Lumu Emmanuel Roy Muyingo A, Brenda Nabachwa B, Faith Mugisha Ahabyoona C
This study evaluates the Parish Development Model (PDM) as a decentralized rural development initiative aimed at enhancing the economic empowerment of coffee smallholder farmers in Hoima District, Uganda. Using a convergent mixed-methods approach, the research integrates Sen’s Capability Approach, Resilience Theory, and Social Capital Theory to examine three dimensions: institutional support, resource capacity building, and community engagement. Quantitative data were collected from 278 farmers through stratified random sampling, while qualitative insights were obtained from 12 key informant interviews and 8 focus group discussions. Findings indicate that while PDM has improved coffee yields by 37% among beneficiaries and strengthened trust in SACCOs with transformational leadership, significant barriers persist, including elite capture, gender-based land tenure disparities, and low uptake of climate-smart practices. Policy recommendations include community-vetted beneficiary selection, gender-responsive governance measures, and climate-resilient financing. The results offer lessons for scalable decentralized development models applicable in ASEAN and other Global South contexts.
BACKGROUND: In the homeless population, barriers to housing and supportive services include a lack of control or access to data. Disparate data formats and storage across multiple organizations hinder up-to-date intersystem access to records and a unified view of an individual's health and documentation history. The utility of blockchain to solve interoperability in health care is supported in recent literature, but the technology has yet to be tested in real-life conditions encompassing the complex regulatory standards in the health sector. OBJECTIVE: This study aimed to test the feasibility and performance of a blockchain system in a homeless community to securely store and share data across a system of providers in the health care ecosystem. METHODS: We performed a series of platform demonstrations and open-ended qualitative feedback interviews to determine the key needs and barriers to user and stakeholder adoption. Account creation and data transactions promoting organizational efficiency and improved health outcomes in this population were tested with homeless users and service providers. RESULTS: Persons experiencing homelessness and care organizations could successfully create accounts, grant and revoke data sharing permissions, and transmit documents across a distributed network of providers. However, there were issues regarding the security of shared data, user experience and adoption, and organizational preparedness for service providers as end users. We tested a set of assumptions related to these problems within the project time frame and contractual obligations with an existing blockchain-based platform. CONCLUSIONS: Blockchain technology provides decentralized data sharing, validation, immutability, traceability, and integration. These core features enable a secure system for the management and distribution of sensitive information. This study presents a concrete evaluation of the effectiveness of blockchain through an existing platform while revealing limitations from the perspectives of user adoption, cost-effectiveness, scalability, and regulatory frameworks.
Chapter 2 situates the book in the context of a rapidly urbanizing India. It describes India’s demographic shift to cities and towns since Independence in 1947 and the concurrent proliferation of slum settlements. The chapter further outlines the formal institutions of governance in India’s post-decentralization cities and the sources of public finance that are used to provide services to slums. It then goes on to delineate the mediated, nonprogrammatic environment in which slum residents seek access to public services. The chapter ends with a description of the organizational structures of the Bharatiya Janata Party (BJP) and Indian National Congress (INC) in Bhopal and Jaipur and how they have percolated neighborhoods.
More than 500,000 people experience homelessness in America each day. Local and federal solutions to the problem have had limited success because of the fragmentation of services and lack of valid and timely information. Billions of dollars spent to provide reliable, timely, and actionable information in health care have exposed the difficulty of establishing such a system using the prevalent information technology solutions. However, relying on successful examples of the use of blockchain to help refugee populations and poor farmers internationally, we have partnered to propose an innovative solution to this problem using the case of people experiencing homelessness in Austin, Texas. This paper aims to describe one of the first applications of blockchain technology for addressing homelessness in the United States by creating a digital identity for people experiencing homelessness and engaging emergency medical services and clinical providers. The authors argue that a lack of documentation to prove personal identity and the inability to access own records are major hurdles for empowering persons experiencing homelessness to be resilient and overcome the life challenges they face. Furthermore, it is argued that this lack of information causes misdiagnosis, duplication, and fragmentation in service delivery, which can be potentially addressed by blockchain technology. Further planning for creating a program on the ground with additional funding will demonstrate the results of using blockchain technology to establish digital identity for persons experiencing homelessness.
