Legal Imperatives Research Articles

Tailored educational intervention for primary care to improve the management of dementia: the EVIDEM-ED cluster randomized controlled trial.

BackgroundEarly diagnosis of dementia is important because this allows those with dementia and their families to engage support and plan ahead. However, dementia remains underdetected and suboptimally managed in general practice. Our objective was to test the effect of a workplace-based tailored educational intervention developed for general practice on the clinical management of people with dementia.MethodsThe tailored educational intervention was tested in an unblinded cluster randomized controlled trial with a pre/post-intervention design, with two arms: usual/normal care control versus educational intervention. The primary outcome measure was an increase in the proportion of patients with dementia who received at least two documented dementia-specific management reviews per year. Case identification was a secondary outcome measure.Results23 practices in South-East England participated. A total of 1,072 patients with dementia (intervention: 512, control: 560) had information in their medical records showing the number of reviews within 12 months (or a proportion of) before intervention or randomization and within 12 months (or a proportion of) after. The mean total number of dementia management reviews after the educational intervention for people with dementia was 0.89 (SD 1.09; minimum 0; median 1; maximum 8) compared with 0.89 (SD 0.92; minimum 0; median 1; maximum 4) before intervention. In the control group prior to randomization the mean total number of dementia management reviews was 1.66 (SD 1.87; minimum 0; median 1; maximum 12) and in the period after randomization it was 1.56 (SD 1.79; minimum 0; median 1; maximum 11). Case detection rates were unaffected. The estimated incidence rate ratio for intervention versus control group was 1.03 (P = 0.927, 95% CI 0.57 to 1.86).ConclusionsThe trial was timely, coinciding with financial incentives for dementia management in general practice (through the Quality Outcomes Framework); legal imperatives (in the form of the Mental Capacity Act 2005); policy pressure (The National Dementia Strategy 2009); and new resources (such as dementia advisors) that increased the salience of dementia for general practitioners. Despite this the intervention did not alter the documentation of clinical management of patients with dementia in volunteer practices, nor did it increase case identification.Trial registrationNCT00866099/Clinical Trials

Sex Reassignment Technology: The Dilemma of Transsexuals in Islam and Christianity

The birth of people with confused or ambiguous sex makeup as a biological fact since the annals of history has posed the challenge of accommodating them within the binary gender of sociocultural systems. In this process, the role of religion as a defining factor in social engineering has been paramount. Major religions, such as Islam and Christianity, have addressed this issue within the frame of their God-ordained laws by devising a set of moral and legal imperatives specific to the "third gender." Modern developments in medicine and biology, however, have made sex reassignment possible for this category of people, today called transsexuals. The question is: How do Islam and Christianity respond to it. After presenting an analytical view of both Muslim scholars and Christian religious authorities on the legitimacy of sex reassignment for transsexuals, this paper attempts to explore if such a dilemma can be resolved.

Radio and the consolidation of Portuguese identity: a critical assessment of compliance monitoring by the ERC

The promotion of Portuguese language and culture through radio broadcasters is one of the statutory requirements established by law. Considering that the state media regulatory body (Entidade Reguladora para a Comunicação Social - ERC) is responsible for regulating and monitoring media activity in Portugal, it shall verify compliance with these rules which are postulated by a system of quotas for the Portuguese music broadcasting. We consider this system an essential starting point in order to assess the quest for the Portuguese identity and consolidation through radio. This assessment is based on a certain understanding of language: a legalistic approach derived from the wording of the law that foresees language as a crucial element for the definition of a so-called Portuguese identity and as a constitutive premise of a cultural pattern. 
 Bearing in mind the legal framework for the radio and for the regulatory body, we scrutinize broadcasters’ performance according to the established system of quotas through the analysis of the regulatory body’s findings stated in the ERC’s 2009 Report of Regulation.
 This article deconstructs the significance of the system of quotas for the Portuguese music broadcasting considering a regulatory approach on behalf of legal imperatives in terms of identity, language and culture promotion, trying to answer some questions: What are radio broadcasters expected to do? What legal imperatives do they have to follow? Do they actually comply with them? What kind of intervention does the Portuguese regulatory body develop in this matter?

