AbstractNew Public Management (NPM) has been the most significant public policy reform in decades. Despite its widespread use, it has been a contested policy from its initial adoption. There has been a succession of replacement policies which have been proposed over its life to date. Yet NPM is still in evidence. The expression NPM was coined by Hood (1991). It referred to the mimicry of private sector practices (on management structures and styles, on ownership models and the focus on accounting practices, and quantification and performance management within private sector organisations). Writings on New Public Management (NPM) have been extremely influential, even if it can no longer be described as ‘new’. It is often described as a set of management techniques and practices, which have now achieved global significance. The attractiveness of NPM to policy makers is evident. The NPM focus on results coincides with political imperatives. NPM has the appearance of ready-made answers to policy proposals. Many management consultants have become adept at advancing the case for NPM, generally, and as a solution to specific problems. However, many academic commentators have criticised NPM implementation programmes. Despite such criticism, the adherence of policymakers to NPM has ensured its prominent role in public life. This chapter outlines four dimensions of NPM, which focus on understanding both the pervasive nature of NPM and the challenges to the prevailing logic of NPM in public policy: mature NPM, NPM in action, alternative models to NPM, and NPM’s role in contemporary society.

Introduction. Post-acute sequelae of SARS-CoV2 infection, or PASC, is defined as the presence of persistent symptoms for at least two months after an acute infection with COVID-19. A potential pathophysiologic mechanism for PASC is microvascular thrombosis. Using EQ-5D-5L index scores, we previously reported that extended thromboprophylaxis for 30 days with apixaban did not impact quality of life (QoL) at 30 or 90 days after discharge (Wang et al, Ann Intern Med 2023; 176:515-523). The purpose of this investigation was to determine whether anticoagulation had a variable impact on the individual domains measured by EQ-5D-5L. Methods. ACTIV 4c was a prospective, randomized, placebo-controlled, double-blind clinical trial comparing post-discharge thromboprophylaxis with apixaban 2.5 mg twice daily to placebo for 30 days in patients hospitalized with COVID-19. Participants were enrolled at 107 hospitals in the US between February 2021 and June 2022. We ascertained symptoms and QoL by EQ-5D-5L at 2 days, 30 days, and 90 days after hospital discharge by electronic or telephone follow-up. The five domains of EQ-5D-5L are: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each domain has 5 levels of response, ranging from “no problems/none” to “unable to perform/extreme”, which are used to determine individual scores. We analyzed the impact of treatment (placebo vs. apixaban), antiplatelet therapy (yes vs. no), and highest WHO severity score during hospitalization (score <5 vs. score ≥5) on degree of impairment at 2, 30, and 90 days post-discharge using a chi-square test for those participants who completed the survey at each timepoint. We also used a proportional odds model to test for at least moderate impairment in each EQ-5D-5L domain, also at 30 and 90 days, using odds ratios adjusted for age (restricted cubic spline with 3 knots), sex, D-dimer (normal or abnormal), BMI (restricted cubic spline with 3 knots), antiplatelet usage (yes/no - at enrollment), WHO severity score (<=5 vs. > 5), and the randomized treatment. Results. We randomized 1217 participants hospitalized with acute COVID-19 onto ACTIV 4c, with 610 participants assigned to apixaban and 607 participants to placebo. A total of 208 participants taking apixaban (43.5%) and 219 participants taking placebo (45.0%) reported moderate or greater impairment in one or more of the EQ-5D-5L domains by 2 days after hospital discharge. The individual domain most frequently reported as impaired was usual activities (33.0% of all study participants). By 30 days after discharge, 151 participants taking apixaban (30.8%) and 165 taking placebo (33.4%) reported moderate or greater impairment in one or more domains. The individual domain with the largest improvement was usual activities, affecting 17.4% of all study participants. By 90 days, 152 participants taking apixaban (31.5%) and 142 participants taking placebo (28.5%) reported moderate or greater impairment in one or more domains. Extended thromboprophylaxis with apixaban was not associated with improved scores for any of the individual EQ-5D-5L domains at 30 days or 90 days (Table 1). Stratification by WHO severity score during hospitalization revealed a significant improvement in the domain for usual activities for participants with score <5 compared to those with a score ≥5 (p=0.015) by 30 days, but this difference was not present by 90 days. Stratification by anti-platelet use did not identify any domains with improvement associated with antiplatelet therapy at 30 or 90 days. Using adjusted odds ratios, we did not find a benefit for apixaban at 30 days (Figure 1) or at 90 days (data not shown). Conclusion. Almost half of patients hospitalized with COVID-19 have decreased QoL at time of discharge, with the greatest impact on performance of usual activities. Impaired QoL persists for up to 90 days after hospital discharge in one-third of patients. Extended thromboprophylaxis with apixaban for 30 days at the time of hospital discharge in participants with acute COVID-19 was not associated with improvements in QoL as assessed by EQ-5D-5L.

