Independent Sector Research Articles

The impact of the COVID-19 pandemic on children and adolescent mental health in-patient service use in England: interrupted time-series analysis of national patient records.

During the initial phases of the COVID-19 pandemic, children and young people (CYP) faced significant restrictions. The virus and mitigation approaches significantly impacted how health services could function and be safely delivered. To investigate the impact of COVID-19 lockdowns on CYP psychiatric admission trends during lockdown 1 (started 23 Mar 2020) and lockdown 2 (started 5 Nov 2020) of the COVID-19 pandemic in England. Routinely collected, retrospective English administrative data regarding psychiatric hospital admissions, length of stay and patient demographic factors were analysed using an interrupted time series analysis (ITSA) to estimate the impact of COVID-19 lockdowns 1 and 2 on service use trends. We analysed data of 6250 CYP (up to 18 years of age) using ordinary least squares (OLS) regression analysis with Newey-West standard errors to handle autocorrelation and heteroscedasticity. Psychiatric hospital admissions for CYP significantly fell during lockdown 1, and then fell even further during lockdown 2. A greater proportion of admissions during lockdown were out of area or to independent sector units. During lockdown, the average age of CYP admitted was higher, and a greater proportion were female. There was also a significant increase in the proportion of looked-after children and CYP from the most socioeconomically deprived areas admitted during lockdown 2. During both lockdowns, fewer CYP had psychiatric admissions. The subsequent rise in admissions for more socioeconomically deprived CYP and looked-after children suggests that these CYP may have been disproportionately affected by the pandemic, or overlooked during earlier phases.

Family-Centered Early Intervention Deaf/Hard of Hearing (FCEI-DHH): Call to Action.

This Call to Action is the eighth and final article in this special issue on Family-Centered Early Intervention (FCEI) for children who are deaf or hard of hearing (DHH) and their families, or FCEI-DHH. Collectively, these articles highlight evidence-informed actions to enhance family well-being and to optimize developmental outcomes among children who are DHH. This Call to Action outlines actionable steps to advance FCEI-DHH supports provided to children who are DHH and their families. It also urges specific actions to strengthen FCEI-DHH programs/services and systems across the globe, whether newly emerging or long-established. Internationally, supports for children who are DHH are often siloed, provided within various independent sectors such as health/medicine, education, early childhood, and social and disability services. With this Call to Action, we urge invested parties from across relevant sectors to join together to implement and improve FCEI-DHH programs/services and systems, build the capacity of early intervention (EI) Providers and other professionals, extend research regarding FCEI-DHH, and fund EI supports, systems, and research, all with the aim of advancing outcomes for families and their children who are DHH.

Adaptive Antenna Array Control Algorithm in Radiocommunication Systems

An important element of modern telecommunications is wireless radio networks, which enable mobile subscribers to access wireless networks. The cell area is divided into independent sectors served by directional antennas. As the number of mobile network subscribers served by a single base station increases, the problem of interference related to the operation of the radio link increases. To minimize the disadvantages of omnidirectional antennas, base stations use antennas with directional radiation characteristics. This solution allows you to optimize the operating conditions of the mobile network in terms of reducing the impact of interference, better managing the frequency spectrum and improving the energy efficiency of the system. The work presents an adaptive antenna algorithm used in mobile telephony. The principle of operation of adaptive systems, the properties of their elements and the configurations in which they are used in practice are described. On this basis, an algorithm for controlling the radiation characteristics of adaptive antennas is presented. The control is carried out using a microprocessor system. The simulation model is described. An algorithm was developed based on the Mathcad mathematical program, and the simulation results of this algorithm, i.e., changes in radiation characteristics as a result of changing the mobile position of subscribers, were presented in the form of selected radiation characteristics charts.

Reduced Fertilization to Improve Sustainable Use of Resources and Preserve Postharvest Quality of Fresh-Cut Wild Rocket (Diplotaxis tenuifolia L.) in Soil-Bound and Soilless Cultivation.

