bluuebunny/crossref_metadata_2025 huggingface dataset:
National Competition Policy: Progress and Prospects
Authors: Althaus Catherine
Published: March 2008

National Competition perspectives Policy — contending perspective.

The Hilmer Report is to competition what fertiliser is to grass (Ian Salmon, BCA 1995).

These reforms are good for the Australian economy and community. They hold the promise of helping to deliver more growth, more jobs and lower inflation but with higher real wages and a better standard of living (Hon. George Gear MP 1995).

The legislation has the potential to be very far reaching and may have implications far broader than originally intended (General Evidence — Australian Senate Economics Legislation Committee 1995).

The process of putting detailed legal and administrative flesh on the bare bone of the principles was not going to be easy. The resolution of issues. at times came down to the balance of power rather than good sense (Christine Charles, South Australian Dept of Premier and Cabinet 1995).

The practical failure to deliver on the claims about competition and efficiency are becoming increasingly evident (Professor Frank Stilwell 1995).

The Commission has a number of concerns on the impact on rural and remote communities and how the competing demands of increased competition and maintaining levels of community service obligations will be balanced in a newly competitive environment (ATSIC 1995).
National Competition Policy: The Downside
Authors: Butler Gavan
Published: March 2008

Identifying the ‘downside’ of competition policy raises the question of whether there is an ‘up‐side’. Competition is supposed to drive the organisers of commodity production to minimise the costs they have to bear in some short to medium term, within environments more or less circumscribed by government regulations. The actual period tends to be that for which the providers of finance are prepared to wait for returns after a poorly performing company is restructured. Economists used to say that cost minimisation requires an industry structure in which there are many independent producers. Nowadays, more enlightened writers speak of ensuring that the market positions held by existing producers are contestable by prospective new producers.

The question of what government in Australia may do to establish competition in this sense of competition has recently focussed on the desirable re‐organisation of public enterprises, perhaps especially those that exist at the level of the states. So what are the dimensions of the ‘downside’ of opening the market positions occupied by public enterprises to contestation by private companies, especially those which are monopolies? The answer takes a large measure of the gloss off the Hilmer promises. The problems to be addressed are: the limit put on contestability where there is an element of natural monopoly; the tendency for cost minimisation to depend on the tighter management of labour; and, the difficulty of insisting simultaneously on both ‘competition’ and the satisfaction of ‘community service obligations’ (CSOs).
Specific Purpose Programs in Human Services and Health: Moving from an Input to an Output and Outcome Focus
Authors: Duckett Stephen , Swerissen Hal
Published: March 2008

The content and control mechanisms of specific purpose programs are regularly under review, currently through processes associated with the Council of Australian Governments (COAG), with most proposals for reform in this area arguing for a shift to a focus on outputs or outcomes. This article reviews the place and role of specific purpose programs in the human services and health field, and identifies four issues which need to be addressed as part of any refocus onto outputs and outcomes. The four issues are: specification of objectives; measurement of outputs and/or outcomes; mechanisms for ensuring accountability to consumers; and systems of sanctions and rewards.
The Privatisation of GIO Australia: Success or Failure?
Authors: Casey Anthony , Dollery Brian
Published: March 2008

The privatisation of GIO Australia took place amidst acrimonious public debate on the merits of selling this government trading enterprise. Yet the innovative methods employed in the privatisation process represented a landmark in contemporary Australian economic history, With the passage of time and the attendant flow of information, it is now possible to assess the outcome of the privatisation of GIO Australia. Without considering the wider philosophical dimensions of privatisation, we conclude that from a tripartite perspective that the privatisation of GIO Australia should be regarded as successful.

The article is subdivided into four main parts. Section 1 provides a brief synopsis of the historical evolution of GIO; Section 2 details the actual privatisation process. Section 3 analyses the impact of the privatisation in terms of its effects on the GIO, the wider insurance market in Australia, and the ‘net worth’ of the NSW government. The article ends with some brief concluding remarks in Section 4.
What is the Future of the Federation?
Authors: Galligan Brian
Published: March 2008

Federalism has proved enduring in Australia, despite predictions of its imminent demise. Yet new challenges of internationalism and social movements are cutting across old political boundaries and eroding the sovereign nation state. This article, which draws on ideas developed at length in my recent book A Federal Republic: Australia's Constitutional System of Government (Cambridge University Press, 1995), argues that the characteristics of federalism may prove surprisingly compatible with social and international trends.
Managing and Leading in the Next Century
Authors: Mellors John
Published: March 2008

A ‘quick scan’ of the literature on management and leadership reveals a wealth of writings 1 This article offers a broad overview and some thoughts, based on personal observation and experience, on future management and leadership needs in the Australian public sector. The present article first outlines, by way of illustration, some key pressures for continuing change within Australia's public sector and their possible implications for future management needs. Second, it addresses the distinction between ‘management’ and ‘leadership’; and suggests that while the requirements placed on public sector management will continue to change, the skills required of public sector leaders are essentially timeless (and differ, in some respects, from private sector stereotypes of ‘leadership’).

