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21.
Louise Locock 《Public administration》2000,78(1):91-109
This paper presents findings from empirical research exploring recent developments in healthcare rationing in the UK, and how far these were influenced by the National Health Service (NHS) internal market. Results suggest explicit rationing has continued to spread, but the focus has shifted from exclusions of whole treatments from NHS provision towards a reconciliation of implicit and explicit approaches. There is growing interest in explicit criteria to guide decision making, within which clinicians exercise discretion in indi-vidual cases. The market contributed to the growth in explicit rationing, notably by decoupling healthcare purchasers (health authorities and GP fundholders) and providers (hospital and community health services) from their previously shared responsibility to manage resources. However, other factors have been influential, especially concern to control rising expenditure. Having originally prompted more explicit decisions (especially exclusions), resource pressures are now rekindling interest in fixed provider budgets and implicit clinical decision making. The paper concludes by considering the implications for rationing of proposals to abolish the NHS internal market. 相似文献
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Many studies highlight constitutional asymmetry as a desirablefeature of federal systems in multinational countries. Thisarticle looks at India which, mainly because of the specialprovisions for Kashmir in the 1950 constitution and the statusof newer small states in the north-east, is generally describedas asymmetrically federal. I show that, while India exhibitsconsiderable de facto asymmetry, asymmetry in the constitutionalpowers granted to individual states has (i) not been importantfor India's ability to hold together as oftenassumed and (ii) not entailed special protection of culturalor national minorities. I thus cast doubt on the normative politicalphilosophy, particularly informed by Canadian and Spanish debates,that advances the idea of asymmetrical federalism as a modelof governance in potentially divided societies. 相似文献
23.
Louise Shelley 《Crime, Law and Social Change》2003,40(2-3):231-250
This paper focuses on the trafficking and smuggling of human beings fromand through the former Soviet Union. It explores the reasons for the risein the illegal movement of people; the groups which facilitate it; the demographics of the people who are moved and the business side, includingthe profits, the disposition of profits and the use of corruption to facilitatethe trade. With the disintegration of state control over national territory, this mass movement of people often violates national laws and the national sovereignty of the countries of the Soviet successor states and the countrieswhere the former Soviet citizens move illegally. The paper concludes that thistrade mirrors and contributes to the overall downward development of thepost-Soviet economies. In contrast, a comparative look at the respective Chinese developments indicates that trade in human beings tends to facilitatethe growth of both the Chinese legitimate and illegitimate economies. 相似文献
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This study investigated the following variables for their unique and combined contributions to dating aggression: exposure to aggression in the family of origin (witnessing interparental aggression or being the victim of aggressive parenting); attitudes justifying dating aggression (when humiliated or in selfdefense); child-to-parent aggression; child sexual abuse; violent sexual victimization; alcohol use; and socioeconomic status. One hundred and eleven male and 179 female undergraduates reported on their own aggressive behaviors directed toward dating partners. Together, the predictor variables accounted for 41% of the variance in male-to-female aggression but only 16% of the female-to-male aggression. Humiliation, as a justification for dating aggression, contributes to the prediction of both males' and females' dating aggression, while self-defense, although a highly endorsed condition for justifying dating aggression, does not predict actual aggressive behavior. Exposure to interparental aggression plus the product between exposure and humiliation contribute to the prediction of males' dating aggression but exposure does not play a role in females' dating aggression. Violent sexual victimization contributes unique variance to both males' and females' dating aggression. The present data highlight the importance of examining specific circumstances under which males and females justify dating aggression and how such attitudes condoning aggression affect actual behaviors. 相似文献
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Kingbäck M Karlsson L Zackrisson AL Carlsson B Josefsson M Bengtsson F Ahlner J Kugelberg FC 《Forensic science international》2012,214(1-3):124-134
Venlafaxine (VEN) is an antidepressant drug mainly metabolized by the cytochrome P450 (CYP) enzyme CYP2D6 to the active metabolite O-desmethylvenlafaxine (ODV). VEN is also metabolized to N-desmetylvenlafaxine (NDV) via CYP3A4. ODV and NDV are further metabolized to N,O-didesmethylvenlafaxine (DDV). VEN is a racemic mixture of the S- and R-enantiomers and these have in vitro displayed different degrees of serotonin and noradrenaline reuptake inhibition. The aim of the study was to investigate if an enantioselective analysis of VEN and its metabolites, in combination with genotyping for CYP2D6, could assist in the interpretation of forensic toxicological results in cases with different causes of deaths. Concentrations of the enantiomers of VEN and metabolites were determined in femoral blood obtained from 56 autopsy cases with different causes of death. The drug analysis was done by liquid chromatography tandem mass spectrometry (LC/MS/MS) and the CYP2D6 genotyping by PCR and pyrosequencing. The mean (median) enantiomeric S/R ratios of VEN, ODV, NDV and DDV were 0.99 (0.91), 2.17 (0.93), 0.92 (0.86) and 1.08 (1.03), respectively. However, a substantial variation in the relationship between the S- and R-enantiomers of VEN and metabolites was evident (S/R ratios ranging from 0.23 to 17.6). In six cases, a low S/R VEN ratio (mean 0.5) was associated with a high S/R ODV ratio (mean 11.9). Genotyping showed that these individuals carried two inactive CYP2D6 genes indicating a poor metabolizer phenotype. From these data we conclude that enantioselective analysis of VEN and ODV can predict if a person is a poor metabolizer genotype/phenotype for CYP2D6. Knowledge of the relationship between the S- and R-enantiomers of this antidepressant drug and its active metabolite is also important since the enantiomers display different pharmacodynamic profiles. 相似文献
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Various aspects of the judicial process have been hypothesized as damaging to sexual harassment plaintiffs, though limited research has been conducted that actually examines this hypothesis. We examined data from a large sample of women who participated in a class action lawsuit alleging workplace sexual harassment and discrimination (n?=?1218) and another sample of similarly situated women who opted out of litigation (n?=?465, non-litigants). We then followed the litigants for 5 years. This study takes an initial look at some of the variables theorized to play a role in the psychological outcomes of both harassment and subsequent litigation. Both the severity of harassment and participation/persistence in the litigation process were related to psychological outcomes at each of three assessments across a 5-year period; the frequency and severity of harassment, as well as plaintiffs’ cognitive appraisals of their situation, appeared to have the strongest relationship to psychological harm. Results of multivariate analysis of covariance (MANCOVA) revealed that participation and persistence in litigation played a consistent role in psychological outcomes across time, over and above the impact of harassment itself. However, litigation did not appear to be the cause of psychological outcomes as posttraumatic stress disorder (PTSD) symptomatology, in particular, was the result of the original harassment experience. 相似文献