Performance measurement and financial incentives for community behavioral health services provision

This article analyzes the uses of performance measures in contracting for behavioral health services. A flexible performance measurement methodology, called Data Envelopment Analysis (DEA),is used to measure cost efficiency and cost effectiveness. The use of measures in controlling costs, allocating program funds and administrating performance-based contracting is demonstated.     

Champions of local authority innovation revisited

This article revisits the concept of the public sector innovation champion. Reflecting changes in sectoral and wider contexts and conceptual advances in the innovation literature, it suggests that much of the underlying thinking behind the original article is of continuing relevance and suggests a number of directions in which this could now be extended, particularly in terms of the nature of innovation and the role of champions therein. It concludes by considering how innovation champions of the future will require a new skillset which draws on new and emergent technologies to align diverse sets of stakeholders in networks of ‘open innovation’.     

Cajun Louisiana: Culture as a Way of Life

This essay evaluates the character of the unique French culture of the Acadiana region of Southwest Louisiana. This Cajun space represents twenty-two of the state's sixty-four parishes (counties) of Louisiana—about one-third of the state. What follows is a discussion of the persistence of a distinct way of life in the face of powerful forces of cultural homogenization. This entails (1) what it means to be Cajun; (2) the nature of the Acadiana homeland; (3) the survival and maintenance of distinguishing forms of cultural distinctiveness. A coda reflects on the contentious issue of cultural authenticity as imagined and reimagined. As a distinctive cultural space, Acadiana is a rarity in the dominant American ethos. It is an interesting case study of the survival of communal culture that has similarities with other spaces, such as Cornwall, Brittany, and Bavaria.     

Ruptured cerebral artery aneurysm and bacterial meningitis in a man with osteogenesis imperfecta

This report describes a 38-year-old man with osteogenesis imperfecta who died of a ruptured cerebral artery aneurysm and bacterial meningitis. He had multiple long bone fractures in the past, and approximately 4 months before death, he had surgery to relieve symptoms of basilar impression. The surgery was complicated by a postoperative wound infection. For the next 4 months, he had intermittent headaches and vomiting. He was found dead in his bed at home. At autopsy, he had a ruptured anterior communicating artery aneurysm and bacterial meningitis. Cerebrospinal fluid and blood cultures had growth of Staphylococcus aureus. Osteogenesis imperfecta is a disorder of type I collagen. Type I collagen is present in many tissues, including blood vessels. The etiology of cerebral artery aneurysm formation is multifactorial. Some patients with cerebral artery aneurysms have been shown to have abnormalities in type III collagen. There has not been a reported relationship made between abnormalities in type I collagen and aneurysms. Meningitis can also result in cerebral artery aneurysms, but they are usually due to Aspergillus or Mycobacterium species. The case we report is unique; cerebral artery aneurysm formation may have been due to osteogenesis imperfecta and/or bacterial meningitis.     

HUMAN TISSUE LEGISLATION AND MEDICAL PRACTICE: A BENEFIT OR A BURDEN?

The scandals surrounding organ removal and retention throughout the United Kingdom provoked several Inquiries and ultimately led to law reform. Although the medical professions were well represented at the Inquiries, little was heard of the voices of those at the 'coal face'. In this scoping study, funded by the Wellcome Trust, we interviewed a number of doctors and others engaged in the uses of human tissue and organs to explore their hopes, concerns and fears about the role of the law in their practices. We found that those involved in transplantation were more aware of, and more actively involve with, the law, whereas others, such as pathologists, had less direct engagement with the law. Most of those we interviewed expressed the hope that law reform would provide much-needed clarity. Although some expressed concern that the law might be over-intrusive, most felt that the placing of authority firmly in the hands of the person him or her self to decide what should happen to their bodies was to be welcomed.