Townies

His work has been featured in numerous publications.     

What could be achieved with greater public hospital autonomy? Comparison of public and PNFP hospitals in Uganda

The policy of hospital autonomy has been discussed for some time in Uganda. There is little evidence from Uganda or elsewhere that increased autonomy will improve hospital performance. This article compares the performance of three private not‐for‐profit (PNFP) and public hospital pairs to address this question. PNFP and public hospitals have similar management structures but PNFP hospitals had better trained managers and a church affiliated chair in the hospital management committee. Both types have problems with personnel management but these appear more pronounced in public hospitals. Drug supply management appears better in PNFP hospitals. Overall, workloads are similar, but analysis of patterns of utilisation and prices across services suggest that patient choice of facilities is influenced by relative price levels, and that willingness to pay is higher for PNFP services. PNFP hospitals are more successful at generating revenue. There are no clear differences in efficiency between PNFP and public hospitals but there is some evidence of higher quality levels in PNFP hospitals. PNFP hospitals' performance is plausibly related to three areas of managerial autonomy. First, better management of drug supply is facilitated by their freedom to purchase drugs from the open market. Second, greater success with personnel management is plausibly related to their greater autonomy over staffing. Third, higher levels of cost recovery are enabled by their freedom to set fees. However, differences in accountability and competence of hospital management, and population willingness to pay for services may also help to explain differences. Further, the use of PNFP financing strategy by public hospitals has implications for universal access to hospital services. Although there appear to be potential advantages from greater public hospital autonomy, the Ugandan government should ensure it has developed strategies to enhance public hospital management and to protect access to public hospitals before advancing further with hospital autonomy policy. Copyright © 2002 John Wiley & Sons, Ltd.     

Federalism with a Russian face: regional inequality, administrative capacity and regional budgets in Russia

The paper reviews fiscal federalism in Russian practice. Central control over sub-national budgets has tended to increase. In the classic literature on fiscal federalism such centralisation is potentially damaging to both static efficiency and growth. The paper reviews the propositions in that literature and the assumptions made in it, and notes that weak administrative capacity at sub-regional level, weak electoral competition and extreme unevenness of economic development across regions may provide grounds for greater central control than is treated as desirable in the established literature. The patterns of budgetary transfers from national to regional level are analysed and conclusions drawn about the effectiveness of the evolving fiscal-federal system in Russia.     

Firework displays as sources of particles similar to gunshot residue

In light of past research being targeted to find specific particles which may be similar to gunshot residue (GSR), this project was formulated to detect any possible particulate by random particle fallout onto substrates at firework displays and to assess the impact this may have on GSR evidence. Firework residue was collected at a display site, from amongst spectators as well as from the author's hair 90min after the display. SEM-EDX analysis has detected such particulate in all three scenarios, with the firework particle population at large providing a solid ground for discrimination from GSR. Wind dispersal was found to decrease the particle population and subsequently, the latter's discriminatory power. Some particles, if treated individually were found to be indistinguishable from GSR. Findings also include residues which may mimic strontium based GSR as well as GSR which may be mixed with that from previous firings. The continuous changes made to primer and propellant compositions by manufacturers also call for greater consideration when classifying particles as originating from pyrotechnic devices. Furthermore, authorities such as police forces should be made more aware about the incidence of such particle transfer in firework related periods.     

Housing instability is as strong a predictor of poor health outcomes as level of danger in an abusive relationship: findings from the SHARE Study

Advocates, clinicians, policy makers, and survivors frequently cite intimate partner violence (IPV) as an immediate cause of or precursor to housing problems. Research has indicated an association between homelessness and IPV, yet few studies examine IPV and housing instability. Housing instability differs from homelessness, in that someone experiencing housing instability may currently have a place to live but faces difficulties with maintaining the residence. We present baseline findings from a longitudinal cohort study of 278 female IPV survivors with housing as a primary concern. Our analysis indicates the greater the number of housing instability risk factors (e.g., eviction notice, problems with landlord, moving multiple times), the more likely the abused woman reported symptoms consistent with PTSD (p < .001), depression (p < .001), reduced quality of life (p < .001), increased work/school absence (OR = 1.28, p < .004), and increased hospital/emergency department use (OR = 1.22, p < .001). These outcomes persist even when controlling for the level of danger in the abusive relationship and for survivors' drug and alcohol use. Importantly, both housing instability and danger level had stronger associations with negative health outcomes than other factors such as age, alcohol, and drug use; both make unique contributions to negative health outcomes and could contribute in different ways. Housing instability is an important and understudied social determinant of health for IPV survivors. These findings begin to address the literature gap on the relationship between housing instability, IPV, and survivors' health, employment, and utilization of medical care services.     