Mahagében KFT & Péter Dávid: Re-Directing the EU VAT's Perfect Storm

On June 21, 2012 the Court of Justice of the European Union (CJEU) rendered judgment on two Hungarian references, Mahageben kft v. Nemzeti Ado-es Vamhivatal Del-dunantuli Regionalis Ado Folgazgatosaga and Peter David v. Nemzeti Ado-es Vamhivatal Del-dunantuli Regionalis Ado Folgazgatosaga (Mahageben/David). The Mahageben/David decisions clarify the CJEU’s earlier holdings in the joined cases of Alex Kittel v. Belgium and Belgium v. Recolta Recycling SPRL (Kittel/Recolta). Kittel/Recolta is a critically important decision. It is central to the EU’s anti-fraud effort. It is one of three legal imperatives that earlier this year appeared to be coalescing into a Perfect (enforcement) Storm. After Mahageben/David the Perfect Storm needs to be re-assessed, because Mahageben/David limits Kittel/Recolta in some respects, while it broadly re-affirms it in others. This paper examines the relationship between Mahageben/David and Kittel/Recolta and then updates the analysis of the Perfect Storm. Kittel/Recolta stands for the proposition that a trader who enters into a transaction knowing or having the means to know that by doing so he is a participant in fraud, forfeits the right to deduct input tax incurred on purchases that were related to the fraud. Both the standards that are applied (the “known/should have known” formulation) and the scope of its application have been debated. Mahageben/David largely resolves these debates. First, in terms of the Kittel/Recolta standards the CJEU has told the legal community that it will translate the expression aurait du savoir (should have known in the official English translation of Kittel/Recolta) as ought to have known. The narrower definitions that have been argued for will not be used. Secondly, in terms of the scope of Kittel/Recolta, the CJEU has indicated that Kittel/Recolta is not limited to privity relationships, and it is applicable throughout the supply chain (but not at all in the customer chain). The consequence is that the Perfect Storm needs to be modified by removing Stage 2, and Hypo III. These no longer apply because they are dealing with fraud in the customer chain.

Legal imperatives for consent for children participating in research

Legal imperatives for consent for children participating in research

Entertaining Children: an Exploration of the Business and Politics of Childhood

This article explores the conflict between the constructions of childhood and their political/legal implications in the context of the entertainment business, as related to the demands imposed upon children by parents and theatre managers in the late nineteenth and early twentieth centuries. Once children could move freely both within and between countries, these conflicts and concerns assumed a global dimension. Through a number of case studies, the authors offer some fresh observations about how legal and social imperatives affected the transmission of values about children employed as entertainers between Britain and Australasia during the period from 1870 to the start of the First World War – from the Education Acts of the 1870s to the legislation of 1910–1913 restricting the export of child entertainers. Gillian Arrighi is a Lecturer in Drama at the University of Newcastle, Australia. She has recently published articles in Theatre Journal (Dec 2008), Australasian Drama Studies (April 2009 and Oct 2010), and in Impact of the Modern: Vernacular Modernities in Australia 1870s–1960s (Sydney, 2008). She is associate editor of the e-journal Popular Entertainment Studies. Victor Emeljanow is Emeritus Professor of Drama at the University of Newcastle, Australia, and General Editor of the e-journal Popular Entertainment Studies. He has published widely on subjects ranging from the reception of Chekhov in Britain and the career of Theodore Kommisarjevsky, to Victorian popular dramatists. He co-wrote with Jim Davis the award-winning Reflecting the Audience: London Theatregoing 1840–1880 in 2001, and his chapter on staging the pirate in the nineteenth century was included in Swashbucklers and Swindlers: Pirates and Mutineers in Nineteenth-Century Literature and Culture, edited by Grace Moore (2011).