Finally the article suggests why and how we should be seeking to develop ‘leadership in depth’ within public sector organisations, drawing on some illustrations from the Australian Department of Administrative Services.
Thailand: The Politics of Reform of the Secretariat of the Prime Minister
Authors: Bowornwathana Bidhya
Published: March 2008

This article discusses the politics of administrative reform. Though politicians and bureaucrats may agree on a reform blueprint, both tend to view administrative reform as means towards achieving different ends. To demonstrate the ‘political tool’ function of administrative reform, I will review the reform experience of the Thai Office of the Secretariat of the Prime Minister (OSPM) during the Chuan government (1992–95). Despite several proposals to reform the OSPM, at the end of its tenure the Chuan government had made only minor changes to the OSPM. This article argues that while failing to achieve significant reform, the process does demonstrate the politician‐bureaucrat relationship.

The article is divided into two parts. The first outlines the conceptual framework which captures the politics of reform. The second presents four case studies representing efforts to introduce reform to the OSPM during the period of the Chuan government.

During the Chuan government, the author served as the Head of the Secretariat of the Administrative Reform Commission (ARC), ad hoc office in the OSPM established by the Prime Minister, charged with reviewing proposals to reform the OSPM. The author was also appointed to committees which were assigned to advise the PM about ways to reform the OSPM.
Symposium: Exporting Government Services
Authors: Smith RFI
Published: March 2008

To explore the prospects for exporting government services, guest symposium editor RFI Smith invites three agencies to comment on their experience. This overview stresses the need to specify carefully costs and benefits in taking operations offshore — both in strict financial terms and in dealing with perception and accountability issues.

The prospects for exporting public sector skills and services are at the same time tantalising and frustrating. After initial enthusiasm in the 1970s and 1980s, the management of export programs has turned out to be complex, demanding and not without controversy. Such programs have challenged their proponents to be at once sophisticated in business management, rigorous and transparent in public accountability, and sensitive to the capabilities and ambitions of private sector providers of similar services. Further, after approximately 10 to 20 years of experience in different Australian jurisdictions, aims, methods and estimates of results remain diverse.
Achieving Sustainable Development: Scientific Uncertainty and Policy Innovation in Tasmanian Regional Development
Authors: Davis Bruce
Published: March 2008

Following the UNCED Conference of 1992, most nations have committed themselves to sustainable development. But what does this phrase mean in practice and how is it being implemented in federal countries such as Australia? In particular, what are the implications for peripheral regional economies such as Tasmania? This article examines the establishment and initial operations of the Sustainable Development Advisory Council (SDAC) in Tasmania and actions taken with respect to two major projects: development and ratification of a State Coastal Policy and redevelopment of the Mt Lyell copper mine in western Tasmania, designated a Project of State Significance (POSS). Both involve a perplexing conjunction of scientific uncertainty, economic significance and innovative policy‐making. Do they indicate a need to reinvent policy process? What are the broader implications for public policy?
Executive Encroachments on the Independence of the Commonwealth Auditor‐General
Authors: Funnell Warwick
Published: March 2008

Until recently Commonwealth governments have been able to have very extensive executive intrusions in public sector audit accepted largely as benign and untainted by political interests, thereby maintaining an illusion of an unfettered, autonomous public sector audit function. An interpretation of independence has been embedded which has been at odds with the operational reality. A conditional form of independence has been promoted as substantive independence and has thereby created multiple and often conflicting beliefs about what is and what ought to be the nature of independence in public sector audit. Differences in the independence of the person of the auditor‐general have been confused with the independence of the office.
Some Thoughts about the Roles, Responsibilities and Future Scope of Auditors‐General
Authors: Barrett Pat
Published: March 2008

This article treats Auditors‐General in a generic sense, but focuses on those institutions developed out of the Westminster system of government which undertake financial statement or regularity audits as well as performance or value for money or efficiency‐type audits. The audit offices included are those at both federal and state levels in Australia, the United Kingdom, United States of America, Canada and New Zealand.

The article is in two parts. The first selectively addresses perceived roles and responsibilities arising out of parliamentary legislation, debates and reviews or inquiries, Auditor‐General reports, papers or similar contributions by academic and other interested commentators. The second deals with the future scope for influence, focusing mainly on possible contributions to the improved performance of the public sector including that of audit offices themselves. The latter recognises that auditors‐general are very much part of the governance framework within which they operate. While they might be able to influence its development, the framework largely dictates their role, responsibilities and possible scope for action. Reflecting on that framework beyond the next few years might be an inviting conceptual exercise but is unlikely to add much value.
The Processes of Public Accountability
Authors: Mulgan Richard
Published: March 2008

