Distribution by Scientific Domains
Distribution within Humanities and Social Sciences

Kinds of Authorities

  • central authority
  • colonial authority
  • decision-making authority
  • development authority
  • enforcement authority
  • environmental authority
  • european food safety authority
  • executive authority
  • financial services authority
  • fiscal authority
  • food safety authority
  • government authority
  • health authority
  • housing authority
  • intellectual authority
  • legal authority
  • legitimate authority
  • litigation authority
  • local authority
  • local government authority
  • local health authority
  • medical authority
  • monetary authority
  • moral authority
  • municipal authority
  • national authority
  • national health authority
  • national regulatory authority
  • palestinian authority
  • parental authority
  • political authority
  • prescriptive authority
  • professional authority
  • public authority
  • public health authority
  • regional health authority
  • regulatory authority
  • religious authority
  • safety authority
  • services authority
  • state authority
  • strategic health authority
  • tax authority
  • traditional authority
  • water authority

  • Terms modified by Authorities

  • authority area
  • authority figure

  • Selected Abstracts


    ABSTRACT. The Tennessee Valley Authority (TVA) was the largest, most comprehensive, and most controversial regional development and planning project in U.S. history. Geographers were involved from its inception and made impressive contributions. Aside from the unit area method of data gathering and mapping, little is known about their contributions, some of which were truly ahead of their time. Although their work and recommendations were often discarded and unheeded because of political turbulence, the geographers rarely complained or entered into the political arena. Their work in the TVA has generally gone unheralded and even unappreciated within the geography profession. The primary purpose of this article is to document their contributions. [source]


    Daniel F. Brossart
    The factor structure of the Personal Authority in the Family System Questionnaire (PAFS-Q) has been used in numerous studies, but the factor structure has not been examined since its development in 1984. This study examined the factor structure of the PAFS-Q. Findings suggest a six-factor solution with important differences from those reported when the PAFS-Q was developed. The main differences between this study and the original factor analysis are that this study found separate Mother and Father Intimacy factors instead of a single Intergenerational Intimacy factor and the original Spousal Fusion and Spousal Intimacy factors were not separate factors in the current study. Implications and future directions for research are also discussed. [source]


    Summary. The strategies political elites implement to garner political authority and legitimacy in emergent polities are scrutinized in a case study from Iron Age Edom, located in modern southern Jordan and the south-east corner of the State of Israel. Edom provides a productive context in which to conduct this investigation as local elites managed a fractious polity consisting of unstable segmentary identities, while at the same time, remaining loyal to the successive Assyrian, Babylonian, and Persian empires that dominated them. This tenuous position required elites to maintain a flexible elite identity while promoting broader metaphors of attachment (e.g. Edomite) among their disparate constituents. This case study ultimately moves toward an understanding of political polities, not as disembodied entities (e.g. States), but as embedded phenomena within the societies they comprise. [source]


    In November 2004, the assassination of the filmmaker Theo van Gogh in Amsterdam by an Islamic extremist shocked The Netherlands. Critics of multiculturalism quickly linked the murder to the perceived failure of ,soft' integration policies and questioned the authority and legitimacy of Amsterdam's political leadership. This article studies the response of political leaders to those challenges from a performative perspective. Analysing governance as performance illuminates the importance of actively enacting political leadership in non-parliamentary settings such as talk shows, mosques and other religious meeting places, and improvised mass meetings in times of crisis. The authors distinguish different discursive means of performing authority, make suggestions for dealing with crisis events in ethnically and culturally diverse cities and draw some lessons from this approach as well as for methods of studying public administration. [source]


    THE HEYTHROP JOURNAL, Issue 4 2010
    First page of article [source]

    Head and neck cancer in the UK: what is expected of cytopathology?