Background: Patients hospitalized with COVID-19 have an increased incidence of thromboembolism. The role of extended thromboprophylaxis after hospital discharge is unclear. Objective: To determine whether anticoagulation is superior to placebo in reducing death and thromboembolic complications among patients discharged after COVID-19 hospitalization. Design: Prospective, randomized, double-blind, placebocontrolled clinical trial. (ClinicalTrials.gov: NCT04650087) Setting: Done during 2021 to 2022 among 127 U.S. hospitals. Participants: Adults aged 18 years or older hospitalized with COVID-19 for 48 hours or more and ready for discharge, excluding those with a requirement for, or contraindication to, anticoagulation. Intervention: 2.5 mg of apixaban versus placebo twice daily for 30 days. Measurements: The primary efficacy end point was a 30-day composite of death, arterial thromboembolism, and venous thromboembolism. The primary safety end points were 30-day major bleeding and clinically relevant nonmajor bleeding. Results: Enrollment was terminated early, after 1217 participants were randomly assigned, because of a lower than anticipated event rate and a declining rate of COVID-19 hospitalizations. Median age was 54 years, 50.4% were women, 26.5% were Black, and 16.7% were Hispanic; 30.7% had a World Health Organization severity score of 5 or greater, and 11.0% had an International Medical Prevention Registry on Venous Thromboembolism risk prediction score of greater than 4. Incidence of the primary end point was 2.13% (95% CI, 1.14 to 3.62) in the apixaban group and 2.31% (CI, 1.27 to 3.84) in the placebo group. Major bleeding occurred in 2 (0.4%) and 1 (0.2%) and clinically relevant nonmajor bleeding occurred in 3 (0.6%) and 6 (1.1%) apixaban-treated and placebo-treated participants, respectively. By day 30, thirty-six (3.0%) participants were lost to follow-up, and 8.5% of apixaban and 11.9% of placebo participants permanently discontinued the study drug treatment. Limitations: The introduction of SARS-CoV-2 vaccines decreased the risk for hospitalization and death. Study enrollment spanned the peaks of the Delta and Omicron variants in the United States, which influenced illness severity. Conclusion: The incidence of death or thromboembolism was low in this cohort of patients discharged after hospitalization with COVID-19. Because of early enrollment termination, the results were imprecise and the study was inconclusive.

A 59-year-old woman was found unresponsive at home. Initial neurologic examination revealed aphasia and right-sided weakness. Laboratory results demonstrated a serum calcium level of 17.3 mg/dL (corrected serum calcium for albumin concentration was 16.8 mg/dL). Extensive workup for intrinsic aetiology of hypercalcemia was unrevealing. Further discussion with family members and investigation of the patient's home for over-the-counter medications and herbal supplements revealed chronic ingestion of calcium carbonate tablets. CT angiogram of the brain revealed multifocal intracranial vascular segmental narrowing, which resolved on a follow-up cerebral angiogram done 2 days later. These findings were consistent with reversible cerebral vasoconstriction syndrome.Appropriate blood pressure control with parenteral agents, calcium channel blockade with nimodipine and supportive care therapies resulted in significant improvement in neurologic status. By discharge, patient had near-complete resolution of neurologic symptoms.

