Interim findings: civil society engagement with land rights advocacy in Kenya

ASC – Publicaties niet-programma gebonde

The Passamaquoddy Indians: Casinos, Controversy, and Creative Apparel

Indian enterprises often invoke images of casinos and powwows. In fact, entrepreneurial ventures and wealth among tribes are as diverse as the tribes themselves. Unlike one-source business models (i.e., casinos), for example, many indigenous activists favor a diversified economic plan, making the most of federal and state laws and grants as well as a volatile political and financial climate to best serve their people. This paper highlights the efforts of one such tribe. Leaders of Maine’s Passamaquoddy tribe have investigated several enterprise routes over the last few years, using Tribal 8A (a federally-sponsored set of policies for eligible Indian tribes, Alaska Native Corporations [ANCs] and Native Hawaiian Organizations [NHOs]) as an impetus for their development. The result is a flexible business paradigm that ranges from joint ventures in blueberry production and distribution to the manufacture of chemical protective apparel for the U.S. military. But at what cost? What happens to Passamaquoddy cultural values in the process of the tribe regaining its financial stability? The notion of living on a reservation, while making chemical protective apparel for the American government, paints a portrait of contradictory identities. In the end, earning a living should not preclude living and “(l)earning” about one’s heritage

Self-reported test ordering practices among Canadian internal medicine physicians and trainees: a multicenter cross-sectional survey

Abstract Background Over-testing is a recognized problem, but clinicians usually lack information about their personal test ordering volumes. In the absence of data, clinicians rely on self-perception to inform their test ordering practices. In this study we explore clinician self-perception of diagnostic test ordering intensity. Methods We conducted a cross-sectional survey of inpatient General Internal Medicine (GIM) attending physicians and trainees at three Canadian teaching hospitals. We collected information about: self-reported test ordering intensity, perception of colleagues test ordering intensity, and importance of clinical utility, patient comfort, and cost when ordering tests. We compared responses of clinicians who self-identified as high vs low utilizers of diagnostic tests, and attending physicians vs trainees. Results Only 15% of inpatient GIM clinicians self-identified as high utilizers of diagnostic tests, while 73% felt that GIM clinicians in aggregate (“others”) order too many tests. Survey respondents identified clinical utility as important when choosing to order tests (selected by 94%), followed by patient comfort (48%) and cost (23%). Self-identified low/average utilizers of diagnostic tests were more likely to report considering cost compared to high utilizers (27% vs 5%, P = 0.04). Attending physicians were more likely to consider patient comfort (70% vs 41%, p = 0.01) and cost (42% vs 17%, p = 0.003) than trainees. Conclusions In the absence of data, providers seem to recognize that over investigation is a problem, but few self-identify as being high test utilizers. Moreover, a significant percentage of respondents did not consider cost or patient discomfort when ordering tests. Our findings highlight challenges in reducing over-testing in the current era