Industrial rationalization of a cottage industry: multi-institutional hospital systems

The environment facing hospitals, generally supportive until the 1970s, may now be characterized as complex, turbulent, and constrained. In response to such environmental conditions, hospitals have adopted new strategies and structures. The strategies, described as corporate rationalization, have led away from the traditional structure of freestanding, autonomous hospitals and toward the formation of multi-institutional systems. These systems are designed to provide sufficient strength to cope with the environment, to acquire scarce and valued resources, to allow organizational stability, to achieve organizational purpose, to enable growth and/or survival, and to enhance market position. The impact of multi-hospital systems is viewed in two major areas: acquisition, retention, and utilization of economic and human resources, and organizational, political, and social factors.     

Two Decades of Change: A Ranking of Key Issues Affecting Intergovernmental Relations

This article describes the results of a 1981 survey of 1,000randomly selected scholars of American government and politicswho were asked to rank the most significant intergovernmentalevents and trends of the past twenty years. Responses were receivedfrom almost 40 percent of these scholars; no significant returnbiases were detected. These scholars ranked civil rights andvoting rights acts as the most significant events of these decades.General Revenue Sharing and the reapportionment cases were rankedsecond and third in importance. The increased flow of federaldollars to states and local governments was ranked the mostimportant trend affecting intergovernmental relations, followedby the increased public disaffection with government and thegrowing dependence of local governments on state and federalaid. The Vietnam War and the inflationary spiral it initiatedwas ranked as the most significant social event affecting thecourse of intergovernmental relations, followed closely by theenergy crisis and the beginnings of the "Great Society." Thearticle also examines the effects of party identification, age,year of degree, government experience, region, and city sizeon scholarly attitudes toward these events and trends. Whilethe overall rankings were not dramatically altered, partisanship,region, and city size all were factors found to be noticeablyrelated to scholarly rankings of these important events andtrends.     

C: Reviews and notes bibliographies and works of reference

INTRODUCTORY GUIDE TO MIDDLE EASTERN AND ISLAMIC BIBLIOGRAPHY. (Middle East Libraries Committee Research Guides, 5.) Edited by PAUL AUCHTERLONIE. Oxford, Middle East Libraries Committee, 1990. v, 84pp. £9.50.

SUFI WOMEN. By JAVAD NURBAKHSH. Translated by L. Lewisohn. Rev. ed., London & New York, Khaniqahi‐Nimatullahi Publications, 1990. 263pp. 8 illustrations. £7.95.

WHO'S WHO IN THE ARAB WORLD 1990–1991. Tenth edition, thoroughly revised and completed. München, New York, London, Paris, K.G. Saur, for Publitec Publications, 1990. 927 pp. £180.00

INVENTARIO DE FOLLETOS: SECCIÓN DE ÁFRICA Y MUNDO ÁRABE DE LA BIBLIOTECA NACIONAL, I (CAJAS 7000 A 7021). By JAVIER GÓMEZ LÓPEZ & others. Madrid, Biblioteca Nacional, 1989. 124pp.

BIBLIOGRAFIA DE LA LITERATURA HISPANO‐ARABE. Compiled by MARIA JESUS RUBIERA MATA. Alicante, Universidad de Alicante, 1988. 75pp. Ptas. 566.‐

ESTUDIOS ONOMÁSTICO‐BIOGRÁFICOS DE AL‐ANDALUS, I. Edited by MANUELA MARlN. Madrid, CSIC, Instituto de Filología, Departamento de Estudio Árabes, 1988. 610,[2]pp.

ESTUDIOS ONOMÁSTICO‐BIOGRÁFICOS DE AL‐ANDALUS, II. Edited by MARlA LUISA ÁVILA. Granada, CSIC, Escuela de Estudios Árabes, 1989. 342,[2]pp.

AL‐ADAB AL‐TÜNISI AL‐MU'ASIR. By JEAN FONTAINE. Tunis, al‐Dar al‐Tūnisiyya li‐1‐Nashr, 1989. 191pp. TD3.200.

ENGLISH‐PERSIAN DICTIONARY OF LEGAL AND COMMERCIAL TERMS. Compiled By K.FAHIM, J. HABIBION and F. VITTOR. Leiden, Brill, 1989. 81pp. Hfl 150.

FLORA OF EASTERN SAUDI ARABIA. By JAMES P. MANDAVILLE. London, Kegan Paul International, in association with the National Commission for Wild Life Conservation and Development, Riyadh, 1990. x, 482pp. 200 colour ills. £95.00.     

Genetic markers in human bone: I. Deoxyribonucleic acid (DNA) analysis.

Deoxyribonucleic acid (DNA) was isolated from a number of spongy and compact human bone tissue specimens, and the yield was estimated on a "per milligram of starting tissue" basis. DNA was, in addition, isolated from a number of corresponding blood and bone tissue specimens. Spectrophotofluorometry and ethidium bromide visualization on minigels were used to estimate the quantity and degree of degradation of DNA. The DNA from several blood-bone pairs is shown to give concordant restriction fragment length polymorphism (RFLP) typing results by two different typing protocols with five different single-locus probes. DNA from several additional blood-bone pairs is shown to give concordant results for human leucocyte antigen (HLA)-DQ alpha phenotypes following polymerase chain reaction (PCR) amplification and hybridization to specific allele-specific oligonucleotide (ASO) probes, and for the variable numbers of tandem repeats (VNTR) length polymorphisms 3' to the human apolipoprotein B (APOB) gene following PCR amplification with specific primers and analysis of the products by electrophoresis and ethidium bromide visualization.     

Pitfalls in the diagnosis of drug smuggler's abdomen

Narcotics "body packing" can be detected in abdominal X-rays by the ring shadow caused by air trapped in the packs. In a series of 82 cases admitted for abdominal X-ray in Helsinki, Finland, in 1982 through 1988, we encountered 9 (11.0%) true positives, 3 (3.6%) false positives, and 1 (1.2%) false negative. The false positives were due to the constipation often associated with the narcotics abuse. The false negative X-ray diagnosis was attributable to an inexperienced radiologist. False negatives may also be associated with packets containing marijuana, packs with few wrappings, aluminum-foil coated packs, and machine-packed narcotics. Searching for trapped air in radiographs, repeated X-raying by an experienced radiologist, use of computed tomography, or combined urinary drug screening may be applied to diminish false findings and to avoid unnecessary arrest for the purpose of fecal screening over several days.