Reducing fertilizer input is a goal for helping greenhouse farming to achieve higher sustainability in the production process while preserving overall crop performance and quality. Wild rocket plants were cultivated in a plastic greenhouse divided into two independent sectors, one for soil-bound (SbS) cultivation and another equipped for soilless (ScS) cultivation systems. In both SbS and ScS, the crop was subjected to treatments consisting of a high- and a low-input fertilization program (HF and LF treatment, respectively). Water use efficiency (WUE) and partial factor productivity (PFP) for nutrients (N, P, K, Ca, and Mg for ScS, and N for SbS) were measured. Rocket leaves, separated for the cultivation system and fertilization program and collected at different cuts during the growing cycle, were cold stored at 10 °C until 16 d. On each sampling day (at harvest and during storage), the sensory parameters, respiration rate, dry matter, color, electrolyte leakage, antioxidant activity, total phenols, total chlorophyll and ammonia content were evaluated. In ScS, the PFP for all nutrients supplied as fertilizers showed a significant increase with the LF treatment, with values higher than 30% recorded for N, K, and Ca. As for the postharvest performance, rocket leaves cultivated in ScS showed better qualitative traits than those cultivated in SbS, as suggested by the lower values of ammonia content and electrolyte leakage recorded at the end of storage period in samples grown in ScS. Moreover, in ScS, the data showed lower membrane damage in LF than HF rocket leaves. Finally, regarding total chlorophyll content, even if no effect of each treatment was recorded in SbS, rocket cultivated in ScS showed a better retention of this parameter by applying LF rather than HF treatment. In addition to this, a PLS model (R2 = 0.7) able to predict the cultivation system, using as a variable non-destructively measured total chlorophyll content, was implemented. Low fertilization input, both in SbS and in ScS, allowed satisfying production levels and more sustainable management of nutrients. LF treatment applied to ScS also had in positive effects on the postharvest quality of fresh-cut rocket leaves.

Critical Notes on Crude Oil Mining as a Prime Mover of Timor Leste’s Economic: The Paradox of Abundance

After the international recognition of Timor-Leste's independence, the oil and gas sector has provided a very dominant contribution to the development of the economy and government. In fact, oil and natural gas revenues are expected to be a major determinant of the country's economic growth, although it is known that the final outcome will depend largely on the use of oil and gas revenues. The purpose of this critical note is to contribute critical thinking about the negative impact of the abundance of natural resources, especially crude oil, in Timor Leste, which continues to be the main source of the economy. While it is true that oil revenues are critical to achieving the goals set out in the Timor-Leste national development program, it is also true that oil revenues pose challenges to governance capacity, as international experience shows that countries are rich in natural resources (oil and gas). nature) often experience more waste and corruption than other countries. The negative effect of abundance on natural resources has become known as the "resource curse".

Teaching Teenagers: Mistaking Insecurity for Apathy

Returning to studios after COVID-19, student–teacher tensions seem to be higher than ever. Teenagers who spent the beginnings of their young adulthood in isolation clash with instructors who might mistake their stress and insecurity for apathy and laziness. In this article, I examine my personal experience with teaching teenagers and offer strategies for success in opening lines of communication between instructors and high-school-age students in the independent sector.

Assessing the clinical and cost-effectiveness of inpatient mental health rehabilitation services provided by the NHS and independent sector (ACER): protocol

