Programme and performance budgeting in Malaysia

This paper reviews the evolution of programme and performance budgeting (PPB) in Malaysia from its beginning in 1969, through the in-depth implementation phase which began in 1972, to the present day. It outlines the system in the Ministry of Health, where PPB has been extensively developed and comments on the systems established in other in-depth ministries, in several of which little appears to have been achieved. In 1981 all other agencies were asked to adopt PPB in their budget submissions. Compliance has been superficial. The paper explores the constraints to the further development of PPB. These range from difficulties of securing appropriate staff, lack of top-level commitment and information problems, to the inherent difficulties of programming and performance measurement. In seeking to evaluate the success of PPB the paper adopts two approaches. The first, involving a small questionnaire survey amongst those involved in PPB, reveals rather guarded opinions concerning its usefulness and progress. The second, which explores the use made of PPB, reveals little use by legislators, budget officers or line managers, and no link between PPB and the planning process. However the audit department expresses considerable interest in relation to performance auditing. In summary the achievements of PPB have been modest.     

Sudden death in an infant resulting from torsion of the uterine adnexa

A 2-month-old infant girl died suddenly as a result of torsion of the uterine adnexa. The infant was found unresponsive in bed and was pronounced dead shortly after her arrival at a hospital. There were no antecedent signs of illness. At autopsy, the right ovary and right fallopian tube were twisted and were dark purple, swollen, and necrotic. The right ovary was enlarged by a follicle cyst 4 cm in diameter, which likely precipitated the torsion. The mechanism of death was unclear but may have resulted from the release of cytokines produced in response to necrotic adnexal tissue. Fatal uterine adnexal torsion has been reported rarely in infants; in all those cases there were antecedent symptoms. Torsion of the uterine adnexa should be included in the differential diagnosis of sudden death in infancy.     

Antitrust, health care quality, and the courts

Antitrust law represents the principal legal tool that the United States employs to police private markets, yet it often relegates quality and nonprice considerations to a secondary position. While antitrust law espouses the belief that vigorous competition will enhance quality as well as price, little evidence exists of the practical ability of courts to deliver on that promise. In this Article, Professors Hammer and Sage examine American health care as a vehicle for advancing understanding of the nexus among competition, quality, and antitrust law. The Article reports results of a comprehensive empirical review of judicial opinions in health care antitrust litigation between 1985 and 1999, with specific attention to courts' handling of quality and other nonprice concerns. Professors Hammer and Sage conclude that, although antitrust law cannot be expected to serve as the sole oversight mechanism for industries as complex and quality dependent as health care, courts have been successful incorporating some nonprice factors into antitrust analysis.     

The forensic and investigative significance of reverse paternity testing with absent maternal sample

The authors are involved in the extraction of DNA material from calcified tissues, oftentimes teeth, and analysis of such material to assist the investigative process, frequently by confirming the identity of the victim. Biologic or molecular techniques for the purposes of human identification have evolved to allow increasingly discriminating tests for use in criminal and noncriminal death investigations, as well as paternity disputes. The goal of such tests is to either include 2 samples (ie, they are from the same person, or in the case of paternity, they are from related individuals) or exclude 2 samples (ie, they are from different people or from unrelated individuals). Regardless of the system used and when data error has been eliminated, an exclusionary conclusion is irrefutable. The probability of excluding the falsely accused has steadily increased over the years as new methods are developed. Conventional ABO blood typing, for example, has a probability of exclusion (PE) of only 17%. This value increases to 53% with the inclusion of the Rh and MN systems. Additional serological markers can provide a probability of exclusion of greater than 99%. Today, the current method of choice for human identification is the polymerase chain reaction for the amplification of short tandem repeat (STR) multiplexes. This paper discusses the implications of nonpaternity in reverse paternity testing when only paternal DNA is available.     

Abortion in Australia: access versus protest

Currently in Australia anti-choice protesters' right to freedom of speech and freedom to protest is privileged over a woman's right to privacy and to access a health service safely, free from harassment, intimidation and obstruction. This article considers how this situation is played out daily at one Victorian abortion-providing clinic. The Fertility Control Clinic was thrown into the spotlight after the murder of its security guard by an anti-choice crusader in July 2001. Australian common law appears not to offer women protection from anti-choice protesters. By contrast, United States and Canadian "bubble" legislation sits comfortably with key constitutional rights. It would be a useful development if Australian governments passed legislation to ensure the rights, wellbeing and safety of Australian women accessing health services. Such legislation would be another step away from the misogynistic and androcentric values once central to our legislative framework.     

Poppy seed consumption and toxicological analysis of blood and urine samples

Poppy seeds contain morphine in different amounts. Reported concentrations are up to 294 mg morphine/kg poppy seeds. Since penalties based on Street Traffic Law (parapgraph 24a StVG) in Germany (administrative offence) require definitive proof of morphine in blood samples, and the "Grenzwertkommission" in consultation with the Ministry of Transportation recommended a threshold of free morphine of 10 ng/mL, the question arose whether the consumption of poppy seeds can lead to a blood concentrations equal or higher than 10 ng/mL of free morphine. Therefore, five volunteers ate poppy seed products (50 mg morphine/kg poppy seeds). In urine, all on-site tests were enzyme immunologically positive for opiates and were positive to morphine by GC/MS. All the blood samples were negative to morphine by EIA and to free morphine by GC/MS. However, after hydrolysis, morphine was detected by GC/MS in all cases. Accordingly, in Germany, penalties based on parapgraph 24a StVG are not likely to cause road users any concerns should they have consumed poppy seeds. Driver Licensing Authorities, however, should be advised of this problem to avoid unjustified legal measures.     

Why decentralize decision making? English local actors' viewpoints

Decentralized decision making has created restructuring from larger to smaller administrative units, but in many places, strays little from existing arrangements. Moves toward decentralization from central government to city‐regions, and in some areas, below city‐region scale to neighborhoods, reflect a mandate for reform. What is the nature and extent of desired reforms? Using an institutionalist lens, homogeneity and heterogeneity in local narratives about possible future reform can be surfaced. This article emphasizes the importance of understanding the role of local actors' narratives in shaping decentralized institutions. This article uses the findings from a Q‐methodology study to identify and interrogate distinctive local viewpoints on attempts to decentralize decision making in England. In a systematic empirical analysis, local actors' narratives were largely in favor of relatively minor modifications to the status quo. The findings question a conflation of decentralization with participation in decision making.