The landmark report, Responding to Grief, Trauma, and Distress After a Suicide: U.S. National Guidelines, identifies the suicide bereaved as an underserved population and recommends systematic development of peer grief support to help meet the needs of survivors of suicide loss. A widespread array of peer grief support after suicide (PGSS) services exists nationally, but only as a decentralized network of autonomous programs. Some research indicates that peer support is generally helpful to the suicide bereaved, a finding that is reinforced by a large body of emerging research showing that peer support is effective in mental illness and substance abuse recovery. The practice, study, growth, and refinement of peer support in those fields have generated viable ideas about the elements and principles of effective peer support-for individual practitioners and for programs and organizations-that could be used to guide the systematic implementation of PGSS. In addition, a comprehensive PGSS program (Tragedy Assistance Program for Survivors) that currently serves a large population-survivors of suicide in the military-could be a model for national PGSS systems development. Finally, there are several frameworks for systems development-zero suicide, consumer-operated services, recovery-oriented systems of care, and the consumer action research model-that could guide the expansion and increased effectiveness of PGSS in keeping with the Guidelines' recommendation.
This paper examines the antecedent and contingent causes sparking the Umbrella Movement in Hong Kong. Spurred by two contingent events generating pre-emptive and backlash mobilization, the movement is a spontaneous transformation of the staged Occupy Central campaign. Based on an onsite survey (n = 1681) and in-depth interviews (n = 18), this paper demonstrates how protest experience and social media networked and rallied autonomous individuals from diverse backgrounds to occupy the physical spaces, thereby sustaining a self-mobilized, horizontal and resilient movement. Spontaneity, however, did not come out of nowhere. As an integral part of Hong Kong’s bottom-up activism and ecology, this spontaneous episode encapsulates antecedent events diffusing stalwart actors, decentralized organization and transgressive repertories. This paper situates spontaneity in temporal, spatial and emotional contexts to understand the uncompromising claims and participatory practices of the spectacular occupation.
Jennan A. Phillips, Michael Holland, Debra D. Baldwin, Linda Gifford Meuleveld · 8 authors
Marijuana (cannabis) is the most frequently used illicit drug of abuse in the United States and worldwide. Moreover, it is second only to alcohol as the most prevalent psychoactive substance seen in cases of driving under the influence of drugs.1,2 It is also by a wide margin, the drug most often detected in workplace drug-testing programs. The primary psychoactive substance in marijuana is delta-9-tetrahydrocannabinol, known simply as THC. Present in steadily increasing concentrations in street-purchased, smokeable plant material, the THC content in marijuana averaged 3% in the 1980s, but by 2012 it had increased to 12%.3 The US government classifies marijuana as a Schedule I drug (defined as those drugs with no currently accepted medical use and a high potential for abuse,4 and the use/possession of which is subject to prosecution). Workers covered by federal drug-testing programs are uniformly prohibited from using marijuana at any time. In addition, federal law allows employers in every state to prohibit employees from working while under the influence of marijuana and are permitted to discipline employees who violate this prohibition. Nevertheless, with public attitudes toward marijuana use changing, prohibitions for its consumption outside of federal law now vary from state to state. Although the possession and use of marijuana continue to be prohibited by federal law, numerous states and the District of Columbia currently have enacted laws regarding marijuana use that conflict with federal law and policy,5 with legislation pending in other states.6–8 This changing legal environment and the evolving scientific evidence of its effectiveness for treatment of select health conditions require an assessment of the safety of marijuana use by the American workforce. Although studies have suggested that marijuana may be used with reasonable safety in some controlled environments, there are potential workplace consequences involved in its use that warrant scrutiny and concern. The potential consequences of marijuana use in the workplace include the risk and associated cost of adverse events and the loss of productivity. These safety concerns and the changing legal scene have led the American College of Occupational and Environmental Medicine (ACOEM) and the American Association of Occupational Health Nurses (AAOHN) to develop this guidance document to assist occupational health professionals and employers in identifying and addressing impairment issues related to the use of marijuana and prevention of injuries related to impairment. This guidance summarizes current evidence regarding marijuana consumption, discusses possible side effects including temporary impairment as it relates to the workplace, reviews existing federal and state laws and legal implications for health care professionals and employers, and suggests various strategies available to employers for monitoring workers for marijuana use. It is outside the scope of this article to address any potential medical benefit of marijuana. Studies conducted to evaluate the effects of marijuana drug use by workers have demonstrated variable risk. This variability relates to study design, demographics, work type, and potential confounders (eg, general risk-taking behavior among illicit drug users). This discussion on the effects of marijuana is based on a literature search of the currently available evidence (see the Appendix). Articles were graded using the following criteria: inadequate for evidence due to low-quality research; adequate