BackgroundMental health rehabilitation services provide specialist treatment to people with particularly severe and complex problems. In 2018, the Care Quality Commission reported that over half the 4,400 mental health inpatient rehabilitation beds in England were provided by the independent sector. They raised concerns that the length of stay and cost of independent sector care was double that of the NHS and that their services tended to be provided much further from people’s homes. However, there has been no research comparing the two sectors and we therefore do not know if these concerns are justified. The ACER Study (Assessing the Clinical and cost-Effectiveness of inpatient mental health Rehabilitation services provided by the NHS and independent sector) is a national programme of research in England, funded from 2021 to 2026, that aims to investigate differences in inpatient mental health rehabilitation provided by the NHS and independent sector in terms of: patient characteristics; service quality; patient, carer and staff experiences; clinical and cost effectiveness.MethodsACER comprises a:1) detailed survey of NHS and independent sector inpatient mental health rehabilitation services across England; 2) qualitative investigation of patient, family, staff and commissioners’ experiences of the two sectors; 3) cohort study comparing clinical outcomes in the two sectors over 18 months; 4) comprehensive national comparison of inpatient service use in the two sectors, using instrumental variable analysis of routinely collected healthcare data over 18 months; 5) health economic evaluation of the relative cost-effectiveness of the two sectors. In Components 3 and 4, our primary outcome is ‘successful rehabilitation’ defined as a) being discharged from the inpatient rehabilitation unit without readmission and b) inpatient service use over the 18 months.DiscussionThe ACER study will deliver the first empirical comparison of the clinical and cost-effectiveness of NHS and independent sector inpatient mental health rehabilitation services.Trial registrationISRCTN17381762 retrospectively registered.

The toponym $n-nxn and its connotation till the end of the middle kingdom of Egypt

The present research paper focuses on the term $n-Nxn as a sign of a geographical region located in Upper Egypt and its connotation in the royal and non-royal texts. It highlights the political and religious significance of the toponym. Moreover, it explores the definable territorial divisions in Upper Egypt that were created in the second half of the Fifth Dynasty since upper Egypt was divided into three administrative unites in conjunction with Agricultural areas, therefore, some high elite titles linked with a specific regions such as,spAwt 9( the ninth provinces).and imy-r spAwt Hryw-ib an overseer of the Middle provinces of Upper Egypt, and consequently , by the second have of sixth Dynasty, the provinces of $n -Nxn was referred from Archaeological records regarding it as an administrative sector included some Nomes, but it would appear that they didn't give any crucial information on its extensions or its location. moreover ,by the Middle Kingdom, $n -Nxn attested for the first time in literary texts as An important geographical region associated with legitimacy of of the throne, the notion of centralization and the power and authority of the King. Nevertheless, it wasn't An independent administrative sector, and it designates to A geographical area situated in wart rsy “the southern administrative sector.

Independent sector and peri-operative cardiac arrest as reported to the 7th National Audit Project of the Royal College of Anaesthetists.

The 7th National Audit Project (NAP7) of the Royal College of Anaesthetists studied peri-operative cardiac arrest including those that occurred in the independent healthcare sector, which provides around 1 in 6 NHS-funded care episodes. In total, 174 (39%) of 442 independent hospitals contacted agreed to participate. A survey examining provider preparedness for cardiac arrest had a response rate of 23 (13%), preventing useful analysis. An activity survey with 1912 responses (from a maximum of 45% of participating hospitals) showed that, compared with the NHS caseload, the independent sector caseload was less comorbid, with fewer patients at the extremes of age or who were severely obese, and with a large proportion of elective orthopaedic surgery undertaken during weekday working hours. The survey suggested suboptimal compliance rates with monitoring recommendations. Seventeen reports of independent sector peri-operative cardiac arrest comprised 2% of NAP7 reports and underreporting is likely. These patients were lower risk than NHS cases, reflecting the sector's case mix, but included cases of haemorrhage, anaphylaxis, cardiac arrhythmia and pulmonary embolus. Good and poor quality care were seen, the latter including delayed recognition and treatment of patient deterioration, and poor care delivery. Independent sector outcomes were similar to those in the NHS, though due to the case mix, improved outcomes might be anticipated. Assessment of quality of care was less often favourable for independent sector reports than NHS reports, though assessments were often uncertain, reflecting poor quality reports. Overall, NAP7 is unable to determine whether peri-operative care relating to cardiac arrest is more, equally or less safe than in the NHS.