Is the Legalization of Human Rights Really the Problem? Genocide in the Guatemalan Historical Clarification Commission

At the same time as the globalization of human rights increased in pace and scope after the Cold War, there has been a growing sense of the shortcomings of human rights for addressing legacies of mass atrocities. Critics have noted how human rights commissions have often failed to document past violence adequately, and how establishing fundamental human rights in new constitutions has done little to address the pressing socio-economic needs of the population. In analyzing why this is often the case, some observers have pointed to the legal character of human rights as the main source of their inadequacy. The legalization of human rights, understood as the positivization of norms in international conventions and tribunals, national constitutions and domestic courts, exacerbates the tendency of human rights to overlook the wider political, social and cultural contexts that generate mass violations. This seems to be one of the most severe criticisms of human rights; they operate without sufficient awareness and understanding of the macro-historical context (e.g. apartheid, the Cold War, economic inequality) in which mass violations occur. Since they hold no theory of why violations happen in the first place, human rights institutions are powerless to prevent them in the future. In this chapter, I argue that the problem is not the legalizing of human rights, in and of itself. The application of legal norms in historical investigation can be beneficial, depending on the kind of legal categories being employed. In the case of the Guatemalan Historical Clarification Commission, the rigorous legalization of norms on genocide in the last 10 years has led to some favorable outcomes, including obliging human rights institutions to develop an explanation for why violence occurs in particular societies. So it is not ‘legalization’ that matters, but how that legalization unfolds. Some aspects of the legalization of human rights are indeed detrimental to a full account of how and why human rights violations occurred and how victims experienced these abuses. The creation of new human rights institutions employing the category of genocide has also led to an in-depth exploration of the collective and systematic nature of violence, and the shared intentionality of actors. As in the case of Guatemala, the category of genocide can lead to a fuller and more contextual account which draws in questions of racism, material inequalities and US foreign policy. If this argument is correct, then it might be more constructive for scholarly commentators to dedicate more energy to influencing and channeling the process of legalization in a direction which encompasses both the legal imperatives and the moral dimensions of human rights.

Distribution and availability of trace elements in municipal solid waste composts

Trace element contamination is one of the main problems linked to the quality of compost, especially when it is produced from urban wastes, which can lead to high levels of some potentially toxic elements such as Cu, Pb or Zn. In this work, the distribution and bioavailability of five elements (Cu, Zn, Pb, Cr and Ni) were studied in five Spanish composts obtained from different feedstocks (municipal solid waste, garden trimmings, sewage sludge and mixed manure). The five composts showed high total concentrations of these elements, which in some cases limited their commercialization due to legal imperatives. First, a physical fractionation of the composts was performed, and the five elements were determined in each size fraction. Their availability was assessed by several methods of extraction (water, CaCl(2)-DTPA, the PBET extract, the TCLP extract, and sodium pyrophosphate), and their chemical distribution was assessed using the BCR sequential extraction procedure. The results showed that the finer fractions were enriched with the elements studied, and that Cu, Pb and Zn were the most potentially problematic ones, due to both their high total concentrations and availability. The partition into the BCR fractions was different for each element, but the differences between composts were scarce. Pb was evenly distributed among the four fractions defined in the BCR (soluble, oxidizable, reducible and residual); Cu was mainly found in the oxidizable fraction, linked to organic matter, and Zn was mainly associated to the reducible fraction (iron oxides), while Ni and Cr were mainly present almost exclusively in the residual fraction. It was not possible to establish a univocal relation between trace elements availability and their BCR fractionation. Given the differences existing for the availability and distribution of these elements, which not always were related to their total concentrations, we think that legal limits should consider availability, in order to achieve a more realistic assessment of the risks linked to compost use.

'Never heard of it'- understanding the public's lack of awareness of a new electronic patient record.

The introduction of electronic patient records that are accessible by multiple providers raises security issues and requires informed consent - or at the very least, an opportunity to opt out. Introduction of the Summary Care Record (SCR) (a centrally stored electronic summary of a patient's medical record) in pilot sites in the UK was associated with low awareness, despite an intensive public information programme that included letters, posters, leaflets, and road shows. To understand why the public information programme had limited impact and to learn lessons for future programmes. Linguistic and communications analysis of components of the programme, contextualized within a wider mixed-method case study of the introduction of the SCR in pilot sites. Theoretical insights from linguistics and communication studies were applied. The context of the SCR pilots and the linked information programme created inherent challenges which were partially but not fully overcome by the efforts of campaigners. Much effort was put into designing the content of a mail merge letter, but less attention was given to its novelty, linguistic style, and rhetorical appeal. Many recipients viewed this letter as junk mail or propaganda and discarded it unread. Other components of the information programme were characterized by low visibility, partly because only restricted areas were participating in the pilot. Relatively little use was made of interpersonal communication channels. Despite ethical and legal imperatives, informed consent for the introduction of shared electronic records may be difficult to achieve through public information campaigns. Success may be more likely if established principles of effective mass and interpersonal communication are applied.