    CYTOPATHOLOGY, Issue 2 2009
    G. Kocjan
    Objective:, This review highlights the role of cytopathology in cancer management within UK Head and Neck Cancer Networks and informs on the issues raised by recent UK Department of Health documents and other UK professional guidance. UK guidance requires the formal involvement of cytopathologists within multidisciplinary cancer teams, with medical and non-medical cytopathology staff setting up and running rapid access lump clinics, and support for image-guided fine needle aspiration cytology (FNAC) services. UK guidance also makes recommendations for training, resources and quality control. This review also highlights the resource gap between best practice evidence-based guidance for head and neck (HN) cancer services and existing UK provision for cytopathology, as evidenced by lack of availability of experienced staff and adequacy of training and quality control (QC). Finally, it stresses the importance in the UK of the Royal College of Pathologists' guidance, which defines the need for training, the experience needed for new consultants, the requirements for audit and QC. The implications for the additional resources required for HN cancer cytopathology services are discussed. Recent professional guidance specifying the provision of HN cancer services in the UK includes a cytopathology service for cancer networks, such as rapid access FNAC clinics. Although these clinics already operate in some institutions, there are many institutions where they do not and where the provision of cytopathology services would have to be restructured. This would need the support of local cancer networks and their acceptance of the detailed requirements for cytopathology, including resources, training and QC. The standards are not defined locally, as Strategic Health Authorities and Primary Care Trusts have been instructed by the Department of Health to support, invest and implement them. [source]

    Reasons for variation in coverage in the NHS cervical screening programme

    CYTOPATHOLOGY, Issue 6 2001
    C. E. McGAHAN
    Reasons for variation in coverage in the NHS cervical screening programme In order to investigate reasons for variation in coverage of cervical screening, data from standard Department of Health returns were obtained for all Health Authorities for 1998/1999. Approximately 80% of the variation between health authorities is explained by differences in age distribution and area classification. Considerable differences between Health Authority and Office of National Statistics (ONS) population figures in City and Urban (London) areas for the age group 25,29 years and for City (London) for age group 30,34 years, suggest an effect of list inflation in these groups. Coverage as a performance indicator may be more accurately represented using the age range 35,64 years. Using this narrower age range, the percentage of health authorities meeting the 80% 5-year coverage target increases from 87% to 90%. [source]

    Primary teachers as readers

    ENGLISH IN EDUCATION, Issue 1 2008
    Teresa Cremin
    Abstract In the context of the continued pressure and politicisation of the teaching of reading in England, the United Kingdom Literacy Association (UKLA) sought to ascertain patterns in primary teachers' reading, both personally and professionally. The project, undertaken in 11 Local Authorities in England, explored 1200 primary teachers' personal reading habits and preferences, investigated their knowledge of children's literature, and documented their reported use of texts in the classroom through a questionnaire. In addition, it sought to establish the extent of the teachers' involvement with and use of local area/school library services. This paper reports on the findings with reference to the teachers' personal reading, the frequency of this reading and the sources they use to select their reading material. It also considers the teachers' favourite childhood texts and the books they identified as highly significant to them, as well as their perceptions of the importance of literature. Connections are made to the data gathered about their knowledge of children's literature, and how primary teachers decide which literature to work with in the classroom. [source]

    Why Do Governments Delegate Authority to Quasi-Autonomous Agencies?

    GOVERNANCE, Issue 2 2006
    The Case of Independent Administrative Authorities in France
    In recent years, there has been a considerable degree of delegation from governments to quasi-autonomous agencies. Various reasons have been put forward to explain why governments decide to delegate authority in this way. Some reasons are based on a transaction-cost approach, such as credible commitments. Other reasons are more contextual. For instance, governments may be responding to a process of cross-national policy transfer. In the literature on delegation some hypotheses have already been tested. Specifically, evidence has been found suggesting that governments create agencies to commit credibly to particular policy choices. However, other hypotheses, particularly ones based on contextual explanations, have proved much more difficult to operationalize. This article aims to help fill this gap. It does so by focusing on the creation of Independent Administrative Authorities in France. Does the qualitative evidence in this particular case corroborate the quantitative studies that have been undertaken elsewhere? [source]