First report from the Swedish National Forensic Psychiatric Register (SNFPR)

To the best of our knowledge, the present register is the only nationwide forensic psychiatric patient register in the world. The aim of this article is to describe the content of the Swedish National Forensic Psychiatric Register (SNFPR) for Swedish forensic patients for the year 2010. The subjects are individuals who, in connection with prosecution due to criminal acts, have been sentenced to compulsory forensic psychiatric treatment in Sweden. The results show that in 2010, 1476 Swedish forensic patients were assessed in the SNFPR; 1251 (85%) were males and 225 (15%) were females. Almost 60% of the patients had a diagnosis of schizophrenia, with a significantly higher frequency among males than females. As many as 70% of the patients had a previous history of outpatient psychiatric treatment before becoming a forensic psychiatric patient, with a mean age at first contact with psychiatric care of about 20 years old for both sexes. More than 63% of the patients had a history of addiction, with a higher proportion of males than females. Furthermore, as many as 38% of all patients committed crimes while under the influence of alcohol and/or illicit drugs. This was more often the case for men than for women. Both male and female patients were primarily sentenced for crimes related to life and death (e.g., murder, assault). However, there were more females than males in treatment for general dangerous crimes (e.g., arson), whereas men were more often prosecuted for crimes related to sex. In 2010, as many as 70% of all forensic patients in Sweden had a prior sentence for a criminal act, and males were prosecuted significantly more often than females. The most commonly prescribed pharmaceuticals for both genders were antipsychotics, although more women than men were prescribed other pharmaceuticals, such as antidepressants, antiepileptics, and anxiolytics. The result from the present study might give clinicians an opportunity to reflect upon and challenge their traditional treatment methods.     

The future of western Canada: economic,social, and political

Abstract. Western Canada is generally regarded as consisting of the three prairie provinces and British Columbia. It is a region that is very sensitive to technological and economic trends. Regional social and political adjustments result from these trends, and since Canada is a federation the political decisions are divided between the federal government and each of the four constituent provinces. This leads to frictions between the governments, especially with regard to energy policies, natural resource use, transportation costs, and the location of secondary industries. The economy of western Canada is mainly extractive, and the products are subject to many price and output fluctuations which are very difficult to control by public policies. Nevertheless, the region has experienced substantial economic growth since the thirties at a rate comparable to that of all Canada, and the region should continue to grow at least in pace with Canada in future decades, with the highest growth rates in Alberta and British Columbia. Much will depend upon the continuation of a high level of investment financed in large part by external savings, involving much foreign ownership. Urbanization has proceeded rapidly in western Canada, accompanied by many social adjustments. The public sector has expanded markedly, and further relative growth is envisaged. Throughout the years the region has sent large contingents of opposition members to Ottawa, regardless of the party in power. This alienation is greatest in Alberta and least in Manitoba. Separation is alive in the region, patricularly in Alberta, where much larger petroleum revenues would be obtainable if separation occurred. Federal-provincial tensions involving western Canada will intensify in the future, calling for continuous negotiations and constitutional jurisdictional judgements. Sommaire. On considère généralement que les trois provinces des Prairies et la Colombie-britannique constituent l'Ouest du Canada. C'est une région très sensible aux mouvements technologiques et économiques. Les ajustements régionaux - sociaux et économiques - sont le résultat de ces tendances, et comme le Canada est une fédération, les décisions politiques se trouvent partagées entre le gouvernenient fédéral et chacune des quatre provinces de l'Ouest. Ceci donne lieu à des frictions entre gouvernements, surtout lorsqu'il s'agit des politiques énergétiques, de l'usage des ressources naturelles, des coûlts de transport et de l'emplacement des industries secondaires. L'économie de l'Ouest du Canada est surtout extractive et ses produits sont sujets à toutes sortes de fluctuations de prix et d'apports que les politiques publiques ont beaucoup de peine à réglementer. La région a connu, cependant, une croissance économique significative depuis les années 30, à un taux comparable à celui de tout le Canada et la région devrait continuer à croître au moins au même rythme que le reste du Canada dans les décennies à venir, avec les taux de croissance les plus élevés en Alberta et en Colombie-britannique. Cela dépendra beaucoup de la continuation du volume élevé d'investissements, financés en grande partie par de l'épargne provenant de l'extérieur de la province et avec une grande participation étrangère. L'urbanisation a été rapide dans l'Ouest du Canada, ce qui a demandé de nombreux ajustements sociaux. Le secteur public a connu une grande expansion et l'on s'attend encore à une croissance relative. Au cours des années, la région a envoyéà Ottawa des contingents importants de députés de l'opposition, quel qu'ait été le parti au pouvoir. C'est en Alberta que l'aliénation est la plus grande, alors qu'elle est à son minimùm au Manitoba. Le séparatisme existe dans la région, en particulier en Alberta où il serait possible d'augmenter considérablement les revenus provenant du pétrole si la Province était indépendante. Les tensions fédérales-provinciales concernant l'Ouest du Canada ne feront qu'augmenter à l'avenir, ce qui exigera des négociations continues et des jugements constitutionnels sur des questions de juridiction.