The Reimbursement Gap

A number of medical, ethical, and legal obligations compel physicians to provide procedural sedation and analgesia (PSA) to pediatric patients requiring painful procedures in the emergency department (ED). Recognizing the additional demands that PSA places on ED physicians, the American Medical Association has approved Current Procedural Terminology codes for PSA in conjunction with ED procedures. However, some insurers have indicated reluctance or refusal to pay for PSA in the ED, despite these Current Procedural Terminology codes and the legal and ethical imperatives. This reimbursement gap between an obligation to provide care and an inability to obtain reimbursement from insurers places ED physicians who care for children in an awkward position. This article reviews physicians' legal and ethical obligations to provide PSA to pediatric patients in the ED, assesses health insurers' obligations to pay for this procedure, and examines insurers' policies and practices. We found significant variability among private and public insurers in their willingness to pay for PSA. Emergency department PSA charges at one tertiary care pediatric center are reimbursed at less than half the rate of other ED services. Although existing state laws and federal regulations arguably require that insurers provide reimbursement for pediatric PSA, certain legislative and regulatory initiatives could clarify insurers' payment obligations.

Sex, Gender and Cultural Intelligence in the Canadian Forces

Cultural awareness, along with the capacity to effectively develop and apply cultural knowledge, has become critical for military leaders. Based on a multi-dimensional model of cultural intelligence and a review of selected aspects of the Canadian Forces' (CF) experience with gender integration, this paper highlights implications for the development of culturally intelligent military leaders and teams. The gendered evolution of the CF in recent decades has been critical in preparing the CF for the complexity of challenges that it faces today. In spite of progress, significant resistance to expanded roles for women has been based upon the assumption that gender is a dichotomous biologically determined construct. On the other hand, the institutional discourse that has developed in the face of legal imperatives permitting women to join the combat arms since 1989 claims that the CF is gender neutral. The analysis presented in this paper suggests that such limited constructs of gender act to reduce the capacity of the CF to develop cultural intelligence, a critical contributor to mission success, among male and female members.

From a seed to a forest: Microdata access at Statistics Canada

Informed decision making on social issues requires current, comprehensive and very well-targeted research. Societies face two primary challenges in order to respond to this need for timely information – access to relevant data and a corps of qualified researchers to conduct the analyses. As part of a response to the challenges that confront Canadian policy research, Statistics Canada established the Microdata Access Division. The mandate of the Division is to manage and provide access services to data that are generally classified as restricted and to do so while respecting the legal and ethical imperatives that govern such access. This article describes Statistics Canada’s approach to providing access while managing disclosure risk.

Imaging May Delay Transfer of Rural Trauma Victims: A Survey of Referring Physicians

Delayed transfer to a trauma center due to unnecessary imaging results in suboptimal patient outcome and increases healthcare costs. Unnecessary imaging may result from beliefs regarding trauma center requirements and legal concerns. We hypothesized that referring physicians consider factors other than clinical criteria when deciding to order imaging studies before transfer of trauma patients. A mail survey of 218 referring physicians to a level I trauma center elicited factors affecting decision to obtain imaging studies before transfer. Graded answers to six questions were obtained and demographics of the physician respondent. Statistical analysis was performed using Fisher's exact test. One hundred forty-nine of 218 surveys were returned (68.3%). One-third (33.1%) of respondents obtain imaging because of perceived expectations of the receiving trauma center, independent of patient acuity. Twenty percent incorrectly think that the law prohibits transfer before patients are stabilized. Twenty-eight percent obtain imaging because of liability concerns, even if that imaging delays transfer. Overall, 45% obtain imaging for either perceived requirement or liability concern. Non-advanced trauma life support (ATLS)-certified physicians are more likely to use all available resources before transfer than ATLS-certified physicians. Factors other than patient care dictate imaging acquisition in almost half of those surveyed. Misperception of expectations, misunderstanding of legal imperatives, and liability concerns all delay transport of the injured. ATLS-certified individuals use imaging more appropriately, thus, promoting more timely transfer. State-wide protocols, education, and liability reform may reduce transport delays.

