This paper is the fruit of an attempt to distinguish the elements, present in a fiscal decentralization process, that are likely to contribute to efficiency enhancement in the provision of social services in developing countries. From the methodological point of view, the paper makes an effort, whenever possible, to isolate the economic from the political in the arguments for and against fiscal decentralization. These two sets of arguments, economic and political, both equally important, are often intermingled in the literature. The distinction between them may improve our understanding of the advantages and limitations of the selection of a 'decentralized' provision of social services. Although nearly all the aspects of the fiscal decentralization process may be of some relevance in terms of the issue of equitable social service provision, the paper tries to stress the need to provide adequate incentives to local bureaucracies through the design of transfers and through community participation.
Via regression analysis, this study is able to establish factors that impinge on per capita social sector expenditures. In addition, 32 out of the 62 provincial governments have allocated less on social sectors than what is needed to maintain their 1991 expenditure level in real terms. Inconsistencies regarding budget allocation of provincial governments on the social sectors and the objective indicators are detected.
EXERCISE, SUDDEN DEATH The sudden death of a competitive athlete is a personal tragedy with great impact on the lay and medical communities(26). Sudden deaths in athletes are usually caused by previously unsuspected cardiovascular disease(1,3,6,11,17,23,31,37,41,42,45,57,59,60,61,62,63,65,67). Such an event often assumes a high public profile because of the generally held perception that trained athletes constitute the healthiest segment of our society. The death of a well-known elite athlete often emphasizes this visibility (26,33). Athletic field catastrophes strike to the core of our sensibilities and often galvanize us. They also inevitably raise a number of practical and ethical issues. This statement is a response to these considerations and represents the consensus of a panel appointed by the American Heart Association Science Advisory and Co-ordinating Committee. The panel comprised cardiovascular specialists, other physicians with extensive clinical experience with athletes of all ages, and a legal expert. The panel 1) assessed the benefits and limitations of preparticipation screening for early detection of cardiovascular abnormalities in competitive athletes; 2) addressed cost-efficiency and feasibility issues as well as the medical and legal implications of screening; and 3) developed consensus recommendations and guidelines for the most prudent, practical, and effective screening procedures and strategies (the recommendations are listed at the end of this statement). This endeavor seems particularly relevant and timely, given the large number of competitive athletes in this country, recent public health initiatives on physical activity and exercise, and the staging of the 1996 Olympic Games in the United States. Definitions and Background The competitive athlete has been described as one who participates in an organized team or individual sport requiring systematic training and regular competition against others while placing a high premium on athletic excellence and achievement (37). The purpose of screening, as described here, is to provide medical clearance for participation in competitive sports through routine and systematic evaluations intended to identify clinically relevant and preexisting cardiovascular abnormalities and thereby reduce the risks associated with organized sports. However, detection of a possible cardiovascular abnormality on a standard screening examination is only the first tier of recognition; referral to a specialist for further diagnostic investigation will probably be required. When a definitive cardiovascular diagnosis is made, the consensus panel guidelines of the 26th Bethesda Conference (34) should be used to formulate recommendations for continued participation or disqualification from competitive sports. The current guidelines focus primarily on the potential for population-based screening of high school and collegiate athletes rather than individual clinical assessments of athletes and apply to competitors of all ages and both genders. These recommendations may also be extrapolated to athletes in youth, middle school, and masters or professional sports, and in some instances to participants in intense recreational sports or those engaged in careers concerned with public safety (e.g., firefighters, police officers, and airline pilots). It is also recognized that overall preparticipation screening goes well beyond the considerations described here, which are limited to the cardiovascular system. These recommendations are predicated on the probability that intense athletic training is likely to increase the risk for sudden cardiac death (or disease progression) in trained athletes with clinically important underlying structural heart disease, although at present it is not possible to quantify that risk. Certainly the vast majority of young athletes who die suddenly do so during athletic training or competition(1,41,42,63). Finally, early detection of clinically significant cardiovascular disease through preparticipation screening will in many instances permit timely therapeutic interventions that may prolong life. Causes of Sudden Death A variety of cardiovascular abnormalities represent the most common causes of sudden death in competitive athletes(1,3,6,11,17,23,31,33,37,41,42,45,57,59,60,61,62,63,65,67). The