Mark E. Tompkins

The Accountability Paradox in an Age of Reinvention The Perennial Problem of Preserving Character and Judgment

The rapidly expanding literature on accountability reveals a centrally important paradox: Responsible interpretation and application of external accountability demands depends on the cultivation of the virtues that support good administrative judgment, but the institutions and mechanisms that are used to communicate these external standards, and that monitor compliance with them, often threaten the very qualities that support responsible judgment. Consulting a rich and varied literature, this paradox is explored as it emerges in both the more familiar compliance-based accountability processes and the less well-understood performance-based processes associated with reinvention and the new public management.

Trends and racial differences in birth weight and related survival.

Objective: In the past two decades, infant mortality rates in the United States declined in African-American and White populations. Despite this, racial disparities in infant mortality rates have increased and rates of low birth weight deliveries have shown little change. In this study, we examine temporal changes in birth weight distributions, birth weight specific neonatal mortality, and the birth weight threshold for an adverse risk of survival within both racial groups in order to explore the mechanisms for the disparities in infant mortality rates. Method: Single live births born to South Carolina resident mothers between 1975 and 1994 and considered White or African-American based on the mothers report of maternal race on the birth certificate were selected for investigation. We define the birth weight threshold for adverse survival odds as the birth weight at which 50% or more of infants in the population died within the first month of life. Results: Despite significant increases in very low birth weight percentages, neonatal mortality rates markedly declined. Birth weight specific neonatal mortality decreased for both races, although greater reductions accrued to White low birth weight infants. By the end of the study period, the birth weight at which over 50% of newborns died within the first month of life was 696 g for Whites and 673 g for African-Americans. Discussion: The ongoing decline in neonatal mortality is mainly due to reductions in birth weight specific neonatal mortality, probably related to high-risk obstetric and neonatal care. Technological developments in these areas may have differentially benefited Whites, resulting in an increasing racial disparity in mortality rates. Moreover, the relatively greater and increasing mortality risk from postmaturity and macrosomia in infants of African-America mothers may further exacerbate the racial gap in infant mortality.

Have Gubernatorial Elections Become More Distinctive Contests

Gubernatorial and presidential elections over the period 1947-1986 are examined, using a previously reported process for decomposing partisan electoral outcomes series into their long-term and short-term components. These measures are employed to examine the proposition that gubernatorial elections have become increasingly isolated from outside forces. It is found that presidential coattails appear to be declining in importance (but not only because a number of states have moved to off-year elections). Gubernatorial elections have converged around a national pattern of relatively close competition, unlike state-level presidential contests, which have shifted in favor of Republican candidates. The pattern of gubernatorial outcomes varies more from state to state, however. In specific elections, the short-term forces remain in rough equilibrium between the parties in gubernatorial contests, but not in presidential contests, where the average short-term shifts favoring one party or the other fluctuate from one election to the next. On the other hand, gubernatorial elections respond less uniformly than presidential elections to these election-specific, national-level forces. This evidence suggests that the gubernatorial election contest has, in general, become more distinctive from the national context, reflecting a more fully autonomous office.

A comparison of gestational age reporting methods based on physician estimate and date of last normal menses from fetal death reports.

Utilizing 10,587 cases from the 1980 National Center for Health Statistics Fetal Death Statistics File, we examined the comparability of two methods of determining the gestational age of a fetal death, the calculated interval from date of last normal menses (DLNM) and the physicians estimate. The physician estimated gestational age distribution exhibits even number digit preference and a distinct clustering at the 40-week value. The DLNM distribution appears more smoothly distributed but with a more pronounced post-term tail. An exact agreement between the two methods is observed in only 27.9 per cent of the cases. A 1.7 week mean difference between the methods indicates a systematic underestimation by physician reported gestational age when compared to that calculated from the DLNM, potentially biasing gestational age distributions when the physician estimate is substituted for cases with a missing DLNM. Over 8 per cent of cases 20+ weeks by DLNM are estimated as less than 20 weeks by the physician. This underestimation has important implications for the completeness of reporting of fetal deaths on vital records and the comparability of fetal death rates. Further, it may limit investigations of the completeness of reporting of less than 500 gram live births.

Variations in the reporting of gestational age at induced termination of pregnancy.

