Deaths associated with liposuction: case reports and review of the literature

Tumescent liposuction is a common cosmetic procedure that is performed as an outpatient service in physician's offices and is largely believed to be safe. The protuberant areas of the body containing the undesirable fat deposits are injected with normal saline containing lidocaine and epinephrine for pain control and hemostasis, and the waterlogged cells are suctioned out via cannula through a small incision. We recently encountered three cases in which deaths were attributed to this procedure. Two showed fat embolization in the lung and one died from fluid overload. The osmium tetroxide post-fixed lung sections showed fat emboli in the interstitial capillaries and arterioles. We reviewed the recent literature and found that pulmonary thromboemboli, fat embolization, fluid overload, and lidocaine and epinephrine intoxication are found at autopsy in many cases. Forensic pathologists responsible for determining the cause and manner of death should become familiar with the postmortem findings and risks of liposuction therapy and communicate them to their clinical colleagues and communities.     

Five‐year effects of an anti‐poverty program on marriage among never‐married mothers

Using data from an experimental evaluation of the New Hope project, an anti‐poverty program that increased employment and income, this study examined the effects of New Hope on entry into marriage among never‐married mothers. Among never‐married mothers, New Hope significantly increased rates of marriage. Five years after random assignment, 21 percent of women assigned to the New Hope condition were married, compared to 12 percent of those assigned to the control group. The New Hope impact on marriage was robust to variations in model specification. The program also increased income, wage growth, and goal efficacy among never‐married mothers, and decreased depression. In non‐experimental analyses, income and earnings were associated with higher probability of marriage and material hardship was associated with lower probability of marriage. © 2006 by the Association for Public Policy Analysis and Management     

Efficiency Measurement in Spanish Local Government: The Case of Municipal Water Services

In this work, we established a procedure for evaluation of the efficiency of the water supply. This procedure has allowed us to find that the proposed indicators have a discriminating capability in the analysis of the service, and to reject criticisms traditionally assigned to the sensitivity of the data envelopment analysis (DEA) technique in relation to degrees of freedom. The results obtained show that the population density, as a factor that defines one of the particular characteristics of the surroundings of each municipality, has a statistically significant impact on the indexes of efficiency, this affirmation not being extended to the public or private ownership of the service. The scale inefficiency is higher than the technical inefficiency. These typologies of efficiency are, principally, motivated by the supply side of the service, which is specially linked with the necessary infrastructure. The demand of the citizens is satisfied with a behavior close to optimal.     

Designing a merit‐based process for appointing boards of abcs: Lessons from the Nova Scotia reform experience

Abstract: Efforts to design merit‐based appointment systems for the boards of government agencies, boards and commissions (abcs) have gained greater priority over the past decade in order to enhance public confidence in the integrity of the political process, improve the governance of organizations operating at arm's length from ministers, and reduce the risks to the public interest and public purse that come with incompetent boards. The Nova Scotia reform experience in this regard is instructive because this province's appointment regime not only encompasses a legislative committee veto over ministerial appointments, a power unique to this province in the Canadian and comparative Westminster systems, but also uniquely sets the merit standard as relative‐merit, that is, the appointment of the most qualified of all applicants, and not merely a qualified candidate. This article reviews this provincial experience and concludes that a merit‐based appointment system that pursues relative merit can be created but only by restricting the authority of ministers to a veto over the appointment of candidates nominated by the abcs themselves. Sommaire: Ces dix demières années, les efforts déployés pour concevoir des systemes de nomination au mérite pour les conseils d'administration d'organismes, des régies et des commissions du gouvernement ont obtenu une priorité beaucoup plus grande, et cela, afin de rehausser la confiance du public envers I'intégrite du processus politique, d'ameliorer la gouvernance d'organismes fonctionnant sans contrôle ministériel direct et de réduire les risques que représentent les conseils incompétents pour le bien et les deniers publics. L'expérience de la réforme entreprise en NouvelleÉcosse est à cet égard instructive pour les partisans de la réforme. Le régime de nomination de cette province comporte non seulement un droit de veto de la part d'un comité législatif sur les nominations ministéielles, pouvoir unique à cette province dans le systéme canadien et le systéme comparatif de Westminster, mais il établit également la norme de mérite comme un mérite relatif, c'est‐à‐dire la nomination de la personne la mieux qualifiée parmi tous les candidats et non simplement la nomination d'une personne qualifiée. Le présent article examine I'expérience de cette province et conclut qu'un système de nomination au mérite visant le mérite relatif peut être mis en place, mais seulernent à condition de limiter le pouvoir des ministres à opposer leur veto à la nomination de candidats par les organismes, régies et commissions gouvernementaux.     

Ethics revisited in a society in transition: the case of the former East Germany

Since 1990, the German government has been demanding from the civil servants of the former East Germany a new adaptability and creativity that was never promoted in the GDR bureaucracy. The article analyses the change of ethics in the former East Germany after 1990. It looks at the development of the German civil service, discusses the economic disparity between East and West, and examines the ethical tradition in the former socialist country. It uses the case of the selection in 2001 of the city of Leipzig by BMW as the location of a new manufacturing plant as an illustration of the new goal‐oriented activities of the present Eastern bureaucracy. More than 250 European cities were competing for the new plant, which will create over 10,000 jobs. The level of performance of the Leipzig bureaucracy in the BMW case reveals the new efficiency and professionalism of the former Eastern civil service. In addition to Leipzig, virtually all the local and state administrations from the former East Germany have developed a sense of the necessities of the time, including globalization. Copyright © 2002 John Wiley & Sons, Ltd.     

The effect of child support on welfare exits and re‐entries

Much of the literature on welfare dynamics has focused on the effects of recipient characteristics and state‐level characteristics such as welfare benefits and economic conditions; there has been very little analysis on the effects of child support. This paper, using the 1979‐1996 National Longitudinal Survey of Youth, examines whether child support affects the likelihood of leaving and re‐entering welfare. The results indicate that strong child support enforcement is important in helping young mothers exit and stay off welfare. Women with $1000 child support payments in the previous year were 18 percent more likely to exit welfare and 12 percent less likely to re‐enter welfare. Compared with women in states that pursued child support least vigorously, women in states that had passed extensive child support enforcement legislation and that spent more money on child support enforcement were 79 percent more likely to exit welfare and about 60 percent less likely to re‐enter welfare. © 2002 by the Association for Public Policy Analysis and Management.