and system support costs. The KB project aimed to build a multilingual knowledge base for comparing and pooling knowledge and experience.
Smallholder farmers in Southern Africa are faced with the challenge of securing their livelihoods within the context of a wide variety of biophysical and socio-economic constraints. Agriculture is ...inherently risky, particularly in regions prone to drought or dry spells, and risk-averse farmers may be viewed by researchers or extension agents as reluctant to invest in agricultural innovations that have potential to improve their livelihoods. However, farmers themselves are more interested in personal livelihood security than any other stakeholder and it is the farmers’ perceptions of needs, investment options and risks that drive their decision-making process. A holistic approach to agricultural innovation development and extension is needed to address both socio-economic and biophysical dynamics that influence adoption and dissemination of innovations. This paper, presents a methodology for involving farmers from the Bergville district of South Africa in the process of innovation development through facilitation of farmer-driven gardening experiments. Facilitating farmer-driven experimentation allows farmers to methodically assess the value of innovations they choose to study while providing researchers with a venue for learning about socio-economic as well as biophysical influences on farmers’ decisions. With this knowledge, researchers can focus on developing innovations that are socially and economically appropriate and therefore, more readily adoptable. The participatory process gave farmers the tools they needed to make informed decisions through critical thinking and analysis and improved their confidence in explaining the function of innovations to others. Researchers were able to use farmers’ manually collected data and observations to supplement laboratory generated and electronically recorded information about soil water dynamics to understand water balances associated with different garden bed designs, and to investigate whether trench beds, drip irrigation and water harvesting with run-on ditches tended to improve water use efficiency. Wetting front detectors (WFD) were shown to have some potential as management tools for farmers, provided certain limitations are addressed, while drip irrigation was found to be impractical because the available drip kits were prone to malfunction and farmers believed they did not provide enough water to the plants. Farmers participating in a series of monthly, hands-on workshops that encouraged individual experimentation tended to adopt and sustain use of many introduced garden innovations. Farmers who were also seriously involved in a formalized research and experimentation process at their own homesteads became more proficient with gardening systems in general, through continual trial-and-error comparisons and making decisions based on observations, than those who were not involved. This suggests that the practice of on-going experimentation, once established, reaches beyond the limits of facilitation by researchers or extension agents, into the realm of sustainable change and livelihood improvement through adoption, adaptation and dissemination of agricultural innovations.
We treated two patients with large ovarian cysts in pregnancy conservatively. In both cases, aspiration of the cysts under ultrasound guidance allowed successful vaginal delivery. In one case, the ...cyst fluid reaccumulated, and required further aspiration in labour. In both cases, benign ovarian cysts were removed laparoscopically at a later date. Various strategies for dealing with ovarian cysts in pregnancy are discussed.
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