There is a sameness to writing on public accountability which does not always do justice to the subject. With responsibility and accountability conflated and an idealised version of the Westminster model held up as the only test, ministers constantly appear irresponsible. Yet a more complex account of public accountability is possible, one which acknowledges that no single institution can undertake the important work of ensuring accountability from ministers, the parliament and public servants.
Taking ‘WA Inc’ Seriously: An Analysis of the Idea and its Application to West Australian Politics
Authors: Stone Bruce
Published: March 2008

During the late 1980s and early 1990s, the term WA Inc (or WA Incorporated) became a by‐word in the West Australian community for the failings, especially in their commercial activities, of the West Australian Labor governments of that period. Despite popular and academic interest in the notion of ‘WA Inc’, it is arguable that the conceptual linkage between ‘business’ and government, once central to popular interpretations of the term, remains under‐analysed. This article has two main purposes: to illuminate usage of ‘WA Inc’ by identifying several basic referents of the term and relating these to popular criticisms of the West Australian government in the 1980s and to determine the importance of those criticisms, thereby contributing to the larger debate about capacity of government to emulate private sector business.
What Do We Talk About? Publications in AJPA 1970–95
Authors: Althaus Catherine
Published: March 2008

This survey looks at three key aspects of the AJPA — who publishes, what they talk about and how they approach their subject. The findings suggest a continuing responsiveness to trends in public administration and a broad inclusive definition of the field.
Boutique Government and the Challenge of Contemporary Leadership
Authors: Campbell Colin
Published: March 2008

The demands on natural leaders have changed dramatically in recent decades. Opportunities for bold innovation appear to have passed, prompting instead a focus on consensus building and partnership. Drawing on evidence from five Anglo‐American democracies, this article argues that a diminished faith in public institutions and declining willingness to support altruistic community programs are reshaping the possibilities for national chief executives.
Seeking to Inspire Public Policy Analysts
Authors: Chesterman John
Published: March 2008

The 1997 Public Policy Network Conference was held at Melbourne University's Centre for Public Policy. John Chesterman, one of the organisers, provides a taste of the debates.

The 1998 Public Policy Network Conference will be held at Victoria University, Wellington, on 29 and 30 January. Enquires or offers of papers may be forwarded to Dr RJ Gregory (e‐mail Bob.Gregory@vuw.ac.nz).
A Regulatory Analysis of Australia's Anti‐dumping Law and Policy: Statutory Failure or Regulatory Capture?
Authors: Feaver Donald
Published: March 2008

Anti‐dumping and countervailing (AD/CVD) law and policy permits nations to impose corrective duties against unfairly traded imports found to have injured domestic industries. However, administrators of AD/CVD policy around the world are criticised for misusing the remedy as an elaborate and complex protectionist mechanism.

A problem with many critical reviews is that explanations as to how misuse occurs, or at what point in the administrative process regulatory authorities are able to exercise bias, are rarely provided. In the Australian context, the task of identifying a source and opportunity for misuse is made complicated by three major forces affecting the decision‐making processes of the Australian regulatory authorities, the Australian Customs Service and Australian Anti‐Dumping Authority (ACS and ADA). This article examines the influence which Australia's international obligations, government and public policy processes and the Federal Court have upon the administration of AD/CVD law and policy in order to determine the degree of autonomy afforded to the ACS and ADA.
Measuring the Performance of Community Organisations in Queensland and New Zealand
Authors: Ryan Neal , Brown Kerry
Published: March 2008

The need to measure qualitative outcomes is well documented. This article argues that despite this recognition many programs are still evaluated using unreliable numerical indicators. This has particular ramifications for community service programs that deal with the sharp end of social problems. While the New Zealand government has instigated a comparatively detailed approval standards, the Queensland government's community service guidelines are still applied almost on an ad hoc, case by case basis. Both New Zealand and Queensland performance indicators are directed towards process outputs, with a primary focus of government being centred on financial accountability. The satisfaction of the client remains the core responsibility of the service provider, but there is little assessment of how successful programs are in meeting individual requirements. This article suggests that there needs to be the development of a more collaborative relationship between governments and community service organisations, to ensure both financial and social objectives are fully realised.
The Environment: How to Solve Problems That Don't Respect Borders
Authors: Hundloe Tor
Published: March 2008

Many environmental problems do not respect political or jurisdictional borders. Not only does this frustrate the formulation of technical solutions, it also leads to duplication of effort, overlap and jealousies.

