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Public Value Accounting: Establishing the Philosophical Basis
Questions of how best to define the ends, justify the means, and measure the performance of governments have preoccupied political economists for centuries. Recently, the concept of public value—defined in terms of the many dimensions of value that a democratic public might want to see produced by and reflected in the performance of government—has been proposed as an alternative approach. This article develops three philosophical claims central to the practice of public value accounting: (1) when the collectively owned assets of government are being deployed, the appropriate arbiter of public value is the collectively defined values of a \"public\" called into existence and made articulate through the quite imperfect processes of democratic governance; (2) the collectively owned assets include not only government money but also the authority of the state; (3) the normative framework for assessing the value of government production relies on both utilitarian and deontological philosophical frameworks.
Journal Article
Animation
With an introduction by John Lasseter-- and very little else in the way of words-- this second book in The Artist Series lavishly showcases the most brilliant animation created by such luminaries as Ub Iwerks, Norm Ferguson, Ben Sharpsteen, Hamilton Luske, Dick Huemer, Grim Natwick, Art Babbitt, Fred Moore, Bill Tytla, Frank Thomas, Ollie Johnston, Milt Kahl, Marc Davis, John Lounsbery, Ward Kimball, Eric Larson, Les Clark, Wolfgang Reitherman, John Sibley, Bill Justice, Clyde Geronimi, Ted Berman, Glen Keane, Andreas Deja, Eric Goldberg, Mark Henn and Tony Bancroft. The artwork-- much of which has never before been published-- offers the opportunity to marvel at the those magical lines of pencil that brought life to so many unforgettable Disney characters. Animation represents a rare opportunity to enjoy a glimpse into the truly spectacular trove of treasures from the Walt Disney Animation Research Library.
Book
Patterns and characteristics of maxillofacial fractures in women
Purpose
Facial trauma in women is complex with physical, psychosocial, and cultural influences impacting clinical presentations. Although multifactorial, assaults and falls are principally reported as the main causes.
Methods
A retrospective review was conducted from January 2012 to January 2017 at the Women and Children’s Hospital and Royal Adelaide Hospital, Adelaide. All maxillofacial fractures in women that attended or were referred to the unit were included in this study. The primary objective was to analyse epidemiological trends of facial fractures and clinical outcomes in the South Australian female population.
Results
There is a bimodal distribution of facial fractures at 25–35 years and 65 + years. Indigenous females were 19.5 years younger than non-indigenous females (30.5 vs 49.9,
P
< 0.001). Approximately half the cohort had a fall-related facial fracture, followed by assault (26.2%), and sports (10.3%). There was a higher proportion of non-alcohol-related trauma from assaults than alcohol-related assaults (72.5% vs 27.5%,
P
< 0.001). Over half (58.0%) of the cohort had a midface fracture. The elderly had increased odds of 1.9 fold for facial fractures in winter, largely from falls, compared to younger women. Associated injuries were present in almost half the elderly women with 2.6 times the risk compared to younger women. Younger women had higher incidences of surgical intervention (52.6% vs 14.3%,
P
< 0.05).
Conclusions
Young women disproportionately experience larger incidences of non-alcohol-related assaults requiring operative intervention of the mandible, whereas elderly women principally suffer fall-related facial fractures with higher rates of associated injuries.
Journal Article
Secondary metopic craniosynostosis after posterior cranial decompression in cloverleaf skull deformity
Cloverleaf skull deformity or Kleeblattschadel syndrome is a severe condition where multiple cranial sutures are absent and prematurely fused, leading to a trilobate head shape. The remaining open sutures or fontanelles compensate for rapid brain expansion, while the constricted fused calvarium restricts brain growth and results in increased intracranial pressure. Recent data show that early posterior cranial and foramen magnum decompression positively affects infants with cloverleaf skulls. However, long-term sequelae are still rarely discussed. We hereby report a child who developed secondary metopic craniosynostosis after posterior cranial decompression, which required a front-orbital advancement and cranial remodelling as a definitive procedure.
Journal Article
Multisuture craniosynostosis: a case report of unusual presentation of chromosome 14q32 deletion
Multisuture craniosynostosis is associated with a number of syndromes and underlying gene mutations. It is rarely caused by chromosome disorders. For the management, multisuture craniosynostosis raises concerns about abnormal head shape and risks of increased intracranial pressure in affected patients. Calvarial reconstruction to reshape the skull shape and expand the intracranial volume plays an essential role in correcting particular problems. Here, we report a 2-month-old female infant presenting with low birth weight, abnormal head shape, dysmorphic facies and pinnae, hypotonia, and feeding difficulty. Three-dimensional computed tomographic scans revealed left unicoronal and sagittal synostoses. Chromosome microarray analysis revealed de novo chromosome 14q32.12–q32.31 deletion. Among the deleted genes,
YY1
and
BCL11B
are the most likely candidate genes causing craniosynostosis. Some clinical features of the patient are similar to Temple syndrome indicating that the deleted region is paternal in origin. In summary, this is a rare case of chromosome 14q32 deletion with multisuture craniosynostosis. We also report the multidisciplinary management and clinical outcomes after early cranial vault remodelling procedures.
