How to Succeed in Reorganizing: The Case of the Norwegian Health Administration*

There has been a growing concern about administrative reform in many countries during the last 10–20 years. The central administrative apparatus has been restructured, partly as an instrument to fulfill collective, political goals. This study of the reorganization of the central health administration in N orway shows that political and administrative leaders increase their control through a planned reorganization. But such a comprehensive reform also creates problems in adjusting to new administrative roles.     

Detection of ketosis in vitreous at autopsy after embalming

Ketosis occurs in ketoacidosis or malnourishment. When either is suspected in relation to a death, it may be important to analyze for ketosis at autopsy. We encountered a case where starvation was suspected in a deceased nursing home resident, where the body had been embalmed prior to autopsy. Gas chromatography (GC) was unable to separate acetone from formaldehyde, a component of embalming fluid. The Acetest is a simple test that can detect acetone and acetoacetate in body fluids. We validated the Acetest with GC on vitreous. The Acetest and GC were consistent except at very low levels of acetone or acetoacetate. The sensitivity of the Acetest for acetoacetate in vitreous was 10 mg/dL, consistent with early starvation. Significant interference from embalming fluid did not occur. The Acetest was negative in the described case. The Acetest is a simple and useful test for the detection of ketosis in embalmed autopsies.     

The periphery-dominated centre

Abstract Irish political parties cannot be easily fitted into a conventional left-right framework. The Lipset-Rokkan centre-periphery concept is employed to explain this situation, and, in particular, to throw light on the persistent success of Fianna Fáil, the nationalist-populist party which has dominated the system since 1932. It is argued that Ireland affords an example of a polity in which the political concerns and style of the rural periphery came to 'invade' and dominate the urban centre for more than a generation. Evidence from a study of urban party activists indicates a persistence of rural political styles and ideological perspectives in a social context which has been for well over half a century.     

Radical Reform in New Zealand: Crisis, Windows of Opportunity, and Rational Actors

This article uses three perspectives to explain the radical economic and state sector reforms undertaken in New Zealand starting in 1984. We interpret the reforms using a rational-comprehensive perspective, a garbage can perspective and a modified garbage can perspective identified in the work of John Kingdon. With New Zealand as an illustrative case, we explore the conditions under which radical reform is possible, the factors governing the adoption of reforms, and the impact on the reform process of a country's historical and cultural traditions. Our analysis emphasizes the import of a package of ready-made solutions, strong advocates (particularly a well-placed policy entrepreneur) who attach the solutions to a problem, and the existence of a 'window of opportunity' for adoption of the reforms. We conclude with a discussion of the implications of adopting reforms that run counter to a nation's long-established traditions.     

Coping with Complex Leadership Roles: The Problematic Redefinition of Government-owned Enterprises

Inspired by New Public Management, many countries have changed their central public apparatus from an integrated to a more segregated structural model. A central element in this process is structural devolution and the establishment of new or reorganized state-owned companies with increased business autonomy and new formal control systems. This paper focuses on how this development, as exemplified by the case of Norway, is affecting the role of central executive political and administrative leaders. The study, based on elite interviews, shows that corporatization has made the role of central leaders more complex and ambiguous and undermined traditional political control. We interpret this development from a transformative perspective, underlining how structural devolution is filtered through the dynamic context of environmental pressure and internal structural and cultural factors; in addition, experiences from New Zealand are used to contrast the Norwegian case.     

Weight force during prone restraint and respiratory function

Prone maximal restraint position (PMRP, also known as hogtie or hobble) is often used by law enforcement and prehospital personnel on violent combative individuals in the field setting. Weight force is often applied to the restrained individual's back and torso during the restraint process. We sought to determine the effect of 25 and 50 lbs weight force on respiratory function in human subject volunteers placed in the PMRP. We performed a randomized, cross-over, controlled trial on 10 subjects placed in 4 positions for 5 minutes each: sitting, PRMP, PRMP with 25 lbs weight force (PMRP+25), and PRMP with 50 lbs weight force placed on the back (PMRP+50). We measure pulse oximetry, end-tidal CO2 levels, and forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). FVC and FEV1 were significantly lower in all restraint positions compared with sitting but not significantly different between restraint positions with and without weight force. Moreover, mean oxygen saturation levels were above 95% and mean end-tidal CO2 levels were below 45 mm Hg for all positions. We conclude that PMRP with and without 25 and 50 lbs of weight force resulted in a restrictive pulmonary function pattern but no evidence of hypoxia or hypoventilation.