Modernising Local Government: Micro-Organisational Reform and Changing Local Structural Configurations

This article takes an indicative group of county, metropolitan and unitary authorities located in the English West Midlands to examine how effectively local government is grappling with modernising’ reforms in a context where the appropriate unit of analysis has become problematic because of broader changes to local governance. Sub-national territorial structural variability is becoming more pronounced while, paradoxically, what stands out in the micro-organisational dimension is the extent to which local authorities are increasingly working to a common reform agenda, notwithstanding the need to resolve incoherences in New Labour's modernisation project. The explanation for these observed (contrary) changes lies not only in the vagaries of top-down pressures emanating from central political and regulatory infiuences, but also in local institutional dynamics, as well as in lateral or peer dissemination of ‘good’ practice within local government.     

Sub-national Responses to Climate Change in England: Evidence from Local Area Agreements

Abstract

The machinery of governance to address climate change at the sub-national level in England continues to evolve. Drawing on documentary evidence and the views of civil servants and local authority officials from the English West Midlands, this article explores the process through an examination of the inclusion of climate change indicators in the recent round of Local Area Agreements (LAAs), negotiated between central government and local authorities and Local Strategic Partnerships. Considerable popularity has been accorded these indicators nationally, but there are important variations in the pattern of take up. Moreover, significant uncertainties surround the contribution of local measures to reduce CO₂ emissions and the targets attached to measures to adapt to climate change are seen as undemanding. Conversely, the impending Carbon Reduction Commitment will act as a powerful incentive for public bodies to cut CO₂ emissions from their estates. Although potentially contributing to greater coherence in tackling climate change, achieving collective action through LAAs will prove problematic.     

How do psychiatric patients on prison healthcare centres differ from inpatients in secure psychiatric inpatient units?

Abstract

Mentally ill prisoners have consistently been highlighted as a group with complex needs. However, it is not clear what these needs are, how effective prison health services are in meeting the needs of this vulnerable group, and whether there would be any benefit to transferring them to psychiatric facilities. This study compared the characteristics and needs of mentally ill patients in prison healthcare centres (HCC prisoners) with patients in forensic medium secure psychiatric units (MSU inpatients) in the UK. HCC prisoners and MSU inpatients were in fact very similar. Where they did differ, though, was that MSU inpatients were significantly more likely to be of non-white ethnicity, diagnosed with psychotic or substance use disorders, and have recorded histories of drug misuse. HCC prisoners and MSU inpatients reported the same number of needs overall, according to the CANFOR-S (Camberwell Assessment of Need Forensic Short Version), but HCC prisoners reported significantly higher levels of unmet need. The need for transfer to alternative services was common in both groups, with bottlenecks evident at all levels. The high level of unmet need reported in the HCC prison sample is of particular clinical concern and highlights the need for improved assessment and treatment services in this setting.     

External Validity in Policy Evaluations That Choose Sites Purposively

Evaluations of the impact of social programs are often carried out in multiple sites, such as school districts, housing authorities, local TANF offices, or One‐Stop Career Centers. Most evaluations select sites purposively following a process that is nonrandom. Unfortunately, purposive site selection can produce a sample of sites that is not representative of the population of interest for the program. In this paper, we propose a conceptual model of purposive site selection. We begin with the proposition that a purposive sample of sites can usefully be conceptualized as a random sample of sites from some well‐defined population, for which the sampling probabilities are unknown and vary across sites. This proposition allows us to derive a formal, yet intuitive, mathematical expression for the bias in the pooled impact estimate when sites are selected purposively. This formula helps us to better understand the consequences of selecting sites purposively, and the factors that contribute to the bias. Additional research is needed to obtain evidence on how large the bias tends to be in actual studies that select sites purposively, and to develop methods to increase the external validity of these studies. © 2012 by the Association for Public Policy Analysis and Management.     

