Relation of Federal Taxation to the Financing of Small Business

Aims. To explore general practitioners’ (GPs’) descriptions of their thoughts and action when prescribing cardiovascular preventive drugs. Methods. Qualitative content analysis of transcribed group interviews with 14 participants from two primary health care centres in the southeast of Sweden. Results. GPs’ prescribing of cardiovascular preventive drugs, from their own descriptions, involved “the patient as calculated” and “the inclination to prescribe,” which were negotiated in the interaction with “the patient in front of me.” In situations with high cardiovascular risk, the GPs reported a tendency to adopt a directive consultation style. In situations with low cardiovascular risk and great uncertainty about the net benefit of preventive drugs, the GPs described a preference for an informed patient choice. Conclusions. Our findings suggest that GPs mainly involve patients at low and uncertain risk of cardiovascular disease in treatment decisions, whereas patient involvement tends to decrease when GPs judge the cardiovascular risk as high. Our findings may serve as a memento for clinicians, and we suggest them to be considered in training in communication skills

The proper way of dwelling at the Early Neolithic gathering site of Almhov in Scania, Sweden

The Early Neolithic (c. 4000–3500 BC) site of Almhov, located in southwestern Scania, Sweden, is interpreted as a gathering and feasting site, subsequently transformed into a burial site with ancestral monuments. The focus of the article is on the pit pairs and pit clusters at the site, and on the dierential distribution of artefacts and animal bones within them, thereby touching upon more general topics such as material culture patterning, structured deposition and the categorization of animals during the Early Neolithic

Economic choices can be made using only stimulus values

Decision-making often involves choices between different stimuli, each of which is associated with a different physical action. A growing consensus suggests that the brain makes such decisions by assigning a value to each available option and then comparing them to make a choice. An open question in decision neuroscience is whether the brain computes these choices by comparing the values of stimuli directly in goods space or instead by first assigning values to the associated actions and then making a choice over actions. We used a functional MRI paradigm in which human subjects made choices between different stimuli with and without knowledge of the actions required to obtain the different stimuli. We found neural correlates of the value of the chosen stimulus (a postdecision signal) in ventromedial prefrontal cortex before the actual stimulus–action pairing was revealed. These findings provide support for the hypothesis that the brain is capable of making choices in the space of goods without first transferring values into action space

Leadership in rural medicine: The organization on thin ice?

Objective. To explore the personal experiences of and conceptions regarding leading rural primary care in Northern Norway. Design. Qualitative content analysis of focus-group interviews. Setting. Lead primary care physicians in the three northernmost counties. Subjects. Four groups with 22 out of 88 municipal lead physicians in the region. Results. Three main categories were developed and bound together by an implicit theme. Demands and challenges included the wide leadership span of clinical services and public health, placed in a merged line/board position. Constraints of human resources and time and the ever changing organizational context added to the experience of strain. Personal qualifications indicates the lack of leadership motivation and training, which was partly compensated for by a leader role developed through clinical undergraduate training and then through the responsibilities and experiences of clinical work. In Exercising the leadership, the participants described a vision of a coaching and coordinating leadership and, in practice, a display of communication skills, decision-making ability, result focusing, and ad hoc solutions. Leadership was made easier by the features of the small, rural organization, such as overview, close contact with cooperating partners, and a supportive environment. There was incongruence between demands and described qualifications, and between desired and executed leadership, but nevertheless the organization was running. Leadership demonstrated a “working inadequacy”. Conclusion. Under resource constraints, leadership based on clinical skills favours management by exception which, in the long run, appears to make the leadership less effective. Leadership training which takes into account the prominent features of rural and decentralized primary care is strongly needed

A qualitative study of final-year medical students’ perspectives of general practitioners’ competencies

Objectives: To investigate final-year medical students' perspectives of general practitioners' competencies. A further aim of the study was to investigate which type of clinical problems is properly managed by GPs according to students. Methods: We conducted a qualitative study of 49 final year medical students from two programmes. Reflective writing statements were used to collect data. Qualitative content analysis was employed to analyse data. Results: Three themes were identified to explain the conditions of a general practitioner (GP). They are: 'prerequisites', 'patients´ problems' and 'competence and clinical judgment' which reflect the specific features of primary care, presentation of symptoms by patient and the way that GPs approach an actual encounter. Conclusions: The students valued the importance of unselected patient problems, straightforwardness in contact and care as the characteristics of a competent GP. They viewed patients with different approaches and related their observations to problems of fragmentation within this large area of medical care. This is a period in the training of students in which students' views of general practice are formed

