Health‐care reform and the dimensions of professional autonomy

Abstract: A “managed competition” model was introduced in the Canadian province of Ontario as part of the government's reform of home care. With this model, it was assumed that competitive forces would encourage quality while driving down costs. While such reforms often achieve cost controls by constraining the incomes and practices of health‐care workers, there has been relatively little analysis of the extent to which self‐governing health‐care professionals, particularly those outside of medicine and nursing, may experience a decline in their ability to control the content and context of their professional work. In this article, the authors analyse the results of thirty‐six in‐depth interviews with representatives of Community Care Access Centres (CCACs), the organizations that purchase and coordinate the delivery of home‐care services, and rehabilitation provider agencies to examine the impact of Ontario's managed competition reform on rehabilitation professionals. Findings suggest that the impact of the reform varied across the economic, political, and clinical dimensions of professional autonomy and that, despite a general loss of autonomy under the managed competition model, market forces also served to mitigate the loss of autonomy, thus contributing to a remarkable resilience of professional autonomy. Sommaire: Un modèle de « concurrence dirigée » a été introduit récemment dans la province canadienne de l'Ontario dans le cadre de la réforme gouvernementale des soins à domicile. Avec ce modèle, il était présumé que les forces de la concurrence encourageraient la qualité tout en faisant baisser les coûts. Alors que de telles réformes parviennent souvent à maîtriser les coûts en réduisant les revenus et les pratiques des travailleurs de la santé, il y a eu relativement peu d'analyses de faites sur la mesure dans laquelle les professionnels de la santé autonomes, particulièrement ceux qui exercent en dehors de la médecine et de la profession infirmière, connaissent une perte de contrôle sur le contenu et le contexte de leur travail professionnel. Dans le présent article, les auteurs analysent les résultats de trente‐six entrevues en profondeur menées auprès de représentants des Centres d'accès aux soins communautaires (CASC), organismes qui achètent et coordonnent la prestation des services de soins à domicile, et organismes de prestation de soins de réadaptation, afin d'examiner les conséquences de la réforme de la concurrence dirigée de l'Ontario sur les professionnels de la réadaptation. Les résultats laissent entendre que l'effet de la réforme a varié en fonction des dimensions économiques, politiques et cliniques de l'autonomie professionnelle et que, malgré une perte d'autonomie générale liée au modèle de concurrence dirigée, les forces du marché ont également permis d'atténuer la perte d'autonomie, contribuant ainsi à la remarquable résilience dont font preuve ces professionnels en la matiére.     

Devolution and Development: Territorial Justice and the North-South Divide

One of the unintended consequences of devolution under New Labouris that it might make it more difficult to secure territorialjustice between the nations and regions of the United Kingdom.Centralized regional policy, the aim of which was to promoteeconomic equity between the regions, has been replaced by adevolved regional policy that aims to promote an economic dividendwithin each region. In the unlikely event that devolution yieldsa uniform economic dividend in each region, the result doesnothing to redress the territorial inequalities at the heartof the North-South divide. Treating unequal regions equallyis not a recipe for territorial justice.     

Sediment fingerprints: a forensic technique using quartz sand grains.

The analyses of 738 soil and sediment samples taken during the investigation of 20 forensic cases are combined in a database for retrospective comparisons. Quartz sand grain surface textures are combined into grain types which are analysed at one of five orders of classification. This classification also provides frequency data on the number of grain types found in a sample, the individuality of the quartz grain type assemblages and quartz grain type ratios. The technique, developed primarily as an exclusion mechanism, suggests possibilities, in some circumstances, that significant interpretations can be achieved at different orders of classification. The technique provides excellent exclusionary results and, when combined with other independent lines of analysis, is a powerful tool in forensic interpretation because it uses quartz as its discriminatory mineral. The technique also highlights the potential for computer image recognition analysis.     

A PRACTITIONER'S PERSPECTIVE ON UNIFIED FAMILY COURTS: CASE STUDIES

As a summary of simple examples demonstrating practical advantages of a family court, this article relates a few experiences from the perspective of a family law attorney who practices regularly in the Fulton County Family Division in Atlanta.     

Victimization as a cause of delinquency: The role of depression and gender

Victimization as a correlate of delinquency has been largely neglected in the criminological literature, despite research on Agnew's general strain theory (GST) suggesting that victimization is a type of strain likely to cause delinquency (Agnew, 2002). This study examined the role of depression and gender as potentially indispensable mechanisms in the victimization-delinquency relationship. Findings indicated that victimization has a positive effect on both delinquency and depression, and consistent with a GST explanation, the connection between victimization and delinquency is most pronounced for males with trait depression. This study added to the GST literature by distinguishing between trait and state emotion and by delineating GST predictions regarding each emotional form.     

The testosterone–cortisol ratio: A hormonal marker for proneness to social aggression

Social aggression is an escalating hazard for individuals and society. It is most frequently observed as impulsive–reactive aggression in antisocial personality disorder (APD), but in psychopathic aggressive personalities instrumental social aggression is more prominent. However, the psychobiological mechanisms underlying human social aggression are still poorly understood. Here we propose a psychobiological mechanism that may explain human social aggression wherein the steroid hormones cortisol and testosterone play a critical role. High levels of testosterone and low levels of cortisol have been associated with social aggression in several species but it seems that in those individuals wherein these hormonal markers combine social aggression is most violent. In this review we discuss fundamental and clinical research which underscores the potential of the testosterone–cortisol ratio as a possible marker for criminal aggressive tendencies.     

COMMUNICATION STRATEGIES ON SOCIAL CORPORATE RESPONSIBILITY: THE ROLE OF FREEDOM OF EXPRESSION

The political and the economic spheres increasingly overlap. Consumption is viewed not only as an economic act, but also as an act of political and moral significance. Due to the blurring of the commercial and the political spheres, consumers use their purchasing power as a carrot and a stick for corporations to comply with corporate social responsibility (CSR) standards. As a consequence, corporate communication strategies tend to highlight commitment to CSR standards, portraying companies as “good corporate citizens.” Conversely, other stakeholders expose unethical business practices so as to induce corporate change. Both sides tend to invoke freedom of expression with a view to opposing limitations on their communication strategies. Taking two well-known examples as a starting point, the present article explores the role of freedom of expression as a means to incite corporate actors to both adopt and comply with CSR standards from a comparative perspective. Using an economic framework, it argues that non-commercial expression critical of corporate practices deserves a higher level of protection than corporate communication strategies.