New Public Management and Management Education: Foundations of Successful Management Reform

International experience shows that the main objective of New Public Management (NPM) reform has predominantly been to overcome the current crisis in funding and public service delivery. The achieving this objective has involved adopting a philosophy of 'more for less' or, in other words, by enhancing 'value for money' in public service delivery. To this end,NPM reforms have generally aimed at replacing the inherited or traditional bureaucratic structure of management with a market – or at least a competition-based – contract arrangement. As is the case in any contested market setting, the main concern of state and public administration is no longer merely to ensure a legally correct application of laws, but also to use scarce resources as 'efficiently' as possible in the pursuit of the desired ends of increased productivity and 'more for less'.     

Sickle cell trait-associated deaths: a case series with a review of the literature

This study presents a series of 16 carriers of hemoglobin S (HbS) who died during various circumstances. Many of the cases were associated with mild to moderate exertion. The onset and/or duration of symptoms varied from a few minutes to several hours with many displaying a prolonged lucid interval with stable vital signs. Despite seeking medical treatment, sickle cell trait-related micro-occlusive crisis was never considered in the differential diagnosis. Several cases were associated with sudden death. In those deaths which were delayed, high anion gap and uncompensated metabolic acidosis were typical and were not heat related. Also characteristic were large increases in creatine kinase, alanine aminotransferase, and aspartate aminotransferase along with myoglobinemia. Although the antemortem diagnosis of rhabdomyolysis was made, the underlying cause was never deduced by the clinicians. The sickling found at autopsy is not always a postmortem artifact, and in the right circumstances can be diagnostic.     

Service Quality Effects of Incentive Regulation on Access Service in Telecommunications in the United States

Incentive regulation in the form of price caps was adopted for interstate access service in 1991 as a way to provide local exchange carriers with an incentive to improve their productive efficiency. An issue that has arisen with the adoption of price cap regulation is whether deterioration in service quality for interstate access service has been an unintended consequence. The analysis in this paper uses several different measures of service quality, including the average installation interval, the percent of commitments met, total trouble reports, and the average repair interval for both switched access service and special access service, to investigate empirically whether there has been a decline in service quality between 1991 and 2000. The results are conclusive. Overall service quality has fallen. To rectify the situation, a proposal is offered to adjust the price cap index to penalize LECs who fail to provide an acceptable level of aggregate service quality.     

Correlates of outcome following acute glutethimide overdosage

Potential predictors of outcome following acute glutethimide overdosage were assessed in 63 patients hospitalized with this diagnosis at a large urban medical center between 1962 and 1975. Their mean age was 34 years (range, 15 to 84 years) and 62% were female. Assisted ventilation was required in 59% of cases, and 32% developed hypotension. Six patients died, including all three aged 60 years or older. Multiple regression analysis confirmed that age was the major identifiable determinant of survival, regardless of other factors. Among identifiable determinants of coma grade, glutethimide dose, glutethimide plasma concentration, and coingestion of barbiturates were the most important. An ingested dose of 10 g or more, or a plasma concentration exceeding 30 microgram/ml, was almost always associated with deep coma. However, a relatively small ingested dose or a low plasma level by no means ruled out development of serious intoxication, particularly in those patients who also ingested barbiturates. Thus elderly individuals are at high risk for fatal outcome following glutethimide overdosage and should receive priority for intensive care and monitoring. Glutethimide dose, plasma concentration, and history of coingestion of barbiturates are of value in predicting development of deep coma. These items of information should be obtained on admission whenever possible.     

Importance of radiological diagnosis applied to necroscopy

The authors evaluate the consequences of incomplete necroscopic examinations wherein it was impossible to apply radiological resources to locate firearm projectiles. The study includes 8185 reports from the Instituto Médico-Legal Afranio Peixoto in Rio de Janeiro, Brazil, representing the totality of corpses processed from January to December 2001; of these, 3122 were gunshot victims, 309 of which were buried with unremoved projectiles, being liable to future judicial reappraisal. During the same period, there were 23 exhumation requests by police authorities, 12 of them querying the existence of projectiles. The authors looked into the formal reasons assumed by the medico legal experts to conclude their reports from incomplete examinations, and suggest that gunshot necroscopic examinations should follow specific protocols, as incomplete autopsies will require further exhumations, at unnecessary additional costs.     

行政法官在发展社会政策中的作用

<正>行政法官有一种严重的、在一定意义上属于低人一等的情结。①相比于"真正的"法官,他们对自身的地位过度敏感。然而他们在社会中的作用却使其他法官黯然失色。尽管他们的价值常常受到成本—效益(cost effectiveness)的衡量,但最重要贡献却在于社会政策的发展方面。②鉴于行政国家的发展,他们已成为政策发展的关键角色。正如伟大智者詹姆斯·兰迪斯(James Landis)所言:"对行