Between EU Requirements, Competitive Politics, and National Traditions: Re–creating Regions in the Accession Countries of Central and Eastern Europe

The article studies the impact of the European Union (EU) on the reforms of regional administration in Central and East European (CEE) accession countries. It analyzes the motives, process and outcomes of regional– or mesolevel administrative reforms in five countries—Bulgaria, the Czech Republic, Hungary, Poland, and Slovakia—considering whether the EU has shaped these reforms to a higher degree than in relation to its incumbent member states. The article finds that the EU Commission's interest in regional self–governments with a substantial fiscal and legal autonomy has provided an additional rationale and an incentive to re–create regional self–governments. Advocates of regional self–government and an institutionalization of regions in the accession countries have referred to European trends and (perceived) EU expectations of regionalization. Thus, the Commission and the preaccession framework have become catalysts for a process in which most CEE regions have already enhanced and will further increase their political salience. However, the trajectories and outcomes of regional–level reforms can be better explained by a combination of domestic institutional legacies, policy approaches of reformers and their adversaries, and the influence of ethnic/historical regionalism.     

New Labour and Government in Britain: Change or Continuity?

The 1997 British election marks a major change in British government. Eighteen years of Conservative rule had brought about growing inequality and social division and have generated powerful demands for new directions in public policy, especially in the areas of welfare and public administration. On welfare state reform Labour is constrained by election promises to restrain taxation and public expenditure. New Labour ministers influenced by the New Right have in any case largely rejected traditional social democratic redistributive strategies and are seeking instead new ways of reducing welfare dependency.
The virulent spread of quangos at all levels of government and a marked increase in the centralisation of power in Whitehall have given a new impetus to demands for constitutional reform. Labour's response to these demands is a major program of regional devolution, House of Lords reform and open government measures.
This article explains what 'New Labour' means and discusses New Labour policies on welfare and constitutional reform and their implications for the future of public administration in Britain.     

Discrepancy between CYP2D6 phenotype and genotype derived from post-mortem dextromethorphan blood level

OBJECTIVE: To describe the death of a toddler after a therapeutic dose of dextromethorphan and its investigation. STUDY DESIGN: Case report, cytochrome P450 phenotype and genotype determination in the victim and post-mortem drug redistribution study performed in rats. RESULTS: A 20-month Asian male who received 3 mg of dextromethorphan once at 09:00 h and again at 22:00 h was found dead at 04:35 h. Post-mortem examination showed signs of early bronchopneumonia (bacterial cultures were negative); dextromethorphan and dextrorphan blood concentrations taken from the heart cavity were 500 ng/ml (1. 84 micromol/l) and 200 ng/ml (0.78 micromol/l), respectively. Despite the dextromethorphan level being almost 100-fold higher than expected after therapeutic doses, intentional or unintentional overdose was extremely unlikely; other potential causes were investigated. Post-mortem drug redistribution study performed in rats showed that dextromethorphan does not undergo extensive redistribution after death (6+/-5-fold increase) and could not explain the observed dextromethorphan level. The dextromethorphan/dextrorphan concentration ratio of 2.5 found in this toddler was compatible with a slow CYP2D6 metabolizer phenotype. However, the toddler exhibited a fast metabolizer genotype. Potential reasons for this discrepancy are discussed. CONCLUSION: CYP450 phenotypes derived from post-mortem blood levels should be interpreted with caution and preferably confirmed by a genotype analysis.     

Causes of death of patients in an institution for the developmentally disabled

The causes of death of 53 severely to profoundly developmentally disabled patients who died in an intermediate care facility were reviewed. Respiratory disease, predominantly pneumonia and aspiration, accounted for 72% of deaths. Seven patients died of nonrespiratory causes, and in 8 patients, no cause of death could be determined, even after a complete autopsy or investigation. The median age at death was 20 years. The weights of these patients' organs at autopsy were lower than those for normal individuals of the same age. The lifespan of these severely impaired individuals continues to be significantly shortened, even with improved methods of care.