Adjusting to New Ways of Working: Experiments with Service Delivery in the Public Sector

In response to the perceived failure of both the state and market models of service delivery, governments have embarked on a reform program that draws on the community sector to expand the suite of available policy and service delivery arrangements. This paper explores and identifies the nature of changed relationships between government and the community sector. It uses a case study that examines the operation of a new type of community organisation, and analyses the affectivity and outcomes from the experience of a community based networked arrangement. Although there is evidence of a shift to more relationship‐ oriented models of operation because of either mandate or preference both community and government sectors have found it difficult to make the necessary adjustments to these new ways of working. Community has begun the shift to this new relational approach but finds it difficult to sustain the momentum and tends to revert to more independent and competitive modes. Governments find it difficult to make the necessary adjustments to power‐sharing and resource allocation and continue to operate as ‘business as usual’ through the traditional bureaucratic authority of command and control. In this way, the rhetoric of collaboration and partnership between government and the community sector is not necessarily matched by policy and action supporting the practice of ‘new ways of working’ although these ‘experiments in service delivery’ have opened the way for adopting more innovative and effective approaches to service delivery.     

When silence threatens safety: lessons from the first Canberra Hospital neurosurgical inquiry

Despite widespread institutional and professional support, the recommendations of the Bristol Royal Infirmary Inquiry may be insufficient to reduce patient risk from impaired senior medical practitioners. Using the First Inquiry into Neurosurgical Services at the Canberra Hospital as a case study, this article argues that the Bristol-type recommendations--which emphasise reformulation of clinical governance structures, including early reporting of "sentinel events" and compulsory clinical audits--will be ineffective without a reformed institutional ethos that encourages open transparency and respect for those committed to such processes. Such reformulation may need to commence in medical education and involve new strategies including the use of portable digital technology to facilitate self-assessment of performance and immediate reporting of adverse incidents.     

Oxycodone intoxication in an infant: accidental or intentional exposure?

A case is presented of a 10 month old male who went into cardiac arrest at a local store. The infant subsequently expired and was autopsied at the Office of the Chief Medical Examiner, State of Maryland. The only remarkable finding was the detection of oxycodone in the postmortem specimens; the blood and liver oxycodone concentrations were 0.6 mg/L and 1.6 mg/kg, respectively. Oxycodone was identified and quantitated by gas chromatography-nitrogen-phosphorus detection and confirmed by full scan electron ionization gas chromatography-mass spectrometry. The medical examiner ruled that the cause of death was oxycodone intoxication, and the manner of death was homicide. The key toxicologic question in this case was whether or not it was reasonable for the infant to be exposed to oxycodone exclusively through breast milk or through an alternate source. It was concluded that, at best, there were serious concerns about the likelihood of drug exposure through consumption of breast milk.     

Interest groups and state Medicaid drug programs

A simultaneous equations model is estimated to analyze the interaction between state Medicaid pharmaceutical drug reimbursement rates, drug recipients per capita, and expenditures per drug recipient. Interest groups are shown to have a strong positive impact on pharmacy reimbursement rates, which, in turn, have an impact on pharmacy participation rates and drug utilization and expenditure patterns. Finally, a strong inverse relationship exists between expenditures per recipient and program size. The results verify the existence of substantial variation in state Medicaid programs and point to potentially growing disparities as a result of current policies.     

Fatal diphenhydramine intoxication in infants

Diphenhydramine is an antihistamine available in numerous over-the-counter preparations. Often used for its sedative effects in adults, it can cause paradoxical central nervous system stimulation in children, with effects ranging from excitation to seizures and death. Reports of fatal intoxications in young children are rare. We present five cases of fatal intoxication in infants 6, 8, 9, 12, and 12 weeks old. Postmortem blood diphenhydramine levels in the cases were 1.6, 1.5, 1.6, 1.1 and 1.1 mg/L, respectively. Anatomic findings in each case were normal. In one case the child's father admitted giving the infant diphenhydramine in an attempt to induce the infant to sleep; in another case, a daycare provider admitted putting diphenhydramine in a baby bottle. Two cases remain unsolved; one case remains under investigation. The postmortem drug levels in these cases are lower than seen in adult fatalities. We review the literature on diphenhydramine toxicity, particularly as it pertains to small children, and discuss the rationale for treating these cases as fatal intoxications.     

Deposition of 7-aminoflunitrazepam and flunitrazepam in hair after a single dose of Rohypnol

In recent years, there has been a notable increase in the number of reports on drug-facilitated sexual assault. Benzodiazepines are the most common so-called "date-rape" drugs, with flunitrazepam (Rohypnol) being one of the most frequently mentioned. The aim of this study was to determine whether flunitrazepam and its major metabolite 7-aminoflunitrazepam could be detected in hair collected from ten healthy volunteers after receiving a single 2 mg dose of Rohypnol using solid phase extraction and NCI-GC-MS. Such data would be of great importance to law enforcement agencies trying to determine the best time interval for hair collection from a victim of drug-facilitated sexual assault in order to reveal drug use. Ten healthy volunteers (eight women and two men, 21 to 49 years old) participated in the study. The following hair samples were collected from each volunteer: one before flunitrazepam administration, and 1, 3, 5, 14, 21, and 28 days after. In five volunteers, 7-aminoflunitrazepam was detected 24 h after flunitrazepam administration and remained in hair throughout the entire 28-day study period (0.6-8.0 pg/mg). In two cases, 7-aminoflunitrazepam appeared in hair 21 days after drug intake (0.5-2.7 pg/mg), and in two subjects 14 days later (0.5-5.4 pg/mg). In one volunteer, 7-aminoflunitrazepam was detected on day 14 and 21 but concentrations were below the quantitation limit. Flunitrazepam was detected in some samples but all concentrations were below the quantitation limit (0.5-2.3 pg/mg).     

Parent-adolescent separation: The role of parental divorce

Previous research has identified Emotional Separation and Personal Control as two sets of home leaving indicators that are associated, respectively with relatively troubled and relatively untroubled parent-adolescent separation. As expected, among late adolescent males, parental divorce was highly related to endorsement of Emotional Separation as an important composite indicator of having left home. For females, being a firstborn was associated with endorsing Personal Control as an important composite indicator of home-leaving. Findings were interpreted as supporting previous research which has indicated that males experience more adjustment problems after parental divorce than females.Received Ph.D. from Michigan State University. Current research interests are parent-adolescent separation and perceptions of loneliness.Received Ph.D. from Michigan State University. Current research interests are adolescent-parent separation and evaluation research.