Intra-operative Tranexamic Acid Administration Significantly Decreases Incidence of Postoperative Bleeding Without Increasing Venous Thromboembolism Risk After Laparoscopic Sleeve Gastrectomy: a Retrospective Cohort Study of Over 400 Patients.

There is evidence that tranexamic acid (TXA) reduces surgical bleeding and is widely used in trauma, obstetrics and other specialties. This practice is less well-established in laparoscopic sleeve gastrectomy (LSG) due to concerns surrounding venous thromboembolism (VTE); equally postoperative bleeding is a serious complication often requiring re-operation. This retrospective cohort study compared 30-day outcomes following primary LSG in patients receiving intra-operative TXA (March 2020-July 2022) to those who did not (March 2011-March 2020). The primary outcome was postoperative bleeding (Hb < 9g/dL) requiring transfusion or re-operation. Secondary outcomes were incidence of VTE, serious postoperative complications (Clavien-Dindo > grade 3) and death. Patients underwent standardised-protocol LSG without staple line re-enforcement under a single surgeon within the independent sector (private practice). TXA 1g intravenous was administered immediately after a methylene blue leak test, prior to extubation. TXA group had 226 patients and non-TXA group had 192 patients. Mean age was 40.5 ± 10.3 and 39.1 ± 9.8years, respectively. In the TXA group, no postoperative bleeds [versus 3 (1.6%) in non-TXA group, p = 0.0279] occurred. One staple line leak (0.4%) occurred in the TXA group compared to zero in the non-TXA group (p = ns). There was no VTE or death. This is the largest cohort study of intra-operative TXA in primary LSG to date, which demonstrates significant decrease in postoperative bleeding without increasing VTE risk. The authors recommend administration of TXA immediately following leak test, or removal of bougie to maximise efficacy. Data of TXA in LSG is awaited from the randomised controlled PATAS trial.

A Modular Cataract Surgery Training Model Incorporating Human Factors and a Pedagogical Theory.

High volume cataract lists arecost-effective, reduce waiting times, and facilitate surgical teaching.We propose a stepwise training modelthat incorporates human factor principles and a reflective pedagogical approach, which has not been documented previously. Surgical training in ophthalmology is effective when a modular approach is utilised. High volume lists further enhance training by increasing exposure to a newer way of learning and working. We evaluated the efficiency and safety of trainee-assisted cataract surgery across a single NHS eye unit and an independent sector (IS) provider. We examined results from audits of surgical efficiency and safety in trainee-assisted high-volume lists, including a single-centre comparative evaluation of consultant-only and trainee lists. The quantitative and qualitative information gained from these projects helped us to implement a modular, structured training programme that utilises a reflective cycle of pedagogy, suitable for any grade of trainee. Our projects included an audit following cataract surgery performed by a surgical trainee over a 5-month period, which showed excellent post-op refractive results and no cases of intra-operative and post-operative complications. A single-centre observational study demonstrated comparable surgical throughput and safety results for trainee and solo consultant high volume lists. Systemic and ocular complication rates were reported to be similar for low and medium risk cataract surgery among trainee supervised IS and NHS lists. Cataract surgery outcomes and patient feedback support the effectiveness of the surgical training model. Combining Gibbs' reflective cycle of critical reflection with the International Council of Ophthalmology's principles helped us to develop the QM Model of modular teaching for cataract surgery, which we believe is suitable for utilisation in all surgical centres in the NHS and IS settings, for both low volume and high-volume surgical lists regardless of trainee experience.

How can patient experience of abortion care be improved? Evidence from the SACHA study.