precise lesions responsible for athletic field catastrophes differ considerably with regard to age. For example, in youthful athletes (younger than 35 yr) the vast majority of sudden deaths are due to several congenital cardiac malformations (Fig. 1). Hypertrophic cardiomyopathy is the predominant abnormality occurring in about one third of cases (41,42,63). The next most frequent cause is congenital coronary anomalies, particularly anomalous origin of the left main coronary artery from the right sinus of Valsalva(2,55). These deaths occur most commonly in team sports such as basketball and football, which have the highest levels of participation. Older athletes (35 yr and older) represent a different athletic population because they do not primarily participate in organized team sports but instead focus on individual endeavors such as long-distance running. The vast majority of deaths in middle-aged athletes are caused by atherosclerotic coronary artery disease (59,60,65,67). Because this statement focuses on the cardiovascular evaluation of athletes, other related medical problems that may cause sudden death, such as cerebral aneurysm, sickle cell trait (19), nonpenetrating blunt chest impact (39), and bronchial asthma are not considered here. Issues related to drug screening also are not considered here, although it is known that ingestion of agents such as cocaine may have severe adverse cardiovascular consequences (16,66). Screening for systemic hypertension, although not regarded as an important cause of sudden unexpected death in young athletes (18), has been addressed. Prevalence and Scope of the Problem The design of a screening strategy must take into account the fact that sudden cardiac death in athletes is an infrequent event and that only a small proportion of participants in organized sports in the United States is at risk(5,63). Indeed, each of the lesions known to be responsible for sudden death in young athletes occurs infrequently in the general population, ranging from the relatively common, such as hypertrophic cardiomyopathy (1:500)(32), to the very rare, such as coronary artery anomalies, arrhythmogenic right ventricular dysplasia, long QT syndrome, or Marfan syndrome, for which reliable estimates of frequency are lacking. Therefore, it is reasonable to estimate that congenital malformations relevant to athletic screening probably account for a combined prevalence of approximately 0.2% in athletic populations. The large reservoir of competitive athletes in the United States constitutes a major obstacle to screening strategies. There are approximately 4 million competitive high school-age athletes (grades 9-12) in addition to smaller numbers of collegiate (500,000) and professional (5000) athletes. This does not include an unspecified number of youth, middle school, and masters level competitors, for which reliable numbers are not available. Although the prevalence of athletic field deaths nationally is not known with certainty, it appears to be in the range of 1:100,000 to 1:300,000 high school-age athletes and is disproportionately higher in males(42,63). Among older athletes, available estimates(40,59) suggest that the frequency of sudden cardiac death due principally to coronary artery disease may exceed that of younger athletes (1:15,000 joggers and 1:50,000 marathon runners). Considering such a relatively low prevalence, the heightened awareness and intense interest in sudden death in athletes, often fueled by the news media, are perhaps disproportionate to its actual numerical impact as a public health problem. Ethical Considerations There is general consensus that within a benevolent society there is a responsibility on the part of physicians to initiate prudent efforts to identify life-threatening diseases in athletes to minimize cardiovascular risk associated with sport. Specifically, there also appears to be an implicit ethical (and possibly legal) obligation on the part of educational institutions (e.g., high schools and colleges) to implement cost-efficient strategies to ensure that their athletes are not subject to unacceptable medical risks. Despite sufficient resources, it is recognized that there may not be a high motivation among professional teams or athletes to implement cardiovascular screening. This may be due to the economic pressures inherent in such a sports environment, for which athletic participation is a vocation and financial remuneration is often substantial. The extent to which preparticipation screening efforts can be supported at any level of competitive athletics is mitigated by cost-efficiency considerations, practical limitations, and the awareness that it is not possible to achieve a zero-risk circumstance in competitive sports(30). Indeed, there is often an implied acceptance of risk on the part of athletes. As a society we permit or condone many athletic activities known to have intrinsic risks that cannot be controlled absolutely-e.g., automobile racing or mountain climbing, as well as more traditional competitive sports such as football, in which the possibility of serious traumatic injury exists. It is important to clearly acknowledge those limitations associated with preparticipation screening in order to 1) inform the public, which might otherwise harbor important misconceptions about the principles and efficacy of athletic screening, and 2) offer appropriate guidance to physicians and healthcare workers responsible for screening. Legal Considerations Although educational institutions and professional sports organizations must use reasonable care in conducting their athletic programs, currently there is no clear legal precedent regarding their duty to require or conduct preparticipation screening of