The authors are concerned that a remaining refuge of substantive democracy in America, the public sector, is in danger of abandoning it in favor of the market model of management. They argue that contemporary American democracy is confined to a shrunken procedural remnant of its earlier substantive form. The classical republican model of citizen involvement faded with the rise of liberal capitalist society in the late nineteenth and early twentieth centuries. Capitalism and democracy coexist in a society emphasizing procedural protection of individual liberties rather than substantive questions of individual development. Today's market model of government in the form of New Public Management goes beyond earlier "reforms," threatening to eliminate democracy as a guiding principle in public-sector management. The authors discuss the usefulness of a collaborative model of administrative practice in preserving the value of democracy in public administration.
ObjectiveOveruse of diagnostic imaging for patients with low back pain remains common. The underlying beliefs about diagnostic imaging that could drive overuse remain unclear. We synthesised qualitative research that has explored clinician, patient or general public beliefs about diagnostic imaging for low back pain.DesignA qualitative evidence synthesis using a thematic analysis.MethodsWe searched MEDLINE, EMBASE, CINAHL, AMED and PsycINFO from inception to 17 June 2019. Qualitative studies that interviewed clinicians, patients and/or general public exploring beliefs about diagnostic imaging for low back pain were included. Four review authors independently extracted data and organised these according to themes and subthemes. We used the Critical Appraisal Skills Programme tool to critically appraise included studies. To assess confidence in review findings, we used the GRADE-Confidence in the Evidence from Reviews of Qualitative Research method.ResultsWe included 69 qualitative studies with 1747 participants. Key findings included: Patients and clinicians believe diagnostic imaging is an important test to locate the source of low back pain (33 studies, high confidence); patients with chronic low back pain believe pathological findings on diagnostic imaging provide evidence that pain is real (12 studies, moderate confidence); and clinicians ordered diagnostic imaging to reduce the risk of a missed diagnosis that could lead to litigation, and to manage patients’ expectations (12 studies, moderate confidence).ConclusionClinicians and patients can believe that diagnostic imaging is an important tool for locating the source of non-specific low back pain. Patients may underestimate the harms of unnecessary imaging tests. These beliefs could be important targets for intervention.PROSPERO registration numberCRD42017076047.
In the post-Cold War era, the United States Army has undergone a dramatic transformation. In this new security era, the Army is increasingly participating in nontraditional operations. Also during this period, the frequency with which American service members have been operationally deployed (OPTEMPO) has increased. In this article, we analyze the impact of multiple deployments on peacekeeping attitudes, personal morale, and reenlistment intentions. In terms of peacekeeping attitudes, the greatest effects were on judgments of the appropriateness of alternative personnel to perform peacekeeping operations. With respect to morale and reenlistment intentions, we found support for the negative impact of multiple deployments on personal morale. However, we found no statistical support for the relationship between number of deployments and reenlistment intentions.
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