New public management and the Thatcher healthcare legacy: enough of the theory, what about the implementation?

Initial evaluations of Thatcherism suggest that it represented a policy formulation success but implementation failure (Marsh and Rhodes 1992), with healthcare reforms particularly unsuccessful because they did not challenge the autonomy of the medical profession (Wistow 1992a and 1992b). More extensive analyses of the implementation of new public management (NPM) within health care take this challenge more seriously. According to Ferlie et al. (1996), doctors were gainers and losers, since the rise of the management function coincided with a rise in medical involvement in management decisions. However, this article argues that the rise of the purchasing function of health authorities undermined this 'gain' to the medical profession. Further, the significance of the case study—AIDS policy in Scotland—is that profound change has occurred in a policy area in which one would least expect this to happen.     

Psychosocial Correlates of Intimacy Achievement Among Adolescent Fathers-to-Be

We investigated the relation between urban psychosocial stressors and intimacy achievement in a sample of 59 African American, Hispanic American, and White adolescent fathers-to-be. Participants received an intimacy score based on Orlofsky's Intimacy Status Rating Scale. Those with higher cumulative psychosocial stressors had lower levels of intimacy. One psychosocial risk factor, low interpersonal empathy, was significantly associated with intimacy levels. African Americans had lower levels of intimacy than Hispanic or White participants.     

Research in Context: Measuring Value Change

Abramson and Inglehart find a significant trend toward postmaterialist values in Western Europe, which they argue is largely driven by the gradual processes of generational replacement. Clarke, Dutt, and Rapkin argue that this trend is a methodological artifact of the wording of Inglehart's four-item measure of materialist/ postmaterialist values. They claim that because this battery does not include a question about unemployment, in periods of high unemployment respondents tend to choose postmaterialist goals. The long-term trend toward postmaterialism in Western Europe, they argue, results from rising levels of unemployment during the past two decades. Abramson and Inglehart point out that increases in inflation have a short-term impact on decreasing postmaterialism, but maintain that the positive relationship between unemployment and postmaterialism is spurious. As this analysis shows, Clarke, Dutt, and Rapkin find a positive relationship between unemployment and postmaterialism by building a model that has little theoretical justification and that is not robust to changes in specification. As this analysis demonstrates, unemployment is actually linked with support for materialist goals, and the trend toward post-materialism is robust in the face of alternative time frames, models, and specifications. The weight of the evidence demonstrates that the long-term trend toward postmaterialism in Western Europe is driven by generational replacement.     

Auditor Tenure, Fixed Fee Contracts, and the Supply of Substandard Single Audits

Our purpose is to provide empirical evidence of the relations between the quality of governmental audit services and auditor tenure and between quality and fixed fee audit contracts. Audit quality is assessed by Offices of Regional Inspectors General and is based on a review of the audit reports and supporting working papers. We test a model of quality supplied on a sample of audit engagements selected from a population of audited federal assistance programs. The empirical analysis finds that the probability of receiving a substandard audit increases with the length of the auditor-client relationship. Our analysis finds a positive relation between fixed fee contracts and the incidence of violations of professional standards among audits of federal assistance programs. Additionally, we provide evidence that the incidence of noncom-pliance with professional standards is significantly lower when the audit contract contains a provision for administrative and/or legal remedies in the event of substandard performance.     

A Classification Tree Approach to the Development of Actuarial Violence Risk Assessment Tools

Since the 1970s, a wide body of research has suggested that the accuracy of clinical risk assessments of violence might be increased if clinicians used actuarial tools. Despite considerable progress in recent years in the development of such tools for violence risk assessment, they remain primarily research instruments, largely ignored in daily clinical practice. We argue that because most existing actuarial tools are based on a main effects regression approach, they do not adequately reflect the contingent nature of the clinical assessment processes. To enhance the use of actuarial violence risk assessment tools, we propose a classification tree rather than a main effects regression approach. In addition, we suggest that by employing two decision thresholds for identifying high- and low-risk cases--instead of the standard single threshold--the use of actuarial tools to make dichotomous risk classification decisions may be further enhanced. These claims are supported with empirical data from the MacArthur Violence Risk Assessment Study.     

Socioeconomic change and suicide: a time-series study from the Republic of Ireland

This ecological study examined the association between seven socioeconomic indicators (GDP, unemployment rate, female labor force participation rate, alcohol expenditure, marriage rate, percentage of births outside of marriage, and indictable crime rate) and total, male, and female rates of suicide and suicide plus undetermined death in Ireland during the period 1968-2000. Analysis of the data expressed as absolute values showed highly significant associations between the socioeconomic indicators and the total, male, and female suicide rates. However, these associations were explained by the strongly trended data. The trended nature of the data was removed by using year-to-year differences. Analysis of the first-differenced data showed that none of the socioeconomic indicators was associated with the total, male, or female suicide rates with the exception of indictable crime, which had a significant independent effect on the female suicide rate (coefficient = 2.0, p < .01) but not on suicide plus undetermined death. This study highlights the need to use econometric methods in time-trend analyses, the lack of age-sex specific exposure data in this area, and the challenge of understanding trends in suicide in their socioeconomic context.     

Semi-automated ultrasound facial soft tissue depth registration: method and validation

A mobile and fast, semi-automatic ultrasound (US) system was developed for facial soft tissue depth registration. The system consists of an A-Scan ultrasound device connected to a portable PC with interfacing and controlling software. For 52 cephalometric landmarks, the system was tested for repeatability and accuracy by evaluating intra-observer agreement and comparing ultrasound and CT-scan results on 12 subjects planned for craniofacial surgery, respectively. A paired t-test evaluating repeatability of the ultrasound measurements showed 5.7% (n = 3) of the landmarks being significantly different (p < 0.01). US and CT-scan results showed significant differences (p < 0.01) using a Wilcoxon signed rank test analysis for 11.5% (n = 6) of the landmarks. This is attributed to a difference in the volunteer's head position between lying (CT) and sitting (US). Based on these tests, we conclude that the proposed registration system and measurement protocol allows relatively fast (52 landmarks/20 min), non-invasive, repeatable and accurate acquisition of facial soft tissue depth measurements.     

The Microbial Rosetta Stone database: A common structure for microbial biosecurity threat agents

Infectious microorganisms are important to multiple communities engaged in biodefense and biosecurity, including the agencies responsible for health, defense, law enforcement, agriculture, and drug and food safety. Many agencies have created lists of high priority infectious microorganisms to prioritize research efforts or to formally control the possession and distribution of specific organisms or toxins. However, the biological classification of infectious microorganisms is often complex and ambiguous, leading to uncertainty and confusion for scientists involved in biosecurity work. To address this problem, we created a database, known as the Microbial Rosetta Stone, which resolves many of these ambiguities and includes links to additional information on the microbes, such as gene sequence data and scientific literature. Here we discuss the efforts to coordinate organism names from pathogen lists from various governmental agencies according to biological relatedness and show the overlap of high-priority organisms from multiple agencies. To our knowledge, this is the first comprehensive coordination of pathogens, synonyms, and correct taxonomic names. The organized tables and visual aids are freely available at http://www.microbialrosettastone.com. This website provides a single location where access to information on a broad range of disease-causing organisms and toxins is available to members of the biosecurity community.