athletes to detect medically significant abnormalities. In the absence of binding requirements established by law or by athletic governing bodies, most institutions and teams rely on their team physician or other medical personnel to determine appropriate medical screening procedures. A physician who has medically cleared an athlete to participate in competitive sports is not necessarily legally liable for an injury or death caused by an undiscovered cardiovascular condition. Malpractice liability for failure to discover a latent asymptomatic cardiovascular condition requires proof that a physician deviated from customary or accepted medical practice in his or her specialty in performing preparticipation screening of athletes and that use of established diagnostic criteria and methods would have disclosed the medical abnormality. The law permits the medical profession to establish the appropriate nature and scope of preparticipation screening of athletes based on its collective medical judgment. This necessarily involves the development of reliable diagnostic procedures in light of cost-benefit and feasibility factors. The current guidelines for cardiovascular preparticipation screening of athletes constitute some evidence of the proper medical standard of care; they will establish the legal standard of care if generally accepted or customarily followed by physicians (47) or relied upon by courts in determining the nature and scope of the legal responsibility borne by sponsors of competitive athletes in determining medical fitness. Current Customary Practice Currently there are no universally accepted standards for the screening of high school and college athletes, nor are there approved certification procedures for healthcare professionals who perform screening examinations. Some form of medical clearance by a physician or other trained healthcare worker, usually consisting of a history and physical examination, appears to be customary for high school athletes. Standards may be mandated by state legislatures or left to the individual state high school athletic associations or school districts. However, there is no uniform agreement among the states as to the precise format of preparticipation medical clearances; in fact, 11 states do not have a standard medical form, and five do not even require an examination. Some forms are specific, whereas others require only the signature of a physician to clear an athlete to compete in organized sports. In a substantial minority of states, nonphysician healthcare workers are allowed to perform preparticipation screening: chiropractors (10 states) and advanced nurse practitioners or physician assistants (with or without physician supervision, 15 states). Appropriate models of the preparticipation examination have been developed by a number of medical organizations and investigators (7,8,14,56). Expectations of Standard Screening Preparticipation screening by history and physical examination alone(without noninvasive testing) is not sufficient to guarantee detection of many critical cardiovascular abnormalities in large populations of young trained athletes. Indeed, hemodynamically significant congenital aortic valve stenosis is probably the lesion most likely to be reliably detected during routine screening because of its characteristically loud heart murmur. Detection of hypertrophic cardiomyopathy by standard screening is unreliable because most patients have the nonobstructive form of this disease, characteristically expressed by only a soft heart murmur or none at all(28,29,34,70). Furthermore, most athletes with hypertrophic cardiomyopathy do not experience syncope or have a family history of premature sudden death due to the disease(35,42). The standard personal history conveys a generally low specificity for detection of many cardiovascular abnormalities that lead to sudden cardiac death in young athletes, particularly those associated with symptoms such as chest pain or impaired consciousness. In older athletes, however, a personal history of coronary risk factors and a family history of premature ischemic heart disease can be useful for identifying those individuals at risk. Effectiveness and Limitations of Noninvasive Screening Tests The addition of noninvasive diagnostic tests to the screening process in young athletes clearly has the potential to enhance detection of certain cardiovascular defects. For example, the two-dimensional echocardiogram is the principal diagnostic tool for clinical recognition of hypertrophic cardiomyopathy, demonstrating otherwise unexplained asymmetric left ventricular wall thickening, the sine qua non of this disease(20,28,29,34,70). Screening for hypertrophic cardiomyopathy with DNA testing for a variety of known mutations in genes encoding proteins of the sarcomere is not yet practical or feasible for large populations, given the substantial genetic heterogeneity of the disease (13,58,68). Echocardiography can also be expected to detect other relevant abnormalities associated with sudden death in young athletes, such as valvular heart disease, aortic root dilatation, and left ventricular dysfunction (with myocarditis and dilated cardiomyopathy). However, even such diagnostic testing cannot itself guarantee identification of all important lesions, and some diseases may not be with any screening For example, identification of many congenital coronary artery usually requires a examination that coronary although in young athletes it is possible with to raise a (or even such as the left main coronary artery from the right sinus of right ventricular usually cannot be reliably with and the available noninvasive for this disease is which is both and not universally available issues are important