Managerial Perceptions of Privatization: Evidence from a State Department of Transportation

Mid-level managers have largely been ignored in studies of privatization’s stakeholders, despite their significant role in implementing privatization processes. This paper examines seeks to remedy that gap by examining managerial perceptions of privatization within a state department of transportation. Based on various theories of bureaucratic behavior, we hypothesize that professional identity will correlate with negative privatization perceptions and that stronger contractor-manager relationships and beliefs about privatization’s professional benefits will correlate with favorable perceptions. These hypotheses are tested with mail survey data from mid-level agency managers. Statistical modeling indicates that relationship quality is positively correlated with privatization perceptions; professional identity, when measured as a preference for technical work, is negatively correlated with privatization perceptions; and beliefs in privatization’s benefits do not correlate with privatization perceptions.Georgia Department of Transportatio

Searching for Patterns of Competitive and Relational Contracting over Time: Do Prime and Subcontractor Networks Follow Similar Patterns?

This paper explores and compares two sets of contractual relationships over a twelve-year period: the patterns of contracting between a state transportation agency and its prime contractors providing engineering design services, and between the prime- and sub-contractors. We find evidence that patterns of relational and competitive contracting may co-exist in the same contracting context. While the patterns of agency-prime contracting are indicative or relational contracting, the patterns of prime-sub contracting imply relatively more competitive processes. Implications for policy and theory of outsourcing are discussed

A comparison of age-standardised event rates for acute and chronic coronary heart disease in metropolitan and regional/remote Victoria: a retrospective cohort study

Abstract Background Acute and chronic coronary heart disease (CHD) pose different burdens on health-care services and require different prevention and treatment strategies. Trends in acute and chronic CHD event rates can guide service implementation. This study evaluated changes in acute and chronic CHD event rates in metropolitan and regional/remote Victoria. Methods Victorian hospital admitted episodes with a principal diagnosis of acute CHD or chronic CHD were identified from 2005 to 2012. Acute and chronic CHD age-standardised event rates were calculated in metropolitan and regional/remote Victoria. Poisson log-link linear regression was used to estimate annual change in acute and chronic CHD event rates. Results Acute CHD age-standardised event rates decreased annually by 2.9 % (95 % CI, −4.3 to −1.4 %) in metropolitan Victoria and 1.7 % (95 % CI, −3.2 to −0.1 %) in regional/remote Victoria. In comparison, chronic CHD age-standardised event rates increased annually by 4.8 % (95 % CI, +3.0 to +6.5 %) in metropolitan Victoria and 3.1 % (95 % CI, +1.3 to +4.9 %) in regional/remote Victoria. On average, age-standardised event rates for regional/remote Victoria were 30.3 % (95 % CI, 23.5 to 37.2 %) higher for acute CHD and 55.3 % (95 % CI, 47.1 to 63.5 %) higher for chronic CHD compared to metropolitan Victoria from 2005 to 2012. Conclusion Annual decreases in acute CHD age-standardised event rates might reflect improvements in primary prevention, while annual increases in chronic CHD age-standardised event rates suggest a need to improve secondary prevention strategies. Consistently higher acute and chronic CHD age-standardised event rates were evident in regional/remote Victoria compared to metropolitan Victoria from 2005 to 2012

High-Resolution Single Nucleotide Polymorphism Analysis Distinguishes Recrudescence and Reinfection in Recurrent Invasive Nontyphoidal Salmonella Typhimurium Disease

Invasive nontyphoidal Salmonella Typhimurium disease is a common and frequently recurrent cause of bacteremia across sub-Saharan Africa. We use high-resolution single nucleotide polymorphism analysis to distinguish between reinfection and recrudescence in disease recurrence within single individuals over time

Ceftriaxone-Resistant Salmonella enterica Serotype Typhimurium Sequence Type 313 from Kenyan Patients Is Associated with the blaCTX-M-15 Gene on a Novel IncHI2 Plasmid