e14034 Background: Primary brain malignancy is distinct from other oncologic diagnoses in its presentation and course. Recent treatment advances have modestly improved survival; yet, prognoses for afflicted patients remain grim, which often leads to non-oncology providers questioning the pertinence of aggressive critical care in this population. By relating patient and disease factors with mortality rates in malignant brain tumor (MBT) patients admitted for critical care, we seek to identify valuable prognostic factors and clarify the expected outcomes following intensive care unit (ICU) admission among these patients. Methods: A single-institution retrospective review was performed of 80 primary MBT patients admitted to neuro- or medical ICUs over a five-year period. The Electronic Health Record (EHR) was queried to identify MBT patients who had been admitted to the ICU. Patients undergoing planned surgical resection or with post-operative complications were excluded, as were patients with brain metastases. A matched control group of 80 solid tumor (ST) patients (excluding brain tumors) was included for comparison. Similar aged matched controls were randomly identified via EHR over the same time period to include non-brain, ST patients admitted to the ICU. Demographic, oncologic, and admission data were related to outcomes, which included complication rates (ICU mortality, six-month mortality) and change in Karnofsky Performance Status (KPS) score. Results: The average age was 55.9 (20-83) and 62.8 (27-89) years in the MBT and ST group, respectively (p = 0.10). ICU mortality was 15% and 21% (p = 0.411) and six-month mortality was 46% and 65% (p = 0.10) in the MBT and control groups, respectively. The most common reasons for ICU admission were seizures (36%) and septic shock (21%) among MBT patients, compared to hypoxic respiratory failure (43%) and septic shock (30%) among ST patients. The MBT group’s KPS score decreased by 23.6 ± 26.82 during their ICU admission, while the control group KPS decreased by 27.0 ± 28.3 (p = 0.87). Average length of ICU stay was 3.82 ± 4.4 days in the MBT group, compared to 2.95 ± 1.83 days in the control ST group (p = 0.29). Average length of hospital stay was 9.07 ± 9.0 days in the MBT group and 8.67 ± 7.76 days in the ST group (p = 0.92). Conclusions: No significant difference was observed in ICU or 6-month mortality when comparing primary MBT and ST patients. Change in KPS score across ICU admissions was similar among the two groups. Our data indicate that despite their guarded prognosis, MBT patients fare no worse than those with other solid tumor types at our institution in the critical care setting. These similarities in mortality and functional scores justify medical ICU admission in patients with primary brain malignancy, and should inform intensivist and oncologist admission patterns.

Reviewed by: Materiality and Aesthetics in Archaic and Classical Greek Poetry by Amy Lather Peter J. Miller Materiality and Aesthetics in Archaic and Classical Greek Poetry. By Amy Lather. Edinburgh: Edinburgh University Press. 2021. Pp. xi, 266. Attractive objects are attractive—even, perhaps especially, in their literary forms. This concept stands at the heart of Amy Lather's dense, complex, and suggestive Materiality and Aesthetics in Archaic and Classical Greek Poetry. Lather engages with a wide array of theoretical approaches from cognitive science, psychology, and, in general, "New Materialism." Her book, across a diverse body of texts (and some detailed study of vase painting), mostly from the archaic period, assesses poikilia and objects characterized as poikilos in order to investigate "how minds and things interact" (2). "New Materialism" is particularly suitable to the study of archaic concerns with poikilia, the broad range of which ("alternately entrancing, beguiling, stunning and perplexing" [223]), alongside its representation, points to the very modes in which perception was thought to take place in archaic and classical Greece. This book will be useful to those interested in "New Materialism," aesthetics, and archaic poetry. While Lather takes on the difficult task of integrating theory from outside classical studies and explains it well, the book will challenge classicists who are not versed in these theoretical models. I, for instance, returned to the opening chapters' explanations of key aspects of "New Materialist" theory throughout the course of reading. The book does, however, have many novel arguments and interpretations to offer, so the reader is encouraged to spend time carefully with the opening chapters, in order fully to understand the complex theoretical framework. Greek poetry—as so many have made clear—is heavily invested in objects, from its beginnings in Homeric poetry, or, indeed, in the famous Cup of Nestor. Lather does not only take objects as topics in early Greek poetry, but also as productive elements themselves for the development of cognitive processes and thought more generally. Her [End Page 136] suggestion accords well with the close connection of objects to language and verse, not only in their appearance in, for example, Homer, but in physical objects on which early inscriptions in verse appear. Lather's book intervenes in this rich subject area by "considering how matter impinges on or even constitutes human thought and activity as well as how human cognitive processes develop and evolve from their interactions with things" (4; Lather's italics). Important to these claims early in the book are terms like vitality and vibrancy: the former is the "agentive" power, or power to act, while the latter is the appearance of this characteristic (i.e., vitality) in objects (5). Beyond these terms, Lather also introduces "enactive perception and extended mind" and "material engagement," both of which aim to "destabilize the hierarchy of agency between persons and things" (5). Enactive perception suggests that all "higher order" thinking relies on interactions with things; in contrast, "material engagement" suggests that things help to constitute thought itself. These terms and ideas recur throughout and form the basis of Lather's arguments about many aspects of poikilia in Greek poetry. The book is divided into six chapters. The first three look at different materials and creations and how they engage with poikilia and "scaffold" human cognition: fabric and textile decoration, both in visual art and in its representation in literature; armour and weaponry; artificial life or automata. The second three chapters focus less on specific items and turn rather to lyric and poikilia, metis and poikilia, and finally to the question of how feminine guile is materialized in archaic (and some classical) poetry. A conclusion, a bibliography, an index locorum, and a subject index round out the book. The first three chapters offer novel insights into many familiar passages from the archaic poetic corpus. Chapter One is particularly noteworthy for ranging from literary representation of fabric to its visual representation in sculpture and vase-painting. Lather focuses on the value of poikilia in texts about textiles or the artistic works that represent them (18). Why, she wonders, was poikilia thought to enhance textiles and how did it function to describe...

