Search

Given the concern for local government problems in the U.S. such as the "new" federalism, direction of recent federal reports, and the lack of generally acceptable policies, the purpose of this article is to analyze representative financial indicators and trends for local governments in one state and examine what this implies for state based policies. In addition to economic issues such as inflation, unemployment, and declining revenues, recent reports and research on urban problems emphasize the instability and uncertain future which faces our cities and local governments in the coming decade.

The article discusses about various issues related to policy and research on city size. This research has focused on community size as one characteristic among several which may legitimately demand differential policy, not because special policy is necessarily demanded, but rather because special, negative policy is apt to be implemented by default as continued attention on the fiscal plights of large communities prevents study and decisions from being made regarding smaller communities. Questions have been raised concerning the ability of smaller communities to meet new fiscal challenges both because of their relatively smaller tax bases and managerial capability.

Government organizations and managers face some of the most intractable problems that a society can produce; however, the power and resources to overcome or effectively deal with these issues are not easily defined or derived. Local government economic development is an example of a complex, open-systems milieu where the competing needs of federal, state, private sector, citizens, and other relevant local governments converge to produce a condition of intense competition or conflict and high levels of ambiguity. Major questions about who is responsible for economic development in local government and who has the authority or power to promote or obstruct economic development remain unanswered.

A 3.5 year old boy with Morquio's disease was referred with a persisting left hemiparesis four months after a fall and was found to have craniocervical junction compression due to atlantoaxial subluxation and significant anterior soft tissue compression. Transient unconsciousness at the time of the fall was probably due to medullary concussion as a result of hyperextension, not a head injury. Spinal cord compression due to atlantoaxial subluxation at the craniovertebral junction is a major cause of disability and death in these patients. Once cervical myelopathy appears, early posterior occipitocervical fusion has been advocated in order to arrest the progression of neurological disability and this is successful in most cases. This conventional approach was considered unsafe because of the significant anterior compression. A combined anterior transoral decompression with posterior fusion to deal with this particularly difficult problem is described. [ABSTRACT FROM AUTHOR]

This pilot study seeks to identify the psychological problems in middle aged and elderly subjects with impaired hearing, and to determine whether hearing aids improve these. The results indicate three main areas of psychological handicap and suggest that these are reduced by the provision of a hearing aid. [ABSTRACT FROM AUTHOR]

Despite the considerable attention which the growth of information systems technology in government has received over the past two decades, research focusing on the development, confirmation, or extension of theories which explain the use of a wide range of technological innovations has had a mixed record of success. In particular, two issues stand out. Divergent and frequently ambiguous definitions of utilization have led to relatively little replication of findings in various public settings. Second, relatively little empirical research has been under taken which explicitly incorporated and tested multiple alternative explanations of potential determinants of utilization, leading to continued fragmentation in the research literature. This analysis, using a national sample of state budgeting offices, draws on theoretical propositions offered over the past decade and more to operationalize utilization as the impact of technology on key organizational deciston-making processes and assess the relative explanatory power offered by three alternative explanations for the successful use of information systems technology. The findings suggest that unique combinations of three types of factors—environmental, managerial-organizational, and technological—will explain and account for the successful uutilization of technology in various settings. [ABSTRACT FROM PUBLISHER]

As the U.S. economy begins to show some signs of revitalization, there are many who question whether local government is able to keep pace with such change. The present study attempts to address this issue by examining patterns in reactions by local officials to events facing their jurisdictions. Findings indicate that manager's attitudes and strategies for coping with change have changed accordingly - from a reactive "wait-and-see" posture to proactive modes of revenue-generation and lobbying. As government service delivery becomes more information-intensive, local officials should use available tools and techniques to forecast and plan for longer-term adjustments. [ABSTRACT FROM AUTHOR]

Examines the characterization of the Alzheimer's disease (AD) by a progressive cerebral atrophy. Use of volumetric magnetic resonance imaging in assessing various stages of the disease; Assessment on the efficacy of the disease-modifying treatments; Statistical analysis of the disease progression in AD.