Difficult Reputations and the Social Reality of Occupational Medicine

This response to Tee Guidotti's (2008) critique of Elaine Draper's 'The Company Doctor: Risk, Responsibility, and Corporate Professionalism' (2003) argues that a forthright examination of the conflicts of those working in the field of occupational medicine is essential to maintaining the health of the profession and to promoting constructive policies. Research for 'The Company Doctor' reveals how doctors walk a tightrope of professional demands on them. The author describes how corporate employment affects medicine and science and how professionals working in corporations are subject to the decisions of company managers and to economic and legal imperatives stemming from their status as corporate employees. Analyzing company doctors' role in confronting toxics and responding to liability fears in corporations, the author argues that problems of lost credibility, stigmatization, and tarnished reputation that company doctors describe largely stem from the organizational constraints, economic interests, and other aspects of the social context of their work. These social forces exert powerful pressure on the ethical framework and daily work lives of these professionals as well as on the reputation of their field. The author discusses ways in which the conflicting demands from being both a corporate employee and a physician are a social and structural problem beyond individual ethics.

Trends in Australian rehabilitation: Reviving its humanitarian core

Purpose. This paper discusses how vocational rehabilitation (VR) in Australia has been captured by economic concerns, leading to its failure to deliver promised outcomes. Both public and private sector VR in Australia have undergone significant changes over the last two decades. The demise of non-profit and socially-based rehabilitation in favour of fixed funding models (e.g., managed care or case-base funding), coupled with the growing emphasis on cost containment has placed many VR providers in an unfamiliar environment dominated by bureaucratic, legal, economic and political imperatives. Although it was expected that VR would address rising injury costs, its inability to do so has jeopardized its existence.Conclusion. Ironically, it is economic imperatives that are now prompting the re-invention of old concepts that appear to offer the same cost-containment possibilities rehabilitation offered in the 1990s. The most significant among these trends are self-management, coordinated care, community rehabilitation and welfare-to-work incentives. Perhaps the major challenge now, however, is to define a new dimension for rehabilitation and capture the essence of these trends to ensure that they contribute to a possible revival of a model of VR that focuses on the client's broad social context and responds to client-centred goals.

Who Wins in the Status Games? Violence, Sexual Violence, and an Emerging Single Standard among Adolescent Women

Throughout U.S. history, women have changed their sexual behaviors in response to, or as actors affecting, economic, political, and legal imperatives; to preserve health; to promote new relationship, identity or career paths; to assert a set of values; as a result of new reproductive technologies; or to gain status. In adjusting to pressures or goals, women have not always acted, or been able to act, in the interests of their own health, identity, or status. As this article will demonstrate, women, in the short or long run, may attempt to preserve status at the cost of other values such as health. This may occur through conscious and critical choice or through less conscious processes in reaction to relatively larger forces whose impact has not been critically analyzed. With the awareness in the 1980s in the United States of an emergent and incurable sexually transmissible infection, HIV, it would have been anticipated that a new sexual caution may have appeared. Yet, across several research projects in the late 1990s and into the 21st century, as our research team interviewed youth in a high HIV seroprevalence neighborhood in New York City about HIV prevention, we began to hear that a substantial minority of young women and men were participating in social settings for sexual behavior that (1) put youth at risk for HIV; (2) appeared to be motivated by acquisition of status ("props," "points"); and (3) offered few ways for women to win in these status games. We estimate from one random dwelling unit sample that about one in eight youth have been present in these settings and half of them have participated in risky sexual behavior in such settings. The settings are often characterized by men's publicly offhand attitudes toward sexual encounters, are organized around men's status maintenance, and evidence peer pressures that are poorly understood by both young men and women participants. To regain status, some women participants have adopted attitudes more characteristic of men.