E-cigarette, or vaping, product use-associated lung injury (EVALI) has become an epidemic that is increasingly affecting patients across USA. Recently, over 2100 cases have been reported in 49 states, resulting in at least 42 deaths. We present a case of rapid respiratory failure in an otherwise healthy and young patient who used a vaporiser containing tetrahydrocannabinol (THC) during the month prior to admission. The patient eventually required mechanical ventilation. There were significant challenges in achieving the appropriate level of sedation during intubation and mechanical ventilation. As more EVALI cases are being diagnosed in recent months, we highlight an aspect that may be unique to the population of patients who vaporise THC-high sedative and analgesic requirements during intubation and mechanical ventilation.

Critical Care Medicine: January 2020 - Volume 48 - Issue 1 - p 260 doi: 10.1097/01.ccm.0000625976.14523.f3

This contribution introduces the special issue on the roles of accounting practices in the context of reforms to and within public service organizations. The papers in the special issue provide fresh insights into the ways in which calculative practices intervene in public services, and thus come to affect the experiences of such actors, offering important perspectives on how the latter act to resist, reshape, redefine, and change those very practices, or strategically and tactically use (or avoid the use of) accounting to impact the ways in which services are defined and delivered.

Much has been made of economizing. Yet, social scientists have paid little attention to the moment of economic failure, the moments that precede it, and the calculative infrastructures and related processes through which both failing and failure are made operable. This chapter examines the shift from the economizing of the market economy, which took place across much of the nineteenth century, to the economizing and marketizing of the social sphere, which is still ongoing. The authors consider a specific case of the economizing of failure, namely the repeated attempts over more than a decade to create a failure regime for National Health Service (NHS) hospitals. These attempts commenced with the Health and Social Care Act 2003, which drew explicitly on the Insolvency Act 1986. This promised a "failure regime" for NHS Foundation Trusts modeled on the corporate sector. Shortly after the financial crash, and in the middle of one of the biggest scandals to face NHS hospitals, these proposals were abandoned in favor of a regime based initially on the notion of "de-authorization." The notion of de-authorization was then itself abandoned, in favor of the notion of "unsustainable provider," most recently also called the Trust Special Administrators regime. The authors suggest that these repeated attempts to devise a failure regime for NHS hospitals have lessons that go beyond the domain of health care, and that they highlight important issues concerning the role that "exit" models and associated calculative infrastructures may play in the economizing and regulating of public services and the social sphere more broadly.