Australia has attempted to address such jurisdictional problems, as in the case of the Oceans Policy. At a global scale borders are fundamental stumbling‐blocks. Disparities in wealth (the North‐South divide) will need to be addressed if threats such as global warming are to be met.
Australian Public Administration in 1997
Authors: Homeshaw Judith
Published: March 2008

This is the third in the AJPA s resumed series of administrative chronicles. Earlier administrative chronicles (AJPA 55(1) 1996 and 56(1) 1997) by Jenny Stewart and Scott Prasser have focused on the general principles of administrative change at the Commonwealth and state levels. Judith Homeshaw reviews the year 1997 by evaluating the developments since the milestone machinery of government reforms of 1987. She then reviews the prospects for further reform in New South Wales and Tasmania.
Managerialism, Economic Rationalism and Public Sector Reform in Australia: Connections, Divergences, Alternatives
Authors: Orchard Lionel
Published: March 2008

This article outlines and explores the differences and connections in the ideas underpinning the reform of public institutions in Australian society over the past two decades. In particular, the article asks whether public institutions have been renewed or eroded through the changes of the 1980s and 1990s and whether the changes were as inevitable as some advocates and analysts claim. Some ideas and theories appropriate to the future role of government and public institutions in Australia beyond the current consensus are explored. The article offers afresh analysis of public sector reform in Australia and contributes to the ongoing debate about alternatives.
New Governance in Australian Schools: A Place for Business Social Responsibility?
Authors: Sochacki Jeremy Moon and Richard
Published: March 2008

Many public policy areas are being transformed as traditional government roles and relationships with other actors are changing. This article reports on business not‐for‐profit support for Australian secondary schools revealing substantial contributions directed at core educational and schoolwork interface activities. The article explores the nature of these supports, the means by which the relationships between schools and businesses emerge, the motivation of business and broader issues arising from the involvement of business in this and other areas of public policy.
Should the High Court Consider Policy Implications in Deciding Cases?
Authors: Byers Sir Maurice
Published: March 2008

If the High Court is to consider policy implications when making judicial decisions, a number of preliminary matters require examination. First, what parliaments, executive governments and other instrumentalities will be affected? Next, may the High Court validly exercise this function? And last, is it likely to do so?

I shall discuss these preliminary matters in the order stated and thereafter express my view on the question raised by the editors for discussion. In the course of discussion, I shall mention some incidental matters related to the High Court and its functions.
Public Officials, Government and the Public Trust: Schizophrenia?
Authors: Hood Antra
Published: March 2008

In late 1996 the Queensland government introduced new legislation to govern its public sector, the Public Service Act 1996. For a few short weeks the supposedly draconian legislation was front‐page news, as the government was forced to defend its changes to standards of accountability in public sector employment. Was the fuss a storm in a teacup? Were the changes really so significant? In this article the impact of the legislation upon the central core of public sector employment, the public trust, is considered, and the legislation's interrelationship with the Queensland public sector ethics regime is analysed.

These unhappy people were proposing schemes for persuading monarchs to choose favourites upon the score of their wisdom, capacity and virtue; of teaching ministers to consult the public good; of rewarding merit, great abilities and eminent services; of instructing princes to know their true interest by placing it on the same foundation with that of their people: of choosing for employment persons qualified to exercise them; with many other wild chimeras, that never entered before into the heart of man to conceive, and confirmed in me the old observation, that there is nothing so extravagant and irrational which some philosophers have not maintained for truth (Jonathan Swift, Gulliver's Travels).
Maltese Administrative History, with Some Australian Connections
Authors: Wettenhall Roger
Published: March 2008

The Maltese Public Service 1800–1940: The Administrative Politics of a Micro‐State GA PIROTTA (Msida (Malta), Mireva Publications, 1996, 487 pp.).
The Role of IPAA: Public Presentation — Key Issues in Governance
Authors: AC Michael Keating
Published: March 2008

In the December 1997 issue of this journal our editors expressed concern about the decline in teaching of public administration. This does not reflect any decline in the overall level of involvement by government in the economy or society. Rather it seems to reflect changing perceptions of what is needed to succeed in public administration.

This in turn raises the very important issue of what we as a society expect from our future public administrators. While many management skills are common to both business and the public sector, public administration needs to extend beyond the limits of business management to comprehend issues such as accountability, probity and policy processes. Indeed it is increasingly being recognised that what is at stake is not just management per se, but rather the broader array of relationships involved in good governance.

The Institute of Public Administration Australia has over the years played an important role in bringing practitioners and teachers together to help foster a better appreciation of these issues. Now more than ever, when the public sector is experiencing considerable change, there needs to be a lively forum where these broader issues of public administration can be debated and new approaches can be tested.

The National Council of the Institute has accordingly been considering how the Institute might encourage a wider public appreciation of good governance. In order to assist in this process and to provide some guidance to spokepersons, the Council has agreed the following Statement. We hope that all members of the Institute will find this Statement helpful and will be encouraged to promote the ideals it seeks to uphold.
From Uniformity to Diversity? Reinventing Public Sector Industrial Relations in New Zealand
Authors: Walsh Pat
Published: March 2008

Since 1988 industrial relations in New Zealand's public sector have changed significantly. This paper discusses the changing roles of the State Services Commission and chief executives in bargaining with public sector employees, and how these changing roles have affected union representation and wage rates. While theEmployment Contracts Act, 1991resulted in changes to bargaining, generally its effect was minimal in the public sector with respect to bargaining outcomes. However, one of the more significant changes as a result of theEmployment Contracts Acthas been a move to direct employer — employee negotiations. Bargaining in New Zealand's public sector has moved, in the last nine years, from uniformity to diversity, but to what extent?
Commission Impossible? A New Approach To Workplace Relations in the PSMPC
Authors: Bennett Dallys , Shergold Peter
Published: March 2008