    Stakeholders' views on measuring outcomes for people with learning disabilities

    Anita F. Young PhD DipCOT
    Abstract What works and how do we know? These are recurring questions for health and social care professionals, although mediated through differing philosophies and historical perspectives. The aims of the study reported here were to discover views of managers and commissioners of services for people with learning disabilities in Scotland regarding (a) current approaches to service evaluation (as an indication of what is to be measured) and (b) healthcare outcome measurement (as an indication of preferences regarding how this should be measured). A postal questionnaire was used to survey 94 stakeholders from the NHS, Local Authorities, and non-statutory organisations across Scotland. Respondents' views were sought on current approaches to service evaluation within learning disabilities; outcome measurement; appropriateness of specified methods of measuring health outcomes; desired future methods of outcome measurement within learning disabilities; and service user involvement in care. A 77% (73/94) response rate to the questionnaire was achieved. Different methods of service evaluation were used by different stakeholders. Staff appraisal was the most frequently identified method (used by 85% of respondents). Specific outcome measures were used by 32% of respondents although there were differences of opinion as to what constitutes specific outcome measures. Overall there was strong support for goal-setting and reviewing (83%) and individualised outcome measures (75%) as appropriate methods for use with people with learning disabilities. The hypothetical question asking what outcome measures should be introduced for this client group had by far the lowest response rate (51/73). The overwhelming majority of all respondents, 68 (92%), reported user involvement in their service. Staff ambivalence to outcome measurement was evident in the research and respondents highlighted the complexity and multidimensional nature of outcomes for this service user group. Managers recognised that outcome measurement was expected but were uncertain how to go about it. [source]

    Towards an ontology for electronic transaction services

    Nick Adams
    In this paper we present an ontology for transaction services built upon an established ontology for corporate knowledge called the Enterprise Ontology. We introduce the SmartGov platform for the ,Smart' deployment of online services for Public Authorities (PAs) whose requirement of a model of PAs has motivated the ontology, and describe our approach to constructing it. After presenting the ontology we then relate it to the pilot application areas in which the SmartGov platform will be trialed and evaluated. Copyright © 2003 John Wiley & Sons, Ltd. [source]

    The first Australian nurse practitioner census: A protocol to guide standardized collection of information about an emergent professional group

    Sandy Middleton RN PhD
    Middleton S, Gardner G, Gardner A, Della P, Gibb M, Millar L. International Journal of Nursing Practice 2010; 16: 517,524 The first Australian nurse practitioner census: A protocol to guide standardized collection of information about an emergent professional group Internationally, collection of reliable data on new and evolving health-care roles is crucial. We describe a protocol for design and administration of a national census of an emergent health-care role, namely nurse practitioners in Australia using databases held by regulatory authorities. A questionnaire was developed to obtain data on the role and scope of practice of Australian nurse practitioners. Our tool comprised five sections and included a total of 56 questions, using 28existing items from the National Nursing and Midwifery Labour Force Census and nine items recommended in the Nurse Practitioner Workforce Planning Minimum Data Set. Australian Nurse Registering Authorities (n = 6) distributed the survey on our behalf. This paper outlines our instrument and methods. The survey was administered to 238 authorized Australian nurse practitioners (85% response rate). Rigorous collection of standardized items will ensure health policy is informed by reliable and valid data. We will re-administer the survey 2 years following the first survey to measure change over time. [source]

