When silence threatens safety: lessons from the first Canberra Hospital neurosurgical inquiry

Despite widespread institutional and professional support, the recommendations of the Bristol Royal Infirmary Inquiry may be insufficient to reduce patient risk from impaired senior medical practitioners. Using the First Inquiry into Neurosurgical Services at the Canberra Hospital as a case study, this article argues that the Bristol-type recommendations--which emphasise reformulation of clinical governance structures, including early reporting of "sentinel events" and compulsory clinical audits--will be ineffective without a reformed institutional ethos that encourages open transparency and respect for those committed to such processes. Such reformulation may need to commence in medical education and involve new strategies including the use of portable digital technology to facilitate self-assessment of performance and immediate reporting of adverse incidents.     

Explaining lustration in Central Europe: a ‘post-communist politics’ approach

Lustration, the vetting of public officials in Central Europe for links to the communist-era security services, has been pursued most systematically in the Czech Republic, Hungary and Poland. Prior attempts to explain the pursuit or avoidance of lustration focused on the differing experiences of communist rule or transition to democracy. A closer examination finds that although the three countries in question had very different histories, there were identical demands for lustration in the early 1990s. These demands were translated into legislation at different times and varied considerably in the range of offices affected and the sanctions imposed. This article offers an explanation of this variation by focusing on the dynamics of post-communist political competition. We find that the passage of a lustration bill depended on the ability of its most ardent advocates to persuade a heterogeneous plurality of legislators that the safeguarding of democracy required it.     

Predicting Attrition From Treatment Programs for Abusive Men

Attrition in male battering treatment programs is a serious problem. To keep clients in treatment, it is crucial to understand why they drop out. The current study examined the contribution of both client and program characteristics in predicting dropout from treatment programs for abusive men. Data were collected at intake from 306 abusive men who sought treatment at four different sites. The rate of preprogram attrition (from intake to the first treatment session) was higher in the program that had a lengthy waiting list (46%) than in the other programs amp lpar3%-13%). In-program attrition was more highly related to client characteristics than program characteristics (all programs had rates between 36% and 42%). Those men who dropped out after starting treatment tended to have unstable lifestyles (e.g., substance abuse problems, criminal history, unemployment) and to have inflicted more severe abuse than those who completed treatment. Results also supported a significant interaction between verbal aptitude and structure of program; men with low verbal aptitude were the most likely to drop out of an unstructured program. Possible strategies for preventing attrition are discussed.     

Sources of Leader Support and Interstate Rivalry

Since segments of the selectorate differently experience costs and benefits from rivalry, the foreign policy choices of leaders reflect these domestic preferences. As a result, shifts in the composition of the domestic coalition of support backing the leader provide a fundamental determinant of rivalry termination. While previous research sought to explore the relationship between domestic political turnover and rivalry termination using regime transitions as a proxy for turnover of the state’s domestic ruling group, in practice this measure exhibits significant disconnection with the quantity of interest. Further, there are alternative pathways through which regime transitions may lead to rivalry termination. I test the relationship using new data from the CHISOLS project, finding that when rivals undergo a change in the source of support that maintains the leader in office, the probability of rivalry termination rises dramatically. I further find that regime transitions have an effect on the probability of rivalry termination that is independent of the effect of ruling coalition turnover. This study thus both asserts the relationship between domestic political turnover and rivalry termination and clarifies the mechanism by which the relationship operates.     

Foreign policy in the Muslim world: A dialogue between state and society

In the wake of the demise of communism and the advent of the 1990–1991 Gulf War, there is concern among some Western elites about a possible Islamic challenge to the prevailing international order. This paper explores the validity of that concern by looking at patterns of interaction and the notion of foreign‐policy change in four countries in the Muslim world—Iran, Egypt, Algeria, and Indonesia, as well as some developments in the larger Muslim world. Juxtaposing social change on foreign policy, the article postulates that economic realism is the definitive force in the international relations of these states; “militant Islam” is more a tool of radical diplomacy than a manifestation of transnationalism; and ties between states in the Muslim world display a regional regime‐style orientation. Domestic Islamization is found to be a force, which, overall, is contributing to accountability and, therefore, rationalization in the foreign‐policy realm.     

Notes on contributors

This analysis of Germany's management of the Agenda 2000 negotiations in the first half of 1999 has two aims. First, it seeks to highlight the critical role of the presidency in the management of large package deal negotiations in the Union. Second, it seeks to explore the contention of Council insiders that the ‘presidency costs’. This arises from the tension between national preferences and the need for the presidency, as an office of the Union, to foster agreement by producing compromises and by mediating between divergent interests. The paper highlights the complex relationship between the two questions and concludes that the presidency is the lynchpin or central node in any package deal negotiations because of the need for vertical and horizontal co‐ordination of dossiers that are handled in a number of different fora. The presidency is centrally placed to act as an architect of compromise. The ‘presidency costs’ also in that Germany had to abandon its preference for a significant cut in its net contribution in return for an agreement in Berlin.     

Diary of a participatory advocacy film project: transforming communication initiatives into living campaigns

In August 2007, the government of Tanzania made a commitment to doubling the number of training places for skilled midwives, following a five-year campaign by the White Ribbon Alliance for Safe Motherhood in Tanzania (WRATZ), which culminated in the first television screening of a participatory film, ‘Play Your Part’. With contributions from a range of health professionals, communities, a pop singer, and the Minister of Health, the message was that everyone at every level has a part to play in saving mothers' lives. WRATZ was successful because it was able to promote its message in a way that provides a model for advocacy, combining the reactive creativity of journalism and the methodological rigour of participatory video to bring about a tangible impact.