This is a short story about turning commitment into action. It tells how the Public Service and Merit Protection Commission negotiated with its employees to create a certified agreement under the new Workplace Relations Act 1996. The authors conclude that a careful, consultative process has built greater trust within their organisation.
Two Models of Contemporary Public Service Wage Determination in Australia
Authors: Thornthwaite Louise , Hollander Robyn
Published: March 2008

There has been substantial change in industrial relations systems at federal and state level in Australia and this has had dramatic implications for public sector wage‐fixing arrangements. This article outlines the main features of current systems for wage determination in the Australian public service and the public services of each state. While a complex and diverse set of regulations and wage‐fixing mechanisms are in place in these seven jurisdictions, two models are emerging: one a collectivist two‐tiered model and the other a de‐collectivist model which includes provision for individual agreements. The authors discuss the implications of the current wage‐fixing systems and the two emerging models.
Competitive Tendering and Outsourcing — Initiatives and Methods
Authors: Rimmer Stephen
Published: March 2008

Public debate about the use of competitive tendering and contracting (CTC) by governments largely revolves around whether this process actually does lead to better outcomes compared with direct public provision, and whether the formal separation between service specification and delivery enhances or undermines the achievement of policy goals. Over the last decade debate about CTC in Australia has tended to move away from a narrow focus on ideology, towards a broader discussion about how this process can be best managed. The various reviews of CTC currently underway provide an ongoing opportunity for individuals and groups to express their views and highlight their experiences with CTC. These reviews will provide further guidance about how this process can be best managed in the interests of the Australian community.
Contracting Public Sector Services: A Meta‐Analytic Perspective of the International Evidence
Authors: Hodge Graeme
Published: March 2008

The performance framework adopted for this review includes five dimensions — economic, social, democratic, legal and political issues. This article presents summary findings from a statistical (meta‐analytic) review of the performance measurements found in the available international literature on privatisation and contracting‐out government services… This enables an assessment to be made of the extent to which reform objectives appear to have been achieved in practice. The article discusses the gains which result from contracting reforms, and the extent to which these gains accrue to various stakeholders — whether community, customers, the organisation or government.
Trends and Opportunities in the Public Sector: A Critical Assessment
Authors: Yeatman Anna
Published: March 2008

The public sector should be designed to work on behalf of government. Government, in turn, should be designed to work on behalf of a citizen community both to pursue its collective interests and to defend the citizen community against harmful effects of private market activities. At this time, the integrity of the public sector/government has been eroded because the established forms of regulation of the market are outmoded. This has permitted transnational corporations to argue that government should respond more to their agendas often at the expense of citizen needs and claims. At the same time, citizen movements have become more diverse and sophisticated. They represent an opportunity for revisioning the work of government and the public sector.
Progress in neuroprotection in Parkinson’s disease
Authors: Schapira A. H. V.
Published: March 2008

Slowing or aborting the progress of neurodegeneration in Parkinson’s disease (PD) remains the most important unmet need of this disorder. There are several recent developments in trial design and also in drugs under investigation for possible neuroprotective effect. Emphasis has been placed on clinical as opposed to imaging end‐points and these include change in a clinical rating scale, e.g. United Parkinson's disease Rating Scale (UPDRS), or time to additional therapy. The introduction of the delayed‐start, or wash‐in, trial design adds an additional dimension to drug evaluation for neuroprotection. Compounds that have been recently tested in clinical trial include the monoamine oxidase‐B inhibitor rasagiline, the anti‐apoptotic agents TCH346 and CEP1347, and the promitochondrial agent creatine. The dopamine agonists have been evaluated for a neuroprotective effect using imaging end‐points. Perhaps the most important and simplest concept for neuroprotection has been the theory that early dopaminergic support for the degenerating dopaminergic systemper seprovides significant long‐term clinical benefit for PD patients.
Depressive symptoms in Parkinson’s disease
Authors: Lemke M. R.
Published: March 2008

Depression occurs in approximately 45% of all patients with Parkinson’s disease (PD), does not correlate with the stage of motor deficits, reduces quality of life independently of motor symptoms and appears to be underrated and undertreated. Anxiety and depression are the risk factors for the development of PD and may be present many years before the appearance of motor symptoms. Studies using functional imaging techniques indicate a primary relationship between depression and PD. Because of overlapping clinical symptoms, the diagnosis is mainly based on subjectively experienced anhedonia and feelings of emptiness. Serotonergic, noradrenergic and dopaminergic mechanisms play key roles in the aetiology of depression in PD. Tricyclic and newer selective antidepressants including serotonin and noradrenaline reuptake inhibitors appear to be effective in treating depression in PD. Selective reuptake inhibitors seem to be better tolerated because of their favourable side‐effect profile. Experimental and clinical investigations indicate antidepressive effects for pramipexole. Placebo‐controlled studies showed antidepressant effects of pramipexole in patients with different forms of depression. Various studies show that pramipexole improves depression in addition to motor symptoms in patients with PD. Because of the data available as well as clinical reasoning, pramipexole may be used as a first‐line treatment in patients with PD and depression.
Intrinsic muscle strength and voluntary activation of both lower limbs and functional performance after stroke
Authors: Horstman Astrid M. , Beltman Marijke J. , Gerrits Karin H. , Koppe Peter , Janssen Thomas W. , Elich Peter , De Haan Arnold
Published: March 2008