Utilizing the 1980 Induced Abortion File maintained by the National Center for Health Statistics, we compared gestational age from date of last normal menses and the physician-based estimate of gestational age. An average .51 week difference between the two methods was observed. Beyond seven weeks gestation, the date of last normal menses value was underestimated by the physician-based estimate with a markedly greater divergence after 20 weeks. A relatively greater underestimation of the date of last normal menses interval by the physician estimate was apparent for Whites after 13 weeks. The data of last normal menses value for non-state residents was overestimated across the entire range of the date of last normal menses gestational age distribution until 21 weeks.

Administrative Practice and the Waning Promise of Professionalism for Public Administration

For two decades public administration has considered a series of evolving conceptions of professionalism, designed to address some of the fields central concerns. The authors evaluate professionalisms ability to provide practitioners a sense of unity and purpose, to promote virtuous and competent administrative practice, to defend public administrations legitimate institutional role in governance, and to enhance the standing of the field in the eyes of the public and its representatives. They conclude that the professional ideal, even a revised professionalism that avoids explicit claims to autonomous practice, is one that the field should relinquish.

South Carolina's diked tidal wetlands: The presisting dilemmas

Abstract South Carolina has a significant stock of diked coastal wetlands, dating from the days of rice culture before the Civil War. A survey of those controlling these sites along the entire South Carolina coast reveals that many continue to be used for waterfowl hunting, with management practices becoming more intensive than they were when partial data were gathered a decade ago. It also suggests that most of the acreage involved is located in large fields, where management is more difficult and mosquito control problems are more likely. This survey also indicates that public access is limited, but that there is evidence of continuing conflict over ownership. This situation creates a persisting dilemma for coastal zone management, shaping conflicts between alternative strategies for the use of natural systems.

Improved Neonatal Mortality in the 90's is Not Associated with Increased Postponement of Death into the Post-Neonatal Period |[dagger]| 1313

Objective: To determine if the trend in postponement of neonatal death from neonatal and perinatal-related causes into the post-neonatal period demonstrated between the 1970s and 1980s has continued into the 1990s.

TEMPORAL CHANGES IN PRETERM VIABILITY BY RACE. † 1520

Improvements in obstetric and neonatal care over the last several decades have lead to a decline in neonatal mortality. This study utilized South Carolinas linked live birth and infant death records from 1975-1992. We analyzed mortality rates at 7 & 28 days by race, gestational age (GA) and birthweight (BW). Neonatal mortality rate decreased from 14.9 to 9.1 (deaths per 1,000) for African-Americans (AA) and from 10.2 to 4.3 for Whites (W). The most dramatic decrease was in 7 day mortality (12.4 to 7.3 for AA; 8.8 to 3.3 for W). Neonatal mortality decreased overtime for both races in each GA category, but the decrease was most dramatic at 26-32 wks GA. The limit of viability (< 50% survival) was lowered from 26 wks in 1975 to 24 wks GA in 1992 for W. For AA, the limit of viability was already 24 wks GA in 1975,& did not change over the time period. Neonatal mortality rates are lower for AA than for W up to 32 wks GA, but by 37 wks GA, W have lower neonatal mortality. There were no appreciable temporal changes for either race in rates of preterm delivery or of infants with BW < 2500g, although AA demonstrated an increase in births with BW < 1500 g (from 1.8/1000 in 1975 to 2.5/1000 in 1992). CONCLUSION: This decline in neonatal mortality over an 18 year period, due primarily to a reduction in GA-specific and 7 day mortality, reflects high risk obstetric and neonatal intensive care efforts. Renewed efforts should be made in devising strategies to change the GA/BW distribution toward term, and to maximize the health and developmental outcome of surviving high risk preterm infants.

The forgotten worker: Neglected aspects of public service in an information age

One of the most consistent themes among contemporary administrative theorists is that the workplace of the future will be a more hospitable environment for public workers than is currently the case. Decentralization, participative management, and intrinsically satisfying work are commonly forecast. Using survey data from state employees, this study identifies a large class of civil servants that has not yet, and probably will not, enjoy the enriched jobs that are so often predicted. The discussion identifies a number of factors in the work environment of these workers that are likely to frustrate attempts to make their jobs more meaningful and pleasant. Having acknowledged their existence and assessed their plight, the study concludes with a summary of measures that can be taken to address the needs of these “forgotten workers.”