for evidence (+); or high quality (++). High-quality studies, meta-analyses, or multiple adequate studies with the same conclusion qualified as good evidence for the guidance purposes of this document. Statements referring to evidence without a qualifier reflect the results of an adequate study. Other articles are also cited when appropriate to clarify issues that may not have been addressed by studies qualifying as evidence. LEGAL IMPLICATIONS OF MARIJUANA LEGISLATION In late 2009, the US Department of Justice initiated a change in marijuana enforcement policy by issuing a memorandum encouraging federal prosecutors not to prosecute individuals who distribute marijuana for medical purposes in accordance with state law.9 Nevertheless, after voters in Colorado and Washington approved the recreational use of marijuana, the Department of Justice issued another memorandum in August 2013 that reiterated its right to contest the legality of state marijuana laws, stating that the Department “expects states like Colorado and Washington to create strong, state-based enforcement efforts... and will defer the right to challenge their legalization laws at this time.”10 This discordance about use, regulation, and legislation places employers in the challenging position of maintaining compliance with divergent and evolving legislation, while continuing to provide a safe workplace. Americans with Disabilities Act The Occupational Health and Safety Act of 1970 contains a general duty clause that requires employers under its jurisdiction to, among other things, maintain conditions or adopt practices reasonably necessary and appropriate to protect workers on the job.11 This duty may necessitate exclusion of those who are impaired or potentially impaired because of marijuana use. As long as marijuana is illegal under federal law, employers who fire or refuse to hire employees for using marijuana are not in violation of the Americans with Disabilities Act (ADA) or any other federal antidiscrimination statute, although there are restrictions on drug testing.12 Nevertheless, some states limit employer action against workers who use marijuana according to state standards. If drug testing is done, the decision to test must be job-related and necessary for business, and conducted when there is evidence of a safety or job performance problem. Currently, the ADA does not require employers to permit marijuana use as a reasonable accommodation for an individual with a disability, even if that person is a registered medical marijuana patient. In some states, court rulings involving the use of marijuana for medical purposes have held that employers are under no obligation to accommodate medical marijuana users, regardless of whether or not its use is permitted by state law.13 The basis of the rulings has been that a person “currently engaging in the illegal use of drugs” is not a “qualified individual with a disability,” and marijuana is still an illegal drug for the purposes of federal law. Nevertheless, the ultimate effects of specific state laws on this issue are yet unknown.14 Drug and Alcohol Testing Regulations The majority of private employers across the United States are not necessarily required to drug test, and many state and local governments have statutes that limit or prohibit workplace testing unless required by state or federal regulations due to the nature of the job. Guidance issued by the US Department of Transportation (DOT) for its Drug and Alcohol Testing Regulations state that marijuana use remains unacceptable for any safety-sensitive employee subject to drug testing under DOT regulations.9 This safety-sensitive category includes pilots, bus and truck drivers, locomotive engineers, subway operators, aircraft maintenance personnel, transit fire-armed security personnel, and ship captains, among others.9 Federal agencies conducting drug testing must follow standardized procedures established by the Substance Abuse and Mental Health Services Administration (SAMHSA).15 Private nonunion employers who require drug testing for applicants employees are not required to follow but to the legality of In the of testing programs must be even when federal regulations require Act The Act enacted in to safety and requires federal to that will provide as a of a federal of or a federal of any and for federal are required to good to with workplace The does not require drug but it does require that employers and distribute a policy that will be against employees who violate the and provide in the workplace about the of drug use and available and employee are not required to fire employees on the basis of the results of a drug The Act requires employees to by the of the policy and the employer if are of a drug violation in the The or must be after that a covered employee has been of a drug violation in the who work for federal may be subject to including if marijuana use is regardless of whether its use is permitted by state Federal and Transportation of Marijuana marijuana are also subject to federal and local of marijuana if state with the even if are states that medical marijuana. As the US Transportation Safety Administration federal on marijuana on an is illegal and to federal drug Federal agencies in some also many states and the District of Columbia enacted medical marijuana laws or its use, an legal right to fire or refuse to hire an for an drug test due to medical marijuana use on whether the state of has a medical marijuana law that includes employee states that have medical marijuana not provide for employee although there are as and an and against action at work for registered when a marijuana on or to work and have an employer from against a registered qualifying employee who has a drug test for marijuana or if the employee or impaired by marijuana at the work or if to an employee who a drug test violate a or benefit under federal States that to have laws recreational marijuana not provide for employee Colorado allows employers to prohibit the use of marijuana at Nevertheless, another state law, the statute, employers in this state