    Paediatric antibiotic prescribing by general dental practitioners in England

    N.O.A. Palmer
    Objectives. The inappropriate use of antibiotics is known to be a major contributory factor to the problem of antimicrobial resistance. No information is available on how practitioners prescribe antibiotics for children. This study investigated the prescribing of liquid-based antibiotics for children by general dental practitioners in England. Design. Analysis of National Health Service liquid-based prescriptions issued by general dental practitioners in England. Sample and methods. All prescriptions issued by practitioners in 10 Health Authorities in England for February 1999 were collected. All the liquid-based antibiotic prescriptions for children were selected and we investigated the type of antibiotic prescribed, whether sugar free, the dose, frequency and duration. Results. A total of 18614 prescriptions were issued for antibiotics. Of the 1609 liquid-based paediatric prescriptions 88·3% were for generic and 11·7% for proprietary antibiotics, of which 75·5% were for amoxicillin, 15·2% for phenoxymethylpenicillin, 6·6% for erythromycin, 1·7% for metronidazole. Cephalexin, ampicillin, cephadrine and combinations of two antibiotics were also prescribed. There was a wide variation in dosages for all the antibiotics prescribed. A significant proportion of practitioners prescribed at frequencies inconsistent with manufacturers' recommendations and for prolonged periods, with some practitioners prescribing for periods up to 10 days. Only 29·1% of all the prescriptions issued were sugar free. Conclusions. The results of this study show that some practitioners prescribe liquid-based antibiotics inappropriately for children. This may contribute to the problem of antimicrobial resistance. Clear guidelines on the choice of antibiotic, dose, frequency and duration along with educational initiatives for GDPs might reverse this trend. [source]

    Heritage attractions and tourism development in Asia: a comparative study of Hong Kong and Singapore

    Joan C. Henderson
    Abstract The paper compares the principal Asian city destinations of Hong Kong and Singapore with specific reference to heritage attractions and their contribution to tourism development, revealing contrasts and similarities that offer an insight into more general practices and processes. Authorities are actively pursuing tourism marketing and development initiatives incorporating the promotion of selected forms of heritage in order to stimulate visitor arrivals, but also employing heritage to define and articulate national and cultural identity. Heritage is thus shown to have a political and socio-cultural significance in addition to its economic value as a generator of revenue, foreign exchange and employment. These functions help to explain the higher priority allocated to it in strategic planning and its increasing use to attract visitors throughout much of Asia. Contexts may be very different, yet approaches correspond, as demonstrated by the circumstances of Hong Kong and Singapore. Copyright © 2002 John Wiley & Sons, Ltd. [source]

    Can Public Housing Authorities Attract and Hold Upwardly Mobile Households?: A Report from Cincinnati

    JOURNAL OF URBAN AFFAIRS, Issue 3-4 2001
    David P. Varady
    Logistic regression analysis is applied to a pooled, cross sectional data set containing results from approximately 1,300 interviews with Cincinnati Metropolitan Housing Authority (CMHA) residents, carried out between 1995 and 1998 to determine overall levels of residential attachment, and to test whether socially mobile householders had especially weak attachments to their locations. The results highlighted a strong propensity to move among CMHA residents generally. Although most residents stated that they were satisfied with their home, nearly three-fifths said that they expected to move within five years. Multivariate results suggested that socially mobile residents (college educated householders, workers, moderate-income households) were using the CMHA stock as a stepping-stone to better rental housing or homeownership. Public housing officials need to decide whether to make a special effort to hold these upwardly mobile households. A more realistic goal would be to minimize residential turnover caused by environmental problems (e.g., crime), regardless of income level. Policies to achieve this goal are discussed. [source]

    Multiculturalism and the Willingness of Citizens to Defer to Law and to Legal Authorities

    LAW & SOCIAL INQUIRY, Issue 4 2000
    Tom R. Tyler
    A key problem in trying to manage diverse societies is finding social policies that will be acceptable to all individuals and groups. Studies suggest that this problem may not be as intractable as is often believed, since people's acceptance of policies is shaped to an important degree by the fairness of the procedures used by authorities to make policy. When policies are fairly made, they gain widespread support, even among those who may feel that the consequences of the policy for them or their group are undesirable or even unfair. These findings support an optimistic view of the ability of authorities to manage diverse societies. On the other hand, research suggests that the ability of procedural justice to bridge differences among individuals and groups may not be equally strong under all conditions. People's willingness to accept policies is more influenced by procedural justice judgments when they identify with the society that the authorities represent and view them as representing a group of which they are members. They are less influenced by procedural justice judgments when they identify more strongly with subgroups than with society and/or view the authorities as representatives of a group to which they do not belong. [source]

    Transforming readers: teachers and children in the Centre for Literacy in Primary Education Power of Reading project