Fulminant liver failure in a patient on carbamazepine and levetiracetam treatment associated with status epilepticus

A 22-year-old female with a history of developmental delay and seizures successfully treated with carbamazepine and levetiracetam developed fulminant hepatic failure and subsequently died. She had been admitted to the hospital following secondary generalized seizures of 35 min duration. A circulatory shock as well as intoxication was taken into consideration during the clinical course. Autopsy failed to reveal a macroscopically discernible cause of death. Significant findings on microscopic examination included acute tubular necrosis in the kidneys, pre-existing marked accumulation of neutral lipid within the hepatocytes as well as hyperacute liver damage with evidence of almost complete hepatocyte necrosis. Carbamazepine and levetiracetam were simultaneously determined from blood and tissues such as liver, lungs, muscle and kidneys by LC-MS/MS following addition of lamotrigine as an internal standard and liquid-liquid extraction. Validation data are given for levetiracetam. Both carbamazepine and levetiracetam were present in blood at concentrations within or below the therapeutic range, respectively. Moreover, tissue concentrations suggested long-term administration of anticonvulsant drugs, which is in accordance with the medical history. After excessive drug concentrations could be ruled out, the metabolic consequences of a prolonged carbamazepine therapy to cause severe hepatic injury in the present case are discussed. A mechanism of injury to the hepatocytes may be membrane damage by either an increased production of free radicals and/or a decreased free radical scavenging capacity. Following ischemia with reperfusion and during hyperthermia, large amounts of free radicals are formed. Induction of the mixed oxidase activity during longterm administration of carbamazepine may also increase production of free radicals, leaving the hepatic cell more vulnerable to oxidative injury.     

Serum norharman and harman analysis using high pressure liquid chromatography/mass spectrometry and value of beta-carbolines as blood alcohol markers

Firstly, a method for LC-MS/MS-analysis of the beta-carbolines norharman and harman in serum was established and validated. Secondly, serum samples from persons during ethanol loading conditions were investigated (n = 26). Norharman was regularly found positive only in persons with BAC > 1.6@1000. In this subgroup harman was detected in 5 out of 9 cases. The finding of norharman concentrations > 50 pg/mL in the serum of 4 out of 5 control persons was of high interest. In addition serum samples of smokers (n = 9) were analyzed for the beta-carbolines. All samples from smokers were tested positive for norharman with concentrations > 50 pg/mL in 7 cases. These results were in accordance with recent reports in literature and underline that the beta-carbolines norharman and harman do not meet the criteria of alcohol state-markers and positive serum sample testing may result from endogenous as well as from exogenous sources.     

Nursing home quality-of-care cases after Mikes v. Straus

The quality of care rendered to residents of nursing facilities continues to gain attention from legislators, regulators, and the courts. Advocates for improvements in the quality of care by government-funded healthcare providers have identified the False Claims Act (FCA) as a potent tool. The Second Circuit decision in Mikes v. Straus might be viewed as a barrier to FCA claims against nursing facilities. Any impediment imposed by this decision, however, is limited by the facts of the case; the authors believe that carefully-crafted pleadings can enable litigants to rely upon the FCA in pursuing quality-of-care claims against nursing facilities.     

Partition coefficient, blood to plasma ratio, protein binding and short-term stability of 11-nor-Delta(9)-carboxy tetrahydrocannabinol glucuronide

11-Nor-Delta(9)-carboxy tetrahydrocannabinol glucuronide (THCCOOglu) is a major metabolite of tetrahydrocannabinol in blood. Despite its mass spectrometric identification already in 1980, further physicochemical data of THCCOOglu have not been established. Therefore, the octanol/buffer partition coefficient P and the blood to plasma ratio b/p for THCCOOglu concentrations of 100 and 500ng/ml were investigated. Protein binding of the glucuronide was established from spiked albumin solutions at a level of 250ng/ml as well as from authentic samples. The data were compared to those of 11-nor-Delta(9)-carboxy tetrahydrocannabinol (THCCOOH). In addition, the short-term stability of THCCOOglu in plasma at different storage temperatures was studied. Analysis was performed by LC/MS/MS. The glucuronide partition coefficient P (mean: 17.4 and 18.0 for 100 and 500ng/ml, respectively) was unexpectedly lipophilic at pH 7.4. Its blood to plasma ratios averaged 0.62 and 0.68 at 100 and 500ng/ml, respectively. THCCOOglu was highly reversibly bound to albumin (mean: 97%), and the mean fraction bound did not differ from that determined from authentic samples. THCCOOglu degraded even at a storage temperature of 4 degrees C and THCCOOH was identified as a major decomposition product.