Negotiating authority: a comparative study of reform in medical training regimes

Recently the medical profession has faced increased outside pressure to reform postgraduate medical training programs to better equip young doctors for changing health care needs and public expectations. In this article we explore the impact of reform on professional self-governance by conducting a comparative historical-institutional analysis of postgraduate medical training reform in the United Kingdom and the Netherlands. In both countries the medical training regime has shifted from professional self-regulation to coregulation. Yet there are notable differences in each country that cannot be explained solely by diverging institutional contexts. They also result from the strategic actions by the actors involved. Based on an assessment of the recent literature on institutional transformation, this article shows how strategic actions set negotiating authority processes into motion, producing new and sometimes surprising institutional arrangements that can have profound effects on the distribution and allocation of authority in the medical training regime. It stresses the need to study the interactions among political context, the properties of institutions, and negotiating authority processes, as they are crucially important to understanding institutional transformation.     

The role of Salvadorean NGOs in post-war reconstruction

The Peace Agreement signed recently between the Government and FMLN guerrillas in El Salvador marks the end of a decade of civil war. As both sides of the conflict and the international donor community begin to add up the financial costs of reconstruction, the human, social and psychological costs are carried mainly by the poor of El Salvador. Social organisations and NGOs who became strategists of survival now face the challenge of transforming their accumulated experience into alternative proposals for the building of a more just society and a prosperous nation. This article explores the practical complexities of transition from war to peace; and from emergency aid to sustainable development based on the participation of communities, social organisations, NGOs, and international agencies; and the challenges of building on their experience.     

The possible influence of micro-organisms and putrefaction in the production of GHB in post-mortem biological fluid

In recent years, the post-mortem production of the drug of abuse gamma-hydroxybutyric acid (GHB) in biological fluids (e.g. blood and urine) has caused various interpretative problems for toxicologists. Previously, other researchers have shown certain microbial species (Pseudomonas spp. and Clostridium aminobutyricum) possess the necessary enzymes to convert GABA to GHB. A preliminary investigation involving putrefied post-mortem blood indicated there was no observed relationship between "endogenous" GHB concentrations and concentrations of common putrefactive markers (tryptamine and phenyl-2-ethylamine). Microbiological analysis identified the presence of various micro-organisms: Clostridia spp., Escherichia coli, Proteus vulgaris, Enterococcus faecalis and Aeromonoas spp. Equine plasma, human blood and urine samples were inoculated with these and an additional micro-organism (Pseudomonas aeruginosa) and incubated at 22 degrees C for 1 month. Following comparison with control samples and pre-inoculation concentrations, the data indicated an apparent production of GHB in unpreserved P. aeruginosa inoculated blood (2.3 mg/l). All other fluoride-preserved and unpreserved samples (including controls) had GHB concentrations <1mg/l. Although this concentration is lower than is typically associated with "endogenous" post-mortem GHB concentrations, this paper proposes a potential microbial production of GHB with time.     

Aggression and delinquency: Family and environmental factors

Juvenile delinquency has become an increasing concern to society; aggressive behaviors are particularly harmful. This study examined parent and youth behaviors and personality types that may influence delinquent and aggressive behaviors. Youths were referred by the court to an intervention program; ratings of delinquency and aggression were derived from parent reports, self-reports, and court referral data. Results showed that high parent ratings of youth aggressiveness were related to high turmoil in the home and to youths' positive opinions of delinquent peers, while high aggressiveness of the youths' referring offenses was related to lax punishment. Developmentally, this suggests that in adolescence both the peer group and home influences are important in shaping different aspects of the youths' aggressive and delinquent behaviors.This study was partially conducted under University of Virginia Research Policy Council Grant No. 199505. The study was funded in part by a NICHD Training Grant (HD07289) to Dr. D. W. Fulker. Preparation of the paper was facilitated by grant RR-07013-20 awarded to the University of Colorado by the Biomedical Research Support Grant Program, Division of Research Resources, National Institutes of Health.Received Ph.D. in psychology from University of Virginia. Current research interests are intelligence and prosocial and antisocial behaviors from a developmental behavior genetics perspective.Received Ph.D. in psychology from Michigan State University. Current research interests are developmental pathways to problem behaviors of youth in high-risk communities.Current research interests are volunteer interventions with adolescents at risk for delinquency.Current research interests are clinical applications and intervention with adolescents and families.     

Sudden Death Due to Undiagnosed Rheumatic Heart Disease in a Child

We report the case of a 5‐year‐old boy who died from complications of rheumatic heart disease with atypical presentation. He was hospitalized for recent inflammatory and neurological symptoms. He was diagnosed with viral encephalitis. He died the day after he was discharged. The macroscopic autopsy findings were unremarkable. Histology revealed typical rheumatic heart disease. Neuropathology showed cerebral infarction due to an embolic event linked with the rheumatic valvulitis. The cause of death was determined as heart failure due to rheumatic heart disease secondary to an undiagnosed acute rheumatic fever. It is related to an autoimmune response to infection with group A streptococcus. It mainly affects children in developing countries. In our case, viral encephalitis was consistent with the medical history and the proper diagnosis was made on histological analysis. Forensic pathologists should consider this diagnosis facing a sudden unexpected death in childhood, even in industrialized countries.     

Policy-making in a Restructured State: The Case of the 1991 Health Reform Policy in New Zealand

The pressure for efficiency and accountability that led to reform of public institutions worldwide has had implications for public policy-making as well as the management of public services. The difficulties of providing a coordinated and efficient policy process that can respond to the requirements of a more managerialist style of government were evident in New Zealand in the 1980s and early 1990s. The policy process in 1990–91 leading to the introduction of health reform proposals provides an illuminating case study of the tension between participation and speed, and between traditional pluralist and managerialist approaches to policy development. The implications of this for subsequent implementation are discussed.     

‘A conscientious and well-informed Victorian mother’: Elizabeth Gaskell's letters to her daughters

Unlike the majority of the major female authors of the Victorian period, Elizabeth Gaskell was a mother, and her understanding of motherhood was one of the defining preoccupations of both her life and her fiction. In her lively and intimate letters to her four daughters, Gaskell provides a fascinating insight into mid-Victorian motherhood. ‘Conscientious and well-informed’, frank and self-reflexive, Gaskell's letters reflect the social and intellectual ferment of the period and shed light on some of the most pressing issues faced by mothers of the period, including the psychological development and education of children, the Victorian crises of religious schism and unbelief, and the rise of feminism.     

The narratives behind the EU's external perceptions: how civil society and elites in Ukraine,Israel and Palestine “learn” EU norms

ABSTRACT

The EU's normative promotion is a keystone in the arch of its Foreign and Security Policy, reflected in establishing a “ring of friends” in its neighbourhood. However, the EU's normative impact in these countries is often hindered by domestic constraints. Conversely, deeper socialisation through persuasion and “learning” may advance towards the promotion of EU norms better. By tracing the “learning” component of the EU's external perceptions in its Eastern (Ukraine) and Southern (Israel and Palestine) neighbourhoods, this paper elaborates upon the receptiveness of EU norms. Considering the specific attention that the ENP draws towards the support of civil society, this paper focuses on “learning” narratives of EU norms among civil society elites in Ukraine, Israel and Palestine as the key targets of EU assistance – with a particular focus on various conceptualisations of learning in the learning process. Notwithstanding perceptions of the EU as a normative power, we find that the learning processes remain too complex to be captured within a single theoretical framework. Whereas communicative rationality implies learning about each other's identities through rational arguing, our analysis demonstrates that identity performance is one of the most emotive and crucial factors in perceptions of learning.