Objective: To compare the efficacy of a microdose GnRH agonist flare (ML) with a GnRH antagonist/letrozole (AL) protocol before IVF-ET in poor responders. Design: Prospective controlled trial. Setting: Private assisted reproductive technology center. Patient(s): Five hundred thirty-four infertile women classified as past or potential poor responders based on clinic-specific criteria. Intervention(s): Poor responders were prospectively assigned to an ML or AL protocol in a 2:1 ratio, respectively. Main Outcome Measure(s): Results of controlled ovarian hyperstimulation and implantation and ongoing pregnancy rates. Result(s): Patient characteristics were similar between the two protocol groups. There were no significant differences in mean age, number of oocytes, fertilization rates, number of embryos transferred, or embryo score. Peak E2 levels were significantly lower in the AL group. Ongoing pregnancy rates were significantly higher in the ML group (52% vs. 37%). Trends toward increased implantation and lower cancellation rates were also noted, but these did not reach statistical significance. Conclusion(s): Quantitative results of stimulation between the ML and AL protocols were equivalent with the exception of peak E2 levels. However, the higher ongoing pregnancy rates and trend toward superior implantation rates would suggest that ML represents a preferred approach for the poor responder. An increased sample size would be necessary to verify these findings. [Copyright &y& Elsevier]

Background: Preventive care is an essential element of comprehensive primary care medicine, yet many providers do not address the full range of recommended preventive care services. There is little understanding of how, during time-constrained clinical encounters, providers prioritize preventive care services., Objectives: To identify and compare how Department of Veterans Affairs (VA) primary care providers (PCPs) prioritized general preventive care services, including HIV testing., Study Design: A semistructured, qualitative interview design., Methods: We conducted semistructured phone interviews with 31 PCPs across 2 urban VA facilities. Interviews entailed questions about the most common preventive care services in primary care, how decisions are made to address some preventive care services but not others, and the role of clinical reminders (CRs) in prioritizing care. Interviews were audio-recorded and transcribed verbatim. We conducted an iterative thematic analysis of interview transcripts, utilizing NVivo 8, a qualitative data management and coding software., Results: Most PCPs indicated they did not utilize CRs as a primary means of prioritizing general preventive care. Instead, PCPs prioritized general preventive care by attending to patients' individual needs and/or keeping in mind influential clinical training experiences. Prioritizing HIV testing included 1 or a combination of the following strategies: being attuned to HIV risk factors prior to the appearance of the CR, being prompted by the CR, and having a positive attitude toward CR design., Conclusions: Prioritizing preventive care can be accomplished using various strategies, including CRs. Healthcare systems might benefit from encouraging PCPs to use a range of strategies.

In this review a new interpretation of the origin of bony developmental malformations affecting the craniocervical junction and the cervical spine is presented based on recent advances in the understanding of embryonic development of the spine and its molecular genetic control. Radiographs, CT and MRI scans or CT myelograms of patients with Klippel-Feil syndrome were used for demonstration. Detailed clinical and radiological analysis of these patients was published earlier [David KM, Stevens JM, Thorogood P, Crockard HA. The dysmorphic cervical spine in Klippel-Feil syndrome: interpretations from developmental biology. Neurosurg Focus 1999;6(6):1.]. Homeotic transformation due to mutations or disturbed expression of Hox genes is a possible mechanism responsible for Cl assimilation. Notochordal defects and/or signalling problems, that result in reduced or impaired Pax-1 gene expression, may underlie vertebral fusions. This, together with asymmetrical distribution of paraxial mesoderm cells and a possible lack of communication across the embryonic mid-line, could cause the asymmetrical fusion patterns. The wide and flattened shape of the fused vertebral bodies, their resemblance to the embryonic cartilaginous vertebrae and the process of progressive bony fusion with age suggest that the fusions occur before or, at the latest, during chondrification of vertebrae. The authors suggest that the aforementioned mechanisms are likely to be, at least in part, responsible for the origin of the bony developmental malformations affecting the craniocervical junction and the cervical spine.