This special issue focuses on the interactions between accounting, public sector organisations and the socio-economic and political environments in which they operate, with a specific focus on the critical analysis of policy and practice in the fight against corruption. The aim of the special issue is to disseminate knowledge to enable a more sustainable, accountable and less corrupt public sector, regardless of where it is located in the world. It presents the work of a global community of scholars engaged in research projects on policies and strategies related to accountability, transparency, auditing, regulatory disclosure, governance, investor protection and anti-corruption initiatives in public sector organisations. The papers presented here address many different angles of corruption and aspects of the way in which it is reported using a broad range of methodologies, theoretical frameworks and research locations. Collectively, these papers demonstrate that more attention needs be given to investigating the human cost associated with illegal activity that leads to human suffering, inequality, and lifetime costs. They further emphasise that we have much to learn about regulatory disclosure and jurisprudential practice in the fight against fraud and corruption.

The is concerned with improving the educational process by encouraging scholarly inquiry related to American Educational Research Association education and by promoting the dissemination and practical application of research results. AERA is the most prominent international professional organization for educational researchers, with the primary goal of advancing educational research and its practical application. Its more than 22,000 members are educators; administrators; directors of research, testing or evaluation in federal, state and local agencies; counselors; evaluators; graduate students; and behavioral scientists. The broad range of disciplines represented by the membership includes education, psychology, statistics, sociology, history, economics, philosophy, anthropology, and political science.

Purpose The purpose of this paper is to provide an evaluation of public sector research in the 1998–2018 period. Design/methodology/approach The paper uses the extant literature of this era to study the theorisation of, and the findings of, public sector research. Findings This is a vibrant field of a study in a wide range of study settings and with many interdisciplinary studies. The influence of new public management is pervasive over this period. There are numerous instances of innovations in study settings, in key findings and the approach taken by investigators. Research limitations/implications This is not a comprehensive review of all literature in this period. Practical implications This study also explored the relevance of academic research of this era to policymaking by governments. Originality/value This paper offers a distinctive critique of theorisation of public sector accounting research. It reveals the dominant theoretical reference points in use during this period and observes the increasing tendency for theoretical pluralism to investigate complex study settings.

Acute thrombotic thrombocytopenic purpura (TTP) is an aggressive thrombotic microangiopathy that if not treated, can have a 90% mortality rate. Clinical manifestations of this disease include profound thrombocytopenia, hemolytic anemia, and end-organ dysfunction. Neurologic symptoms can occur in 80% of patients and range from mild confusion to coma (Scully et al., Br J Haematol 142:819-826). Here, we present the clinical course of a patient diagnosed with new onset acquired TTP who presented with neurologic changes that waxed and waned during her disease course. In addition to usual clinical and laboratory markers for TTP severity and activity, we also collected and analyzed the protein S100B, an astroglial protein studied as a marker for central nervous system injury and impairment of the blood-brain barrier. Our hypothesis here is that because TTP involves endovascular damage, S100B could function as a biomarker for neurologic dysfunction and ultimately, predict disease activity. As illustrated in this case, our patient's S100B levels did appear to correlate with TTP disease activity and the trajectory of this protein seemed a better predictor of cognitive function. Furthermore, increased S100B velocity seemed to be the earliest indicator of a refractory TTP disease process requiring more intensive plasma exchange (TPE) therapy regimen. Therefore, we would suggest that S100B is a promising predictive biomarker of disease activity in guiding the intensity of TPE therapy for TTP as well as cognitive function.

PURPOSE:To report the only known case, to our knowledge, of bilateral exudative retinal detachments in the setting of thrombotic microangiopathy associated with intravenous abuse of extended-release oxymorphone (Opana ER).OBSERVATIONS:A 35-year-old male presented with headaches and acute, painless vision loss in the context of daily IV abuse of crushed oral Opana ER. The patient was found to have microangiopathic hemolytic anemia (MAHA), acute kidney injury in conjunction with hypertensive crisis and bilateral exudative retinal detachments.CONCLUSIONS AND IMPORTANCE:Bilateral exudative retinal detachments are rare ophthalmic complications that have been reported with thrombotic thrombocytopenic purpura (TTP). Non-TTP thrombotic microangiopathy, initially described as a "TTP-like illness" consisting of MAHA and thrombocytopenia, has been associated with the IV abuse of Opana ER. We report a case of bilateral exudative retinal detachments due to thrombotic microangiopathy in the setting of IV abuse of Opana ER.