The objective of this study was to assess the nature of muscle weakness in both legs after stroke compared with able‐bodied control individuals and to examine whether there is a relationship between the degree of muscle weakness and coactivation of knee extensors and flexors as well as voluntary activation capacity of knee extensors of both paretic and non‐paretic legs and indices of functional performance. Maximal voluntary isometric torques of knee extensors (MVCe) and flexors (MVCf) were determined in 14 patients (bilaterally) and 12 able‐bodied controls. Simultaneous measurements were made of torque and surface EMG from agonist and antagonist muscles. Coactivation was calculated. Supramaximal triplets were evoked with electrical stimulation to estimate maximal torque capacity and degree of voluntary activation of knee extensors. MVCs, activation and coactivation parameters were correlated to scores of seven functional performance tests. MVCe, MVCf and voluntary activation were lower in paretic lower limb (PL) compared with both non‐paretic lower limb (NL) and control. Besides, all these parameters of NL were also lower than control. Electrically evoked torque capacity of knee extensors of PL was about 60% of both NL and control, which were not significantly different from each other. Strong significant correlations between strength, as well as voluntary activation, and functional performance were found. Coactivation did not correlate well with functional performance. Thus, whereas for NL activation failure can explain weakness, for PL both activation failure and reduced intrinsic torque capacity are responsible for the severe weakness. Activation capacity and muscle strength correlated strongly to functional performance, while coactivation did not.
Evaluating Health Care Programs by Combining Cost with Quality of Life Measures: A Case Study Comparing Capitation and Fee for Service
Authors: Grieve Richard , Sekhon Jasjeet S. , Hu Teh‐wei , Bloom Joan R.
Published: March 2008

Objective.To demonstrate cost‐effectiveness analysis (CEA) for evaluating different reimbursement models.

Data Sources/Study Setting.The CEA used an observational study comparing fee for service (FFS) versus capitation for Medicaid cases with severe mental illness (n=522). Under capitation, services were provided either directly (direct capitation [DC]) by not‐for‐profit community mental health centers (CMHC), or in a joint venture between CMHCs and a for‐profit managed behavioral health organization (MBHO).

Study Design.A nonparametric matching method (genetic matching) was used to identify those cases that minimized baseline differences across the groups. Quality‐adjusted life years (QALYs) were reported for each group. Incremental QALYs were valued at different thresholds for a QALY gained, and combined with cost estimates to plot cost‐effectiveness acceptability curves.

Principal Findings.QALYs were similar across reimbursement models. Compared with FFS, the MBHO model had incremental costs of −$1,991 and the probability that this model was cost‐effective exceeded 0.90. The DC model had incremental costs of $4,694; the probability that this model was cost‐effective compared with FFS was <0.10.

Conclusions.A capitation model with a for‐profit element was more cost‐effective for Medicaid patients with severe mental illness than not‐for‐profit capitation or FFS models.
Use of VA and Medicare Services By Dually Eligible Veterans with Psychiatric Problems
Authors: Carey Kathleen , Montez‐Rath Maria E. , Rosen Amy K. , Christiansen Cindy L. , Loveland Susan , Ettner Susan L.
Published: March 2008

Objective. To examine how service accessibility measured by geographic distance affects service sector choices for veterans who are dually eligible for veterans affairs (VA) and Medicare services and who are diagnosed with mental health and/or substance abuse (MH/SA) disorders.

Data Sources. Primary VA data sources were the Patient Treatment (acute care), Extended Care (long‐term care), and Outpatient Clinic files. VA cost data were obtained from (1) inpatient and outpatient cost files developed by the VA Health Economics and Resource Center and (2) outpatient VA Decision Support System files. Medicare data sources were the denominator, Medicare Provider Analysis Review (MEDPAR), Provider‐of‐Service, Outpatient Standard Analytic and Physician/Supplier Standard Analytic files. Additional sources included the Area Resource File and Census Bureau data.

Study Design. We identified dually eligible veterans who had either an inpatient or outpatient MH/SA diagnosis in the VA system during fiscal year (FY)'99. We then estimated one‐ and two‐part regression models to explain the effects of geographic distance on both VA and Medicare total and MH/SA costs.

Principal Findings. Results provide evidence for substitution between the VA and Medicare, demonstrating that poorer geographic access to VA inpatient and outpatient clinics decreased VA expenditures but increased Medicare expenditures, while poorer access to Medicare‐certified general and psychiatric hospitals decreased Medicare expenditures but increased VA expenditures.

