Bureaucratic Job Mobility and The Diffusion of Innovations

In studies of innovation, policy entrepreneurs recognize latent demand for new policies and then expend resources to promote them. But studies of policy entrepreneurs have generally focused on the demand for innovation, while neglecting the supply side of policy entrepreneurship. This article argues that bureaucratic labor markets affect the emergence of policy entrepreneurs, and so affect the diffusion of policy innovations across local governments in the United States. Analysis of a survey of municipal police chiefs and water utility managers relates governments' hiring and promotion policies to their adoption of professionally fashionable innovations. Agency heads who advanced to their current positions diagonally (arriving from another organization) are more likely to initiate these innovations than are agency heads who were promoted from within. Bureaucratic policy entrepreneurs emerge where government demand for innovation meets a supply of mobile administrators, who carry the priorities of their professions into the agencies that they serve.     

The Silent Reform of Swiss Federalism: The New Constitutional Articles on Education

This article examines the decision‐making process leading to the new constitutional articles on education in Switzerland. It analyzes how actors from both state levels (Confederation and cantons) could reach consensus in a process that was prone to a “joint‐decision trap”. To that end, we hypothesize which factors may be conducive to a “problem‐solving” style of policy‐making in a compulsory negotiation system. Rich empirical material from various sources supports our theoretical arguments: We show that shared beliefs and a common frame of reference, the procedural separation between constitutional and distributional issues, neutral brokers, and informal structures were all beneficial to the success of the reform project.     

Reporting a fatality during tumescent liposuction

Deaths of patients during elective surgery have drawn attention to the danger of anesthesia. Tumescent local anesthesia is subcutaneous infiltration of large volumes of dilute lidocaine with epinephrine to produce vasoconstriction while delivering anesthesia over large areas without lidocaine toxicity. This report documents the case of a 38-year-old woman who attended an outpatient clinic to undergo liposuction of the abdomen and bilateral hips and thighs. According to one witness, around 30 min after anesthesia administration, the victim suffered an episode of tonic–clonic convulsion. When the emergency medical services arrived the patient was in asystole. She died in spite of attempted cardiopulmonary resuscitation. The patient had no significant past medical history including no history of allergies or any known complications with anesthesia. A complete autopsy was performed and possible causes of death such as myocardial infarction, aspiration of food or foreign body, and pulmonary embolism were discarded. Anaphylactic shock was considered a possible but unlikely explanation for the fatality. Toxicological analyses revealed the presence of lidocaine and mepivacaine in heart blood, at concentrations of 4.9 and 16.2 mg/L, respectively. All drugs involved in the case were detected using gas chromatography with nitrogen–phosphorus detector and confirmed using gas chromatography–mass spectrometry full scan mode after solid-phase extraction using Chem-Elut columns. An additional high-performance liquid chromatography coupled to diode-array detection screening also obtained the same results. Based on the autopsy findings, case history, and toxicology results, the forensic pathologists ruled that the cause of death was an overdose of local anesthetic agents. The Court of Law ruled the death as an involuntary homicide due to gross negligence.