the feasibility of screening large athletic however, in the vast majority of instances financial and personnel are for such In in which the of testing is the responsibility of such as or professional the are probably ranging from to For example, if the of hypertrophic cardiomyopathy in a young athletic population is to be even at it would to detect even one previously Screening that noninvasive testing at have been described however, these efforts have been in and professional for all but Some investigators have an echocardiogram for population screening, limited to and about such public based on efforts usually cannot be because of for the use of available and are to be on a to provide effective screening of all high school and collegiate athletes. important of screening with two-dimensional is the potential for or may from of for left ventricular wall (or particularly large for that require of a diagnosis the of an and such as hypertrophic cardiomyopathy or other Indeed, such clinical cannot be in some and medical for the and by of the and the for may occur because the of hypertrophic cardiomyopathy may not be or in young athletes (younger than 15 yr) with hypertrophic cardiomyopathy, left ventricular may be or and not diagnostic of that disease The has been as a more practical and cost-efficient to routine for population-based screening Indeed, the is in about of patients with hypertrophic is in other lesions such as coronary and will usually identify the important but long QT However, recent that a certain proportion of in with long QT may have or no on the In preparticipation screening the with the echocardiogram because of its of for recognition of structural cardiovascular The also has a relatively low specificity as a screening in athletic populations because of the high frequency of that are associated with the of an heart to In screening large populations of older trained athletes, routine use of testing to detect coronary artery disease is limited by its low specificity and there have been relatively of cardiovascular screening efforts in large athletic of these have noninvasive testing or limited echocardiogram or in high school or collegiate athletes. The populations have in from to athletes, who usually at In definitive of cardiovascular abnormalities These are with the experience in a systematic for preparticipation evaluation of athletes has been in for more than yr on and Sudden cardiac death in young athletes is a of in the suggest that hypertrophic cardiomyopathy is an important cause of sudden death in young competitive athletes from referral populations with hypertrophic cardiomyopathy have It is possible that this circumstance the limited of certain individuals the and to health care and to athletic screening. Indeed, the that a disease such as hypertrophic cardiomyopathy will be clinically detected may be different and athletes. Sudden death on the athletic field is in young of all such The death may be by participation of different training or cardiac Hypertrophic cardiomyopathy is also commonly recognized clinically in These also suggest the possibility that a of from sudden death is in some to available do not provide a to screening based on or The American Heart Association that some form of preparticipation cardiovascular screening for high school and collegiate athletes is and based on and medical Noninvasive testing can enhance the diagnostic of the standard history and physical however, it is not prudent to routine use of such tests as or testing for detection of cardiovascular disease in large populations of young or older athletes. This is based on both practical and cost-efficiency considerations, given the large number of competitive athletes in the United the relatively low frequency with which the cardiovascular lesions responsible for these deaths and the low of sudden cardiac death in the athletic This however, is not intended to all efforts at population screening that may be by individual there is that the use of noninvasive testing in athletic populations in many among substantial numbers of athletes and their as well as from and athletic Indeed, in such a circumstance with a low of disease in the a great that the number of would exceed that of we that a and personal and family history and physical examination to identify (or raise those cardiovascular lesions known to cause sudden death or disease in young athletes is the available and most practical to screening populations of competitive sports of age. Such cardiovascular screening is an and should be for all athletes. that both a history and a physical examination be participation in organized high school (grades through and collegiate sports. Screening should be In an history should be Indeed, this is with procedures that are customary for most high school and collegiate athletes in the United States. However, it is important to that recommendations or requirements by athletic governing regarding the nature and scope of preparticipation medical evaluations of athletes are not among the states, nor can they necessarily be as medically sufficient in many Therefore, because of this heterogeneity in the design and of preparticipation we also a standard for preparticipation medical to guidelines would have a substantial and impact on the health of athletes by the safety of athletic Despite the limitations of the history and physical examination in coronary artery disease in older athletes 35 a personal history of coronary risk factors or a family history of premature ischemic heart disease may be useful for identifying that disease with screening and should be competitive In it is prudent to perform medically testing in older than (and older than who to in regular physical