Models of abortion care have changed significantly in the last decade, most markedly during the COVID-19 pandemic, when home management of early medical abortion with telemedical support was approved in Britain. Our study aimed to examine women's satisfaction with abortion care and their suggestions for improvements. Qualitative, in-depth, semi-structured interviews. A purposive sample of 48 women with recent experience of abortion was recruited between July 2021 and August 2022 from independent sector and National Health Service abortion services in Scotland, Wales and England. Interviews were conducted by phone or via video call. Women were asked about their abortion experience and for suggestions for any improvements that could be made along their patient journey - from help-seeking, the initial consultation, referral, treatment, to aftercare. Data were analyzed using the Framework Method. Participants were aged 16-43 years; 39 had had a medical abortion, 8 a surgical abortion, and 1 both. The majority were satisfied with their clinical care. The supportive, kind and non-judgmental attitudes of abortion providers were highly valued, as was the convenience afforded by remotely supported home management of medical abortion. Suggestions for improvement across the patient journey centred around the need for timely care; greater correspondence between expectations and reality; the importance of choice; and the need for greater personal and emotional support. Recent changes in models of care present both opportunities and challenges for quality of care. The perspectives of patients highlight further opportunities for improving care and support. The principles of timely care, choice, management of expectations, and emotional support should inform further service configuration.

РАЗРАБОТКА МЕТОДА ОПТИМИЗАЦИИ МАРШРУТОВ РЕГИОНАЛЬНОЙ ЛОГИСТИКИ НА ОСНОВЕ ГРАВИТАЦИОННОЙ МОДЕЛИ УПРАВЛЕНИЯ ТРАНСПОРТНЫМИ ГОРОДСКИМИ УЗЛАМИ

This article discusses the optimization of logistics routes, starting with the identification of key points of regional economic development. The proposed structure includes the principles of the theory of spatial interaction, in particular, the methodology for optimizing regional logistics networks based on the gravitational model. This approach uses economic zones as a contextual background to demonstrate the practical applicability and feasibility of the model. The integration of data on economic zones provides a real context that allows you to verify the results of the model and ensure the practical significance of the developed optimization strategies. Logistics, functioning as an independent sector of the economy, is also a key element of the regional economy. Thus, research on the optimization of logistics routes aimed at stimulating the future growth of the logistics industry has theoretical significance and practical applicability.

Međuzavisnost rodne zastupljenosti i postignutih rezultata u tijelima državne uprave u Republici Hrvatskoj

Each institution in the state administration in the Republic of Croatia organizes its operations through numerous administrative organizations (administrations) and organizational units (independent sectors, sectors, services, departments, sections and sub-sections) whose number and responsibilities differ with regard to their internal organization. In this paper, the emphasis is on state administration bodies, that is, on ministries and state administrative organizations. The paper tries to answer the research question of whether there is a difference in the efficiency of the operations of state administration bodies in the Republic of Croatia in relation to the representation of women and men among employed officials and state employees. The aim of the paper is to recognize the importance and analyze gender representation in state administration bodies in the Republic of Croatia and to determine whether there is a difference in the efficiency of work results in state administration bodies in relation to the representation of women and men. The research covers 16 ministries and 12 state administrative organizations in the Republic of Croatia, which employ a total of about 49,820 employees. According to the research results, there is no statistically significant difference between business efficiency and gender representation in state administration bodies in the Republic of Croatia.

Peritoneal malignancy in the global COVID-19 pandemic: experience of recovery and restoration in a high-volume centre through NHS and independent sector collaboration.

Treatment of peritoneal malignancy with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) requires substantial critical care, theatre and nursing resources. The COVID-19 pandemic caused challenges in providing a high volume, tertiary referral service. We reviewed data on referrals and operations performed in a tertiary referral centre in both NHS and independent sector settings. The impact of COVID-19 on activity was assessed using 2019 as a benchmark. New patient referrals were similar, with 891 in 2019 compared with 833 in 2020. Delivery of CRS and HIPEC operations were initially impacted by COVID-19. NHS and independent sector collaboration facilitated recovery, with 284 patients treated in 2020 compared with 280 in 2019. Close collaboration and structural organisation between the clinical and management teams in the NHS and independent sectors facilitated recovery and restoration of a complex tertiary referral service for peritoneal malignancy during the COVID pandemic.