Multidrug-resistant bacteria pose a major challenge to the clinical management of infections in resource-poor settings. Although nontyphoidal Salmonella (NTS) bacteria cause predominantly enteric self-limiting illness in developed countries, NTS is responsible for a huge burden of life-threatening bloodstream infections in sub-Saharan Africa. Here, we characterized nine S. Typhimurium isolates from an outbreak involving patients who initially failed to respond to ceftriaxone treatment at a referral hospital in Kenya. These Salmonella enterica serotype Typhimurium isolates were resistant to ampicillin, chloramphenicol, cefuroxime, ceftriaxone, aztreonam, cefepime, sulfamethoxazole-trimethoprim, and cefpodoxime. Resistance to β-lactams, including to ceftriaxone, was associated with carriage of a combination of blaCTX-M-15, blaOXA-1, and blaTEM-1 genes. The genes encoding resistance to heavy-metal ions were borne on the novel IncHI2 plasmid pKST313, which also carried a pair of class 1 integrons. All nine isolates formed a single clade within S. Typhimurium ST313, the major clone of an ongoing invasive NTS epidemic in the region. This emerging ceftriaxone-resistant clone may pose a major challenge in the management of invasive NTS in sub-Saharan Africa

A Novel Linear Plasmid Mediates Flagellar Variation in Salmonella Typhi

Unlike the majority of Salmonella enterica serovars, Salmonella Typhi (S. Typhi), the etiological agent of human typhoid, is monophasic. S. Typhi normally harbours only the phase 1 flagellin gene (fliC), which encodes the H:d antigen. However, some S. Typhi strains found in Indonesia express an additional flagellin antigen termed H:z66. Molecular analysis of H:z66+ S. Typhi revealed that the H:z66 flagellin structural gene (fljBz66) is encoded on a linear plasmid that we have named pBSSB1. The DNA sequence of pBSSB1 was determined to be just over 27 kbp, and was predicted to encode 33 coding sequences. To our knowledge, pBSSB1 is the first non-bacteriophage–related linear plasmid to be described in the Enterobacteriaceae

Phenotypic Determination and Antimicrobial Resistance Profile of Extended Spectrum Beta-lactamases in Escherichia coli and Klebsiella pneumoniae in Accra, Ghana

Extended-spectrum beta-lactamases (ESBLs) are plasmid-mediated beta lactamases commonly found in the Enterobacteriaceae that are capable of hydrolysing ?-lactams except carbapenems and cephamycins. ESBLs confer resistance to several non-ß-lactam antibiotics. ESBL-producing organisms appear susceptible to cephalosporins in vitro using conventional breakpoints but ineffective in vivo. This work sought to determine the occurrence of ESBL in E. coli and K. pneumoniae and their antibiotic resistance profile. Four hundred K. pneumoniae and E. coli non-duplicate isolates were collected at the Central Laboratory of Korle Bu Teaching Hospital and Advent Clinical Laboratories. They were definitively identified and their minimum inhibition concentration and antibiotic sensitivity testing for 17 antibiotics were determined using Vitek 2 Compact System (bioMérieux, Marcy I’Etoile, France).  The isolates were confirmed as ESBL-producing strains using the Combination Disk Synergy Method. The results indicated that 202 (50.5%) of the bacterial isolates were ESBL-producing phenotypes with high resistant to gentamicin, ciprofloxacin, tetracycline and trimethoprim/sulfamethoxazole indicating 82.2%, 79.7%, 70.8% and 97% resistant rates respectively. imipenem and amikacin were the antibiotics of choice with 99% and 94.1% susceptibility rates (MIC90 of ?1µg/ml and 4µg/ml respectively). It is imperative to routinely detect ESBL-phenotypes in health facilities, implement appropriate antibiotic administration policy and infection control measures in the hospitals.   Keywords: Extended Spectrum Beta-lactamase, Antimicrobial Resistance, ?-lactams, K. pneumoniae, E. col