Editor's Choice: Sexual Harassment Education on Campus: Communication Using Media

Sexual harassment is a pervasive problem on our nation's college and university campuses, one that can have devastating results. Educational institutions had been shielded from liability for sexual harassment until the late 1990s, when two landmark Supreme Court decisions set forth a new standard for liability of institutions where students are harassed. This shift in law, plus recent legal imperatives indicating that training is an important prevention tool, has encouraged institutions to strengthen their anti-harassment training. This article discusses the educational program at Hostos Community College, a program that utilizes a multimedia approach coupled with discussion. This blended approach successfully meets both the current legal prevention requirements and satisfies the needs of a complex environment of a metropolitan college.

Integrating DAM with DRM: Imperatives and opportunities for digital content lifecycles

One of the most important elements of complexity in content processes is content rights. The processes of managing access to content based on rights information are increasingly necessary nowadays due to various business imperatives. Adding persistent protection to content is the most effective way to control and track access. In this paper, after a brief introduction to digital rights management terms, we explore many of the business and legal imperatives which have led to content processes that are more complex from a rights perspective. Then we discuss some of the ways in which content-handling systems should integrate rights information in order to provide more complete solutions to digital asset management and distribution problems, at lower costs and with faster, lower-risk deployments. We conclude by explaining how adoption of a standard Rights Expression Language goes a long way towards ensuring that integration of content-processing systems through rights information is seamless, predictable and cost-effective for all types of content producing organizations.

The Nature of the International Intellectual Property System: Universal Norms and Values or Western Chauvinism?

Membership and participation in the multilateral trade system is now premised on adoption of the TRIPs Agreement which has in effect internationalised intellectual property (IP) law. This has highlighted the problematic nature of IP as a legal transplant that, it is argued, lies in its domestication of norms and values that are fundamentally irreconcilable or irrelevant in their transposed context. The preferential shift towards knowledge-based economic systematisation in which IP rights play a crucial role has propelled information and communication technologies (ICTs) as the vanguard for economic growth. The gap in terms of economic development between developed and less developed countries is ascribed to how fully they have exploited and utilised ICT. The discourse is replete with rhetoric of a ‘digital divide’ or ‘knowledge gap’ manifesting a cyber-age reincarnate of fossilised stereotypes embedded in the construction of ‘otherness’. The rapidity with which technology and the information superhighway operate has contributed to the predominance of Occidental legal and commercial imperatives implicit in the conception of IP. The far-reaching effects of IP law have entrenched the misappropriation of indigenous knowledge and culture, and pose a danger to the wellbeing of the vast majority of people in developing countries. Developing countries and indigenous communities have sometimes resorted to human rights to avert these threats. The chauvinism typified in the formulation of IP treaties and some judicial decisions involving claims to customary rights of ownership, lays claim to an unqualified morality and indisputable sagacity embodied in the norms and values intrinsic to the Western and (increasingly) multilateral model of IP, and the attendant universalism with which they are advocated. It is postulated that there can be no valid claim to universalism. The multilateral international IP regime is a negotiated compromise between original stakeholders with a background that recognises the peculiarities of the law in their respective countries. Furthermore, the violence and nature of law by which distinction and definition is constituted by purported difference from the Other militates against ecumenical claims upon which the transplantation of IP law is propagated. Finally, it is argued that consideration of the problematic nature of IP as a legal transplant must take into account the basic makeup of IP to avoid a cosmetic consciousness on the subject.

Web site accessibility of German and UK tourism information sites

Information exchange is important in any transaction but is perhaps particularly important for transactions in the travel and tourism industry where information gratification plays such a crucial role. Internet‐based technologies allow organisations to exchange information with an often geographically dispersed and wider marketplace without a loss of quality. However, merely being online, publishing a Web site is not enough. Organisations need to ensure their Web sites obtain “traffic” or “hits” and, importantly, that the content of their sites is accessible. Accessible Web sites mean access for all, accommodating different user capabilities and needs. This research examines the emerging competitive and legal imperatives to consider the issue of Web content accessibility as well as what makes for an accessible Web site. In spite of the strong competitive and legal imperatives for accessibility, a survey of 100 UK and German‐based travel and tourism Web sites conducted here revealed disappointingly low levels of accessibility. As the Internet and Web come to play a more important part in individual lives, this finding suggests that many organisations need to work harder to ensure that their often considerable investments achieve what they set out to do – communicate effectively with what they hope is a larger marketplace.