Pursuing performance and maintaining compliance: Balancing performance improvement and accountability in Ontario's public health system

This article examines the compatibility between performance improvement and compliance‐based accountability in the implementation of a new system of public health performance management in Ontario. Findings from this mixed‐method study show that only minor elements of performance improvement get incorporated into pre‐existing compliance‐based accountability structures, that reinforcement of accountability structures works to the detriment of performance improvement intentions, and that limiting managerial influence in developing performance measures and targets diminish the utility of information for improvement. The study concludes that achieving a better balance requires an alternative to top‐down decision making that goes beyond consultation to include partnership.     

Public Opinion, Political Communication and the Internet

In contemporary society public opinion is generally mediated by the mass media, which has come to encompass the Habermasian 'public sphere'. This arena is now characterised by the conflict between market and democratic principles, by competing interests of politicians and the media. The presentation of information for debate becomes distorted. The opinion of the 'public' is no longer created through deliberation, but is constructed through systems of communication, in conflict with political actors, who seek to retain control of the dissemination of information. The expansion of the internet as a new method of communication provides a potential challenge to the primacy of the traditional media and political parties as formers of public opinion.     

Feminist histories

Shirley Fitzgerald, Rising Damp: Sydney 1870–90 Oxford University Press) Melbourne, 1987; Marilyn Lake, The Limits of Hope: Soldier Settlement in Victoria 1915–38 (Oxford University Press) Melbourne, 1987.     

Sudden death in right ventricular dysplasia with minimal gross abnormalities

Arrhythmogenic right ventricular cardiomyopathy is emerging as a relatively common cause of exercise-induced sudden death in the young. The diagnostic criteria at autopsy are, however, not fully established, leading to both over- and underdiagnosis. We report a young man and a young woman dying suddenly of right ventricular dysplasia during exercise, in whom the gross autopsy findings in the right ventricle were minimal or even absent. However, the histologic features in both right and left ventricles were typical of the disease, and consisted of fibrofatty infiltrates with typical myocyte degeneration of the right ventricle and subepicardial regions of the left ventricle. These cases illustrate that microscopic findings are diagnostic and may be present in the absence of gross findings. Marked fat replacement is not essential for the diagnosis of right ventricular dysplasia, and the right ventricle should be extensively sampled histologically in all cases of sudden unexpected death, especially those that are exercise related.     

Adrenocortical insufficiency

Primary adrenocortical insufficiency is a rare disease which may present with protean clinical symptoms and signs. At one end of the spectrum is the patient with a long clinical history with marked pigmentation and documented episodes of crises which may follow relatively minor viral illnesses. The other extreme is illustrated by patients with a rapid deterioration in health culminating in unexpected or unexplained death. In the latter instances, the forensic pathologist may well be involved, and the case will present a significant challenge to diagnosis. We report 5 cases of primary and secondary adrenocortical insufficiency seen at the Victorian Institute of Forensic Medicine in 1 year. One adult man presented as a case of sudden unexplained death. In 2 cases, the diagnosis of adrenocortical insufficiency was raised following postmortem examination and confirmed by the treating physician following further consultation. In the remaining 2 cases, the diagnosis was known prior to postmortem examination and the diagnosis confirmed.     

Childhood sexual abuse and multiple dimensions of self-concept

The purpose of this investigation was to examine the relationship between child sexual abuse (CSA) and self-concept in a nonclinical sample of female college students. Participants with a history of CSA had lower scores than participants without a history of CSA on four domains of self-concept: familial, affect, competence, and physical. History of CSA was not associated with lower self-concept in the social and academic domains. The primary conclusions to be drawn from this study are that CSA may be differentially associated with various domains of self-concept, and thus multidimensional assessment of self-concept can yield useful information that cannot be gathered from global measures which yield a single composite score.     

DNA analysis of ingested tomato and pepper seeds

Ingested food is one of the important types of forensic evidence obtained during a medicolegal autopsy. Many materials containing seeds pass through the human digestive system and are still recognizable; thus, they can be valuable for providing investigative leads. Currently, the identification of seeds relies on microscopic and morphologic examination. However this method sometimes can be problematic. For example, the microscopic appearance of the ingested tomato and pepper seeds is very similar; thus, it is not always easy to distinguish these seeds by comparing their physical characteristics. Tomato and pepper seeds were selected as a model system to assess the value of performing DNA analysis as an alternate and/or complimentary means of seed identification. Results of blind testing indicate that the deoxyribonucleic acid-amplified fragment length polymorphism (DNA-AFLP) results were able to discriminate between pepper and tomato seed samples after they passed through the digestive system.     

A randomized experimental study of sharing crime data with citizens: Do maps produce more fear?

The larger roles of the community in crime prevention and improvements in technology have increased police–citizen communication and the distribution of information from police departments to private citizens. Combined, these changes have led to the current movement among law enforcement agencies toward sharing both summary reports and maps of crime with community groups. Although the dissemination of crime information is intended to benefit community members, there is a lack of empirical evidence demonstrating the effects of crime mapping on citizen perceptions and fear of crime. This experiment compared three formats for disseminating crime data; two popular types of crime maps (i.e., graduated symbol and density) and the traditional tabular format of crime statistics. A randomized experimental design was used to measure residents fear of crime and their perception of the safety of different areas of Redlands, CA. Overall, residents who viewed either type of map reported less fear than those who viewed tabular statistics. Respondents who viewed graduated symbol maps consistently reported less fear than either density maps or tabular statistics. However, there were differences depending on the type of map. While graduated symbol maps were associated with the lowest levels of fear of robbery, theft or assault; density maps produced different reactions depending on the area of the city. Finally, the maps did not stigmatize high crime areas of Redlands. Where statistically significant differences existed, respondents who were given maps were more likely to recommend someone move into an area than those who were given tabular statistics.     

"If it hurts you, then it is not a joke": adolescents' ideas about girls' and boys' use and experience of abusive behavior in dating relationships

This study examined adolescents' ideas about girls' and boys' use and experience of physical and psychological abuse in heterosexual dating relationships. Canadian high school students who were enrolled in Grades 9 and 11 took part in single-gender focus groups. Eight themes emerged from the analysis. The themes highlight the importance teenagers place on context for defining specific behaviors as abusive. They also underscore gender differences in the criteria adolescents use to make these judgments, in the forms of abusive behavior teenagers typically use in a dating relationship, and in the reasons for youths' declining use of physical abuse and increasing use of psychological abuse. These views have important implications for future research and for programs targeting adolescent dating violence.