It is not documented that paediatric neurosurgery is special in respect to potential benefits of centralization, but tolls for such patients and their families would likely be higher than in adults.
The trade barriers would come down, while the federal government would be granted only limited powers -- in order to secure the people's freedom from the larger potential problem of undue federal centralization.
Implications for Future Research: We postulate that, in regions where leaders verbalized loss of control, change in focus and reduced focus on local issues of concern created by centralization, there is potential to lead to alienation and possibly disengagement from this quality improvement initiative, resulting in less support and less alignment between Hoshin Kanri and regional Lean initiatives.
Rotenberg also profited from the centralization, likely with Putin's blessing.
Centralization of IRB function, as has been done with the National Cancer Institute's Central IRB Initiative, offer a potential solution, by coordinating and centralizing IRBs for large, multicenter studies.
Therefore, the necessary degree of centralization to obtain a potential or optimal benefit is not known; being either local, regional, national, or even international.
The specific question as to the potential significant improvement in patient survival by centralization of breast cancer treatment in hospitals with a certain minimum annual volume was answered by, inter alia, the landmark study by Roohan et al. [ 8].
Studies examining the overall tradeoffs associated with increasing centralization vs. decentralization (e.g. potential C sequestration from manure application to cropland soils; NOx and CH4 emissions; costs of transportation for livestock, milk and meat, and manure; air and water quality; and impacts on rural communities such as odors and health risks) are needed.
One potential implication of our findings is that further centralization of surgical expertise towards higher-volume hospitals in a small county like Ireland could provide a way to constrain LOS and achieve better economy of scale.
The wiki network is found to be non-central (i.e. degree centralization is 0.1457 and betweenness centralization is 0.060).