from employees for engaging in while and legal have with to employees who have been for testing for marijuana, and as of this issue is under by the Colorado state and federal laws legal and in the workplace will Although state laws laws marijuana require employers to permit drug use in the workplace to employees who to work this employers may to that employees to work in an state and not or while and state laws in to permitted use in the workplace, and drug testing be employer with legal to that with any state or local laws and their testing programs to legal of the legal the medical implications of marijuana use for the must be In to the risk of due to employers must also the that in and may as available to In that of workers were in some of illicit drug use the the legalization of marijuana in states, this that of to work after marijuana majority the drug Although this may not reflect the behavior of the US working as a the the for workplace addressing workers who use and marijuana is THC because of across the THC after due to of the substance to the and as as The and associated impairment as of the of when are and THC is the of the THC is by the the psychoactive which in the after the THC and The or and for or even in This is the in workplace drug-testing programs. vary with the and the of marijuana, impairment after and in about and to after studies that impairment in test studies on the of impairment after use were conducted when marijuana had a THC the of study results to is as the of may be studies have demonstrated impairment to to on specific performance but studies are and the studies this used In addition, no of performance impairment associated with every and accepted in the workplace the the use of As impairment studies were also conducted when had a is available It is that impairment may be and with marijuana. The majority of studies of impairment related to driving and to a state to after marijuana among recreational behavior from use and is good evidence that marijuana impairment from THC users, but the to which impairment is in safety-sensitive is This be to the who has at a alcohol a yet is still or are the to and effects are with concentrations and of among marijuana to the nature of or to is also by not for a because the of the and from the the has been The after after is some evidence that with impairment to a of performance study of demonstrated impairment of driving to after of This impairment not with In addition, although a state may have regulations regarding the of THC to be used in it is not this is may have the in The from marijuana use with THC of and of with the effects are of and increased and a of and effects include of impaired and in and and These effects are by of a in and increased and study that and to were the most related to marijuana of are used by drug law enforcement who of Marijuana Although studies that impairment in the workplace due to marijuana are now to numerous studies using driving and impairment of the necessary for safe of a by use have been of the regarding impairment and risk in the workplace due to alcohol has been from studies of driving impairment and same of studies be used to impairment in the workplace from studies have been to the of driving impairment in to the of THC in or studies of risk associated with use to impairment in because some of studies used the of the as evidence of drug use. In addition, many potentially had for THC after and even from the of the and of THC from the studies and of studies, including driving and that and related to driving performance were impaired in a with increasing THC is good evidence from a and the following and driving studies that marijuana of and and to on from studies of risk have that when marijuana in were to be at and there a with THC concentrations to be for the Studies have that while using individuals impaired performance in driving and In the driving studies, the were in to and maintain and and on for a study of from in an increased for a from for THC to for THC or studies have that with a test were to to be involved in a without In a study of effects of marijuana, that any of the psychoactive associated with the impairment of the to with a of THC and concentrations study that under THC a of to established and of THC to were of study that impaired on THC drivers, and those with of THC were at increased risk of In there is good evidence from a of studies and a that of an of to for and to for marijuana impairment to a of on a of of THC be used as with other medical of impairment from marijuana. The also be and it may provide regarding impairment. Nevertheless, as the of THC and to use as a for impairment is not known at this the the for to impairment and to this impairment to may to use the of THC and to impairment because is to THC. are to impairment by some performance and effects at most of a for allows some for of the in effects to a of or using the seen in the impairment studies the current of alcohol impairment for safety-sensitive workers under federal testing laws this may be used to an of the of this THC and may not impairment in an individual This be only when a medical for impairment has been in with of the which led to the for the basis of the the is a of THC of to impairment. The that there are states using for driving under the influence of drugs (eg, Colorado and Washington use in to in of THC and as a for driving under the influence when by behavior states address marijuana and of have for any of It is the of the that a of be used to a safe workplace Marijuana a is of impaired by marijuana use, and of impairment must be in and of that for testing be This is the same policy as that used for in drug-testing programs. impairment is employees are for alcohol and drug drug testing for marijuana by testing the which be for after use, and has no with impairment. This testing is for programs and in marijuana use is illegal or prohibited by the Nevertheless, a drug test use is not evidence of impairment. Although this use is still prohibited under this not be reasonable or in employer drug testing