    LITERACY, Issue 2 2010
    Olivia O'Sullivan
    Abstract This paper presents findings from a national project in England, The Power of Reading (Centre for Literacy in Primary Education), which has involved to date 41 projects over 5 years, in 16 Local Authorities nationally, with 900 schools and 1,350 teachers. The paper presents findings for the first 4 years. Our data demonstrate how professional development has increased teachers' knowledge of children's literature and developed their confidence in using a wide range of creative pedagogies based on texts. The paper draws on evidence to describe how the emotional power of texts can affect both teachers and children and change their engagement as readers. A range of evidence demonstrates children's responses to texts and their developing understanding through writing, talk, drawing and art work. We provide evidence to show how these factors have increased children's motivation and attainment as readers. [source]

    The impact of privatization and regulation on the water and sewerage industry in England and Wales: a translog cost function model

    David S Saal
    After the ten Regional Water Authorities (RWAs) of England and Wales were privatized in November 1989, the successor Water and Sewerage Companies (WASCs) faced a new regulatory regime that was designed to promote economic efficiency while simultaneously improving drinking water and environmental quality. As legally mandated quality improvements necessitated a costly capital investment programme, the industry's economic regulator, the Office of Water Services (Ofwat), implemented a retail price index (RPI)+K pricing system, which was designed to compensate the WASCs for their capital investment programme while also encouraging gains in economic efficiency. In order to analyse jointly the impact of privatization, as well as the impact of increasingly stringent economic and environmental regulation on the WASCs' economic performance, this paper estimates a translog multiple output cost function model for the period 1985,1999. Given the significant costs associated with water quality improvements, the model is augmented to include the impact of drinking water quality and environmental quality on total costs. The model is then employed to determine the extent of scale and scope economies in the water and sewerage industry, as well as the impact of privatization and economic regulation on economic efficiency. Copyright © 2000 John Wiley & Sons, Ltd. [source]

    Proto-Uto-Aztecan: A Community of Cultivators in Central Mexico?

    Jane H. Hill
    Authorities on the origin and history of Uto-Aztecan have held that speakers of the protolanguage were foragers who lived in upland regions of Arizona, New Mexico, and the adjacent areas of the Mexican states of Sonora and Chihuahua about 5,000 years ago. New lexical evidence supports a different view, that speakers of the protolanguage were maize cultivators. The Proto-Uto-Aztecan speech community was probably located in Mesoamerica and spread northward into the present range because of demographic pressure associated with cultivation. The chronology for the spread and differentiation of the family should then correspond to the chronology for the northward spread of maize cultivation from Mesoamerica into the U.S. Southwest, between 4500 and 3000 B.P. [Uto-Aztecan, cultivation, Mesoamerican, historical linguistics, migration] [source]

    The Audit Commission: guiding, steering and regulating local government

    Josie Kelly
    How does the non-executant state ensure that its agents are fulfilling their obligations to deliver nationally determined policies? In the case of elected local government in England and Wales, this function is carried out by the Audit Commission (AC) for Local Authorities and the Health Service for England and Wales. Since being established in 1983, it is the means by which local authorities are held to account by central government, both for its own purposes and on behalf of other interested stakeholders. Although the primary function of the AC is to ensure that local authorities are fulfilling their obligations, it does so by using different methods. By acting as a regulator, an independent expert, an opinion former and a mediator, the AC steers local authorities to ensure that they are compliant with the regulatory regime and are implementing legislation properly. [source]

    Revenue authorities: are they the right vehicle for improved tax administration?