Metaphorographic - Performative Experiences In Performances: (and :

The article aims to analyze the choreographic structures in the performances made by companies in the independent sector. The realization of performative atmospheres specific to immersive theater within artistic products represents an area of research still unexplored. Traveling from concept to artistic materialization requires a reordering of the professional relationship between the director and the choreographer or the stage movement coordinator. These professional relationships and the principles under which they are established are often discussed, but their mapping often remains in an ambiguous area. The objective of this work is to re-discuss the role of the choreographer and/or the stage movement coordinator in the creation of artistic products.

Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: report 11, techniques and complications of local anesthesia for cataract surgery in the United Kingdom.

To describe variation in local anesthesia techniques and complications over a 10-year period for cataract surgery in the United Kingdom. Reporting centers to the Royal College of Ophthalmologists (RCOphth) National Ophthalmology Database (NOD). Retrospective cross-sectional register-based study. Data from the RCOphth NOD were used. Eligible for analysis were 1 195 882 cataract operations performed using local anesthesia between April 1, 2010, and March 31, 2020, in 80 centers. Overall, topical anesthesia alone was used in 152 321 operations (12.7%), combined topical and intracameral in 522 849 (43.7%), sub-Tenon in 461 175 (38.6%), and peribulbar/retrobulbar in 59 537 (5.0%). In National Health Service (NHS) institutions, 48.3% of operations were topical with/without intracameral vs 88.7% in independent sector treatment centers (ISTCs). 45.9% were sub-Tenon in NHS vs 9.6% in ISTCs. 5.8% were peribulbar/retrobulbar in NHS vs 1.7% in ISTCs. Anesthetic complication rates decreased from 2.7% in the 2010 NHS year to 1.5% in the 2019 NHS year (overall, 2.1% for NHS; 0.2% for ISTCs). Overall anesthetic complication rates were 0.3%, 0.3%, 3.5%, and 3.1% for topical alone, combined topical/intracameral, sub-Tenon, and peribulbar/retrobulbar, respectively. Complication rates were higher for sharp-needle anesthesia (peribulbar/retrobulbar) in patients taking warfarin rather than direct oral anticoagulants (4.8% vs 3.1%; P = .024). Considerable variation was observed between centers on anesthetic choices and anesthetic complication rates. Combined topical and intracameral is the most common choice of anesthesia for cataract surgery in the United Kingdom and is associated with lower anesthetic-related complication rates than sub-Tenon and peribulbar/retrobulbar anesthesia. Variation in the anesthetic choice exists between centers and between NHS and ISTC sectors.

BS P04 The Legacy of the Adjustable Gastric Band; 5-year study of the presentation and management of gastric band-related complications

Abstract Background Laparoscopic adjustable gastric banding (LAGB), once one of the most popular surgical treatments for obesity, now represents less than 10% of procedures undertaken nationally. No accurate figures exist regarding how many UK patients have undergone LAGB; approximately 5000 procedures were submitted to NBSR between 2013-2015. Alongside procedures undertaken abroad and privately, the total number is likely to be several multiples of this figure over the last 20 years. Currently there is a perception that LAGB-related complications account for a disproportionate volume of non-elective episodes compared to other procedures. This study describes the presentation and management of gastric band dysfunction. Methods This was a retrospective review of all referrals, attendances and admissions to a regional bariatric service with a dedicated bariatric on-call, serving the North West of England between. The study period was January 2018 and April 2023. All elective outpatient (OPC) and non-elective (NE) LAGB-related episodes were included. Patient demographics, band-related data, presentation, investigations, interventions, and related complications were collected and described. Results 375 episodes (212 OPC; 163 NE) accounted for 58% of all OPC and 44% of NE activity. Most patients had LAGB in the independent sector (OPC presentation 73% UK, 18% abroad; NE presentation 80% UK, 20% abroad). Median time from index surgery was 8 years (IQR 5-11, range 0-30 years). Erosions and infections accounted for 4% (14/375) and 5% (20/375) of cases, respectively. LAGB removal was required in 59% of OPC and 60% of NE presentations. LOS for NE presentations was 3 days (IQR 2-6, range 0-41 days). 5 patients required ITU admission (median LOS 2 days). Conclusions Whilst representing only a small proportion of current elective practice, LAGB-related complications represent the majority urgent and non-elective activity in the outpatient and emergency settings. Given that LAGB related complications often present many years after the index procedure, it is likely that this phenomenon will continue to be a challenge for UK surgeons and services for years to come. This has training implications for the future generation of bariatric surgeons and general surgical trainees, many of whom will likely never have seen a gastric band placed, and yet will have to manage complications, a significant proportion of which are complex.

