The National Health Service (NHS) was established in 1948 to provide equitable healthcare for all citizens. Over the years the NHS has gone under different reforms and changes. In 2002 the NHS launched one of its biggest changes in structure since its commencement in 1948. The scale of these changes are greater than those established following the white paper “Working for Patients” in 1989 (Conservative Government) that indicated the introduction of the internal market (focus on efficiency). This review therefore proposes to give a brief summarize of the structural changes and current structure of the NHS in the England. The NHS plan was published in July 2000 (Labour Government) and outlined a 10 year plan of investment in the NHS. This delineates a vision for a service planned around the patients and more responsive to patients’ needs. The Government emphasizes on the empowering of staff at all levels as a way to achieve this vision. "Shifting the Balance of Power" is part of the Government’s plans for implementation of the NHS Plan and has directed to the establishment of new structures. The main feature of change has been giving locally based Primary Care Trusts the role of running the NHS and, with the local authorities, improving health in their areas. The PCTs are receiving 75% of the NHS budget to act as primary services provider, commissioner (service purchaser), network developer and controller. In addition, all former Health Authorities have been abolished and new Strategic Health Authorities (SHA) have been created to serve larger areas and with a more strategic role. The SHAs are responsible for developing strategic frameworks for the local health service; performance of the local health service; and building capacity in the local health service. The Department of Health is also refocusing to reflect these changes, including the abolition of its Regional Offices and relegating some of its operational responsibilities to SHAs and other rganizations. While NHS Trusts (the organizations responsible for running most NHS hospitals, mental health and learning disability services, ambulance services and patient transport) continue to have the similar functions as before, they will have to create new working relationships with PCTs and SHAs. In addition Foundation Trust, which often referred ‘Foundation Hospitals’, were set up in April 2004 and are freestanding hospitals with greater autonomy within the NHS. New structures signify new relationships and partnerships both between NHS organizations and with other stakeholders. All NHS organizations locally - PCTs, Care Trusts and NHS Trusts -are now part of a single structure in which they are supposed accountable to SHAs, which are in turn accountable to Department of Health and ultimately to Secretary of State for Health. Relationships with other collaborators such as Local Authorities and voluntary organizations are also crucial, particularly for PCTs as they work towards improving health and integrating health and social care.  

structural change is defined as a change in the relative weight of the important constituents of the macro-economic indicator such as production, taxes, imports and exports, workforce etc. Since the structure change is one of the main reasons for the growth and economic development of countries, the investigation of the trend of changes in economic important constituents is important. Tax as an important source of state revenue is one of the most significant macro-economic indicators; furthermore it is the most important instrument of the state’ s fiscal policy. So due to the important position of tax in the countries’ economy, evaluating the trend of changes in the tax structure is of paramount importance. Therefore, the purpose of this study is to investigate the structural changes of taxes in Iran, by Bai and Perron method, for the period 1971-2012. The results based on the UDmax and WDmax tests show that there is at least one breakpoint in the movement process of all taxes in Iran; also based on the sequential procedure all breaks have not lead to the structural changes and Iran have not had the structure changes in income tax.

Structural changes of mechanically-activated ilmenite during milling by a planetary mill are monitored and determined as a function of the milling time. The maximum specific BET surface area of 10. 76 m2/g is obtained after 150 min of milling. The results obtained indicate that agglomeration of the particles occurs after 45 min of milling. The maximum X-ray amorphization degree of ca. 95% has been calculated after 150 min of milling. Estimation of the stored energy reveals that the X-ray amorphization degree has a dominant contribution to the excess enthalpy of the activated materials. The surface-weighted crystallite size in the ground ilmenite reaches 4. 45 nm, which corresponds to the volume-weighted crystallite size of 8 nm and 11. 18 nm obtained by the Williamson-Hall and Rietveld methods, respectively. After 150 min of mechanical activation, the root mean square strain, , increases to 0. 78%, which corresponds to the strains of 1. 43% and 1. 04% obtained from the Williamson-Hall and Rietveld methods, respectively. Reduction in the crystallite size leads to the contraction of the ilmenite unit cell after 150 min. The reaction rate constant of the ilmenite dissolution increases by over 58 times after 150 min of milling. Activation energy of the dissolution reaction decreases from 57. 45 kJ/mol to 41. 09 kJ/mol after 150 min of milling.