    Nick Devas
    It is now well recognised that reforms to tax administration are as important as tax policy changes for overall fiscal reform. One institutional model of tax administration, which has been quite widely adopted in Africa in recent years, is that of the semi-independent Revenue Authority. This approach is based on the executive agency model, widely adopted in the UK and elsewhere, as a way of improving performance of certain governmental functions. This article looks at the arguments for and against the Revenue Authority model, and examines a number of practical issues in the design of such an agency. It draws on the recent experience of Revenue Authorities in a number of countries. It concludes that the Revenue Authority model can offer an appropriate institutional framework for reforming tax administration, particular where low pay rates and rigid civil service systems inhibit effective management. However, Revenue Authorities do not solve all problems, and can only be expected to deliver results if they form part of a wider reform. Copyright © 2001 John Wiley & Sons, Ltd. [source]

    Policing: Continuity, Consensus and Controversy The Political Quarterly Lecture 2010

    While British policing has an unparalleled worldwide reputation for excellence, its system of governance has not been formally examined for almost fifty years. Known as the tripartite system, giving overlapping but compatible powers and duties to the Home Secretary, to local Police Authorities and to Chief Officers of Police, it is now long overdue for reconsideration and adjustment. More than one political party is suggesting significant reform but only of individual parts of the system. Given other issues concerning the police, particularly the number of United Kingdom forces and the fixation with the number of police officers as an indication of political success, there is now an urgent need for agreement that policing in Britain should have a holistic and cross-party re-examination, possibly but not necessarily in the form of a Royal Commission. [source]

    Unpacking a Wicked Problem: Enablers/Impediments to Regional Engagement

    Michael J. Christie
    A case study approach is applied to review Local Government Authorities (LGA) regional engagement in the Australian context. We address the question ,What are the key LGA enablers/impediments to regional engagement?' by applying Leydesdorff's (2000) proposition that triple helix type network systems exhibit patterns of complex behaviour if the interaction factors that trigger enablers are reflexively declared. The three strands of the LGA triple helix network system are institutions, industry and government. In this case study the LGA's overall management of its regional stakeholder relationships resulted in impediments that limit strong regional engagement. Importantly, the findings inform practitioners, policy-makers and research audiences of the nature of impediments and, by inference, the nature of enablers in LGA triple helix network systems. [source]

    Study on the enantiomeric ratio of the pharmaceutical substances alkannin and shikonin

    A. N. Assimopoulou
    Abstract The chiral pair alkannin and shikonin (A/S) are potent pharmaceutical substances with a wide spectrum of biological activity; their enantiomeric ratio does not in,uence the major biological activity studied hitherto. Nevertheless, in pharmaceutical development and approval of chiral drugs from the Health and Regulatory Authorities, full documentation of methods of analysis of enantiomeric drugs, is required in order to evaluate the enantiomeric purity of starting materials and ,nal products and to control the stability of enantiomers in pharmaceutical formulations under several experimental conditions. In the present study, the enantiomeric ratio of A/S was determined in several commercial samples of alkannin and shikonin and also the proportion of A/S derivatives in several Alkanna root samples, which are all used as active ingredients in pharmaceuticals. Light and air proved not to in,uence the enantiomeric ratio of A/S on a shikonin commercial sample, and temperature also did not alter the A/S ratio on shikonin and alkannin commercial samples. Microencapsulation of alkannin and shikonin commercial samples in ethylcellulose microspheres and also molecular inclusion of a shikonin commercial sample in , -hydroxypropyl-cyclodextrin, which are used as drug delivery systems, did not alter the A/S enantiomeric ratio. Copyright © 2004 John Wiley & Sons, Ltd. [source]

    Comparative bioavailability of two oral formulations of ranitidine

    Francisco J. Flores-Murrieta
    Abstract The current requirement of the Mexican Authorities to demonstrate the interchangeability of ranitidine formulations is to establish that the dissolution profile of the drug shows similarity. In order to establish if this requirement is adequate, the bioavailability of two formulations that did not meet this similarity were compared. Twenty-five female volunteers received 150 mg ranitidine (Azantac® or Midaven®) under fasting conditions in two separate sessions using a cross-over design. Plasma samples were obtained at selected times for a period of 12 h and stored frozen at ,80°C until analysed. Ranitidine plasma levels were determined and pharmacokinetic parameters were obtained. Values (mean ± SEM) were: Cmax 528.85 ± 25.34 and 563.03 ± 33.25 ng/ml, tmax 2.76 ± 0.19 and 2.79 ± 0.18 h, and AUC12 h 2694.94 ± 99.50 and 2648.51 ± 133.38 ng.h/ml, for Azantac® or Midaven®, respectively. No statistically significant difference was obtained in the parameters evaluated. Moreover, 90% confidence limits were 96.6%,116.2% and 90.7%,105.1% for Cmax and AUC12 h ratios, respectively, indicating that the formulations tested are bioequivalent, despite the dissimilarity in the dissolution profile of the formulations. These results suggest that the comparative dissolution profile is not an adequate test to demonstrate the interchangeability of ranitidine formulations. Copyright © 2005 John Wiley & Sons, Ltd. [source]