training and competitive sports if the physician coronary artery disease on the of risk or other than and or but Older athletes should also be about cardiovascular symptoms such as chest These guidelines should not a of on the part of medical practitioners or the general public because the standard history and physical examination the to reliably identify many cardiovascular abnormalities. Indeed, it is an that standard athletic screening can reliably most important cardiac Preparticipation sports are at present by or physicians or healthcare workers with different training and may be associated with or of an school, or we that athletic screening be by a healthcare with the medical and to reliably a cardiovascular perform a physical examination, and heart it is that such an individual be a this may not be and certain it may be for an trained nurse or physician to perform the screening examination. In states in which nonphysician healthcare are to perform preparticipation screening, it will be to establish a certification process to in performing cardiovascular examinations. Specifically, athletic screening evaluations should include a medical history and physical examination, artery This examination should be in an to cardiac in a or as part of a school The evaluation should also certain critical to the detection of cardiovascular diseases known to be associated with or sudden cardiac death in athletes. The cardiovascular history should include to determine 1) of chest or as well as and unexplained of or associated with 2) detection of a heart murmur or systemic and 3) family history of premature death or or significant from cardiovascular disease in younger than yr or of the of certain (e.g., hypertrophic cardiomyopathy, dilated cardiomyopathy, long QT syndrome, Marfan syndrome, or clinically important These recommendations are with the awareness that the of some from young athletes may on their level of and Indeed, should be responsible for the history forms for high school athletes. The cardiovascular physical examination should not necessarily be limited 1) in both the and to in heart with left ventricular 2) of the artery to of the 3) recognition of the physical of Marfan and in the As cardiovascular abnormalities are or the athlete should be to a cardiovascular specialist for further evaluation cardiovascular abnormalities should be with to the 26th Bethesda Conference consensus panel guidelines for the of for athletic competition of sudden cardiac death in young competitive athletes based on systematic of athletes in the United primarily from to left coronary aortic arrhythmogenic right ventricular valve coronary artery hypertrophic from with of the American
Recent studies have shown that reflector surface adaptation can achieve performance characteristics of the order of phase array antennas without their complexity and cost. This study develops a class of antennas capable of variable directivity (beam steering) and power density (beam shaping). The actuation for these antennas is employed by attaching polyvinylidene fluoride (PVDF) film to a metallized Mylar substrate. A voltage drop across the material will cause the material to expand or contract. This movement causes a moment to be developed in the structure which causes the structure to change shape. Several studies of flexible structures with PVDF films have shown that cylindrical antennas can achieve significant deflections and thereby offer beneficial changes to radiation patterns emanating from aperture antennas. In this study, relatively large curved actuators are modelled and a deflection - force relationship is developed. This relationship is then employed in simulations where the far-field radiation patterns of an aperture antenna are manipulated.
The aim of this paper is to contribute to the financial behavioural analysis of Spanish municipalities since the start of the ambitious process of political and economic decentralization linked to the restoration of democracy at the end of the 1970s. Specifically, the author presents financial figures, reviews the characteristics of the local finance system and the evolution of that system through what has been a series of unfinished reforms, and concludes by suggesting some possible corrections to the imperfections, or loose ends, detected.
David Honeyman, James L. Wattenbarger, Kathleen C. Westbrook
Preface - David S Honeyman, James C Wattenbarger, and Kathleen C Westbrook The Financing of Higher Education - David S Honeyman and Megan Bruhn The Value of Investments in Higher Education - Terry G Geske Capturing the Full Returns State Funding Formulas - Mary P McKeown Promise Fulfilled? Accountability and Quality Evaluation in Higher Education - John V Lombardi and Elizabeth D Capaldi Issues in Benefits and Retirements in Higher Education - Jay L Chronister America's Investment in the Research Enterprise - Karen A Holbrook The Academic Niche Responsibility-Centred Management - Edward L Whalen An Approach to Decentralized Financial Operations Funding Public Education with a State Lottery - Susan Robinson Summers Is Education the Winner? Funding for Community Colleges - Dale F Cambell,Karen Sayles, Lynn Leverty Changing Patterns of Support Funding the Multipurpose Community College in an Era of Consolidation - James C Palmer Competition for Limited Resources - Richard L Alfred Realities, Prospects, and Strategies
This report provides a background for the financing of local infrastructure investment in Romania. It summarizes the U.S. Agency for International Development's strategic context, discusses municipal creditworthiness and decentralized creditworthiness, and provides specific findings related to developing a municipal credit facility for Romania.
