Suchergebnisse

Intergovernmental relationships in the United Kingdom are more confused and uncertain than they have been for a long time. The recent reorganization of local gov ernment has made more complex relationships between the tiers of local authorities, especially in the cities where a single-tier system had prevailed. The establishment of new functional agencies for water and the health services, distinct from local authorities, has further fragmented local power. To work the new system, elected members and their staffs will require diplomatic skills to relate their own authority with tiers both above and below and with other public agencies involved in providing services in their area. Local authorities are not so dependent financially on the central government as is sometimes alleged, and although the center has many de vices available to it to influence local government, the use made of them varies between the departments, and the re sponse to them varies again between the local authorities. Re gional devolution is advocated by nationalist movements in Wales and Scotland, and by some in England who want to reduce the power of the center and involve the public more in government. Seven models of devolution are currently under discussion. Ulster remains a thorny problem. Complications to intergovernmental relationships are introduced by pressure for popular participation in community councils and by Britain's entry into the European Economic Community.

The aim of this paper is to explore the possible varieties of convergence in the public administrations of members of the European Union, as well as the framework for analysing aspects of convergence. It assists students of comparative public administration who attempt to understand "puzzles" triggered by NPM and EU pressures. These pressures seem to push national systems in opposite directions, and not to be united as a single force for a particular model. At the same time, however, both involve assertive action by government to achieve reform in the face of inertia or hostility of public bureaucracies anxious to preserve their traditional arrangements. The paper suggests that the answer to the question "Are West European administrative systems becoming more alike?" cannot be simply "yes" or "no". With the impact of NPM the answer must be "more than they used to", but as a trend toward a common destination, "no". With the impact of the EU the answer must be "yes" and "no" depending on which aspect of an administrative system is being examined.

AN AMAZING SPEECH ABOUT LOCAL GOVERNMENT WAS DELIVERED IN JULY 1982 TO THE SOCIETY OF LOCAL AUTHORITY CHIEF EXECUTIVES. IT WAS AN ADDRESS BY MR. LEON BRITTAN, CHIEF SECRETARY TO THE TREASURY.1 HE PROVIDED AN INSIGHT INTO TREASURY THINKING AND THE ATTITUDE ADOPTED BY THE CONSERVATIVE GOVERNMENT TO LOCAL GOVERNMENT SINCE 1979. HE ATTACKED LOCAL GOVERNMENT FOR OVERSPENDING, WHICH WAS ALLEGED TO BE DAMAGING THE HEALTH OF THE NATIONAL ECONOMY. HE ASSERTED THAT LOCAL GOVERNMENT, BY REFUSING TO STICK TO CENTRAL GOVERNMENT'S TARGETS FOR EXPENDITURE, HAD BROKEN A CONSTITUTIONAL CONVENTION, AND THAT, IF IT DID NOT CONFORM IN THE FUTURE AND ACCEPT THE CENTRAL GOVERNMENT'S RIGHT TO GIVE EFFECTIVE GUIDANCE, THE QUESTION WOULD HAVE TO BE ASKED" IS THE CONVENTIONAL WISDOM STILL RIGHT IN ASSUMING THAT LOCAL AUTONOMY OVER PRIORITIES AND ADMINISTRATION OF SERVICES NECESSARILY IMPLIES COMPLETE FREEDOM ULTIMATELY TO DETERMINE LEVELS OF EXPENDITURE BY SETTING THE LEVEL OF RATES WITHOUT ANY LIMITATION WHATSOEVER?" HE WAS THUS THREATENING AN EFFECTIVE ENND TO LOCAL GOVERNMENT, SINCE OUR SYSTEM OF LOCAL GOVERNMENT HAS BEEN BASED ON THE RIGHT AND THE DUTY OF A LOCAL AUTHORITY TO DECIDE ON THE LEVEL OF ITS EXPENDITURE, IF FINANCED FROM ITS OWN LOCAL TAX, THE RATES-A DECISION FOR WHICH IT IS ACCOUNTABLE TO ITS OWN LOCAL ELECTORATE.

Background. Failed spinal anaesthesia for caesarean section (CS) may be partial or complete and the subsequent discomfort is the most commonly cited cause of litigation in obstetric anaesthesia.Objectives. To determine if there is a standardised approach to: (i) testing the level of block of spinal anaesthesia; and (ii) the management of failed spinal anaesthesia for CS.Methods. A structured questionnaire to ascertain the current practice of testing the level of block and management of three different scenarios of failed spinal anaesthesia was distributed to 51 government hospitals in KwaZulu-Natal, South Africa (SA). All obstetric anaesthetic service providers, ranging from interns to specialist anaesthetists, were invited to complete the questionnaire.Results. A total of 375 responses were received from 42 of the 51 hospitals surveyed. Specialist anaesthetists managed failure of spinal anaesthesia significantly differently than other anaesthetic service providers. Specialists were more likely to convert to a general anaesthetic (GA), while others were more likely to repeat spinal anaesthesia or administer intravenous ketamine, midazolam and opioids. Only 212 respondents (56%) tested the level of block and there was no difference between the groups with regard to the method of assessment of height (p=0.15). Nonspecialists, however, accepted a significantly lower level of block, using pinprick, than specialists (p=0.027), which could lead to a higher failure rate. More than one-third of non-specialists did not consider themselves competent to perform a GA and >90% of respondents agreed that a 'failed' spinal algorithm would be useful.Conclusion. There is a need for standardised assessment of the adequacy of spinal anaesthesia for CS in SA, as well as a failed spinal algorithm.

A journal article on radiation oncology practices in Africa and Ontario, Canada. ; Cancer is a major disease category in higher-income countries (HIC), In HIC, health resources are substantial, with budgets for health care exceeding 10% of Gross Domestic Product of large economies. This resourcing is many times higher than that in low- and-middle-income countries (LMIC) where there are fewer infrastructures and less political and sociocultural support. However, cancer is an increasing concern in LMIC's due to improving longevity and the changing prevalences of etiological agents and broader determinants of disease. Indeed, global mortality from cancer exceeds that from tuberculosis, malaria and HIV-AIDS combined2, and there are many more cancer cases in LMIC than in HIC.