Normering i den nya upplagan av Svensk skolordlista

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“They Have Left Us in a Hole”

A conceptual distinction is made between minimal and substantial democracy, where the latter concept aims to integrate constitutional minimalistically defined democracy with a notion of political equality in actual practice. In this perspective, ‘substantial democratisation’ and ‘development’ are linked to each other. The argument is illustrated through a diachronic case study of a village in Northern Guinea-Bissau. Minimal democratisation through national multi-party elections since the early 1990s has resulted neither in substantial democratization, nor in development in the village. Some limit to people’s patience is indicated by the opening in 2006 of a primary school in the village, run by the parents to substitute for the public school which closed in 1989. The initiative can be seen as an emergency attempt at self-empowerment by a local community in dire need of development. Whether sustainable or not, it concretises the core issue of horizontal self-organisation from below.Une distinction conceptuelle est introduite entre démocratie minimale et démocratie substantielle. Le dernier concept intègre une démocratie minimaliste constitutionnellement définie, et une notion d’égalité politique dans la pratique. Selon cette perspective, la ‘democratisation substantielle’ et le ‘développement’ sont liés. L’argument est illustré avec une étude de cas diachronique d’un village au nord de la Guinée-Bissau. Pour le village, la démocratisation minimale manifestée à travers des élections multi-partistes depuis le début des années 90 n’a abouti ni à la démocratie substantielle, ni au développement. Il y a néanmoins des limites à la patience des villageois, car en 2006 l’école du village, fermée depuis 1989, a été rouverte par les parents d’élèves. Cette initiative pourrait, en effet, être vue comme une tentative de prise de pouvoir (empowerment) par une communauté locale en quête de développement. Durable ou non, cette initiative concrétise la question-clé de l’organisation horizontale par le bas

Corporate engagement in water policy and governance: A literature review on water stewardship and water security

Water is a central ingredient of all economic activities. Even so, water-using corporations were long absent from the theoretical and practical developments of water management, governance and policy. The past 15 years, however, have seen the emergence, proliferation and gradual maturation of global initiatives, guidelines and tools that focus on the role of business and their value chains under the banners of corporate water stewardship and water security. This article takes stock of the available literature and reviews the development to date. It traces the origins of key concepts and initiatives that are part of this new corporate engagement in water policy and governance, and looks at the landscape and corporate-level drivers of the phenomena. The paper reviews the evolution of the associated theory and practice; it also examines the impact of corporate engagement in water on business strategies and actions, and observes the influence it has had on stakeholders and settings from the national to the global level. While the available evidence base is still fragmented, the review findings confirm the previously documented controversies of operating at the public–private interface of water. Among water-using companies, the water stewardship approach is increasingly positioned as a means of achieving collective water security, merging these two fields; in practice, however, the results indicate still-narrow gains. The article concludes with a call for a comprehensive evaluation of corporate water initiatives and for a transdisciplinary research agenda that steers the engagement towards more equitable and sustainable outcomes

Lack of effect of citalopram on magnetic resonance spectroscopy measures of glutamate and glutamine in frontal cortex of healthy volunteers

Magnetic resonance spectroscopy (MRS) is a non-invasive imaging technique that can provide localised measures of brain chemistry in vivo. We previously found that healthy volunteers receiving the selective serotonin reuptake inhibitor, citalopram, daily for 1 week showed higher levels of a combined measure of glutamate and glutamine (Glx) in occipital cortex than those receiving placebo. The aim of this study was to assess if a similar effect could be detected in the frontal brain region. Twenty-three healthy volunteers randomised to receive either citalopram 20 mg or a placebo capsule daily for 7–10 days were studied and scanned using a 3T Varian INOVA system before and at the end of treatment. Standard short-TE (echo time) PRESS (Point-resolved spectroscopy) (TE = 26 ms) and PRESS-J spectra were acquired from a single 8-cm3 voxel in a frontal region incorporating anterior cingulate cortex. Glutamate and total Glx levels were quantified both relative to creatine and as absolute levels. Relative to placebo, citalopram produced no change in Glx or glutamate alone at the end of the study. Similarly, no effect was seen on other MRS measures studied: myo-inositol, choline, N-acetylaspartate and creatine. These data suggest that the effects of serotonin reuptake to modify cortical glutamatergic MRS measures may be regionally specific. This supports the potential for MRS in assessing neuroanatomically specific serotonin-glutamate interactions in the human brain