programs in states with recreational use. to prohibit the use of marijuana in states it is legal with regarding this of THC in the of recreational after legal use of marijuana be to in the of a of results impairment or violation of a law in states marijuana is this in states marijuana use, workplace drug testing of impaired employees be Although alcohol be used to alcohol psychoactive THC be detected in the same and currently requires a It is suggested that the employee of impaired be as the suggests that employers include an of the impaired employee at an occupational in The include a to the or of a alcohol test, and a drug for marijuana, a test for the and evaluate potential impairment from use. The employee be on results established If THC THC for employers who to evaluate psychoactive are a of the employee is impaired by use. THC be in of impairment by a demonstrated on a medical also be Testing of that may in the as a to whether testing is MARIJUANA LEGAL who to be impaired in the workplace be according to employer of THC not with impairment. include an of impairment. The of on impairment includes for the of of and other who to or are required to use of medical recreational marijuana with state law must risk of impairment from marijuana use, for those employees in safety-sensitive The following be medical and other occupational health professionals be with legal in about policy or individual use of marijuana. regarding testing for and possible impairment be and to are for and employees the implications of the results for their based on the policy and for marijuana and other drug use. statutes provide when a is under the influence of alcohol or illegal of use impairment may be necessary in The occupational health for a medical of for duty and on the for which use of medical marijuana be It is for medical to of state for medical the of use to working used (eg, plant material, the for any the job and of use. The occupational health work with to risk based on the safety-sensitive nature of the job. of workplace safety in the of the medical for which marijuana has been may also be who are in federal workplace drug testing programs are prohibited from on state law as a for marijuana or other Schedule I substance Nevertheless, employers be that the and Drug Administration is a Schedule is not a prohibited substance although it may a safety in some Other may be in the are available in other OF Occupational Safety and Health Administration employers have a federal to address impaired workers who to work The for employers is to with a policy regarding use and substance policy includes for and workplace drug assessment workplace drug assessment be based on a the and the employer regarding established by the is a who is by an approved by the US Department of Health and The of the with the and of results test those a test is for the the to about the the used marijuana or a If the use or states that it in the the will about as If that drug has been the this the for of the the the test as for THC whether or not the In the of a test for marijuana in an individual who is a registered medical marijuana the this as a test to the is to the employer to the if under policy and state law. If the test is in the environment (eg, DOT the individual must be from safety-sensitive as driving a In the of an the individual must not be on safety-sensitive in the testing employers in most states may to the registered medical marijuana with a test to that of a recreational legal or The employer and the be in their regulations to for the registered medical marijuana patient. In states this has been the have for the most in of the right to maintain a workplace and medical marijuana with a marijuana test, whether or not use or Although no federal laws prohibit states have laws that limit drug testing for workers in Drug testing is also prohibited in some unless there is reasonable the is impaired and to job workplace that on the of specific individual influence or impairment a specific drug test in may provide a private employer with The of a workplace is a impairment policy that be and by the in with the health and and occupational health also programs to employee including those related to substance without an are also required to follow federal regarding substance The and and DOT regulations drug and alcohol impairment in the workplace at the federal The have a to that and programs are with regulations from Drug and alcohol or impairment programs are not required for every Nevertheless, some state and federal regulations require programs in specific that employee drug testing and in some health care and also require workplace drug regulations drug-testing In the private state laws drug testing for employees or after hire may from nonunion federal regulations require their use, workplace on drug testing must be in and even if of the policy must be laws for medical and recreational marijuana use employers legal when the workplace policy specific to medical marijuana use by employees the work and the job. Although every policy must be to regulations to the specific workplace, employers use the following content as a for workplace for medical marijuana and other of the employees covered by the when the policy prohibited whether employees are required to their of medical marijuana or whether the policy and of the search and of job for work for drug testing with from the consequences for policy whether are after an related to substance to protect employee for policy to policy to occupational health when and and their and is available to substance use or with legal when regarding employee use of medical marijuana. employees in safety-sensitive have been held to regarding use. a reasonable basis for employers to or medical marijuana use by states have the right to employees who were using medical marijuana in accordance with state even if were not using it at the workplace. Nevertheless, currently of simply for the medical use of marijuana. The of legal cases will be in and is is whether the ADA may have implications for medical treatment with