Conclusions. As geographic distance to VA medical facility increases, Medicare plays an increasingly important role in providing mental health services to veterans.
Biofilms in the Edentulous Oral Cavity
Authors: Sachdeo Amit , Haffajee Anne D. , Socransky Sigmund S.
Published: March 2008

Purpose: The oral cavity presents numerous surfaces for microbial colonization. These surfaces produce biofilms of differing complexities unique to each individual. Several studies have looked at biofilms in dentate patients. There has been limited research regarding biofilms on dentures or soft tissues of edentulous patients. The purpose of the present investigation was to provide meaningful data describing microbial ecological relationships in the oral cavity of edentulous patients and to evaluate the microbiota on hard and soft tissue surfaces and saliva in edentulous patients wearing complete dentures.

Materials and Methods: Sixty‐one edentulous subjects with complete maxillary and mandibular dentures were recruited. “Supragingival” biofilm samples were taken from 28 denture teeth for each subject. Biofilm samples were also taken from the dorsal, lateral, and ventral surfaces of the tongue, floor of mouth, buccal mucosa, hard palate, vestibule/lip, “attached gingiva,” and saliva. Samples were individually analyzed for their content of 41 bacterial species using checkerboard DNA–DNA hybridization. Levels and proportions of each species were determined for every sample location.

Results: Periodontal pathogens such as Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis were clearly present in the samples from the edentulous subjects. Microbial profiles in samples from the soft tissue surfaces differed among site locations. Samples from the dorsum of the tongue exhibited the highest bacterial counts followed by the “attached gingiva” and the lateral surfaces of the tongue, while the lowest mean counts were found in samples from the buccal mucosa and labial vestibules. Using cluster analysis of the proportions of the test species, three clusters were formed. The first cluster comprised saliva, supragingival plaque, and the lateral and dorsal surfaces of the tongue. The second cluster comprised the other six soft tissue surfaces. Species on the denture palate formed a third cluster.

Conclusions: One of the major findings in this study was the detection of periodontal pathogens, A. actinomycetemcomitans and P. gingivalis, in the edentulous subjects, as these species were thought to disappear after removal of all natural teeth. This finding has implications regarding future dental treatment and the general health of individuals. Distinct patterns of microbial colonization were seen on the different soft tissue surfaces. Thus, this investigation provided the first step in defining the organisms that are associated with edentulous patients on both soft (mucosa) and hard surfaces (denture). The study also provided meaningful data that described microbial ecological relationships in the oral cavity of edentulous subjects. The authors believe that this study is the first comprehensive assessment of the microbiota in the complete denture‐wearing subject.
In Vitro Evaluation of the Effect of Thermal and Mechanical Fatigues on the Bonding of an Autopolymerizing Soft Denture Liner to Denture Base Materials Using Different Primers
Authors: Minami Hiroyuki , Suzuki Shiro , Minesaki Yoshito , Kurashige Hisanori , Tanaka Takuo
Published: March 2008

Purpose: This in vitro study evaluated the effect of priming procedures on bonding of an autopolymerizing silicone denture liner (Sofreliner) to a denture base material after fatigue processes using cyclic thermal stressing and repetitive mechanical stressing.

Materials and Methods: Denture base specimens were fabricated by use of an autopolymerizing denture base resin and Co–Cr alloy into a cylinder shape 8‐mm diameter and 4‐mm high. The bonding surfaces of denture base specimens were polished with 600‐grit silicon carbide paper. Resin denture base specimens were pretreated with applications of resin primer (Sofreliner Primer or Reline Primer for resin). Metal specimens were pretreated with application of metal primer (Reline Primer for metal) or coated with adhesive resin (C&B Metabond) followed by application of resin primer (Sofreliner Primer). Tensile specimens were fabricated by polymerizing a 2‐mm thickness of Sofreliner between a pair of pretreated denture base cylinders. Repetitive mechanical stressing was performed by using a University of Alabama‐type wear‐testing apparatus as a stress generator. Vertical 75 N load with 15° rotation was applied 66,700, 133,300, 266,700, and 400,000 times, then residual tensile resistance to failure was measured. Seven specimens were fabricated for 16 groups—four cyclic loading groups for four pretreatment groups. Residual tensile resistance to failure of specimens before the fatiguing process and after 5000, 10,000, 20,000, and 30,000 thermocycles were used as reference. The mean values of each group were statistically analyzed by three‐way ANOVA and Bonferroni/Dunn test at a 95% confidence level. Failure modes were assessed for all specimens measured.