    Surgery for menorrhagia within English regions: variation in rates of endometrial ablation and hysterectomy

    DA Cromwell
    Objective, To examine variation between English regions in the use of surgery (endometrial ablation or hysterectomy) for the treatment of menorrhagia. Design, Analysis of Hospital Episodes Statistics (HES) data to produce rates of surgery for English Strategic Health Authorities (SHAs) and Primary Care Trusts (PCTs). Population, Women aged between 25 and 59 years who had endometrial ablation or hysterectomy for menorrhagia between April 2003 and March 2006 in English NHS hospitals. Methods, Multilevel Poisson regression was used to determine the level of systematic variation in the regional rates of surgery and their association with regional characteristics (deprivation, service provision and mix of surgical procedures). Main outcome measure, Age-standardised annual rates of surgery. Results, The English rate of surgery for menorrhagia was 143 procedures per 100 000 women. Surgical rates within SHAs ranged from 52 to 230 procedures per 100 000 women, while rates within PCTs ranged from 20 to 420 procedures per 100 000 women. While, 60% of all procedures were endometrial ablations, the proportion across SHAs varied, ranging from 46% to 75%. Surgery rates were associated with the regional characteristics, but only weakly, and risk adjustment reduced the amount of unexplained variation by <15% at both SHA and PCT levels. Conclusion, Regional differences in surgical rates for menorrhagia have persisted despite changes in practice and improved evidence, suggesting there is scope for improving the management of menorrhagia within England. [source]

    Initial management of cerebrovascular disease by general practitioners

    R. G. J. Gibbs
    Background: The aim of this study was to determine the primary management of patients presenting with a new diagnosis of transient ischaemic attack (TIA) or stroke by general practitioners and to establish whether practice was uniform across the UK, and to determine whether initial management influenced the performance of carotid endarterectomy (CEA) across the health regions of the UK. Methods: Information on regional reporting of new cases of TIA and stroke between 1992 and 1996 was obtained from the General Practice Research Database, a database of six million patients from 450 practices. Analysis of data from the primary care database and routine data sources was undertaken. Main outcome measures were incidence of TIA and stroke, rates of referral for specialist opinion, prescription of antiplatelet agents and rates of CEA. Results: There were twofold differences (P < 0·00005, ,2 test) in the incidence of cerebrovascular disease between Regional Health Authorities (RHAs) between the years 1992 and 1996 and also for each year. Mean stroke incidence per annum was 143 per 100 000 and TIA incidence 183 per 100 000. Yorkshire had the highest incidence at 170 (stroke) and 206 (TIA) per 100 000 of the population compared with 95 and 98 per 100 000 for Oxford. Some 37 per cent of new patients with stroke and 19 per cent of patients with TIA were referred for specialist opinion following initial diagnosis. These rates did not change over time. There was no positive correlation between disease incidence and referral rate; Yorkshire referred the least (14 per cent) and Oxford the most (26 per cent). The majority of referrals for TIA were made to general medicine (39 per cent); 6 per cent of patients were referred directly for surgical opinion. Mean prescription rate of antiplatelet medication over the time period was 17 per cent for patients with stroke and 35 per cent for those with TIA. Mean CEA rate for English RHAs for the time interval was 15·5 per 100 000. There was a positive correlation between the incidence of disease and rate of CEA, with the regions with the highest incidence of disease tending to perform the most CEAs. Conclusion: The incidence of cerebrovascular disease varies significantly across health regions in the UK. There was no correlation between the regional incidence of disease and the number of patients referred for specialist opinion, but CEA rates were generally correlated with the regional difference in incidence of disease. The low referral rate may be a factor in the perceived underperformance of CEA in the UK and the low usage of antiplatelet medication is surprising. © 2000 British Journal of Surgery Society Ltd [source]