Journal Article
Re-imagining early cloverleaf skull deformity management from front to back approach—30 years on
The cloverleaf skull deformity remains among the most complicated craniofacial conditions to successfully manage. Many cases achieve largely unsatisfactory outcomes due to the requirement for frequent reoperation on the cranial vault and failure to deal with all the elements of the craniofaciostenosis in a timely fashion. Early cranial vault surgery without addressing the cranial base deformity and its attendant cerebrospinal fluid flow changes is invariably challenging and disappointing. A recent focus on the expansion of the posterior cranial vault as a primary procedure with the greater volume change allows a delay in fronto-orbital advancement and reduced need for repeat surgery. We herein describe three cases of complex multisuture craniosynostosis with cloverleaf skull deformity who underwent neonatal posterior cranial vault decompression along with foramen magnum decompression. Our report examines the safety and rationale for this pre-emptive surgical approach to simultaneously deal with the cranial vault and craniocervical junction abnormalities and thus change the early trajectory of these complex cases.
Journal Article
The Economic Value of the Delivery of Primary Cleft Surgery in Timor Leste 2000–2017
Background
Plastic and reconstructive surgical teams visiting from Australia, a high-income country, have delivered cleft surgical services to Timor Leste since 2000 on a volunteer basis. This paper aims to estimate the economic benefit of correcting cleft deformities in this new nation as it evolved its healthcare delivery service from independence in 1999.
Methods
We have utilised a prospective database of all cleft surgical interventions performed during 44 plastic surgical missions over the last 18 years. The disability-adjusted life year (DALY) framework was used to calculate the total DALYs averted by primary cleft lip and palate repair. The 2004 global burden of disease disability weights were used. Economic benefits were calculated using the gross national income (GNI) and the value of a statistical life (VSL) methods for Timor Leste. Estimates were adjusted for treatment effectiveness, counterfactual cases, and complications. Cost estimates included the local hospitalisation costs, the foregone salaries of the visiting surgeons and nurses, other costs associated with providing surgical care, and an estimate for foregone wages of the patients or their carers. Sensitivity analysis was performed with income elasticity set to 0.55, 1.0, and 1.5.
Results
During 44 visiting plastic surgical missions to Timor Leste, 1500 procedures were performed, including 843 primary cleft lip and palate operations. The cleft procedures resulted in the aversion of 842 DALYs and an economic return to Timor Leste of USD 2.2 million (GNI-based) or USD 197,917 (VSL-based). Our programme cost USD 705 per DALY averted. The economic return on investment was 0.3:1 (VSL-based) or 3.8:1 (GNI-based).
Conclusion
A sustained and consistent visiting team approach providing repair of cleft lip and palate defects has resulted in considerable economic gain for Timor Leste over an 18-year period. The training of a local surgeon and multidisciplinary team with ongoing support to the in-country cleft service is expected to reduce the cost per DALY averted once the surgeon and team are able to manage clefts independently.
Journal Article
Ports in a Storm: Public Management in a Turbulent World
InPorts in a Storma team of Harvard Kennedy School scholars focus diverse conceptual lenses on a single high-stakes management task -enhancing port security across the United States. Their aims are two: to understand how a public manager might confront that complex undertaking, and to explore the similarities, differences, and complementarities of their alternative approaches to public management.
The book takes as its pivot point the singular case of U.S. Coast Guard Captain Suzanne Englebert and her leadership of efforts to secure America's ports after the September 11 attacks. The Coast Guard had always been responsible for securing America's ports and coastline. But now it was tasked with safeguarding these critical, complex, and vulnerable assets during a time of war, a job it clearly could not handle alone.
Ports in a Stormconsiders the monumental challenge of driving rapid change in a complex system involving hundreds of private organizations and scores of government agencies with their operations intricately intertwined. The book examines Englebert's actions from varied conceptual vantage points, sometimes critiquing questionable calls but more often celebrating her initiative, creativity, persistence, and skill.
The authors use the Coast Guard episode as a testing ground for the eclectic intellectual constructs they have been developing to guide public managers. Instead of starting with theory and searching for examples that fit, they begin with the concrete and then harness scholarship to the service of better practice. And rather than mimic management principles from the business world, they tailor their approach to the very different challenges of managing in a public sector context. The volume allows readers in both the scholarly and practical worlds to see how the theories measure up.
Contributors, including the two volume editors, are Robert D. Behn, John D. Donahue, Archon Fung, Stephen Goldsmith, Elaine Kamarck, Herman B. Leonard, Mark H. Moore, Malcolm K. Sparrow, Pamela Varley, and Richard Zeckhauser.
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