The diagnosis of diffuse axonal injury in routine autopsy practice

A 40-year-old pedestrian was involved in a road traffic accident. He lost consciousness immediately and remained comatose for 6 months until he died of a bronchopneumonia. Examination of the fixed brain revealed the late results of diffuse axonal injury. Not all the features were readily visible macroscopically, but required a limited number of histological sections from readily predictable sites for demonstration. Special stains played only a confirmatory role. This case illustrates some of the problems in diagnosing one of the commoner patterns of brain damage in head injury, and shows how the problem may best be approached in practice.     

Local Government Restructuring: Privatization and Its Alternatives

Local government restructuring should no longer be viewed as a simple dichotomy between private and public provision. A 1997 survey of chief elected township and county officials in New York shows that local governments use both private and public sector mechanisms to structure the market, create competition, and attain economies of scale. In addition to privatization and inter‐municipal cooperation, two alternative forms of service delivery not previously researched—reverse privatization and governmental entrepreneurship—are analyzed here. Logistic regression on the 201 responding governments differentiates the decision to restructure from the level and complexity of restructuring. Results confirm that local governments are guided primarily by pragmatic concerns with information, monitoring, and service quality. Political factors are not significant in the restructuring process and unionization is only significant in cases of simple restructuring (privatization or cooperation used alone). Fiscal stress is not a primary motivator, but debt limits are associated with more complex forms of restructuring. Restructuring service delivery requires capacity to take risks and is more common among experienced local officials in larger, higher‐income communities. Restructuring should be viewed as a complex, pragmatic process where governments combine public and private provision with an active role as service provider and market player. © 2001 by the Association for Public Policy Analysis and Management.     

The Mediated Effect of Contextual Risk Factors on Trajectories of Violence: Results from a Nationally Representative,Longitudinal Sample of Hispanic Adolescents

The current study sought to estimate trajectories of violent behavior and evaluate the direct and indirect effects of contextual factors among Hispanics, stratified by gender. Relying on data from 3,719 Hispanic adolescents surveyed as a part of the National Longitudinal Study of Adolescent Health (Add Health), violence trajectories were estimated using group-based trajectory modeling. The results identified three groups of violence trajectories for both males and females (non-violent, desistors, and escalators) and there were considerable gender differences in the direct and indirect effects of risk and protective factors on violent behavior. Study limitations and policy implications are also discussed.