    Child Health Assessment at School Entry (CHASE) project: evaluation in 10 London primary schools

    S. Edmunds
    Abstract Aims To assess the feasibility of implementing the Child Health Assessment at School Entry (CHASE) questionnaire, developed to capture the multiple dimensions of the health of children in their first year at school, and to evaluate data quality, reliability and validity. Methods Parents of 278 year-1 children, from 10 primary schools in two London boroughs, received a parent questionnaire and school nurses completed a separate questionnaire from health and education records for children whose parents consented. Additional data on free school meal eligibility and ethnicity were obtained from the two Local Education Authorities. The parent questionnaire included the Strengths and Difficulties Questionnaire (SDQ) and four dimensions of the Child Health Questionnaire Parent Form-28 (CHQ-PF28). Results Response rate was 61%. The association between school free school meals eligibility and response rate in each school approached significance (r = ,0.62, P = 0.05). Data completeness of the parent questionnaire was high (mean 98%). Data completeness of the school nurse questionnaire was more variable (mean 82%). Cronbach's Alpha was greater than 0.6 for four of the five SDQ scales and greater than 0.7 for the two CHQ-PF28 multi-item scales. Relative to parents with qualifications, parents with no qualifications rated their children as having significantly more conduct problems, peer problems, and overall mental health problems (P < 0.01) as assessed by the SDQ, and significantly lower global health (P < 0.01) as assessed by the CHQ-PF28. Children with special educational needs and children with long-standing illness or disability were rated as having significantly lower global health (P < 0.05) than children without these. Sample tables of inter-school and inter-borough comparison of key findings demonstrate considerable differences in physical and mental health status. Discussion The questionnaire was acceptable to parents and school nurses, and feasible to implement within existing school resources. Initial tests of internal reliability and validity are satisfactory. These data have the potential to inform interventions and service provision at school and borough level, and public health trends over time. [source]

    The Assessment of Emergency Physicians by a Regulatory Authority

    Jocelyn M. Lockyer PhD
    Abstract Objectives To determine whether it is possible to develop a feasible, valid, and reliable multisource feedback program (360° evaluation) for emergency physicians. Methods Surveys with 16, 20, 30, and 31 items were developed to assess emergency physicians by 25 patients, eight coworkers, eight medical colleagues, and self, respectively, using five-point scales along with an "unable to assess" category. Items addressed key competencies related to communication skills, professionalism, collegiality, and self-management. Results Data from 187 physicians who identified themselves as emergency physicians were available. The mean number of respondents per physician was 21.6 (SD ± 3.87) (93%) for patients, 7.6 (SD ± 0.89) (96%) for coworkers, and 7.7 (SD ± 0.61) (95%) for medical colleagues, suggesting it was a feasible tool. Only the patient survey had four items with "unable to assess" percentages ,15%. The factor analysis indicated there were two factors on the patient questionnaire (communication/professionalism and patient education), two on the coworker survey (communication/collegiality and professionalism), and four on the medical colleague questionnaire (clinical performance, professionalism, self-management, and record management) that accounted for 80.0%, 62.5%, and 71.9% of the variance on the surveys, respectively. The factors were consistent with the intent of the instruments, providing empirical evidence of validity for the instruments. Reliability was established for the instruments (Cronbach's , > 0.94) and for each physician (generalizability coefficients were 0.68 for patients, 0.85 for coworkers, and 0.84 for medical colleagues). Conclusions The psychometric examination of the data suggests that the instruments developed to assess emergency physicians were feasible and provide evidence for validity and reliability. [source]

    Legitimations of the State: The Weakening of Authority and the Restoration of Power

    Michaėl F
    First page of article [source]