여러개의 개별 객체를 모아 하나의 새로운 객체를 생성할 때 각 객체별로 사용자의 접근을 제어하거나, 사용자에 따라 접근 정도를 지정할 필요가 있다. 이 때 가능한 한 사용자 입장에서는 투명하게 동작하도록 하여 사용자로 하여금 자신이 사용하는 각 개체에 어느 정도의 접근이 가능한지를 사전에 알지 않아도 되어야 한다. 본 논문에서는 여러 객체가 혼합된 정보를 검색할 때 개별 객체 수준에서 접근을 제어할 수 있는 방법을 제시한다. 또한 공용키 시스템을 사용할 때 발생하는 공용키 인증문제와 여러 가지 암호를 사용할 때 일어나는 불편한 사용자 인터페이스를 해결하기 위해 Zero-Knowledge Proof 방식을 도입하고, 브라우저 중심의 사용자 인증방법을 제시한다.
Much recent North American research has focused on the decline of the central business district (CBD) as the economic core of metropolitan areas, and the corresponding rise of suburban employment centres. According to the literature, this trend is particularly evident in the case of high-order service functions: business services, finance, insurance, and real estate services, and head offices. In this paper, we argue that the decentralization of high-order service activities and the corresponding CBD decline may be neither as strong a trend nor as universal a phenomenon as certain authors have indicated. Rather, the growth of suburban office employment may reflect a strong CBD whose economic base is becoming increasingly specialized. Using data from the Montreal metropolitan area, we first examine intrametropolitan decentralization in a shift-share framework, then document the mobility of establishments and employment. Our findings suggest that, in spite of a certain level of intrametropolitan decentralization, the CBD continues to be the primary locus of high-order services.
Various types of probabilistic proof systems have played a central role in the development of computer science in the last decade. In these notes, we concentrate on three such proof systems -- interactive proofs, zero-knowledge proofs, and probabilistic checkable proofs
Albert Park, Scott Rozelle, Christine Wong, Changqing Ren
Central-local budgetary arrangements have undergone numerous changes since the 1960s as the Chinese government in its quest for modernization has sought to balance the needs of central control and local autonomy. During the reform period, the falling tax share of GNP and a commitment to greater decentralization of the planning system led to major changes in the public finance system that have devolved expenditure responsibilities and financial authority to local governments. Fiscal decentralization has been credited with hardening budget constraints for local publicly controlled enterprises and government agencies. New budgetary relations have instilled fiscal discipline, allowing local governments to disburse more expenditures only if they generated more revenues. These reforms have helped unleash the entrepreneurial spirit of local bureaucrats, fuelling the rapid growth of rural industry.
This paper is intended to analyze, in a comparative perspective, the financing mechanisms of urban local governments in two groups of countries. The first group refers to a sample of OECD countries. They are rather decentralized, and have institutional features which date back many years from now. The scope of responsibilities faced by these countries. The second group is constituted by a number of Latin American countries. They are, in general, less decentralized and have the characteristic of not having a well established institutional structure. This has experienced various changes over the recent years, one of them being a process of transferring responsibilities to local tiers of governments, a tendency which in general, has not been accompanied by an increasing capacity to get resources neither from the central government nor from the local financial market.
