Mutual benefit, added value? Doing research in the National Health Service

The National Health Service (NHS) has recently been the focus of government efforts to retain pharmaceutical research in the UK. Efforts to foster new partnerships between health care providers and industry have been framed with suggestions that clinical trials can offer patient benefit within the NHS, cutting across ethical and sociological concerns with the possible tension between doing research and offering care. This paper draws on ethnographic research to explore the sometimes awkward juxtapositions between trial protocols and everyday care, individual health and commercial profit, and thus the distribution of value produced through trials. While researchers appear to find the distinction between research and care useful, at least some of the time, both formal and informal strategies for living with this distinction may have the unintended consequence of making research appear supplementary to rather than simply different from clinical care

Cutting in on the \u3ci\u3eChevron\u3c/i\u3e Two-Step

Consider the following scenario: an ambiguous statutory provision could plausibly mean A or B—which could in fact be the opposite of A. A federal agency, drawing upon its scientific and/or experiential expertise, either has or could develop policy-based reasons backed by fact-intensive evidence to prefer one interpretation over the other. But instead of developing and setting forth its policy reasons and subjecting them to vetting in a notice-andcomment rulemaking, the agency instead justifies its interpretive choice in a rule, setting forth its legal analysis of statutory text, perhaps legislative history, and the purpose and structure of the statute as a whole. Subsequently, in a dispute over how the statutory provision should be interpreted, the agency claims that its interpretive view merits judicial deference. In statutory interpretation cases, courts typically invoke the Chevron Two-Step framework and, given that the agency has promulgated a rule, assuming the court agrees that the statutory provision is ambiguous at Step One, the agency is all but assured deference at Step Two. What is wrong with this scenario? First, from a comparative institutionalist perspective, deference to agencies’ statutory interpretations should be premised upon the agencies’ policy-based expertise; thus, it should be withheld where agencies have not provided policy based rationales for their interpretive choices. Second, the “reasoned decisionmaking” element of judicial review drops out of the picture altogether and thus judicial oversight of agencies is diminished. In other words, it should not be “per se” reasonable when an agency chooses—based on unarticulated and thus unvetted policy variables—between two permissible statutory interpretations. This Article proposes a doctrinal solution: the incorporation of State Farm hard look review into the Chevron Two-Step framework. The main goal is to extend the domain of State Farm “reasoned decisionmaking” review, widening the scope of agency rules subject to hard look review. By incorporating this hard look review within the Chevron framework, the model highlights the extent to which agency statutory interpretations are driven by underlying policy choices. And by collapsing the conceptual acoustic separation of Chevron and State FarmV, the model makes it difficult for an agency to evade hard look review by convincing a court that it is a Chevron, not State Farm, case. Moreover, where the Chevron interpretive issue arises between private parties when the agency is not a party, and litigants accordingly cannot raise a direct State Farm challenge to the rulemaking, the model would open the door to an indirect State Farm challenge. This Article explores how this new doctrinal approach, one of hard look review of agency policy decisions at Chevron Step Two, will affect courts and agency decision-making. Finally, the U.S. Supreme Court seems to have reached a critical juncture for Chevron. This particular form of Chevron retreat—widening the space for the application of State Farm—is fundamentally distinct from, and preferable to, setting Chevron aside. Whereas knocking down the Chevron pillar deals a blow to overexuberant regulators and promises to stem the tide of overregulation of the economy and health and safety, heightened judicial scrutiny of the Chevron-State Farm variety will force the agency’s hand in the context of deregulation as well

Five-country Study on Service and Volunteering in Southern Africa Malawi Country Report

This study on the nature and form of civic service and volunteering in Malawi followed a qualitative, descriptive research approach, drawing on information from an extensive document search, interviews with key informants responsible for supporting and/or implementing service and volunteering programmes and a focus group discussion with representatives of national and international organisations running structured service programmes, as well as those involved in district and community-based activities

Culture, authenticity and sport : a study of event motivations at the Ulaanbaatar Naadam Festival, Mongolia

Drawing on the results of an empirical study, this chapter examines the case of the Ulaanbaatar Naadam within the framework of the literature on cultural authenticity and with reference to the contribution of sporting events and competitions to the latter. Differences between overseas and domestic markets attending the event are investigated and conclusions are drawn on the role of cultural authenticity in motivating visitors to attend the Naadam festival

Examination of the Monoamine Oxidase a Gene Promoter on Motivation to Exercise and Levels of Voluntary Physical Activity

Purpose: Monoamine oxidase A (MAO-A) is an enzyme that causes inactivation of monoamine neurotransmitters, such as dopamine. Polymorphisms in the promoter region of the MAO-A gene can change transcriptional activity and the amount of MAO-A produced, leading to alterations in available dopamine levels. MAO-A polymorphisms have been associated with physical activity level. This study examined whether motivation to exercise, and levels of voluntary physical activity are associated with MAO-A gene polymorphisms. Methods: Seventy-one participants (18-24 years, 13 males & 58 females) completed the Behavioral Regulation in Exercise Questionaire-2 (BREQ-2) to assess their motivation to exercise and the International Physical Activity Questionnaire (IPAQ) to assess their level of physical activity. DNA was isolated from a cheek cell sample. MAO-A 3/3 and 4/4 genotype individuals were used for analysis. Results: External motivation to exercise was significantly higher (p \u3c 0.01) in the high transcription 4/4 genotype (ave 1.17 ± 0.7) compared to the low transcription 3/3 genotype (ave 0.42 ± 0.5). Internal motivation to exercise, body mass index, and weekly MET minutes were comparable between genotypes. Conclusion: The results suggest a polymorphism in this monoamine pathway may play a role in increasing sensitivity to external factors that motivate individuals to exercise