marijuana. use of marijuana another issue as some states have laws that protect employees from when in legal outside the workplace the for a policy and medical assessment of employees who to be impaired at the workplace be are often in a position to accommodate state laws that the use of marijuana for medical purposes while federal or based on federal law. workplace safety as as compliance with state and federal legislation, employers state laws on against marijuana and that enacted are with the antidiscrimination Although it that in most states that medical marijuana use, employers continue or the use of marijuana, this may change on the basis of court The that marijuana use be for employees in safety-sensitive whether or not covered by federal drug-testing employers marijuana use at in compliance with state laws, may to simply prohibit their employees from working while using or impaired by marijuana. In some states, employers may to prohibit marijuana use by of their whether on or Nevertheless, in a policy to on when marijuana use is and to evaluate for impairment must be and to policy and is to compliance with and law. and drug-testing regarding impairment and marijuana use outside of work for use by and when referring employees of impairment for an by a qualified occupational health are based on the medical results must also be for and The that employers the following when workplace that address marijuana use in the employees covered by federal drug testing regulations (eg, DOT and other workers under federal marijuana use, on or the is employers may use drug in this in safety-sensitive must not be impaired at work by any whether it be or available may on the job marijuana use for employees in safety-sensitive even when not covered by federal drug testing Nevertheless, legal of the policy in the of state statutes is employers medical marijuana use by with a qualified occupational health is in or states that the use of recreational marijuana must a policy regarding use of marijuana. In many states, the employer may to prohibit employees from simply working while using or under the influence of marijuana or may to prohibit marijuana use on and the job. drug testing or testing at any be reasonable for the employer to and use. a limit of of THC in or as THC the of THC for employers who to evaluate psychoactive the of identifying individuals most to be Nevertheless, employers using the to the of using a to a medical on identifying impairment is is Although it that in most states that the use of medical marijuana, employers may be to continue or the use of marijuana as this may change on the basis of law. the ADA does not in because marijuana is illegal under federal law. is statutes when a is under the influence of alcohol or illegal be as a second test may be of use impairment is required for and a drug test the does not impairment. The of be used for evidence of impairment in is most in of cases because legal may be employers have and procedures for to follow regarding the for identifying potential impairment and the for referring an employee of impairment for an occupational medical include action required by based on the results of the is to compliance with is at hire and at Workers must the substance policy and for The to a workplace and existing policy will influence the a employees their and job and employees also be about to of whether the is medical marijuana, illegal or any In states marijuana use is employers provide regarding the effects of marijuana use, including regarding and effects of This may be from and state The safety of workers and the public must be to workplace and employers must that legalization of marijuana for recreational or medical use does not workplace for safe job The evolving legal on medical and recreational marijuana requires employers to with legal to policy and clarify implications of impaired This changing environment marijuana use requires employers, occupational health and legal to that workplace safety is not The the following for their and
This article presents a conceptual framework for analyzing societal responses to women battering in Israel. The model of policy analysis consisted of three specific dimensions namely: 1) descriptive-operational; 2) analytic interpretive; and 3) chronological. Allocation provision delivery and financing of interventions with the abused Israeli women and their families were conducted from 1986 to 1988 through telephone surveys. Data indicate that due to strong religious influences on family life and political factors poor services were provided to abused women. The influence of social welfare in response to women battering were as follows: 1) intervention in woman battering was specific rather than universal; 2) services have been decentralized since their inception; and 3) intervention has been influenced by a collectivist residential orientation to welfare services. Furthermore government agencies and nongovernmental agencies provide only limited services for physically abused women.
:The development and spread of Acquired Immunodeficiency Syndrome (AIDS) in American urban areas is challenging established policy making structures and patterns in a variety of ways. AIDS is forcing urban policymakers to engage in unusual efforts at large and nonincremental change while possessing relatively little understanding of the ultimate nature and course of the disease. A variety of uncertainties exist, involving the future scope and development of AIDS, current and future treatment costs, legal and administrative responsibilities, workplace concerns, education efforts, financing methods, and political effects. As a consequence, those making AIDS policy must rely upon what Jones (1984) terms ambitious decisionmaking styles. Successful control of AIDS will require decentralized policymaking centered on experimental efforts in each urban area confronted with the disease. Given the wide range of uncertainties regarding the nature of AIDS and effective policy measures, it is unlikely that a truly national AIDS policy will be established in the immediate future.