This article provides an historical overview of the politicization of sexual harassment and legislative remedy in the United States and Sweden. While the American state formally recognizes the existence of sexual harassment and has taken steps against it, the Swedish state has been reluctant to provide legal remedy. This difference can be attributed to Sweden's centralized state and the strength of labor, which had the organizational capacity to effectively dismiss issues pertaining to women's sexual inequality. By contrast, American women benefitted from an autonomous feminist movement and a decentralized state that proved more permeable to feminist demands. Sweden's lack of legislative recognition of sexual harassment provides one of the most compelling challenges to the conventional characterization of the Swedish state as interventionist, innovative and egalitarian. While Sweden prides itself on the adoption of its most recently revised Equal Opportunities Act (1994), intended to promote equal rights for women with respect to employment, it has failed to mitigate effectively a central condition at work which is highly disadvantageous to women, sexual harassment.
Abstract In the epigraph to this chapter, Shaw registers annoyance at those who assume Eliza will marry Higgins for two reasons. The first is the ending itself: if we consider Eliza’s self-interest and her instincts (Shaw assures us), and if we ask what she might do when faced with the choice between a lifetime of fetching Higgins’s slippers and a lifetime of Freddy fetching hers, “there can be no doubt about the answer.” Given a woman like Eliza who knows what she wants, the sequel is clear and to remove any possible doubts, Shaw spends fourteen pages describing Eliza’s choices, her marriage, her later contacts with Higgins, and the flower stand she eventually opens in Covent Garden. But there is more at stake than simply correcting the record. Shaw’s second reason has to do with what the ending implies: a hand-me-down ending can only come from the ragshop of romance. Pygmalion advertises itself as “A Romance in Five Acts,” according to the subtitle, but does so with typically Shavian irony. The mythical conceit of the title and the dramatic conceit of a play about phonetics make it clear that this is no ordinary romance, and Shaw drives the point home in his epilogue, contrasting the expectations of feeble imaginations with the calculus of benefits in real life. “Complications ensued; but they were economic, not romantic.. . . But when it comes to business, to the life that she really leads as distinguished from the life of dreams and fancies, she likes Freddy and she likes the Colonel; and she does not like Higgins and Mr Doolittle.” The stakes are high indeed. If Shaw cannot convince us of his realistic sequel, he cannot convince us that his play, like all great art (and unlike ordinary romance) is “intensely and deliberately didactic.” The proof of the play is in the ending.
In May 1993 the Grameen Bank in Bangladesh ‐ one of the most successful and internationally best‐known self‐help projects ‐ launched a programme to provide poor people in rural areas with basic health care. The first four medical centres were followed by six more by July 1995. The organization and methods of operation of the Grameen Health Programme are based on the tried and tested self‐help principles underlying the loan programme which has been in operation since 1976. The services offered include medical care at reduced fees and free counselling. Target groups are primarily poor women, to whom the programme's women field workers initially give information on simple preventive measures plus advice on avoidance of unwanted pregnancies. This article presents a provisional evaluation based on two primary inquiries conducted in 1994 and 1995. The overall conclusion was that the health programme has still far to go in order to attain the longer‐term objective of becoming self‐financing. Nevertheless, it demonstrates that decentralized access to health services, and preventive healthcare counselling in particular, can be of real assistance to poor people in rural areas.
Professions in the United Kingdom have been periodically marginalized and their growth suspended, but they have shown considerable capacity to adapt. The evolution of 'new model' professions at the end of the last century and the beginning of the present one, which occurred without governmental regula tion or patronage, was associated with the development of an effective and independent form of occupational organization for professional groups. This organization combines control of the labour market with informal cooperation and control within employing organizations, and is identified as a form of occupational 'double closure'. It is characteristic for occupations organized in this sort of way to become encapsulated groups or quasi organizations within formal organizations. This argument is developed in the body of the paper through a consideration of the contemporary situation of professionals in man ufacturing industry and the public services, where new model professions have established themselves firmly in the present century, and where there are some very similar informal structures. The influence of current social and economic change on these forms of professional organization is then discussed, and it is argued that although they are clearly embattled in some of the areas of their traditional strength, because of their developed organizational attributes, professional groups are likely to persist. Contemporary management of profes sional services is not without difficulty in these circumstances; and, in areas where professions are well-established, re-organization is taking place round encapsulated professional groups rather than by re-constructing them. Despite some superficial similarities, therefore, the management of services is different between traditional professional services and newer commercial ones. More over, if the account of professional self-organization developed here is a reli able guide, in the longer term we may expect it to extend to new services, despite current differences in their organization and forms of managerial control.