Extending the Baldrige excellence model for managing community-based social enterprise

Purpose This paper aims to help understand how community-based social entrepreneurs experience world-class “performance excellence” models and to explore the core values that enable social enterprises to become high-performance organizations. Design/methodology/approach Underpinned by Mindsponge processes, the proposed conceptual framework critiques the Baldrige criteria for performance excellence (BCPE) model in a global south context. The mixed-methods study fosters an in-depth analysis. First, it validates the BCPE mechanism in community-based social enterprises (CBSEs) before identifying the significant core values and concepts of BCPE that influence CBSEs to achieve high performance. Findings The BCPE, adapted from global north corporate principles and applied at a community level, can significantly develop global south organization performance excellence. Five core values and concepts from the 11 fundamental beliefs in driving performance excellence were found to support performance excellence in CBSE management. These values and concepts are “customer-focused excellence,” “social responsibility,” “systems perspective,” “visionary leadership” and “focus on success.” Research limitations/implications First, factors influencing performance excellence are not limited to the core values elements discussed. Future research may clarify factors extracted from the “Process” category of BCPE to explore further how CBSEs can enhance their performance in a different formation path. Second, this study only considered the Thai-Phuan community in Pho Tak village, Nong Khai, Thailand, to represent as a single case study. However, different, clustered or contrasting CBSEs in other regions remain open for further exploration to enrich the knowledge of “performance excellence” in a community organization. Finally, a longitudinal study would be a welcome addition. Practical implications The following must be considered. First is setting a clear direction: the organization’s vision and mission, by purposeful design, should ensure that CBSE managers are leading by example and demonstrating the importance of social and environmental value creation. Second is developing institutional culture: fundamental core values focused predominantly on “customer-focused excellence” and “social responsibility” encourage collaboration by “working together to drive success”. Third is developing integrated management system: CBSEs need to ensure that the management systems can collaborate and complement each component to create performance excellence. Fourth is creating a learning organization: CBSEs need to create a culture of continuous learning through data collection, measurement, analysis and modification. Social implications This study clarifies that the implementation of BCPE is crucial to the establishment of performance excellence at both macro- and micro-level organizations. According to the Malcolm Baldrige National Quality Award, the fundamental drivers of BCPE are the same for all types of organizations and in all sectors, whether in the private sector, education, health care or government (Blazey and Grizzell, 2021). By applying the Baldrige excellence model at the community level, this study found that CBSE can similarly strive for excellence and improved performance. This can lead to strengthened services, increased productivity and enhanced quality of life for the community. Originality/value This study provides a novel viewpoint on the Baldrige paradigm. Expressly, BCPE is compatible with global south community-based organizations to enhance performance excellence. Its essential contribution demonstrates that Baldrige model concepts are more widespread within smaller and underdeveloped territories than imagined. The recent (post-study) inclusion of “Community” as an independent sector in the Malcolm Baldrige National Quality Awards validates the research findings and recommendations proposed by this study.

Paediatric hospitalisation related to medications administration errors of non-opioid analgesics, antipyretics and antirheumatics in England and Wales: a longitudinal ecological study

ObjectiveThis study aimed to explore paediatric hospitalisation related to medication administration errors (MAEs) of non-opioid analgesics, antipyretics and antirheumatics in England and Wales.DesignAn ecological study.SettingA population-based study on hospitalised patients...