Results: In the denture‐bonded groups, residual tensile resistance to failure of Sofreliner Primer‐treated group was significantly higher than that of the Reline Primer at each thermocycling interval (p < 0.0001) and up to 133,300 times of cyclic loading (p < 0.0001). In the metal‐bonded groups, residual tensile resistance to failure of the intermediate adhesive resin group was higher than the metal primer‐applied group up to 5000 thermocycles (p < 0.0001); however, there was no significant difference between them after 66,667 cyclic loads (p= 0.1698). Although adhesive resin‐coated specimens of metal‐bonded groups showed mixed failure, metal primer‐applied groups and both denture‐bonded groups consistently revealed cohesive failure of the soft denture liner after cyclic loading.

Conclusions: Application of Sofreliner Primer for a resin denture base provided better bonding after thermocycle and cyclic load testing than did Reline Primer. Using an intermediate adhesive resin layer on a Co–Cr denture base material improved the bonding for up to 5000 thermocycles; however, it did not affect cyclic loading parameters.
Fracture Strength and Fatigue Resistance of All‐Ceramic Molar Crowns Manufactured with CAD/CAM Technology
Authors: Zahran Mohammed , El‐Mowafy Omar , Tam Laura , Watson Philip A. , Finer Yoav
Published: March 2008

Purpose: All‐ceramic crowns are subject to fracture during function, especially in the posterior area. The use of yttrium‐stabilized zirconium‐oxide ceramic as a substructure for all‐ceramic crowns to improve fracture resistance is unproven. The aim of this study was to compare fracture strength and fatigue resistance of new zirconium‐oxide and feldspathic all‐ceramic crowns made with computer‐aided design/computer‐aided manufacturing (CAD/CAM).

Materials and Methods: An ivorine molar was prepared to receive an all‐ceramic crown. Using epoxy resin, 40 replication dies were made of the prepared tooth. Twenty feldspathic all‐ceramic crowns (Vita Mark II) (VMII) and 20 zirconium‐oxide crown copings (In‐Ceram YZ) (YZ) were made using CAD/CAM technique (CEREC‐3D). The YZ copings were sintered and veneered manually with a fine‐particle ceramic (VM9). All crowns were cemented to their respective dies using resin cement (Panavia F 2.0). Ten crowns in each group were subjected to compressive fatigue loading in a universal testing machine (instron). The other ten crowns from each group were loaded to fracture at a crosshead speed of 1 mm/min. Data were statistically analyzed using independent t‐test and Fisher's exact test at α= 0.05.

Results: There was a significant difference between the survival rates of the two materials during the fatigue test (p < 0.001). All VMII crowns survived without any crack formation, while all YZ crowns fractured (40%) or developed cracks (60%). All the YZ crown fractures occurred within the veneering layer during the fatigue test. There was no significant difference in mean fracture load between the two materials (p= 0.268). Mean fracture loads (standard deviation) in N were: 1459 (492) for YZ crowns and 1272 (109) for VMII crowns.

Conclusions: The performance of VMII crowns was superior to YZ crowns in the fatigue test. The premature fractures and cracks of the YZ crowns were attributed to weakness in the YZ veneer layer or in the core/veneer bond.
Comparative evaluation of techniques for the manufacturing of dendritic cell‐based cancer vaccines
Authors: Dohnal Alexander Michael , Graffi Sebastian , Witt Volker , Eichstill Christina , Wagner Dagmar , Ul‐Haq Sidrah , Wimmer Doris , Felzmann Thomas
Published: March 2008

Manufacturing procedures for cellular therapies are continuously improved with particular emphasis on product safety. We previously developed a dendritic cell (DC) cancer vaccine technology platform that uses clinical grade lipopolysaccharide (LPS) and interferon (IFN)‐y for the maturation of monocyte derived DCs. DCs are frozen after 6 hrs exposure at a semi‐mature stage (smDCs) retaining the capacity to secret interleukin (IL)‐12 and thus support cytolytic T‐cell responses, which is lost at full maturation. We compared closed systems for monocyte enrichment from leucocyte apheresis products from healthy individuals using plastic adherence, CD14 selection, or CD2/19 depletion with magnetic beads, or counter flow centrifugation (elutriation) using a clinical grade in comparison to a research grade culture medium for the following DC generation. We found that elutriation was superior compared to the other methods showing 36 ± 4% recovery, which was approximately 5‐fold higher as the most frequently used adherence protocol (8 ± 1%), and a very good purity (92 ± 5%) of smDCs. Immune phenotype and IL‐12 secretion (adherence: 1.4 ± 0.4; selection: 20 ± 0.6; depletion: 1 ±0.5; elutriation: 3.6 ± 1.5 ng/ml) as well as the potency of all DCs to stimulate T cells in an allogeneic mixed leucocyte reaction did not show statistically significant differences. Research grade and clinical grade DC culture media were equally potent and freezing did not impair the functions of smDCs. Finally, we assessed the functional capacity of DC cancer vaccines manufactured for three patients using this optimized procedure thereby demonstrating the feasibility of manufacturing DC cancer vaccines that secret IL‐12 (9.4 ± 6.4 ng/ml). We conclude that significant steps were taken here towards clinical grade DC cancer vaccine manufacturing.