Disability Rights Mandates: Federal and State Compliance with Employment Protection and Architectural Barrier Removal

The findings of this study indicate that the existence of national mandates does not necessarily eliminate the need for citizen groups to be attentive to state capitols and city halls. Ironically, one factor in the rise of regulatory federalism has been the desire of interest groups to concentrate their resources on one government, namely, the national government, rather than 50 different state governments. Yet, success in the national arena is often only partial, and sometimes only largely symbolic. It is the implementation of national rules that takes one back to states and localities. The findings of this study also suggest that problems of policy implementation that are often attributed to intergovernmental obstacles may be as much or more due to intragovernmental obstacles. The rise of regulatory federalism has been fueled by a belief that it is better to have one government rather than 50 governments perform functions. One government can presumably formulate rational and coherent policy, and then coordinate the efficient implementation of that policy, thus avoiding the fragmentation and diversity often said to be characteristic of intergovernmental policy implementation. Yet, the problem with this theory is that intergovernmental fragmentation, which may not be the real issue in every case, may simply be replaced by intragovernmental fragmentation. As more responsibilities are assigned to one government, intragovernmental fragmentation is likely to be exacerbated. What needs to be explored, then, is how intergovernmental policymaking may be, under many circumstances, a more effective way to achieve essential national objectives than purely national policymaking in which compliance requirements are more prominent than alliance incentives. Another issue to be addressed is whether the federal government is as equally willing and able to impose sanctions on its own agencies for noncompliance as it is to impose sanctions on state and local governments. Federal agencies and courts may levy fines, withhold grant funds, or compel state and local governments to alter funding priorities or raise new revenue in order to enforce compliance with national mandates. Would the Congress or the President be prepared, let us say, to withhold 10 percent of the Defense Department\u27s funding in order to compel compliance if the department were not in full compliance with certain mandates applicable to federal agencies? Is the U.S. Supreme Court prepared to compel the Congress and the President to raise taxes to ensure federal compliance with mandates? Does the Congress itself ensure that its own rules and procedures conform to legislated mandates? Finally, the findings of this study suggest that there is a continuing need to build consensus in the intergovernmental system in order to implement policy nationwide. It is not enough to enact mandates more or less unilaterally and to expect compliance to flow swiftly in their wake. Another factor in the rise of regulatory federalism has been the desire of pressure groups to circumvent or override the many veto points said to exist in the federal system. The price of this strategy, however, can be high, including policy ambiguity and the lack of a sufficiently strong consensus to follow through on vigorous implementation. Policy mandates need to be owned, or at least not disowned, by those who must implement them. Thus, bringing federalism back into the national policy-making process can improve the implementation of policy in what must necessarily be an intergovernmental process. The findings and recommendations were approved by the Commission at its meeting on March 10, 1989

Cross-national comparative mixed-methods case study of recovery-focused mental health care planning and co-ordination: Collaborative Care Planning Project (COCAPP)

The care programme approach in England and care and treatment planning in Wales are systems designed to provide mental health service users with a named care co-ordinator who meets regularly with the service user, oversees their care and develops a written plan to guide the care that they receive. These approaches are meant to help people towards recovery. In this study, we investigated whether care is organised to help people’s recovery and whether this is done in a personalised way. We identified six NHS trust/health board sites in England and Wales, and surveyed staff and service users to measure views on recovery, empowerment and therapeutic relationships. At each site we also interviewed managers, clinical staff care co-ordinators, service users and carers about their experiences of care planning. We found that good relationships are important for service users, carers and care co-ordinators in care planning and supporting recovery. Experiences of care planning and co-ordination varied within all sites. People do not always feel involved in their own care. The understanding of recovery and personalisation varied among the service users and staff interviewed. Workers say that there is too much paperwork and, like service users, they rarely look at care plans once written. Staff focus on risk but this does not often appear to be discussed with people using services, which may be problematic. We recommend research to investigate new ways of working and training to increase staff contact time with service users and carers and to improve a focus on recovery

Systematic Review of Potential Health Risks Posed by Pharmaceutical, Occupational and Consumer Exposures to Metallic and Nanoscale Aluminum, Aluminum Oxides, Aluminum Hydroxide and Its Soluble Salts

Aluminum (Al) is a ubiquitous substance encountered both naturally (as the third most abundant element) and intentionally (used in water, foods, pharmaceuticals, and vaccines); it is also present in ambient and occupational airborne particulates. Existing data underscore the importance of Al physical and chemical forms in relation to its uptake, accumulation, and systemic bioavailability. The present review represents a systematic examination of the peer-reviewed literature on the adverse health effects of Al materials published since a previous critical evaluation compiled by Krewski et al. (2007). Challenges encountered in carrying out the present review reflected the experimental use of different physical and chemical Al forms, different routes of administration, and different target organs in relation to the magnitude, frequency, and duration of exposure. Wide variations in diet can result in Al intakes that are often higher than the World Health Organization provisional tolerable weekly intake (PTWI), which is based on studies with Al citrate. Comparing daily dietary Al exposures on the basis of “total Al”assumes that gastrointestinal bioavailability for all dietary Al forms is equivalent to that for Al citrate, an approach that requires validation. Current occupational exposure limits (OELs) for identical Al substances vary as much as 15-fold. The toxicity of different Al forms depends in large measure on their physical behavior and relative solubility in water. The toxicity of soluble Al forms depends upon the delivered dose of Al+ 3 to target tissues. Trivalent Al reacts with water to produce bidentate superoxide coordination spheres [Al(O2)(H2O4)+ 2 and Al(H2O)6 + 3] that after complexation with O2•−, generate Al superoxides [Al(O2•)](H2O5)]+ 2. Semireduced AlO2• radicals deplete mitochondrial Fe and promote generation of H2O2, O2 • − and OH•. Thus, it is the Al+ 3-induced formation of oxygen radicals that accounts for the oxidative damage that leads to intrinsic apoptosis. In contrast, the toxicity of the insoluble Al oxides depends primarily on their behavior as particulates. Aluminum has been held responsible for human morbidity and mortality, but there is no consistent and convincing evidence to associate the Al found in food and drinking water at the doses and chemical forms presently consumed by people living in North America and Western Europe with increased risk for Alzheimer\u27s disease (AD). Neither is there clear evidence to show use of Al-containing underarm antiperspirants or cosmetics increases the risk of AD or breast cancer. Metallic Al, its oxides, and common Al salts have not been shown to be either genotoxic or carcinogenic. Aluminum exposures during neonatal and pediatric parenteral nutrition (PN) can impair bone mineralization and delay neurological development. Adverse effects to vaccines with Al adjuvants have occurred; however, recent controlled trials found that the immunologic response to certain vaccines with Al adjuvants was no greater, and in some cases less than, that after identical vaccination without Al adjuvants. The scientific literature on the adverse health effects of Al is extensive. Health risk assessments for Al must take into account individual co-factors (e.g., age, renal function, diet, gastric pH). Conclusions from the current review point to the need for refinement of the PTWI, reduction of Al contamination in PN solutions, justification for routine addition of Al to vaccines, and harmonization of OELs for Al substances

Digital democracy Information and communication technologies in local politics

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Discussion democracy the response to `Taking Charge: the Rebirth of Local Democracy'

SIGLEAvailable from British Library Document Supply Centre-DSC:3278.247(CLD-RR--19) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Submissions to the Commission on aspects of local democracy

SIGLEAvailable from British Library Document Supply Centre- DSC:3278.247(CLD-RR--8) / BLDSC - British Library Document Supply CentreGBUnited Kingdo